RESUMO
BACKGROUNDS: The lung-to-heart ratio (L/H ratio) in myocardial perfusion scintigraphy (MPS) is a useful marker that complements the sensitivity of ischemia detection. However, it requires planar imaging acquired following a separate protocol in addition to single-photon emission computed tomography (SPECT). We developed a novel method for constructing virtual planar image (VPI) from SPECT data. METHODS: Myocardial phantoms using Tl-201 were built with different amounts of radioactivity in the lungs. SPECT data and conventional planar images of these phantoms were collected with an Anger-type gamma camera. VPIs were constructed by adding all coronal images reconstructed from SPECT data. The clinical utility of VPIs obtained from 52 patients who underwent MPS with Tc-99m sestamibi was evaluated. RESULTS: The radioactivity linearity of VPIs was satisfactory, with a correlation coefficient of r ≥ .99 between the measured amounts of radioactivity and image counts. The L/H ratios obtained from VPI analysis were strongly correlated with those of conventional planar images with a correlation coefficient of r ≥ .99 in the phantom study and r = .929 in clinical application. CONCLUSION: The accuracy of VPI-based L/H ratio analysis was comparable to that of conventional planar image-based analysis. VPIs could be used as an alternative method of obtaining planar images in clinical settings.
Assuntos
Radioisótopos de Tálio , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos , Coração/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Pulmão , PerfusãoRESUMO
BACKGROUND AND AIM: Comprehensive reports on the risk factors for bleeding and early death after percutaneous endoscopic gastrostomy (PEG) are limited. In this multicenter study, we retrospectively investigated the risk factors for bleeding and early death after PEG. METHODS: Patients (n = 1234) who underwent PEG between 2015 and 2020 at Osaka Medical and Pharmaceutical University and its affiliated hospitals (11 institutions in total) were evaluated for postoperative bleeding and early death (within 60 days) after PEG according to patient characteristics, construction method, medical history, medications, preoperative hematological findings, and perioperative adverse events. Multivariate logistic regression was performed to identify independent predictors of bleeding and early death after PEG. RESULTS: The risk factors for bleeding after PEG were PEG tube insertion using the modified introducer method (odds ratio [OR], 4.37; P = 0.0003), low platelet count (OR, 0.99; P = 0.014), antiplatelet therapy (OR, 2.11; P = 0.036), and heparinization (OR, 4.50; P = 0.007). Risk factors for early death were low body mass index (BMI) (OR, 0.89; P = 0.015), low serum albumin levels (OR, 0.50; P = 0.035), and comorbidity of active cancer (OR, 4.03; P < 0.0001). There was no significant association between bleeding and early death after PEG. CONCLUSIONS: We identified several risk factors for bleeding and early death after PEG. Risk factors for bleeding were PEG tube insertion using the modified introducer method, low platelet count, antiplatelet therapy, and heparinization. Risk factors for early death were low BMI, low serum albumin levels, and comorbidity of active cancer.
Assuntos
Gastrostomia , Mortalidade Prematura , Hemorragia Pós-Operatória , Gastrostomia/efeitos adversos , Humanos , Neoplasias/epidemiologia , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Albumina SéricaRESUMO
BACKGROUND: With endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), guidewire manipulation might be a critically limiting step for nonexperts. However, the causes of difficult guidewire manipulation remain unclear. The aim of this study was to evaluate factors associated with successful guidewire manipulation. METHODS: This retrospective cohort study included consecutive patients who underwent EUS-HGS between October 2018 and October 2019.âWe measured scope angle between the long and needle axes of the echoendoscope using still fluoroscopic imaging immediately after puncturing the intrahepatic bile duct. Factors associated with successful guidewire insertion were assessed by multivariable analysis using logistic regression. RESULT: The influence of the angle between the fine-needle aspiration (FNA) needle and echoendoscope on failed guidewire insertion was assessed using receiver operating characteristic (ROC) curves. Area under the ROC curve was 0.86 (95â% confidence interval [CI] 0.00â-â0.76), and an angle of 135° offered 88.0â% sensitivity and 82.9â% specificity for predicting successful guidewire insertion. According to multivariable analysis, only angle between the FNA needle and echoendoscope >â135° was independently associated with successful guidewire insertion (odd ratio 0.03, 95â%CI 0.01â-â0.14; Pâ<â0.05), whereas sex, puncture site, and diameter of puncture site were not significant factors. After multivariable analysis, all variables were adjusted using age ≥â70 or <â70 years, yielding the same results. CONCLUSION: The angle between the FNA needle and echoendoscope might be associated with successful guidewire manipulation during EUS-HGS.âAdjusting this angle to 135° before puncturing the intrahepatic bile duct might be helpful in achieving successful guidewire manipulation during EUS-HGS.
Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Endossonografia , Idoso , Cateterismo , Humanos , Estudos Retrospectivos , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: Hepatectomy is currently recommended as the most reliable treatment for colorectal liver metastases. However, the association between the choice of treatment for recurrence and the timing of recurrence remains controversial. METHODS: Two-hundred ninety-five patients who underwent hepatectomy were retrospectively analyzed for the risk factors and the outcomes for early recurrence within 6 months. The remnant liver volumes (RLVs) and laboratory data were measured postoperatively using multidetector computed tomography on days 7 and months 1, 2, and 5 after the operation. RESULTS: Early recurrence developed in 88/295 patients (29.8%). Colorectal cancer lymph node metastasis, synchronous liver metastasis, and multiple liver metastases were independent risk factors for the occurrence of early recurrence (p < 0.001, 0.032, and 0.019, respectively). Patients with early recurrence had a poorer prognosis than did patients who developed later recurrence (p < 0.001). Patients who underwent surgery or other local treatment had better outcomes. The changes in RLV and laboratory data after postoperative month 2 were not significantly different between the 2 groups. CONCLUSION: Patients with early recurrence within 6 months had a poorer prognosis than did patients who developed later recurrence. However, patients who underwent repeat hepatectomy for recurrence had a better prognosis than did those who underwent other treatments, with good prospects for long-term survival.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatectomia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/secundário , Metástase Linfática , Masculino , Metastasectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Tamanho do Órgão , Prognóstico , Reoperação , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Most advanced elderly cancer patients experience fatigue, anorexia, and declining physical function due to cancer cachexia, for which effective interventions have not been established. We performed a phase I study of a new nonpharmacological multimodal intervention called the nutritional and exercise treatment for advanced cancer (NEXTAC) program and reported the excellent feasibility of and compliance with this program in elderly patients with advanced cancer who were at risk for cancer cachexia. We report here the background, hypothesis, and design of the next-step multicenter, randomized phase II study to evaluate the efficacy of the program, the NEXTAC-TWO study. METHODS: Patients with chemo-naïve advanced non-small cell lung cancer or pancreatic cancer, age ≥ 70 years, performance status ≤2, with adequate organ function and without disability according to the modified Katz index will be eligible. In total, 130 participants will be recruited from 15 Japanese institutions and will be randomized into either the intervention group or a control group. Computer-generated random numbers are allocated to each participant. Stratification factors include performance status (0 to 1 vs. 2), site of primary cancer (lung vs. pancreas), stage (III vs. IV), and type of chemotherapy (cytotoxic vs. others). Interventions and assessment will be performed 4 times every 4 ± 2 weeks from the date of randomization. Interventions will consist of nutritional counseling, nutritional supplements (rich in branched-chain amino acids), and a home-based exercise program. The exercise program will include low-intensity daily muscle training and lifestyle education to promote physical activity. The primary endpoint is disability-free survival. It is defined as the period from the date of randomization to the date of developing disability or death due to any cause. This trial also plans to evaluate the improvements in nutritional status, physical condition, quality of life, activities of daily living, overall survival, and safety as secondary endpoints. Enrollment began in August 2017. The study results will demonstrate the efficacy of multimodal interventions for elderly cancer patients and their application for the maintenance of physical and nutritional conditions in patients with cancer cachexia. This work is supported by a grant-in-aid from the Japan Agency for Medical Research and Development. DISCUSSION: This is the first randomized trial to evaluate the efficacy and safety of a multimodal intervention specific for elderly patients with advanced cancer. TRIAL REGISTRATION: Registered at August 23, 2017. Registry number: UMIN000028801 .
Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Neoplasias Pancreáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Caquexia/epidemiologia , Caquexia/fisiopatologia , Caquexia/prevenção & controle , Caquexia/terapia , Carcinoma Pulmonar de Células não Pequenas/dietoterapia , Carcinoma Pulmonar de Células não Pequenas/patologia , Protocolos Clínicos , Ensaios Clínicos Fase II como Assunto , Terapia Combinada , Terapia por Exercício , Humanos , Japão , Neoplasias Pulmonares/dietoterapia , Neoplasias Pulmonares/patologia , Neoplasias Pancreáticas/dietoterapia , Neoplasias Pancreáticas/patologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: It is yet not clear whether differences in the contrast medium may affect post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). AIM: The aim of this study was to evaluate the rate of PEP between high osmolality contrast medium (HOCM) and iso osmolar medium (IOCM) in a prospective, randomized, controlled trial. METHODS: Patients who were scheduled to undergo a diagnostic or therapeutic procedure under ERCP guidance were included. Patients were excluded from this study if they (1) were < 20 years old; (2) had acute or active pancreatitis; (3) had previously undergone ERCP; (4) had surgical altered upper gastrointestinal tract anatomy; or (5) refused to be involved in this study. RESULTS: Seventy-five patients were randomly assigned to the IOCM group, and 71 patients were assigned to the HOCM group. PEP occurred in 27 patients (18.5%). Although there were no significant differences, the severe grade of PEP was more frequent in the HOCM group than in the IOCM group (p = 0.08). The results of the multivariate analyses for PEP were not identified as independent risk factors. Also, independent risk factors of hyperamylasemia were performing pre-cut. In subgroup analyses, HOCM was an independent risk factor for hyperamylasemia. CONCLUSIONS: In conclusion, HOCM may play a role in the development of PEP and in PEP severity grade.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Pancreatite/prevenção & controle , Ácidos Tri-Iodobenzoicos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/efeitos adversos , Feminino , Humanos , Hiperamilassemia/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND AND STUDY AIM: To date, only a few reports with small numbers of patients have described double stenting (biliary and duodenal), in particular endoscopic ultrasound (EUS)-guided biliary drainage, for patients with obstructive jaundice. In addition, no reports have sought to determine which EUS-guided biliary drainage route has better outcomes. The aim of the current study was to investigate adverse events and stent patency in patients who underwent EUS-guided biliary drainage and duodenal stenting. PATIENTS AND METHODS: Patients who were admitted to the Osaka Medical College with obstructive jaundice caused by lower biliary obstruction and duodenal obstruction due to malignant tumor between June 2012 and April 2014 were retrospectively enrolled in the study. RESULTS: A total of 39 patients were enrolled in the study; 13 underwent EUS-guided choledochoduodenostomy (EUS-CDS), and 26 underwent EUS-guided hepaticogastrostomy (EUS-HGS). Adjusted analyses for covariates using propensity scores showed that the EUS-HGS group had significantly longer stent patency than the EUS-CDS group (duodenal stent patency: median 113 vs. 34 days; hazard ratio [HR] 0.415, 95â% confidence interval [CI] 0.175â-â0.984; Pâ=â0.046; biliary stent patency: median 133 vs. 37 days; HR 0.391, 95â%CI 0.156â-â0.981; Pâ=â0.045). On logistic regression analysis, only EUS-CDS was associated with adverse events, in particular reflux cholangitis (OR 10.285, 95â%CI 1.686â-â62.733; Pâ=â0.012). CONCLUSION: In cases of obstructive jaundice with duodenal obstruction, EUS-HGS may be better than EUS-CDS, with longer stent patency and fewer adverse events.
Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Obstrução Duodenal/cirurgia , Endoscopia do Sistema Digestório/métodos , Endossonografia , Gastrostomia/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Neoplasias do Sistema Biliar/complicações , Neoplasias do Sistema Biliar/cirurgia , Colestase/diagnóstico , Colestase/etiologia , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/etiologia , Feminino , Seguimentos , Humanos , Masculino , Ductos Pancreáticos/cirurgia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: Both endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) cytology may provide tissue diagnoses in solid pancreatic neoplasms. However, there are scant data comparing these two methods. This study aims at retrospectively comparing EUS-FNA and ERCP tissue sampling and ability of cytopathological diagnosis in solid pancreatic neoplasms and to determine usefulness and adverse events of combining both procedures. MATERIAL AND METHODS: Two hundred and thirty four patients suspected to have solid pancreatic mass on abdominal ultrasound and/or computed tomography (CT) were enrolled. EUS-FNA (group A), ERCP cytology (group B) and combined procedures (Group C) performed in 105, 91 and 38 cases, respectively. RESULTS: Sensitivity, specificity and accuracy were 98.9%, 93.3% and 98.1% for group A, and 72.1%, 60% and 71.4% for group B. Those for group C were all 100%. Sensitivity for malignancy in the pancreas head was 100% for group A and 82.4% for group B, and in the pancreas body and tail, 97.6% for group A and 57.1% for group B. EUS-FNA was more sensitive than ERCP cytology in diagnosing malignant pancreatic neoplasms 21-30 mm in size (p = 0.0068), 31-40 mm (p = 0.028) and ≥ 41 mm (p < 0.0001). Sensitivity for pancreatic malignancy with group C was 100% regardless of mass location or size. Adverse events were 1.9%, 6.6% and 2.6% following EUS-FNA, ERCP and combined procedures, respectively. CONCLUSIONS: EUS-FNA is superior to ERCP cytology for diagnosis of solid pancreatic neoplasms. Although combination of both procedures provide efficient tissue diagnosis and with a minimal adverse events rate, a prospective study including larger number of patients is required.
Assuntos
Carcinoma/patologia , Colangiopancreatografia Retrógrada Endoscópica , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) is not normally indicated for an obstructed right intrahepatic bile duct (IHBD). The technical feasibility and clinical efficacy of a novel technique of EUS-BD for right IHBD obstruction were evaluated. A total of 11 patients underwent drainage using either a left or a right biliary access route. The causes of obstructive jaundice were cholangiocarcinoma (nâ=â6), pancreatic cancer (nâ=â3), gastric cancer (nâ=â1), and colon cancer (nâ=â1). After placement of an uncovered metal stent to bridge the obstruction, a hepaticogastrostomy was completed using a covered stent. Mean procedure time was 33.9â±â10.0 minutes. Technical and functional success were achieved in all patients, and no adverse events occurred. This novel method appears to be safe and effective for right IHBD obstruction.
Assuntos
Colestase Extra-Hepática/terapia , Drenagem/métodos , Endossonografia , Ducto Hepático Comum , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase Extra-Hepática/diagnóstico por imagem , Drenagem/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , StentsRESUMO
BACKGROUND AND STUDY AIM: Despite high technical and functional success rates with endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), rates of adverse events have also been high. No reports have focused on EUS-HGS alone with a large sample size about predictors of stent patency. The present study examined predictors of stent patency in patients who underwent EUS-HGS. PATIENTS AND METHODS: The consecutive 51 patients who underwent EUS-HGS using one metallic stent were retrospectively enrolled in this study. Baseline characteristics, stent length from the hepatic portion and in the luminal portion, kinds of stent dysfunction, and stent patency were reviewed. RESULTS: Median duration of stent patency was significantly shorter with stent length in the luminal portion <3 cm (52 days) than with ≥3 cm (195 days; P < 0.01). On the other hand, median duration of stent patency did not differ significantly between ≥4 cm (194 days) and <4 cm (127 days; P = 0.1726). Length of stent in the luminal portion ≥3 cm (Hazard ration [HR], 9.242; 95% confidence interval [CI], 3.255-26.244, P < 0.05) and performance of chemotherapy (HR, 3.022; 95% CI, 1.448-6.304, P < 0.05) were also associated with long stent patency on the Cox proportional hazards model. CONCLUSION: In conclusion, to obtain long-term stent patency, our data suggest that a stent length ≥3 cm in the luminal portion may be suitable for EUS-HGS.
Assuntos
Endoscopia do Sistema Digestório , Endossonografia , Gastrostomia/métodos , Stents , Cirurgia Assistida por Computador , Idoso , Feminino , Gastrostomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Falha de Prótese/efeitos adversos , Estudos Retrospectivos , Stents/efeitos adversosRESUMO
BACKGROUND AND STUDY AIM: To minimize bile leakage and avoid possible death because of stent migration in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), we have recently combined EUS-HGS with EUS-guided antegrade stenting (EUS-AS) of the biliary obstruction using a novel uncovered metallic stent with a fine-gauge delivery system. In this pilot study, we evaluated the feasibility and adverse events associated with this combination therapy using the novel stent. PATIENTS AND METHODS: We performed EUS-guided antegrade stenting and hepaticogastrostomy in 12 consecutive patients. RESULTS: The novel EUS-AS stent was placed across the ampulla of Vater in 8 patients and above the ampulla in 4. Technical and functional success rates were 100â%. In addition, the insertion of the first stent was achieved in all patients without dilation of the fistula between stomach and intrahepatic bile duct. Although 1 patient experienced mild pancreatitis, adverse events such as bile peritonitis or stent dysfunction did not occur during follow-up (mean 122 days, range 62â-â210 days). CONCLUSION: This method appears to safely and effectively avoid adverse events associated with EUS-HGS.
