Real-World Experience of Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Neoplasia

Introduction: Patients with ulcerative colitis (UC) have an increased risk of colorectal cancer. Some studies have recently investigated endoscopic resection of UC-associated neoplasia (UCAN), but the indications for endoscopic resection of UCAN remain controversial. This study sought to clarify the problems encountered in endoscopic submucosal dissection (ESD) for UCAN. Methods: Seventeen lesions in 12 patients with UCAN (UCAN group) and 913 epithelial lesions in 824 control patients without UC (non-UC group) were evaluated. Both groups underwent ESD between January 2010 and December 2017 at Toranomon Hospital, Tokyo, Japan. Treatment outcomes of the 2 groups were compared retrospectively. Results: Univariate analysis showed that the mean tumor size was significantly smaller in the UCAN group than in the non-UC group (25.1 ± 26.7 mm vs. 31.9 ± 19.0; p = 0.0023); however, the R0 resection rate was significantly lower in the UCAN group (70.6 vs. 92.9%; p = 0.001). Multivariate analysis showed a significantly lower negative horizontal margin rate in the UCAN group (odds ratio 11.3, 95% confidence interval 3.588–34.525; p = 0.000). Discussion/Conclusion: ESD for UCAN is associated with a low-negative horizontal margin rate. When performing ESD for UCAN, it is important to evaluate the accuracy of the UCAN demarcation line, especially for flat lesions, using white-light imaging and chromoendoscopy as well as other modalities, including biopsy of surrounding tissues.

PLANÍCIES DE INUNDAÇÃO E ÁREAS INUNDÁVEIS: análise comparativa dos conceitos mediante aplicação nas bacias hidrográficas do ribeirão Bom Jardim e rio das Pedras, Triângulo Mineiro

As planícies de inundação são áreas que margeiam os cursos d’água, podendo inundar em períodos de cheia. Possuem gradiente topográfico baixo, declividades brandas e solos aluviais. As áreas inundáveis podem também ser imergidas em eventos extremos de precipitação, porém não possuem as mesmas características fisiográficas das planícies de inundação, ou seja, estas podem não possuir uma larga margem horizontal no entorno do canal fluvial, não haver deposição de sedimentos, ser encaixadas, porém podem sofrer com o fenômeno da inundação. Sendo assim, este artigo tem como objetivo fazer uma revisão conceitual de planícies de inundação e áreas inundáveis, comparando os dois conceitos e aplicando-os nas bacias hidrográficas do ribeirão Bom Jardim e rio das Pedras, localizadas no Triângulo Mineiro. A partir da fisiografia das áreas, por meio da revisão conceitual e aplicação de ferramentas geocartográficas, constatou-se que toda a planície de inundação do Ribeirão Bom Jardim coincide com as áreas inundáveis, o que não ocorre com o Rio das Pedras. Tais áreas, indistintamente, devem ser preservadas para evitar danos materiais e humanos no futuro. Palavras-chave: Dinâmica fluvial. Deposição sedimentar. Fisiografia. Geocartografia. FLOOD PLANS AND FLOODING AREAS: comparative analysis of the concepts through application in the hydrographic basin of Riverside Bom Jardim and Pedras River, Triângulo Mineiro ABSTRACT Flood plains are areas bordering waterways, which may flood during flood periods. They have a low topographic gradient, gentle slopes and alluvial soils. Flooded areas can also be immersed in extreme precipitation events, but they do not have the same physiographic characteristics of floodplains, ie they may not have a large horizontal margin around the river channel, no sediment deposition, no nesting , but may suffer from the flood phenomenon. Thus, this article aims to make a conceptual review of flood plains and flooded areas, comparing the two concepts and applying them in the river basins of Riverside Bom Jardim and Pedras’s River, located in the Triângulo Mineiro. From the physiography of the areas, through the conceptual review and application of geocartographic tools, it was verified that the entire floodplain of ribeirão Bom Jardim coincides with the flooded areas, which does not occur with the Pedras’s River. Such areas, without distinction, must be preserved to avoid material and human damages in the future. Keywords: Fluvial dynamics. Sediment deposition. Physiography. Geocartography. PLANES DE INUNDACIÓN Y ÁREAS INUNDABLES: análisis comparativo de los conceptos mediante aplicación en las bacias hidrográficas del Ribeirón Bom Jardín y Rio de las Piedras, Triángulo Minero RESUMEN Las planicies de inundación son áreas que bordean los cursos de agua, pudiendo inundar en períodos de lleno. Poseen gradiente topográfico bajo, declividades blandas y suelos aluviales. Las áreas inundables también pueden ser sumergidas en eventos extremos de precipitación, pero no poseen las mismas características fisiográficas de las planicies de inundación, o sea, éstas pueden no poseer un amplio margen horizontal en el entorno del canal fluvial, no hay deposición de sedimentos, ser encajadas pero pueden sufrir con el fenómeno de la inundación. Siendo así, este artículo tiene como objetivo hacer una revisión conceptual de planicies de inundación y áreas inundables, comparando los dos conceptos y aplicándolos en las cuencas hidrográficas del ribeirão Bom Jardim y río das Pedras, ubicadas en el Triángulo Minero. A partir de la fisiografía de las áreas, por medio de la revisión conceptual y aplicación de herramientas geocartográficas, se constató que toda la planicie de inundación del Ribeirão Bom Jardim coincide con las áreas inundables, lo que no ocurre con el Río das Pedras. Tales áreas, indistintamente, deben ser preservadas para evitar daños materiales y humanos en el futuro. Palabras clave: Dinámica fluvial. Deposición sedimentaria. Fisiografía. Geocartografía.

