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Tokyo ESP Episode 11

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Tokyo ESP Episode 11

Unfortunately, Tokyo ESP is not well-executed. Take the first episode, for example. It begins with a group of espers (the aforementioned shadowy organization) taking over the National Diet Building with the intent of ruling Japan. The whole city is thrown into turmoil, and even unaffiliated espers begin wreaking havoc in the midst of this chaos. We are given a glimpse of the school of glowing fish, as well as a mysterious deity-like individual sitting atop a shrine gate ominously eating potato chips with chopsticks. Okay, so far so good.

For me, that big elephant with explosive diarrhea shit was Tokyo ESP, a 12 episode, 2014 series from studio Xebec, the same studio that brought us Mnemosyne, Pandora Hearts, and Heroic Age. Then took a giant shit on me.

And my first thought was, Hey, I know why they surveyed 1001 people and not exactly 1000! And my second thought was, Hey, I think this came up on the blog the first time that episode aired. And indeed, here it is:

The endoscopic approach was mainly based on clinical data such as stool characteristics and previous endoscopic procedures performed in previous episodes in case of recurrent bleeding. Emergency CE and real-time viewing by CE were also considered in some cases. The most common lesion location was the proximal SB (jejunum). Most lesions reported in the studies to date were amenable to endoscopic treatment, and the most frequent bleeding source was a vascular lesion. In addition, many patients required several procedures and/or multiple haemostatic therapies to definitely stop the bleeding, especially for angioectasia and Dieulafoy's lesion. The current trend for BAE treatment is to use a mixed method (injection and thermal or injection and mechanical treatment) in case of vascular lesions and aggressive treatment, particularly in Dieulafoy's lesion because of high re-bleeding risk. A cap-assisted enteroscopy (Fig. 3) may be useful because the cap improves the visualization in case the lesion is located behind a fold or angled loop and the cap facilitates and stabilizes the rapprochement to the lesion if therapy is required. In addition, the cap allows the aspiration of a lesion internally for certain therapeutics, such as the endoloop.

Emergency SB endoscopy is clinically required for severe but selected cases.2, 10 After stabilization of the patient, the timing to perform emergency BAE may be crucial. First, it is very important to individually assess the severity of the patient, considering transfusion requirements, recurrent bleeding and procedures already performed. It is important to analyze the clinical presentation, current medical therapy (anticoagulants, antithrombotic, NSAIDs), personal/family history or any factor that may guide the clinical suspicion of specific SB lesions. Vascular lesions such as angioectasia or Dieulafoy's lesion may cause severe self-limited intermittent OOGIB, which may improve even with conservative management. In these cases, to keep the urgent indication or delay further procedures until complete resolution of the bleeding episode should be discussed by a multidisciplinary team. A SB endoscopy second look can be performed with CE after deep enteroscopy to confirm bleeding cessation (Fig. 4). Emergency BAE has also shown to be useful in SB lesions not amenable to endoscopic haemostasis, such as large bleeding SB tumours. Tattoo injection at the bleeding source and histological sampling when possible may be performed systematically to guide further management. 781b155fdc


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