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Background and Aims: Patients suffering from peptic ulcer (PU) bleeding who have end-stage renal disease (ESRD) may encounter more adverse outcomes. The primary objective is to investigate the risk factors that influence the outcomes of ESRD and chronic kidney disease (CKD) patients with PU bleeding after successful initial endoscopic haemostasis. Methods: A total of 540 patients with PU bleeding after initial endoscopic haemostasis in a tertiary hospital were investigated retrospectively. They were sorted into three groups after randomised age-matched adjustment: ESRD group (n = 90), CKD group (n = 90) and control group (n = 360). Main outcome measurements were rebleeding, requirement for blood transfusion and surgery, length of hospital stay and mortality. Results: The rebleeding rates were 43% for the ESRD group vs. 21% for the CKD group vs. 12% for the control group (overall p = < 0.001). Multivariate analysis showed the predictors of rebleeding were ESRD, time to endoscope, and non-high-dose proton-pump inhibitors (PPI) users. The risk factors for bleeding-related mortality were presence of moderate degree of CKD and ESRD group, time to endoscope, and Rockall score. All-cause mortality was related to presence of moderate degree of CKD and ESRD group, platelet count, time to endoscope, Rockall score and length of hospital stay. Conclusions: ESRD patients who suffered from PU bleeding were at risk of excessive rebleeding and mortality with frequent occurrence of delayed rebleeding. This study suggests that early endoscopy for initial haemostasis and high-dose intravenous PPI are associated with the reduction of rebleeding risk especially in patients with high Rockall scores.
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BACKGROUND: Combinations of Child-Pugh classification and Liver Cancer Study Group of Japan/Tumor-Node-Metastasis (LCSGJ/TNM) have been reported as Japan Integrated Staging (JIS). We previously modified the 6th AJCC/TNM to serve as a better staging system than the 5th and 6th AJCC/TNM. AIMS: To develop a modified TNM-based JIS to predict the survival of hepatocellular carcinoma (HCC) patients more accurately. METHODS: 3764 HCC patients were enrolled from 1986 to 2002 (2882 patients from 1986 to 2000 and 882 patients from 2001 to 2002). We compared the performance of original JIS, modified TNM-based JIS, modified TNM-based JIS combined alpha-fetoprotein (AFP), BCLC, and CLIP. Lower Akaike information criteria (AIC) values indicated better discriminatory abilities. RESULTS: AIC value was lowest in CLIP during all periods. However, during 2001-2002, when early-stage HCC patients were predominant, AIC value was lowest when modified TNM-based JIS combined AFP was used. CONCLUSION: The CLIP system provided the best prognostic stratification in the present cohort of HCC patients who were mainly at late stages. However, early detection of HCCs has become more common in Taiwan in recent years, which has led to the predominance of early-stage HCC patients. Therefore, modified TNM-based JIS combined AFP may now be the most applicable system in recent years.
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Biomarcadores Tumorais/metabolismo , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias/métodos , alfa-Fetoproteínas/metabolismo , Carcinoma Hepatocelular/classificação , Carcinoma Hepatocelular/diagnóstico , Detecção Precoce de Câncer , Feminino , Humanos , Neoplasias Hepáticas/classificação , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/classificação , PrognósticoRESUMO
We assessed the efficacy of interferon (IFN) alpha-2b plus ribavirin therapy in patients with hepatitis C virus (HCV)-related cirrhosis, and elucidated the risk factors for the development of hepatocellular carcinoma (HCC) to determine whether these therapies might reduce the incidence of HCC. One hundred and thirty-two HCV-cirrhotic patients receiving IFN alpha-2b (3 or 5 MU thrice weekly) and oral ribavirin (1,000-1,200 mg/day) for 24 or 48 weeks were analysed. Cumulative incidence of HCC was estimated by the Kaplan-Meier method. The prognostic relevance of clinical variables and HCC occurrence was evaluated by univariate analysis with the log-rank test and by multivariate Cox's regression analysis. A total of 116 patients completed the treatment and 73 (55%) achieved a sustained virological response (SVR). Stepwise logistic regression analysis showed that nongenotype 1b (P < 0.001) and low viral load (P = 0.018) were independent variables of SVR. During a median follow-up period of 37 (12-63) months, HCC developed in 11 patients with non-SVR and five with SVR (P = 0.0178), whereas there was no difference between those with transient biochemical response and nonresponse (P = 0.5970). The Kaplan-Meier method also showed that old age (>or=60 years) (P = 0.0034) and genotype 1b (P = 0.0104) were associated with HCC occurrence. Using Cox's regression analysis, non-SVR (odds ratio = 3.521, P = 0.036), male (odds ratio = 6.269, P = 0.011) and old age (odds ratio = 3.076, P = 0.049) were independent significant risk factors contributing to HCC development. Our results suggest that achieving SVR by IFN alpha-2b plus ribavirin therapy may decrease the incidence of HCC in patients with HCV-related cirrhosis.
