Endoscopic submucosal dissection(ESD)has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurre...Endoscopic submucosal dissection(ESD)has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurrence.However,the time course of ESD for large gastric tumors is frequently prolonged because of the tumor size and technical difficulties and typically requires higher doses of sedative and pain-controlling drugs.Sedative or anesthetic drugs such as midazolam or propofol are used during the procedure.Therapeutic endoscopy of early gastric cancers can often be performed with only moderate sedation.Compared with midazolam,propofol has a very fast onset of action,short plasma half-life and time to achieve sedation,faster time to recovery and discharge,and results in higher patient satisfaction.For overall success,maintaining safety and stability not only during the procedure but also subsequently in the recovery room and ward is necessary.In obese patients,it is recommended that the injected dose be based on a calculated standard weight.Cooperation between gastroenterologists,surgeons,and anesthesiologists is imperative for a successful ESD procedure.展开更多
AIM:To elucidate the endoscopic features that predict the cancer following endoscopic submucosal dissection(ESD)in patients with high-grade neoplasia(HGN).METHODS:We retrospectively analyzed the medical records of pat...AIM:To elucidate the endoscopic features that predict the cancer following endoscopic submucosal dissection(ESD)in patients with high-grade neoplasia(HGN).METHODS:We retrospectively analyzed the medical records of patients who underwent ESD of gastric neoplasms from January 2007 to September 2010.ESD was performed in 555 cases involving 550 patients.A total of 112 lesions from 110 consecutive patients were initially diagnosed as HGN without cancer by forceps biopsy,and later underwent ESD.We classified lesions into two groups according to histologic discrepancies between the biopsy and ESD diagnosis.Gastric adenoma in the final diagnosis by ESD specimens were defined as adenoma group.Lesions with coexisting cancer after ESD were defined as cancer group.RESULTS:The mean age was 65.3 years,and 81 patients were male.There was no significant difference in the age or gender distribution between the adenoma(n=52)and cancer(n=60)groups.Thirty-six of these lesions(32.1%)showed histologic concordance between the forceps biopsy and ESD specimens,16(14.3%)showed a downgraded histology(low-grade neoplasia),and 60(53.6%)showed an upgraded histology(cancer).A red color change of the mucosal surface on endoscopy was found in 27/52(51.9%)of cases in the adenoma group and in 46/60(76.7%)of cases in the cancer group(P=0.006).Ulceration of the mucosal surface on endoscopy was found in 5(9.6%)of 52 lesions in the adenoma group and in 17(28.3%)of 60 lesions in the cancer group(P=0.013).In the multivariate analysis,a reddish surface color change and mucosal ulceration were significant predictive factors correlated with cancer after ESD of the HGN by forceps biopsy.CONCLUSION:HGN with a red color change or mucosal ulceration correlated with the presence of gastric cancer.These finding may help to guide the diagnosis and treatment.展开更多
大型水利枢纽,尤其采用挑流消能工的高坝工程,在泄洪时产生的雾化降雨强度远超自然降雨,由此对枢纽正常运行、泄洪区交通安全、周围环境等均构成危害。对金沙江下游溪洛渡水电站大坝深孔泄洪时雾化影响范围、降雨强度分布、气象特性等...大型水利枢纽,尤其采用挑流消能工的高坝工程,在泄洪时产生的雾化降雨强度远超自然降雨,由此对枢纽正常运行、泄洪区交通安全、周围环境等均构成危害。对金沙江下游溪洛渡水电站大坝深孔泄洪时雾化影响范围、降雨强度分布、气象特性等进行了重点观测研究。结果表明:溪洛渡水电站深孔泄洪雾化降雨强度分布呈现局部降雨强度大、降雨强度沿纵向及岸坡方向递减速度快的特点;观测工况下最大降雨强度达4 704 mm/h;观测时段自然风速未超过3.5 m/s条件下,泄洪区最大风速达16.3 m/s;自然气压为0 k Pa、空气湿度为85%左右时,最大气压约为96 k Pa,空气湿度为100%。观测成果一方面可对溪洛渡水电站岸坡防护设计进行验证,并为以后类似工程的岸坡防护设计提供参考,另一方面可为其他研究手段的完善提供丰富详实数据,具有重要价值。展开更多
文摘Endoscopic submucosal dissection(ESD)has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurrence.However,the time course of ESD for large gastric tumors is frequently prolonged because of the tumor size and technical difficulties and typically requires higher doses of sedative and pain-controlling drugs.Sedative or anesthetic drugs such as midazolam or propofol are used during the procedure.Therapeutic endoscopy of early gastric cancers can often be performed with only moderate sedation.Compared with midazolam,propofol has a very fast onset of action,short plasma half-life and time to achieve sedation,faster time to recovery and discharge,and results in higher patient satisfaction.For overall success,maintaining safety and stability not only during the procedure but also subsequently in the recovery room and ward is necessary.In obese patients,it is recommended that the injected dose be based on a calculated standard weight.Cooperation between gastroenterologists,surgeons,and anesthesiologists is imperative for a successful ESD procedure.
