ABSTRACT
OBJECTIVE: Members of "Asociación de Ecografía Digestiva" decided to carry out a multicenter retrospective study on fine-needle aspiration biopsy for pancreatic space-occupying lesions under ultrasonographic guidance and via the percutaneous route in order to assess this technique s performance versus endoscopic ultrasound-guided biopsy. SUBJECTS: 10 hospitals for a total of 222 patients with suspiciously malignant, 8-120-mm pancreatic lesions were included in the study. RESULTS: The analysis of results shows a sensitivity of 89%, a specificity of 98%, a positive predictive value of 99%, and a negative predictive value of 74%, for an overall diagnostic accuracy of 91%. No major complications occurred. CONCLUSION: Percutaneous fine-needle aspiration for pancreatic lesions is highly cost-effective and has few and mild complications.
Subject(s)
Endoscopy, Gastrointestinal , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/pathology , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , UltrasonographyABSTRACT
Objetivo: en el seno de la Asociación de Ecografía Digestivase decidió realizar un estudio retrospectivo multicéntrico sobre lapunción-aspiración con aguja fina (PAAF) de lesiones ocupantesde espacio pancreáticas, mediante control ecográfico y por víapercutánea, con el objetivo de valorar el rendimiento de dicha técnicay poder compararla con la punción mediante ultrasonografíaendoscópica.Participantes: en el estudio han participado 10 hospitalescon 222 pacientes con lesiones pancreáticas entre 8 y 120 mm,sospechosas de malignidad.Resultados: el análisis de los resultados muestra una sensibilidaddel 89%, especificidad 98%, valor predictivo positivo 99% ynegativo 74%, con precisión diagnóstica global 91%. No encontramosninguna complicación significativa.Conclusión: la PAAF de lesiones pancreáticas por vía percutáneaes de alta rentabilidad diagnóstica y con pocas y leves complicaciones
Objective: members of Asociación de Ecografía Digestivadecided to carry out a multicenter retrospective study on fine-needleaspiration biopsy for pancreatic space-occupying lesions underultrasonographic guidance and via the percutaneous route in orderto assess this techniques performance versus endoscopic ultrasound-guided biopsy.Subjects: 10 hospitals for a total of 222 patients with suspiciouslymalignant, 8-120-mm pancreatic lesions were included inthe study.Results: the analysis of results shows a sensitivity of 89%, aspecificity of 98%, a positive predictive value of 99%, and a negativepredictive value of 74%, for an overall diagnostic accuracy of91%. No major complications occurred.Conclusion: percutaneous fine-needle aspiration for pancreaticlesions is highly cost-effective and has few and mild complications
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Punctures/methods , Biopsy, Fine-Needle/methods , Pancreatic Neoplasms/pathology , Endoscopy, Digestive System , Retrospective Studies , Sensitivity and Specificity , Predictive Value of Tests , Endosonography/methodsABSTRACT
No disponible
Subject(s)
Female , Adult , Humans , Fecal Incontinence , Endosonography/methods , Anal Canal/abnormalities , Rectal Fistula/complications , Rectal Fistula/surgery , Postoperative Complications , Anal CanalABSTRACT
OBJECTIVE: To prospectively assess the usefulness of ultrasonography in predicting the presence of cirrhosis in patients with asymptomatic chronic liver disease in unknown stage. EXPERIMENTAL DESIGN: Eighteen doppler and ultrasonographic features were prospectively assessed immediately before performing laparoscopy and/or liver biopsy. Usefulness of predictive variables selected by multiple regression analysis and included in a scoring scale was determined by ROC curves. PATIENTS: One hundred and thirteen consecutive patients with neither clinical nor biochemical signs of advanced liver disease submitted for study. RESULTS: Liver enlargement, liver surface nodularity, liver parenchyma distortion, flattening of flow wave in hepatic veins, portal and splenic veins dilatation, decreased variability in splenic vein caliber with breathing. Collateral vessels, and splenomegaly were associated to cirrhosis. Multivariate analysis showed the joint assessment of hepatic echostructure, portal vein caliber and spleen area to be the best approach to ultrasonographic staging, with sensitivity of 80%, specificity of 92% and accuracy of 89% in the diagnosis of cirrhosis. CONCLUSIONS: Ultrasonography enabled the presence or absence of cirrhosis to be correctly determined even in patients with asymptomatic disease. Combined assessment of hepatic echostructure, portal vein diameter and spleen size provides the highest accuracy.