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Antivirais/uso terapêutico , Carcinoma Hepatocelular/epidemiologia , Hepatite C/tratamento farmacológico , Interferon-alfa/uso terapêutico , Cirrose Hepática/tratamento farmacológico , Ribavirina/uso terapêutico , Adulto , Idoso , Carcinoma Hepatocelular/prevenção & controle , Quimioterapia Combinada , Feminino , Hepatite C/complicações , Humanos , Incidência , Interferon alfa-2 , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND STUDY AIMS: The purpose of this study was to investigate the safety and clinical effectiveness of a controlled radial expansion (CRE) balloon catheter in dilating benign esophageal strictures, and to assess factors influencing the effectiveness of this procedure. PATIENTS AND METHODS: From February 2000 to June 2002, 25 patients with documented benign esophageal strictures at our hospital were enrolled and treated with CRE balloon dilation. There were 17 men and eight women, with ages ranging from 30 to 82 years. The average age of the enrolled patients was 56.1 years. All of the strictures were dilated using CRE dilators under direct visualization, without fluoroscopic monitoring. The dilation diameters were planned in series up to 15 mm using a "rule of three". If dysphagia and esophageal strictures recurred during the clinical follow-up after completion of a series of dilations, additional dilation was carried out until symptomatic relief was achieved. Effective treatment was defined as the ability of patients with or without repeated dilations to maintain a solid or semisolid diet for more than 12 months. Depending on the effectiveness and duration of treatment, the patients were divided into three groups: group A, the successful group in which the initial series of dilations was effective without the need for any additional dilation for recurrent strictures or dysphagia; group B, the relapse group, in which the initial series of dilations was effective, but additional dilations were needed due to recurrent strictures or dysphagia; and group C, the group in which the initial series of dilations failed or consecutive dilations could not be carried out due to intolerance. RESULTS: The 25 patients received a total of 95 sessions of dilation (3.8 +/- 1.2 sessions per patient). There were 11 patients in group A, 11 patients in group B, and three patients in group C. The median follow-up period was 16.5 months (range 12 - 32 months). The number of initial dilations required to achieve symptomatic relief showed a negative correlation with the pre-dilation diameter of the strictures ( r = - 0.92, P < 0.01). Thinner strictures required more dilations before symptomatic relief was achieved. In addition, the stricture length in group B (5.4 +/- 3.4 cm) was significantly longer than that in group A (2.6 +/- 1.1 cm) ( P = 0.009). The overall success rate was 88 % (22 of 25), including 100 % in the 21 patients with a stricture length of less than 8 cm and 25 % in the four patients with a stricture length more than 8 cm ( P = 0.02). CONCLUSIONS: CRE balloon dilation without fluoroscopy is an effective treatment for esophageal strictures less than 8 cm in length. Pre-dilation diameter and stricture length are factors that influence the numbers of dilations required and the need for additional dilations.