Skin lesions suspicious for melanoma: New Zealand excision margin guidelines in practice

ABSTRACT INTRODUCTION New Zealand guidelines for cutaneous melanoma management recommend excision biopsy specimens of suspected lesions have a 2 mm horizontal margin, and a deep margin into upper subcutis. AIM To assess guideline compliance of suspicious lesion biopsies taken in the community and in a hospital. METHODS Patients admitted to Waikato Hospital, Hamilton, for diagnostic or treatment melanoma surgery during the year ending February 2016 were retrospectively identified, and their demographic and biopsy characteristics examined. RESULTS In total, 140 patients had excision biopsies: 61.4% were performed outside the hospital. Biopsy data were available for 126 specimens. Mean horizontal margin was greater (P = 0.001) in hospital biopsies (4.8 mm, standard deviation (s.d.) 3.7 mm) than biopsies performed elsewhere (2.8 mm; s.d. 1.8 mm). Horizontal margins >2.0 mm occurred in 70.6% of specimens; 21.6% of ≤2.0 mm specimens had a tumour-positive margin. Subsequent wide local excision identified residual melanoma in 9.6% of specimens, which was not associated (P = 0.3) with primary horizontal margin ≤2.0 mm. Mean deep margin of hospital biopsies (6.5 mm; s.d. 2.7 mm) was greater (P < 0.001) than in other biopsies (4.1 mm; s.d. 2.7 mm). Horizontal margin >2.0 mm specimens had greater (P < 0.001) mean deep margin (5.9 mm; s.d. 2.7 mm) than specimens with horizontal margin ≤2.0 mm (mean deep margin 3.3 mm; s.d. 2.7 mm). Deep margin ≤2.0 mm (19.0%) was independently associated with the facility where biopsy was performed (P = 0.001) and horizontal margin (P < 0.001). DISCUSSION The New Zealand biopsy deep margin recommendation does not lend itself to meaningful audit. Compliance with the horizontal margin recommendation was low, but of uncertain clinical significance.

Additional Gastrectomy After Endoscopic Mucosal Resection for Early Gastric Cancer

The aim of this study was to examine the clinicopathological characteristics of cases undergoing additional gastrectomy after endoscopic mucosal resection (EMR) for early gastric cancer (EGC) and the appropriate strategy for treating those after incomplete EMR. We studied 16 patients who underwent additional gastrectomy after EMR for EGC. The reasons for additional gastrectomy were positive horizontal margin (8 cases), indeterminate horizontal margin (2 cases), positive vertical margin (4 cases), submucosal invasion (7 cases), lymphatic invasion (4 cases), venous invasion (1 case), and local recurrence (2 cases, including overlapped cases). Residual cancer was found in 6 of the 13 cases (46%), while no lymph node metastasis was found in any case; there were cases in which local resection was possible depending on tumor location and cases in which additional gastrectomy was performed due to suspected residual cancer but the specimens were free of cancer; follow-up without intervention appears to be feasible in some of these cases. When performing additional gastrectomy after EMR, the most appropriate method should be chosen so as not to worsen the quality of life of the patient while taking radical cure into consideration.