Assuntos
Ductos Biliares/cirurgia , Endossonografia/métodos , Gastrostomia/métodos , Icterícia Obstrutiva/cirurgia , Stents , Idoso , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Masculino , Projetos Piloto , Complicações Pós-Operatórias , Punções , Resultado do TratamentoRESUMO
BACKGROUND AND STUDY AIM: The present study assesses the feasibility as well as the technical and functional success rates of a novel endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) technique called the locking stent method that uses end-bare covered metallic stents (EBCMS). METHODS: Twenty consecutive patients who were histologically diagnosed with unresectable cancer complicated with obstructive jaundice underwent EUS-HGS due to failed endoscopic biliary drainage or inaccessible papilla. We retrospectively collected clinical data for these patients including technical and functional success rates and complications. RESULTS: Seven were treated by EUS-HGS (EUS-HGS group), and 13 were treated using the locking stent EUS-HGS method (LS group). Technical and functional success rates were 100% in both groups. Procedural duration did not significantly differ between the EUS-HGS and LS groups (26.9 ± 9.0 versus 32.3 ± 11.1 min, P = 0.30). Two patients developed complications related to stent migration in the EUS-HGS group. In contrast, although mild post-procedural bile peritonitis required conservative treatment for a few days, none of the stents malfunctioned in the LS group. CONCLUSION: Our method can safely and effectively prevent stent dysfunction, but validation in a prospective clinical trial is required.
Assuntos
Neoplasias do Sistema Digestório/cirurgia , Endoscopia do Sistema Digestório/métodos , Endossonografia/métodos , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/prevenção & controle , Gastrostomia/métodos , Fígado/cirurgia , Falha de Prótese/efeitos adversos , Stents/efeitos adversos , Cirurgia Assistida por Computador/métodos , Idoso , Neoplasias do Sistema Digestório/complicações , Estudos de Viabilidade , Feminino , Humanos , Icterícia Obstrutiva/complicações , Masculino , Metais , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/prevenção & controle , Estudos RetrospectivosRESUMO
BACKGROUND: No previous studies have compared cytology obtained under endoscopic transpapillary gallbladder drainage (ETGD) and EUS-guided fine needle aspiration (EUS-FNA) for thick-walled gallbladders. AIM: The present study investigated the diagnostic yield of bile cytology under ETGD and EUS-FNA for gallbladder tumors. METHODS: A total of 69 patients were diagnosed as having gallbladder wall thickening. Among these patients, 28 patients were diagnosed by clinical follow-up, solely by imaging such as computed tomography or by histological examination of surgical specimens. The remaining 41 patients underwent ETGD and/or EUS-FNA. In these 41 patients, the clinical data collected included gender, age, diameter of gallbladder wall, site of gallbladder wall thickening, final diagnosis, adverse events, and diagnostic yield of ETGD and EUS-FNA. RESULTS: Cyto-histological diagnosis with EUS-FNA was higher than that with ETGD, with a sensitivity of 100 versus 71%, specificity of 100 versus 94%, and accuracy of 100 versus 88%, respectively, in the two groups. In addition, the sampling adequacy of EUS-FNA was 100%. Adverse events were seen in five patients in the ETGD group (mild pancreatitis), although no adverse events were seen in the EUS-FNA group (P = 0.08). CONCLUSION: Our results suggest that EUS-FNA can be safely performed for the diagnosis of gallbladder lesions. Further, this procedure may be the diagnostic method of choice over cytology of bile juice obtained via ETGD to obtain histological evidence of gallbladder cancer.