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Cateterismo , Estenose Esofágica/terapia , Esofagoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/métodos , Esofagoscopia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RetratamentoRESUMO
Nonstructural 5A (NS5A) and the second envelope (E2) proteins of hepatitis C virus (HCV) have the potential to block interferon (IFN)-induced RNA-dependent protein kinase (PKR) and may therefore interfere with the response to IFN therapy, but controversy still exists regarding the relevance of this. This study aimed to assess whether mutations in these regions correlated with the response to combination therapy, IFN and ribavirin. Pretreatment parameters were analysed in 57 HCV-1b patients who had received IFN-alpha2b (3 or 5 MU three times weekly) and ribavirin (800-1200 mg per day) for 24 weeks. The amino acid sequences of the NS5A and PKR-eIF2alpha phosphorylation homology domain (E2-PePHD) were deduced from the corresponding coding sequence, which were determinated by direct sequencing of the HCV genome amplified by the polymerase chain reaction. Twenty (36%) patients achieved a sustained virological response (SVR). The mean number of amino acid substitutions in the NS5A-PKR binding domain (2209-2274), interferon sensitivity-determining region (ISDR) (2209-2248), and E2-PePHD sequence (659-670) in patients with and without SVR were 4.53 +/- 3.31 vs 2.83 +/- 1.78 (P = 0.094), 2.45 +/- 2.74 vs 1.03 +/- 1.32 (P = 0.042) and 0.25 +/- 0.70 vs 0.03 +/- 0.17 (P = 0.109), respectively. Patients with a mutant-type (>/= 4) NS5A-ISDR had a higher rate of SVR (six of nine, 67%) than those with wild-type (five of 22, 23%) (P = 0.038). Stepwise multiple logistic regression analysis of the factors (age, gender, viral load, cirrhosis rate, IFN dosage and amino acid substitutions) revealed that the mutation in NS5A-ISDR (>/= 4 vs < 4) was the only independent variable of treatment outcome. Our study showed that NS5A-ISDR mutations were correlated with the SVR to combination therapy in chronic HCV-1b patients in Taiwan.
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Antivirais/uso terapêutico , Fator de Iniciação 2 em Eucariotos/genética , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Ribavirina/uso terapêutico , Proteínas do Envelope Viral/genética , Proteínas não Estruturais Virais/genética , Sequência de Aminoácidos , Sequência de Bases , Quimioterapia Combinada , Feminino , Hepacivirus/metabolismo , Humanos , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Mutação Puntual , RNA Viral/química , RNA Viral/genética , Proteínas Recombinantes , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Alinhamento de SequênciaRESUMO
BACKGROUND: The sonographic patterns of splenic abscess are seldom reported. We report the different sonographic patterns in 34 proven cases. METHODS: From 1984 to June 2000, 42 patients were diagnosed with splenic abscess by abscess aspiration or pathologic findings of surgical specimens. Among them, 34 cases underwent sonographic studies. RESULTS: Fifteen cases had typical abscess echo patterns that included gas in the abscess (two cases) and debris in the abscess cavity (13 cases). Five cases of abscess showed subcapsular lesions with or without echo in the lesion. Two cases of abscess showed a thickened wall mimicking a tumor with central necrosis. Two cases showed a pattern suggesting a cyst. Ten cases showed a pattern suggesting tumor: eight had multiple lesions and two had solitary lesions. Of those 10 cases, seven multifocal abscesses were hypoechoic, and two solitary and one multifocal abscess were mixed echoic. Mortality from multiple splenic abscesses was higher than that from solitary abscess (p = 0.032). Both patients with gas in the abscess expired. CONCLUSION: Sonography of a splenic abscess is variable. A typical pattern was seen in only 44.1% (15 of 34) of patients in our series. We suggest using needle aspiration in each suspected case. Multiple and gas-containing abscesses indicate a poor prognosis.
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Abscesso/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Abscesso/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esplenopatias/microbiologia , Sucção , UltrassonografiaRESUMO
Antibodies to hepatitis C virus (HCV) may decrease or disappear after viral clearance in treated or spontaneously resolved infection. We evaluated the usefulness of serial antibody assays in predicting the antiviral treatment responses. One hundred and four chronic hepatitis C patients who received 24 weeks of interferon and ribavirin combination therapy were assayed with a third generation enzyme immunoassay anti-HCV. The mean titre of anti-HCV decreased by more than 50% (from 89.5 +/- 10.8 to 43.6 +/- 17.5) at 48 weeks post-treatment in patients with a sustained virological response, while in nonsustained virological responders and nonresponders, the titres remained over 85% of the pretreatment level at 48 weeks post-treatment. There was a divergence of anti-HCV titres between sustained and nonsustained virological responders during 6-9 months. By using the ratio of 9-month to 6-month titres as an index and receiver operator characteristic curve analysis with the cut-off point set at 90%, we could differentiate sustained virological responders from nonsustained virological responders with a sensitivity and specificity of 91.7% and 90.9%, respectively, 3 months after treatment. The titre of this third generation anti-HCV decreased progressively in sustained virological responders and this assay may be used to monitor and predict antiviral treatment responses.
