Duplication cysts are rare gastrointestinal congenital abnormalities. They can occur anywhere throughout the gastrointestinal tract, and gastric duplication cysts are most uncommon, representing only 4-8% of all gastrointestinal duplication cysts. Nowadays several theories try to explain the pathogenic mechanisms involved. These cysts are usually diagnosed during early childhood, and very rarely are detected in adults, mostly incidentally due to a lack of symptoms. Close to 50% of gastric cysts are associated with other abnormalities. It is extremely important that a meticulous differential diagnosis is performed regarding other diseases, mainly malignancies with a cystic component. Although extremely uncommon, a malignant transformation of these lesions has been reported, which highlights the importance of a correct diagnosis. Herein we report the case of a duplication cyst in an adult, which was detected by endoscopic ultrasound-guided fine-needle aspiration, recently proposed as the most accurate technique for the identification of these lesions.

Thalidomide prevented necrosis, cholestasis and fibrosis induced by CCl(4). Its mechanism of action may be related to its anti-inflammatory, anti-tumour necrosis factor-alpha and anti-fibrotic activities reported previously.

The incidence of chronic pancreatitis in Spain is similar to that of other European countries. Given the widespread use of the technique, EUS units are key in detecting the disease, and their activity and results allow to estimate the incidence of chronic pancreatitis over wide, representative population areas.

Pancreatic cancer is the 5 th leading cause of cancer-related death in Western countries. The 5-year survival rate is approximately 4%, without significant changes over the last 50 years. This poor survival rate and bad prognosis are associated with the diagnosis of advanced-stage disease, which precludes the only potential curative treatment-surgical resection. In this setting, the main objective in the management of pancreatic cancer is to perform an early diagnosis and a correct staging of the disease. Endoscopic ultrasonography (EUS) appears to be an essential tool for the diagnosis and staging of pancreatic cancer. EUS diagnostic accuracy for detecting pancreatic tumors ranges from 85 to 100%, clearly superior to other imaging techniques. EUS accuracy for the local staging of pancreatic cancer ranges from 70 to 90%, superior or equivalent to other imaging modalities. EUSguided fine-needle aspiration allows a cyto-histological diagnosis in nearly 90% of cases, with a very low complication rate. At present, the formal indications for EUS-guided fine-needle aspiration are the necessity of palliative treatment or whenever the possibility of neoadjuvant treatment is present. It could be also indicated to differentiate pancreatic adenocarcinoma from other pancreatic conditions, like lymphoma, metastasis, autoimmune pancreatitis or chronic pancreatitis. We can conclude that EUS is an essential tool in the management of patients with pancreatic tumors.

Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain. However, the rate of pancreatic diseases is much lower and does not reach 5% according to published series in Europe and the USA. This association between SLE and pancreatic disease is basically at the expense of episodes of acute pancreatitis. An association with chronic pancreatitis is much more uncommon, and only four articles have been published showing this relationship.Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors, and clinical progression are analyzed. A review of the literature and a brief discussion about pathophysiological mechanisms and the role of corticosteroids are also included.Key words: Systemic lupus erythematosus. Acute pancreatitis. Chronic pancreatitis. INTRODUCTIONSince the first association between systemic lupus erythematosus (SLE) and pancreatitis was documented by Reifenstein et al. in 1939 (1), very few reports about the prevalence of pancreatic diseases in this rheumatologic disorder have been reported.Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain; as described in some series, it has been shown to have a prevalence of 19.2% (2). The rate of pancreatitis in patients with SLE varies depending on individual series from Europe and the United States between 0.7 and 4% (3,4). This association is mainly at the expense of acute episodes of pancreatitis; however only four reports have been published regarding this relationship with chronic pancreatitis (5-7).Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors and clinical progression are analyzed. A review of the literature and a brief discussion about the pathophysiological mechanisms and the role of corticosteroids are also included. METHODSA retrospective review of hospital admissions at Gastroenterology Department, University Hospital, Santiago de Compostela during 2001-2005 with the dual diagnosis of systemic lupus erythematosus and pancreatitis was made. Demographic data, clinical intervention, and progression parameters of pancreatic disease were identified. These patients were collected by searching our institution's computer database using the key words "pancreatitis" and "SLE". Demographic information registered from the medical charts included subject age, gender, time (years) from the initial diagnosis of SLE, alcohol abuse, medications, specially corticosteroids, and criteria used for SLE diagnosis.Clinical data collected included symptoms, SLE activity with a list of organs or systems involved, initial pancreatic enzymes, number of admissions for pancreatitis, and serologies for antinuclear antibodies (ANA) and C-reactive protein levels. All radiological results were documented, including abdominal ultrasounds, helical CT, cholangiopancreatic resonance (MRPC), endoscopic retrograde cholangiopancreatography (ERPC), and endoscopic ultrasounds (EUS

Results concerning morphological and biochemical changes following intravenous administration of different doses of acetaminophen in dogs are reported. Acetaminophen infusion, as a parenteral solution (500 mg per kg per 90 min), produced fulminant hepatitis characterized by a good correlation between Portmann's grade of lesion and percentage of necrosis. All animals died within 76 hr after intoxication. Analysis of biochemical parameters revealed positive correlation between serum bilirubin levels and severity of the hepatic lesion. The experimental model of acetaminophen-induced hepatotoxicity is proposed as a model for evaluation of the therapeutic efficacy of new medical and surgical procedures.

Direct referral of patients for EUS – instead of preprocedural consultation with the endosonographer – has become standard practice (like for other endoscopic procedures) as it is time- and cost-effective. To ensure appropriate indications and safe examinations, the endosonographer should carefully consider what information is needed before accepting the referral. This includes important clinical data regarding relevant comorbidities, the fitness of the patient to consent and undergo the procedure, and the anticoagulation status. In addition, relevant findings from other imaging methods to clarify the clinical question may be necessary. Appropriate knowledge and management of the patients’ anticoagulation and antiplatelet therapy, antibiotic prophylaxis, and sedation issues can avoid unnecessary delays and unsafe procedures. Insisting on optimal preparation, appropriate indications, and clear clinical referral questions will increase the quality of the outcomes of EUS. In this paper, important practical issues regarding EUS preparations are raised and discussed from different points of view.

In “What should be known prior to performing EUS exams, Part I,” the authors discussed the need for clinical information and whether other imaging modalities are required before embarking EUS examinations. Herewith, we present part II which addresses some (technical) controversies how EUS is performed and discuss from different points of view providing the relevant evidence as available. (1) Does equipment design influence the complication rate? (2) Should we have a standardized screen orientation? (3) Radial EUS versus longitudinal (linear) EUS. (4) Should we search for incidental findings using EUS?