RESUMO
BACKGROUND: Narrow-band imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect esophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than that of Lugol chromoendoscopy in expert centers, remains to be established in general practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of esophageal SCC and high grade dysplasia (HGD) in current general practice (including tertiary care centers, local hospitals, and private clinics). METHODS: This prospective randomized multicenter trial included consecutive patients with previous or current SCC of the upper aerodigestive tract who were scheduled for gastroscopy. Patients were randomly allocated to either the Lugol or NBI group.âIn the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI examination was performed after white-light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. RESULTS: 334 patients with history of SCC were included and analyzed (intention-to-treat) from 15 French institutions between March 2011 and December 2015.âIn per-patient analysis, sensitivity, specificity, positive and negative likelihood values were 100â%, 66.0â%, 21.2â%, and 100â%, respectively, for Lugol chromoendoscopy vs. 100â%, 79.9â%, 37.5â%, and 100â%, respectively, for NBI. Specificity was greater with NBI than with Lugol (Pâ=â0.002). CONCLUSIONS: As previously demonstrated in expert centers, NBI was more specific than Lugol in current gastroenterology practice for the detection of early SCC, but combined approaches with both NBI and Lugol could improve the detection of squamous neoplasia.
Assuntos
Carcinoma de Células Escamosas , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Carcinoma de Células Escamosas/diagnóstico por imagem , Corantes , Detecção Precoce de Câncer , Neoplasias Esofágicas/diagnóstico por imagem , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Esofagoscopia , Humanos , Iodetos , Imagem de Banda Estreita , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
We report the case of a 23-year-old patient with very marked hepatic cytolysis (ASAT: 18N; ALAT: 44N) associated with biological icterus and mucocutaneous jaundice. Initially, no etiology was identified due to the absence of toxic consumption, the negativity of hepatotropic virus serologies and tests for autoimmune pathologies. Following the appearance of cutaneous signs three weeks after the onset of hepatic involvement, a syphilis serology was performed, which proved positive and led to the diagnosis of secondary syphilis. To our knowledge, only one case of hepatic syphilis with such intense hepatic cytolysis has been described. Usually, the hepatic damage is moderate, with transaminases not exceeding 5 times normal values. Syphilitic hepatitis is rare and occurs in less than 10% of syphilis cases. This case makes it possible to identify syphilis as a neglected etiology of acute hepatitis which should be considered in a context suggestive of infection even in the absence of skin signs.
Assuntos
Hepatite , Sífilis , Doença Aguda , Adulto , Hepatite/diagnóstico , Humanos , Pele , Sífilis/complicações , Sífilis/diagnóstico , Adulto JovemRESUMO
Localized macronodular tuberculosis of the liver is rare. In this location antituberculosis therapy results in a favorable clinical evolution in 100% of cases. We report a pseudo-tumoral form of this condition with no specific clinical, biological or radiological data. After ultrasound guided needle aspiration cytology suggesting metastasis, the correct diagnosis was obtained on liver biopsy after laparotomy. After what was probably inadequate therapy, the enlargement of several hepatic and splenic macronodules was observed. After two years and eight months, the clinical condition of the patient was good but radiological features remained. The risk of diagnostic errors and the therapeutic difficulties in the zones where the incidence of tuberculosis is low should be noted.
Assuntos
Antituberculosos/uso terapêutico , Neoplasias Hepáticas/diagnóstico , Tuberculose Hepática/diagnóstico , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Hepática/tratamento farmacológicoAssuntos
Condrocalcinose/complicações , Deslocamento do Disco Intervertebral/etiologia , Vértebras Lombares , Compressão da Medula Espinal/etiologia , Doença Aguda , Adulto , Condrocalcinose/cirurgia , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos , Compressão da Medula Espinal/cirurgia , Talassemia beta/complicaçõesAssuntos
Neoplasias do Colo/patologia , Tumores do Estroma Gastrointestinal/patologia , Sarcoma de Kaposi/patologia , Idoso , Neoplasias do Colo/genética , Neoplasias do Colo/cirurgia , Diagnóstico Diferencial , Feminino , Tumores do Estroma Gastrointestinal/genética , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Proteínas Proto-Oncogênicas c-kit/análise , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/genética , Sarcoma de Kaposi/cirurgiaRESUMO
BACKGROUND: EGD, with small-diameter endoscopes, is routinely performed via a nasal route in adults. OBJECTIVE: To evaluate a new ultrathin one-plane bending videoendoscope for transnasal EGD. DESIGN: Single center, prospective, randomized study. SETTING: Edouard Herriot University Hospital. PATIENTS: A total of 122 outpatients (median age, 49 years [18-81 years], 62 men and 60 women) were randomized into 2 groups (on a 2:1 basis) according to the endoscope used: (1) a standard 5.9-mm-diameter videoendoscope (80 patients) or (2) a one-plane bending high resolution 4.9-mm-diameter videoendoscope (42 patients). MAIN OUTCOME MEASUREMENTS: The operator assessed the quality of examination by using standard scores or a 100-mm visual scale. Patients quantified tolerance by using a 100-mm visual scale. RESULTS: The duration of the procedure was the same in each group. The feasibility of transnasal insertion was significantly higher when using the 4.9-mm-diameter endoscope (97.61% [41/42 patients] vs 88.75% [71/80 patients], P<.05). The tolerance of EGD was significantly better in the group with the small videoendoscope, for global discomfort, pain, belching, and bloating. Similarly, acceptation of a new EGD in similar conditions was higher in group 2 (92.9% vs 80%, P<.05). The quality of examination (global, lavage, inflation, suction) was not different between the 2 groups. LIMITATIONS: Evaluation of patient tolerance and quality of examination was based on subjective features. CONCLUSIONS: Availability of a new ultrathin one-plane bending videoendoscope represents a major technical improvement for transnasal EGD, which significantly improves both feasibility and patient tolerance, without affecting the quality of the examination.