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Antivirais/uso terapêutico , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Ribavirina/uso terapêutico , Adulto , Idoso , Antivirais/administração & dosagem , Combinação de Medicamentos , Feminino , Hepatite C Crônica/sangue , Humanos , Técnicas Imunoenzimáticas , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Kit de Reagentes para Diagnóstico , Proteínas Recombinantes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Double pylorus can occur as either a congenital abnormality or an acquired complication of peptic ulcer disease. There has been no report of long-term follow-up of a large series of patients treated for double pylorus. The objective of this study was to determine the course of double pylorus in 20 patients by serial endoscopic examination. METHODS: Among 102,958 endoscopic examinations conducted from 1987 to 1999, a diagnosis of double pylorus was made in 20 patients, 18 of whom were followed from 2 months to 10 years. The demographics, clinical presentations, and outcome, as well as endoscopic patterns of double pylorus, were retrospectively reviewed. The rates of ulcer recurrence and symptoms were estimated and compared. RESULTS: Most fistulous rings were located on the lesser curve of the gastric antrum (75%). Evolution from an original ulcer to fistula was observed in 9 patients. The fistula disappeared in 1 patient, remained open in 12, and converged with the normal pyloric ring in 5 patients. One or more associated systemic diseases and extensive treatment with various drugs were noted in 12 patients. Eradication of Helicobacter pylori in infected patients resulted in a lower percentage of patients with symptoms (36% vs. 100%) and ulcer recurrence (55% vs. 100%) compared with uninfected patients, but the differences were not statistically significant. CONCLUSION: In this study, fistula closure did not occur in the majority of patients. Associated systemic diseases and extensive use of medications might be important factors in persistence of double pylorus. Eradication of Helicobacter pylori was not beneficial in terms of relief of symptoms, prevention of ulcer recurrence, and fistula closure. Surgical intervention should be considered for patients with refractory symptoms, recurrent ulcers, and other complications.
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Duodenopatias/diagnóstico , Fístula Gástrica/diagnóstico , Fístula Intestinal/diagnóstico , Duodenopatias/etiologia , Duodenopatias/terapia , Endoscopia do Sistema Digestório , Feminino , Seguimentos , Fístula Gástrica/etiologia , Fístula Gástrica/terapia , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Piloro/anormalidades , Piloro/patologia , Recidiva , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: We compared the sonographic characteristics of hepatic adenomas with pathologic findings. METHODS: Information over 10 years was collected on 12 patients (six men, six women; mean age = 47 years) with surgically proven hepatic adenomas. Clinical data, sonographic features, and histopathologic findings were reviewed. RESULTS: The tumors in males were smaller and simpler than those in women (p < 0.05, Fisher's exact test). Four of the six larger tumors (>5 cm) showed mixed-echoic patterns corresponding with pathologically intratumoral hemorrhage and necrosis. Four homogeneously hypoechoic tumors had less change in tumor composition. Three homogeneously hyperechoic tumors had evident fatty changes inside. One isoechoic tumor had a hypoechoic rim, that correlated mostly to the tumor itself and compressed liver parenchyma. Seven of the 12 tumors had thin fibrous capsules that were not seen on sonography. CONCLUSION: Hepatic adenomas have variable sonographic appearances depending on changes in the tumor. Hypoechoic, hyperechoic, and mixed-echoic patterns represent simple adenoma, adenoma with fatty metamorphosis, and hemorrhagic necrosis, respectively, in tumors.
