A study of a pancreatic mass: not all is what it seems.

We report the case of a male with no medical history with acute cholangitis secondary to a pancreatic head´s mass suggestive of neoplasm. An EUS-FNA was performed where no atypical cells were identified but a granulomatous component did. The patient was finally diagnosed of disseminated tuberculosis with pancreatic involvement. Pancreatic tuberculosis is an infrequent entity that requires a high index of suspicion due to the variability of its forms of presentation and the high morbidity and mortality without targeted therapy.

Endoscopic submucosal injection of adipose-derived mesenchymal stem cells ameliorates TNBS-induced colitis in rats and prevents stenosis.

BACKGROUND: Mesenchymal stem cells have potential applications in inflammatory bowel disease due to their immunomodulatory properties. Our aim was to evaluate the feasibility, safety and efficacy of endoscopic administration of adipose-derived mesenchymal stem cells (ASCs) in a colitis model in rats. METHODS: Colitis was induced in rats by rectal trinitrobenzenesulfonic acid (TNBS). After 24 h ASCs (107 cells) or saline vehicle were endoscopically injected into the distal colon. Rats were followed for 11 days. Daily weight, endoscopic score at days 1 and 11, macroscopic appearance at necropsy, colon length and mRNA expression of Foxp3 and IL-10 in mesenteric lymph nodes (MLN) were analyzed. RESULTS: Endoscopic injection was successful in all the animals. No significant adverse events or mortality due to the procedure occurred. Weight evolution was significantly better in the ASC group, recovering initial weight by day 11 (- 0.8% ± 10.1%, mean ± SD), whereas the vehicle group remained in weight loss (- 6.7% ± 9.2%, p = 0.024). The endoscopic score improved in the ASC group by 47.1% ± 5.3% vs. 21.8% ± 6.6% in the vehicle group (p < 0.01). Stenosis was less frequent in the ASC group (4.8% vs. 41.2%, p < 0.01). Colon length significantly recovered in the ASC group versus the vehicle group (222.6 ± 17.3 mm vs. 193.6 ± 17.9 mm, p < 0.001). The endoscopic score significantly correlated with weight change, macroscopic necropsy score and colon length. Foxp3 and IL-10 mRNA levels in MLN recovered with ASC treatment. CONCLUSIONS: ASC submucosal endoscopic injection is feasible, safe and ameliorates TNBS-induced colitis in rats, especially stenosis.

Multiseptate gallbladder: a rare ultrasonographic finding.

Multiseptate gallbladder is a congenital abnormality categorized as a gallbladder shape variant with some 20 cases reported thus far in the literature. Clinical presentation may be highly variable, ranging from asymptomatic to chronic pain in the right upper quadrant, cholecystitis, and even pancreatitis. It may be associated with other bile duct abnormalities such as choledochal cyst, ectopic gallbladder or anomalous biliopancreatic junction.

[Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma adjacent to the diaphragm]. / Creación de ascitis artificial para el tratamiento mediante radiofrecuencia percutánea del hepatocarcinoma cercano al diafragma.

Surgical resection is the first-line curative treatment of hepatocellular carcinoma (HCC). However most patients are unable to undergo surgical resection because of advanced tumoral stage, severe liver dysfunction or poor clinical status. Therefore, image-guided tumor ablation techniques have been introduced for the treatment of unresectable HCC. Among them, radiofrequency ablation (RFA) has been demonstrated to be an effective alternative curative therapy. However, local ablative therapy for tumors located close to structures such as the diaphragm or gastrointestinal tract is technically challenging because of the risk of collateral thermal damage to nearby structures or incomplete treatment of the HCC resulting from poor visibility on sonography. The introduction of artificial ascites can separate adjacent organs from the tumor and improve the sonic window. The aim of this study was to evaluate the feasibility, safety and efficacy of RFA with artificial ascites for HCC adjacent to the diaphragm.

Utilidad de la citología por punción aspiración con aguja fina (PAAF) de las lesiones hepáticas focales / Utility of the citology for fine needle aspiration puncture (PAAF) of the focal hepatical lesions

El presente trabajo tiene por objeto lograr información acerca de la naturaleza histológica de las lesiones hepáticas focales (benignas o malignas), mediante la toma de muestra por punción percutánea dirigida bajo control ultrasonográfico. Se estudiaron 67 pacientes con lesiones ocupantes de espacio diagnosticadas por ecografía, equipo tiempo real y transductor sectorial de 3.5 MHz sin aditamento especial para biopsia. Previa asepsia y antisepsia se introduce aguja fina de punción lumbar guiada por el transductor hasta localizar la lesión y mediante presión negativa se toma la muestra que es fijada con alcohol de 96§, para estudio citológico según técnica de Diff-Quick. Se obtuvo material suficiente en todos los casos, excepto en uno. Hubo 5 falsos negativos y ninguno falso positivo. No hubo ningún tipo de complicaciones. La sensibilidad del método fue de 90,8% con una especificidad del 100% y una precisión diagnóstica del 91%. En conclusión creemos que la PAAF bajo control ecográfico es un método de alta rentabilidad diagnóstica y que puede evitar, caso de ser positiva, la realización de otras pruebas más agresivas. Agiliza el diagnóstico y acorta la estancia media hospitalaria. Además, es un método sencillo, económico, con escasas o nulas complicaciones, no agresivo y bien tolerado por el enfermo