基金Supported by Grants of the Gachon University Gil Medical Center,No.2013-35 and 37
文摘AIM:To elucidate the endoscopic features that predict the cancer following endoscopic submucosal dissection(ESD)in patients with high-grade neoplasia(HGN).METHODS:We retrospectively analyzed the medical records of patients who underwent ESD of gastric neoplasms from January 2007 to September 2010.ESD was performed in 555 cases involving 550 patients.A total of 112 lesions from 110 consecutive patients were initially diagnosed as HGN without cancer by forceps biopsy,and later underwent ESD.We classified lesions into two groups according to histologic discrepancies between the biopsy and ESD diagnosis.Gastric adenoma in the final diagnosis by ESD specimens were defined as adenoma group.Lesions with coexisting cancer after ESD were defined as cancer group.RESULTS:The mean age was 65.3 years,and 81 patients were male.There was no significant difference in the age or gender distribution between the adenoma(n=52)and cancer(n=60)groups.Thirty-six of these lesions(32.1%)showed histologic concordance between the forceps biopsy and ESD specimens,16(14.3%)showed a downgraded histology(low-grade neoplasia),and 60(53.6%)showed an upgraded histology(cancer).A red color change of the mucosal surface on endoscopy was found in 27/52(51.9%)of cases in the adenoma group and in 46/60(76.7%)of cases in the cancer group(P=0.006).Ulceration of the mucosal surface on endoscopy was found in 5(9.6%)of 52 lesions in the adenoma group and in 17(28.3%)of 60 lesions in the cancer group(P=0.013).In the multivariate analysis,a reddish surface color change and mucosal ulceration were significant predictive factors correlated with cancer after ESD of the HGN by forceps biopsy.CONCLUSION:HGN with a red color change or mucosal ulceration correlated with the presence of gastric cancer.These finding may help to guide the diagnosis and treatment.
文摘大型水利枢纽,尤其采用挑流消能工的高坝工程,在泄洪时产生的雾化降雨强度远超自然降雨,由此对枢纽正常运行、泄洪区交通安全、周围环境等均构成危害。对金沙江下游溪洛渡水电站大坝深孔泄洪时雾化影响范围、降雨强度分布、气象特性等进行了重点观测研究。结果表明:溪洛渡水电站深孔泄洪雾化降雨强度分布呈现局部降雨强度大、降雨强度沿纵向及岸坡方向递减速度快的特点;观测工况下最大降雨强度达4 704 mm/h;观测时段自然风速未超过3.5 m/s条件下,泄洪区最大风速达16.3 m/s;自然气压为0 k Pa、空气湿度为85%左右时,最大气压约为96 k Pa,空气湿度为100%。观测成果一方面可对溪洛渡水电站岸坡防护设计进行验证,并为以后类似工程的岸坡防护设计提供参考,另一方面可为其他研究手段的完善提供丰富详实数据,具有重要价值。