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Adenoma de Células Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Fígado/patologia , Adenoma de Células Hepáticas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , UltrassonografiaRESUMO
BACKGROUND: Eradication regimens combining two antibiotics with a proton pump inhibitor have been studied intensively. In contrast, only a few studies have focused on the possible role of H2-receptor antagonists in eradication therapy. The mechanism involved in the synergy between antibiotics and proton pump inhibitors is still controversial. OBJECTIVES: To compare the results of two triple-therapy regimens, different only in the antisecretory drugs used, in patients with Helicobacter pylori infection, and to assess the impact of primary resistance to metronidazole on treatment outcome. METHODS: A total of 120 patients with peptic ulcer and non-ulcer dyspepsia were randomly assigned to a 2-week course of either: famotidine 40 mg twice a day, amoxycillin 1 g twice a day and tinidazole 500 mg twice a day (FAT group; n = 60); or omeprazole 20 mg twice a day, amoxycillin 1 g twice a day and tinidazole 500 mg twice a day (OAT group; n = 60). Upper endoscopy was performed prior to treatment and at least 4 weeks after completion of treatment and discontinuation of the antisecretory therapy. H. pylori status was assessed by a biopsy urease test, histology and culture. RESULTS: In the intention-to-treat analysis, eradication of H. pylori was achieved in 48 of the 60 patients (80%; 95% confidence interval: 70-90%) in the FAT group, compared to 50 of the 60 patients (83.3%; 95% confidence interval: 74-93%) in the OAT group. In the per protocol analysis, eradication therapy was achieved in 48 out of 53 patients (90.6%; 95% confidence interval: 83-98%) treated with FAT and 50 out of 57 patients (87.7%; 95% confidence interval: 79-96%) treated with OAT (not significant). The primary metronidazole resistance was present in 28.8% of strains. Overall, per protocol eradication rates in strains resistant and susceptible to metronidazole were 83.3% and 91.3% respectively (P > 0.05). CONCLUSIONS: Two-week courses of either high-dose famotidine or omeprazole, both combined with amoxycillin and tinidazole, are equally effective for eradication of H. pylori infection. In a 2-week triple therapy, metronidazole resistance has no significant impact on eradication rates.
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Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Inibidores Enzimáticos/administração & dosagem , Famotidina/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Antagonistas dos Receptores H2 da Histamina/administração & dosagem , Omeprazol/administração & dosagem , Penicilinas/administração & dosagem , Inibidores da Bomba de Prótons , Tinidazol/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Quimioterapia Combinada , Inibidores Enzimáticos/efeitos adversos , Famotidina/efeitos adversos , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Antagonistas dos Receptores H2 da Histamina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/efeitos adversos , Penicilinas/efeitos adversos , Úlcera Péptica/complicações , Úlcera Péptica/diagnóstico , Úlcera Péptica/tratamento farmacológico , Estudos Prospectivos , Tinidazol/efeitos adversosRESUMO
BACKGROUND: Endoscopic ultrasonography (EUS) is a useful modality to show the sonographic features of gastric stromal tumors (GST) which originate from the gastric wall, but it is difficult to distinguish benign from malignant tumors. This study tried to discriminate between them by their EUS patterns. METHODS: EUS patterns were obtained from 52 histologically proved GST. The tumor size, echo patterns and irregular margin were analyzed. RESULTS: Of 52 GST, 11 were leiomyosarcoma and 41 were leiomyoma. The mean sizes of the leiomyoma and leiomyosarcoma were 3.3 +/- 1.1 cm and 7.1 +/- 2.2 cm (p < 0.01). Using a tumor size > or = 5 cm as a criterion for malignancy resulted in a sensitivity of 72.7% and a specificity of 85.4%. A sonolucent area inside the tumor, resulted in a sensitivity and specificity of 81.8% and 80.5%. With an irregular tumor margin, the sensitivity and specificity were 90.9% and 90.2%. A combination of all 3 criteria, resulted in a sensitivity and specificity of 72.7% and 90.2%. For benign tumors, the criteria of tumor < 5 cm, no sonolucent areas and no irregular margin had a sensitivity of 80.5% and a specificity of 100%. CONCLUSION: Tumor size is not a sensitive criterion of malignancy. An irregular margin and sonolucent areas in the tumor have better sensitivity and specificity for the diagnosis of malignant GST. On the contrary, a GST smaller than 5 cm in size with neither a sonolucent area nor an irregular tumor margin strongly suggests a benign lesion.
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Endossonografia , Leiomioma/diagnóstico por imagem , Leiomiossarcoma/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Feminino , Humanos , Leiomioma/patologia , Leiomiossarcoma/patologia , Masculino , Sensibilidade e Especificidade , Neoplasias Gástricas/patologiaRESUMO
OBJECTIVE: To assess the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma by using a flash echo imaging system, a newly developed technique for detecting echoes from microbubble contrast agents more efficiently. METHODS: Six patients with 7 small nodular hepatocellular carcinomas, proved by fine-needle aspiration cytologic or pathologic examination, were included. Percutaneous ethanol injection was performed until there was no intratumoral color signal on conventional color and power Doppler ultrasonography. A bubble contrast agent was then injected, and flash echo imaging in the subtraction mode was performed for assessment of the therapeutic effect. Dynamic computed tomography, magnetic resonance imaging, and hepatic angiography were also used for evaluation of the therapeutic effect. RESULTS: Five tumors had perfusion defects that were equal in size to or larger than the tumors. No tumor stain was shown on hepatic angiography. Two tumors had partial perfusion defects. Viable tumors were confirmed by tumor resection in 1 case and cytologic examination in the other. CONCLUSIONS: Our preliminary results show that flash echo imaging with subtraction has potential value in evaluation of the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma.
