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2.
J Gastroenterol Hepatol ; 28(4): 593-607, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23350673

RESUMEN

Hilar cholangiocarcinoma (HCCA) is one of the most common types of hepatobiliary cancers reported in the world including Asia-Pacific region. Early HCCA may be completely asymptomatic. When significant hilar obstruction develops, the patient presents with jaundice, pale stools, dark urine, pruritus, abdominal pain, and sometimes fever. Because no single test can establish the definite diagnosis then, a combination of many investigations such as tumor markers, tissue acquisition, computed tomography scan, magnetic resonance imaging/magnetic resonance cholangiopancreatography, endoscopic ultrasonography/intraductal ultrasonography, and advanced cholangioscopy is required. Surgery is the only curative treatment. Unfortunately, the majority of HCCA has a poor prognosis due to their advanced stage on presentation. Although there is no survival advantage, inoperable HCCA managed by palliative drainage may benefit from symptomatic improvement. Currently, there are three techniques of biliary drainage which include endoscopic, percutaneous, and surgical approaches. For nonsurgical approaches, stent is the most preferred device and there are two types of stents i.e. plastic and metal. Type of stent and number of stent for HCCA biliary drainage are subjected to debate because the decision is made under many grounds i.e. volume of liver drainage, life expectancy, expertise of the facility, etc. Recently, radio-frequency ablation and photodynamic therapy are promising techniques that may extend drainage patency. Through a review in the literature and regional data, the Asia-Pacific Working Group for hepatobiliary cancers has developed statements to assist clinicians in diagnosing and managing of HCCA. After voting anonymously using modified Delphi method, all final statements were determined for the level of evidence quality and strength of recommendation.


Asunto(s)
Neoplasias de los Conductos Biliares/terapia , Colangiocarcinoma/terapia , Colangiopancreatografia Retrógrada Endoscópica , Conducto Hepático Común/patología , Tumor de Klatskin/terapia , Asia Sudoriental/epidemiología , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/epidemiología , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/epidemiología , Drenaje/métodos , Endoscopía/métodos , Asia Oriental/epidemiología , Femenino , Humanos , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/epidemiología , Masculino
3.
J Clin Ultrasound ; 41(7): 402-7, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23733737

RESUMEN

BACKGROUND: Hydrocolonic ultrasound (HUS) is a low-cost imaging modality as compared with standard colonoscopy. However, HUS is not popular in the clinical setting due to its somewhat complicated technique of examination and inability to visualize the rectum. We developed a technique to overcome these limitations. METHODS: Ten patients with cancer-suggestive symptoms and 70 asymptomatic patients were included in this study. All patients underwent HUS, with the technique described herein, before colonoscopy on the same day. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: There were 30 men and 50 women with a mean age of 60.9 ± 7.3 (SD) years. Thirteen polyps with a size ≥0.6 cm (four lesions size 0.6 to 0.9 cm and nine lesions size ≥1 cm) were detected by colonoscopy. The detection rate of lesions by HUS was 25% for polyps size 0.6-0.9 cm and 89% for lesions size ≥1 cm in size. Three lesions were missed in the sigmoid colon, one in the transverse colon, and one in the rectum. CONCLUSIONS: HUS is a low-cost and noninvasive procedure for colorectal study. This technique has the potential to be used for the detection of colorectal cancer and polyps.


Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Pólipos Adenomatosos/diagnóstico por imagen , Pólipos del Colon/diagnóstico por imagen , Neoplasias Colorrectales/diagnóstico por imagen , Ultrasonografía/métodos , Agua , Adenocarcinoma/diagnóstico , Pólipos Adenomatosos/diagnóstico , Anciano , Pólipos del Colon/diagnóstico , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Enema , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
6.
J Med Assoc Thai ; 86 Suppl 2: S318-22, 2003 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12930005

RESUMEN

Ruptured bladder or extravasation from the bladder is almost always associated with trauma. Spontaneous extravasation is extremely rare with only a few reported cases. All those reported extravasations occurred in the patients diagnosed with end stage renal disease (ESRD) and were self limiting conditions. During the one-year period of 2001, voiding cystourethrography (VCUG) of 115 patients were performed in our institution with various indications. The authors found 3 cases with extravasation of contrast from the bladder during VCUG. All extravasations were occurred in ESRD patients and the VCUG was performed as part of the routine investigation prior to renal transplantation. The presented cases shared a similar observation of 1) no traumatic catheterization, 2) only minimal and self limiting extravasation and 3) no immediate or delayed symptom associated with extravasation. The cause and mechanism of leakage remain uncertain. Hypertonicity and mucosal changes within the unused bladder were purposed as probably the two main causes of extravasation.


Asunto(s)
Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Fluoroscopía/efectos adversos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/diagnóstico por imagen , Uretra/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Adulto , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
7.
BMJ Case Rep ; 20142014 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-24493107

RESUMEN

A 55-year-old healthy Thai man presented with incidental finding of a well-circumscribed, 5.8×5.4 cm mass in the right side of the pelvic cavity with heterogeneous density by a CT scan performed for trauma. No other distant lesion was detected. The pathology from pelvic mass showed poorly differentiated neuroendocrine carcinoma (NEC). A submucosal mass of 10 cm from the anal verge was found at colonoscopy, and a biopsy showed the same histopathology as in the pelvic mass. Final diagnosis was poorly differentiated primary rectal NEC with metastasis to the right iliac node (by CT scan). Carboplatin and etoposide were given for six cycles and tumour size was decreased.


Asunto(s)
Carcinoma Neuroendocrino/diagnóstico por imagen , Neoplasias del Recto/diagnóstico por imagen , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedades Asintomáticas , Carboplatino/administración & dosificación , Carcinoma Neuroendocrino/tratamiento farmacológico , Carcinoma Neuroendocrino/patología , Etopósido/administración & dosificación , Humanos , Hallazgos Incidentales , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/patología , Tomografía Computarizada por Rayos X
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