Assuntos
Bile/citologia , Carcinoma/diagnóstico por imagem , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Carcinoma/patologia , Feminino , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Eosinophilic cholecystitis (EC) is a rare condition that is characterized by eosinophilic infiltration in the gallbladder wall. We report the case of a 35-year-old woman who presented with unremitting right upper quadrant pain for 1 month. Computed tomography showed a strongly enhanced inner layer of the gallbladder wall. Magnetic resonance imaging of the same area showed low signal intensity on T2-weighted imaging. Cholecystectomy was performed, and histological examination of the surgical specimen revealed >100 eosinophils per high-power field in the inner subserosal layer. The area of these histological findings corresponded to the strongly enhanced inner layer of the gallbladder wall identified on computed tomography.
RESUMO
BACKGROUND AND AIM: The evidence for main pancreatic duct intraductal papillary mucinous neoplasms (MPD-IPMN) malignancy is based predominantly on investigation of resected cases, and the natural history is still unclear. The aim of the present study is to investigate the natural history of MPD-IPMN and examine potential predictors of disease progression in MPD-IPMN patients who conformed to "high-risk stigmata" criteria. METHODS: This study included consecutive 20 follow-up patients and 19 surgical patients with "high-risk stigmata" MPD-IPMN, in whom the diameter of the MPD was > 10 mm, branch duct was < 5 mm, and who underwent clinical follow up for ≥ 2 years. RESULTS: Among surgical patients, mural nodules and MPD diameter of invasive patients were significantly different compared with non-invasive patients. On the other hand, among follow-up patients, univariate analysis revealed the following potential predictors for disease progression: diameter of MPD ≥ 15 mm (hazard ratio [HR], 20.9; 95% confidence interval [CI], 2.59-173.4; P < 0.01); and diffuse lesions of MPD-IPMN (HR, 4.46; 95% CI, 1.10-18.0; P = 0.04). On the other hand, multivariate analysis identified only diameter of MPD ≥ 15 mm (HR, 19.2; 95% CI, 1.87-198.5; P = 0.01) as a potential predictor of disease progression. CONCLUSION: If MPD-IPMN patients have other severe complications or reasons for not undergoing surgical treatment, MPD diameter < 15 mm, negative cytology, and no mural nodules, conservative clinical follow up for several years may be an option.
Assuntos
Adenocarcinoma Mucinoso/cirurgia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Seguimentos , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , RiscoRESUMO
An elderly man in his 70s presented with pain in the right hypochondrium. Computed tomography revealed thickening of the gall bladder wall and liver invasion. In addition, fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed an abnormal accumulation in the gall bladder, leading to a suspicion of gall bladder carcinoma. To confirm the diagnosis, endoscopic ultrasound-guided fine-needle aspiration was performed, which revealed a diagnosis of xanthogranulomatous cholecystitis (XGC). FDG-PET revealed decreased wall thickness and standardized uptake value a month later. Cholecystectomy was performed on the basis of a histological and clinical diagnosis of XGC. Histological examination revealed inflammatory and foamy cells and exuberant granulation of the gall bladder wall, confirming XGC.
Assuntos
Colecistite/diagnóstico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Granuloma/diagnóstico , Tomografia por Emissão de Pósitrons , Xantomatose/diagnóstico , Idoso , Colecistite/diagnóstico por imagem , Colecistite/patologia , Fluordesoxiglucose F18 , Granuloma/diagnóstico por imagem , Granuloma/patologia , Humanos , Masculino , Xantomatose/diagnóstico por imagem , Xantomatose/patologiaRESUMO
Pancreatic cancer is characterized by a high frequency of cachexia, pain and neural invasion (N-inv). Neural damage is occurred by N-inv and modulates pain and muscle atrophy via the activation of astrocyte in the connected spine. The activated astrocyte by N-inv, thus, may affect cachexia in pancreatic cancer. Clinical studies in patients and autopsy cases with pancreatic cancer have revealed that N-inv is related to cachexia and astrocytic activation. We established a novel murine model of cancer cachexia using N-inv of human pancreatic cancer cells. Mice with N-inv showed a loss of body weight, skeletal muscle and fat mass without appetite loss, which are compatible with an animal model of cancer cachexia. Activation of astrocytes in the spinal cord connected with N-inv was observed in our model. Experimental cachexia was suppressed by disrupting neural routes or inhibiting the activation of astrocytes. These data provide the first evidence that N-inv induces cachexia via astrocytic activation of neural route in pancreatic cancer.