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Carcinoma Hepatocelular/diagnóstico por imagem , Aumento da Imagem , Neoplasias Hepáticas/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Adulto , Idoso , Biópsia por Agulha , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/terapia , Meios de Contraste , Etanol/administração & dosagem , Feminino , Humanos , Injeções Intralesionais , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/terapia , Masculino , Microesferas , Pessoa de Meia-Idade , Polissacarídeos , Resultado do TratamentoRESUMO
A 41-year-old woman was admitted to our hospital complaining of chest pain, dysphagia, and odynophagia after an upper respiratory tract infection and nasogastric tube insertion. An upper endoscopy showed a large submucosal bulge along the posterior wall from the upper esophagus with mucosal tears and bridge formation, extending down to the lower esophagus. A barium esophagogram revealed a "double-barreled" esophagus, and chest computed tomography (CT) scan showed eccentric thickening of the esophageal wall. The diagnosis of intramural esophageal dissection (IED) was made and the patient was managed conservatively with nothing by mouth and intravenous hydration. The clinical course was uneventful; the patient was discharged later and up to the time of writing has been completely asymptomatic, with normal swallowing function.
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Doenças do Esôfago/diagnóstico por imagem , Doenças do Esôfago/patologia , Esofagoscopia/métodos , Hematoma/diagnóstico por imagem , Hematoma/patologia , Adulto , Compostos de Bário , Meios de Contraste , Doenças do Esôfago/terapia , Feminino , Seguimentos , Hematoma/terapia , Humanos , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/patologia , Ruptura Espontânea/terapia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
Brunner's gland hamartoma is an uncommon intestinal tumor, most frequently located in the duodenal bulb. We report the endoscopic sonographic (EUS) appearances in 2 cases of Brunner's gland hamartoma. In 1 case, EUS revealed a heterogeneous hypoechoic pedunculated mass, 1.7 cm in diameter, arising from the mucosal and submucosal layers of the wall of the duodenal bulb. Multiple anechoic large and small cystic areas were demonstrated in the tumor. In the other case, EUS revealed a 1.4- x 0.9-cm pedunculated mass with an echogenicity higher than that of the muscular layer and lower than that of the mucosa, arising from the submucosal layer of the duodenal bulb wall. Multiple small anechoic areas were demonstrated in the tumor. We believe that both EUS patterns are typical for Brunner's gland hamartomas.
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Glândulas Duodenais/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Endossonografia , Hamartoma/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Gastric aberrant pancreas (GAP) can be demonstrated by its characteristic patterns on endoscopic ultrasonography (EUS). We tried to classify the EUS figures of GAP to provide a useful EUS pattern for diagnosing this disease. METHODS: Among 68 cases of GAP suspected by EUS, 13 patients who were proven to have GAP by histology from surgical specimens (4 cases), mucosectomy (6 cases), and biopsy (3 cases) were enrolled. EUS was performed under a standard procedure using an Olympus EU-M3 machine with a 7.5/12 MHz inter-changeable transducer. The essential histological finding of GAP is pancreatic tissue in specimens. RESULTS: Among 13 patients with GAP (size from 0.7 to 1.6 cm in diameter), 11 tumors were located in the antrum, and 2 were located at the lower body. All 13 tumors arose from the third layer of the gastric wall with an echogenicity higher than the fourth hypoechoic layer. We classified EUS figures of these 13 GAP into 3 types based on the change of the muscular (fourth) layer below the tumor: Type 1 (6 cases), the fourth layer is intact and has a normal thickness; Type 2 (4 cases), the fourth layer has thickened; and Type 3 (3 cases), the fourth layer has thickened, and there are some hyperechoic densities (tubular-like structures) within the fourth layer. Mucosectomy was performed without any complication in 6 cases (four type 1 and two type 2). CONCLUSION: EUS figures of our 13 cases of GAP were classified into 3 types which will be helpful in the EUS diagnosis of GAP and can provide information on selecting patients for mucosectomy.
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Coristoma/diagnóstico por imagem , Endossonografia , Pâncreas , Gastropatias/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coristoma/classificação , Coristoma/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estômago/diagnóstico por imagem , Gastropatias/classificação , Gastropatias/patologiaRESUMO
BACKGROUND: To determine the incidence, causes, and associated risk factors of adult intussusception. METHODS: Forty-five cases of adult intussusception proven by surgery were collected from 58,000 surgeries performed from December 1986 through December 1998. The condition leading to intussusception, imaging studies, and clinical risk factors were analyzed. RESULTS: Nineteen men and 26 women, 18 to 83 years of age (mean, 52.6 years), experienced intussusception. The incidence of adult intussusception was 0.08% of abdominal surgeries and 3.0% of intestinal obstructions. A benign process was diagnosed in 25 cases (55.6%), malignancy in 16 cases (35.6%), surgery-related intussusception in 1 case (2.2%), and an idiopathic condition existed in 3 cases (6.6%). The major cause of adult intussusception due to benign lesions was polyps (12/25) and for malignancy, it was colonic adenocarcinoma (14/16). The diagnostic imaging rates were 52% for computed tomography, 41% for barium studies and 32% for abdominal ultrasound. There was no mortality due to intussusception; 4 patients (8.9%) died of colon cancer with liver metastasis. No definite risk factor was identified, but leukocytosis and a shorter preoperative duration tended to increase the risk of complications (p = 0.084, 0.082 respectively). CONCLUSION: Malignancy was the major cause of colonic intussusception, as was a benign process the primary cause of intestinal intussusception. These adult patients with intussusception received adequate surgical care and had a good prognosis except for those with colon cancer and liver metastasis.
Assuntos
Intussuscepção/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Intussuscepção/diagnóstico , Intussuscepção/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
PURPOSE: We evaluated the accuracy of high-resolution transabdominal sonography (TAUS) in identifying and characterizing gastric submucosal masses previously detected by endoscopy. METHODS: Patients given endoscopy for suspected submucosal gastric lesions and 2 patients with gastric wall cysts were enrolled. Patients underwent TAUS and then endoscopic sonography (EUS) on the same day, and the sonographic results were compared with endoscopic and histologic findings. RESULTS: Among 101 patients with gastric submucosal masses on endoscopy, TAUS revealed a mass in 94 (93%); of these 94 patients, 60 underwent EUS. The final diagnoses were 31 leiomyomas, 10 leiomyosarcomas, 13 ectopic pancreases, 2 cysts, and 1 glomus tumor, 1 carcinoid tumor, 1 lipoma, and 1 fibroma. Leiomyomas (mean size, 3.2 cm) and leiomyosarcomas (mean size, 7.1 cm) were shown sonographically to originate from the muscular layer. Ectopic pancreases (mean size, 1.2 cm) were shown to originate from the submucosal layer and had a homogeneously echogenic pattern. Gastric cysts were found in the submucosal layer and were anechoic. The glomus tumor and the carcinoid tumor were found in the muscular layer and were hypoechoic. The lipoma and the fibroma were located in the submucosal layer and were echogenic on TAUS. CONCLUSIONS: TAUS had a detection rate of 93% in visualizing submucosal gastric masses previously identified by endoscopy. TAUS is less invasive than EUS and can be used to follow submucosal gastric masses that are not excised.
Assuntos
Mucosa Gástrica/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Diagnóstico Diferencial , Endossonografia , Feminino , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
Hepatocellular carcinoma (HCC) may occur in family clusters. No genetic mechanism has been identified as responsible for this familial tendency. We suspected that a longer hepatitis B virus (HBV) replication phase might be the reason for a higher risk of HCC in families with this disease. We performed liver biochemical tests, test for viral hepatitis markers and hepatitis B e antigen (HBeAg), and liver ultrasonography in relatives of patients with HCC. A total of 1,885 first-degree relatives from 688 families participated in this study. Seven hundred fifty-two relatives were found to be carriers of hepatitis B surface antigen (HBsAg) and 675 of them were tested for HBeAg. The prevalence of HBeAg was 27.4% in relatives of those with HCC and 20% in asymptomatic HBsAg carriers. The HBeAg prevalence rate was higher in relatives of those with HCC > or = 40 years old than in asymptomatic HBsAg carriers. Moreover, HBeAg was more likely to persist in men than in women > or = 40 years old. We conclude that families with HCC showed a prolonged HBV replication phase that may be one of the cofactors for a familial tendency for HCC.
Assuntos
Carcinoma Hepatocelular/genética , Portador Sadio/virologia , Antígenos E da Hepatite B/sangue , Vírus da Hepatite B/fisiologia , Hepatite B/virologia , Adolescente , Adulto , Fatores Etários , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Portador Sadio/imunologia , China/epidemiologia , Feminino , Anticorpos Anti-Hepatite/sangue , Hepatite B/complicações , Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Vírus Delta da Hepatite/imunologia , Humanos , Técnicas Imunoenzimáticas , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Núcleo Familiar , Prevalência , Radioimunoensaio , Análise de Regressão , Ultrassonografia , Replicação Viral , alfa-Fetoproteínas/análiseRESUMO
The sonographic features of hemobilia in the gallbladder have been reported with variation, including an echogenic mass, hypoechoic mass, and scattered intraluminal echoes. The sequential sonographic changes of hemobilia in the gallbladder were observed in a 59-year-old male patient with bilateral intrahepatic duct stones. The sonograms of hemobilia in the distended gallbladder initially showed a hyperechoic, homogeneous, movable mass-like lesion, 36 hours before the onset of upper gastrointestinal (UGI) bleeding. A hypoechoic mass-like lesion with a hyperechoic ring was found 5 days after the onset of UGI bleeding. A faint hypoechoic mass-like lesion was found 7 days after the onset of UGI bleeding (the day of no further bleeding). Scattered echoic densities were found 9 days after the onset of UGI bleeding, then disappearance of the lesion was noted 12 days after the onset of UGI bleeding. The sonographic patterns of hemobilia in the gallbladder vary depending on the timing of lysis of the blood clot. It should be differentiated from gallbladder cancer, a stone, a polyp, sludge, acute gangrenous cholecystitis, and gallbladder empyema.
Assuntos
Ductos Biliares Intra-Hepáticos , Colelitíase/diagnóstico por imagem , Vesícula Biliar/diagnóstico por imagem , Hemobilia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
BACKGROUND: There are etiologic variations of hepatocellular carcinoma (HCC) in different geographic areas. Taiwan is a hyperendemic area for hepatitis B virus (HBV) infection. Hepatitis C virus (HCV) infection also plays an important role in HCC development in Taiwan. Identification of local HCV-endemic areas is important to keep HCV from spreading. This study investigated the etiologic variations of HCC in different geographic areas of Taiwan. METHODS: The authors evaluated the hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti-HCV) status of 284 patients (232 male, 52 female) with HCC. They also evaluated the gender ratio and mean age of these patients. RESULTS: The mean age of HBsAg positive patients was significantly lower than the mean age of HBsAg negative patients (52.6 +/- 12.3 vs. 61.3 +/- 11.2 years) (P < 0.05). The male-to-female ratio was 4.5:1 for all HCC patients, 7:1 for HBsAg positive HCC patients, and 2.8:1 for anti-HCV positive HCC patients. In Chaiyi County in southern Taiwan, the prevalence of anti-HCV in male HCC patients was 52%, significantly greater than that of Taiwan as a whole (27.6%) (P = 0.07). However, the prevalence of anti-HCV in male HCC patients in Taipei County in northern Taiwan was 8.7%, significantly less than that of Taiwan as a whole (P = 0.043). Of a total of 65 Chiayi-based HCC patients, 55.4% were anti-HCV positive and 46.2% were HBsAg positive. In the Chiayi area, results of multiple logistic regression showed that the HCC patients who were age 60 years or older or who were living in the city area both had highly HCV-related disease. CONCLUSIONS: The mean age of patients with HBV-related HCC was significantly lower than that of patients with non-HBV-related HCC. The male-to-female ratio for patients with HBV-related HCC was significantly higher than that of patients with HCV-related HCC. The authors identified an area of Taiwan in which HCV-related HCC was prevalent.