Subject(s)
Liver Cirrhosis/diagnostic imaging , Adolescent , Adult , Aged , Chronic Disease , Diagnosis, Differential , Female , Humans , Hypertension, Portal/diagnostic imaging , Hypertension, Portal/pathology , Laparoscopy , Liver/diagnostic imaging , Liver/pathology , Liver Cirrhosis/pathology , Male , Middle Aged , Prospective Studies , ROC Curve , Regression Analysis , UltrasonographyABSTRACT
Objetivo: establecer la utilidad de la ecografía en la predicción de la existencia de una cirrosis hepática en pacientes con enfermedad hepática crónica clínicamente silente. Diseño experimental: estudio prospectivo y ciego. Inmediatamente antes de la realización de laparoscopia y/o biopsia hepática se practicó una ecografía abdominal, con estudio Doppler. Mediante regresión logística múltiple se determinó el valor predictivo para la presencia de cirrosis de 18 variables analizadas. Mediante curvas ROC se estableció la precisión de las variables predictoras para determinar la presencia o ausencia de cirrosis. Pacientes: ciento trece pacientes consecutivos sin indicios clínicos ni bioquímicos de enfermedad hepática avanzada ingresados para filiación de una hepatopatía crónica. Resultados: el tamaño hepático, la irregularidad de la superficie hepática, la alteración en su ecoestructura, el aplanamiento de la onda de flujo de la vena suprahepática, la dilatación de las venas porta y esplénica, la disminución de las modificiaciones del calibre de la vena esplénica con la respiración, la presencia de circulación colateral y la evidencia de esplenomegalia se asociaron a la presencia de cirrosis. La valoración conjunta de la ecoestructura hepática, el calibre de la vena porta y el tamaño del bazo permitió establecer el diagnóstico de cirrosis con una sensibilidad del 80 por ciento, especificidad del 92 por ciento y precisión del 89 por ciento. Conclusiones: la ecografía permite analizar correctamente la presencia o ausencia de cirrosis aún en pacientes sin indicios clínicos de insuficiencia hepatocelular ni hipertensión portal. La mayor precisión diagnóstica se obtiene mediante la valoración conjunta de la alteración en la ecoestructura hepática, el calibre de la vena porta y el tamaño del bazo (AU)
Subject(s)
Adult , Male , Aged , Female , Middle Aged , Humans , Adolescent , Regression Analysis , Liver Cirrhosis , Prospective Studies , Hypertension, Portal , Diagnosis, Differential , Liver , ROC Curve , Chronic Disease , LaparoscopyABSTRACT
BACKGROUND: To relate the renal hemodynamic changes, as assessed by Doppler ultrasonography,with the development of ascites, renal function, and endogenous vasoactive systems in patients with liver cirrhosis. PATIENTS AND METHODS: 60 cirrhotic patients were studied prospectively, 31 of these compensated and 29 with ascites. The renal resistive index, renal function and plasmatic levels of renin, aldosterone, noradrenaline and ADH activity were determined. RESULTS: The renal resistive index was significantly higher in the cirrhotic patients with ascites (0.68) than in the compensated cirrhotics (0.63) and was significantly correlated with the serum levels of creatinine,urinary excretion of sodium, plasmatic renin activity and plasmatic concentration of aldosterone. CONCLUSIONS: The renal resistive index, study by means of Doppler ultrasonography, shows progressively increased levels with the evolution of the disease, with the deterioration of the renal function and with the activation of the endogenous vasoactive systems.
Subject(s)
Kidney Diseases/diagnostic imaging , Kidney Diseases/etiology , Liver Cirrhosis/complications , Adult , Aged , Ascites , Biomarkers/blood , Female , Humans , Kidney Diseases/diagnosis , Kidney Function Tests , Male , Middle Aged , Prospective Studies , Ultrasonography, Doppler, DuplexABSTRACT
OBJETIVO: valorar los cambios hemodinámicos renales mediante determinación con ecografía Doppler del índice de resistencia (IR) renal en pacientes con hepatopatía crónica en diferentes estadios evolutivos. En pacientes con cirrosis, analizar el IR renal en función de la presencia o no de ascitis y la respuesta al tratamiento diurético. PACIENTES Y MÉTODOS: se estudió de forma prospectiva 24 sujetos con hepatitis crónica, 39 pacientes cirróticos compensados y 34 con ascitis. Los cirróticos con ascitis se dividieron en grupo 1: con respuesta a medidas dietéticas y bajas dosis de diuréticos, y grupo 2: ascitis refractaria o que precisan dosis superiores de diuréticos. RESULTADOS: El IR renal fue significativamente superior en los pacientes cirróticos con ascitis (0,68 ñ 0,06) que en los cirróticos compensados (0,63 ñ 0,03; p < 0,01), y en éstos que en los sujetos con hepatitis crónica (0,61 ñ 0,04; p < 0,05). Los cirróticos con ascitis del grupo 1 presentaron un IR renal inferior a los del grupo 2 (0,65 ñ 0,05 vs 0,72 ñ 0,06; p < 0,01). CONCLUSIONES: el IR renal se incrementa conforme avanza la hepatopatía crónica. Los pacientes cirróticos con elevación del IR renal son no respondedores o requieren mayor dosis de diuréticos. Se requieren estudios para valorar la utilidad del IR renal en la predicción de la respuesta al tratamiento diurético en pacientes con ascitis (AU)
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Ultrasonography, Doppler , Vascular Resistance , Renal Artery , Prospective Studies , Hepatitis, Chronic , Liver Cirrhosis , HemodynamicsABSTRACT
OBJECTIVE: Although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence the risk for HCC in patients with cirrhosis. This study was designed to identify differences in cirrhosis-related risk factors for developing HCC in relation to epidemiological characteristics, stage of the disease and etiology. METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprotein (AFP) concentration was measured. RESULTS: The average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of follow-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infection (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) and AFP levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients, only age (risk increased by 15% per year), and hepatitis C virus infection (relative risk: 5.4) were risk factors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex (relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4.9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% were infected with hepatitis C virus. Alcoholism, Child-Pugh stage and duration of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: The risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infection was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered AFP level.
Subject(s)
Carcinoma, Hepatocellular/etiology , Liver Cirrhosis/complications , Liver Neoplasms/etiology , Adolescent , Adult , Aged , Carcinoma, Hepatocellular/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Liver Neoplasms/epidemiology , Male , Middle Aged , Multivariate Analysis , Risk FactorsABSTRACT
OBJETIVO: determinar la existencia de diferencias en el riesgo de presentar un carinoma hepatocelular (CHC) en pacientes con cirrosis en función de sus características epidemiológicas, evolución de la hepatopatía y su etiología. PACIENTES Y MÉTODOS: 512 pacientes cirróticos en grado A/13 de Child-Pugh menores de 70 años fueron valorados periódicamente mediante ecografía y determinaciones de alfa-fetoproteína (AFP). RESULTADOS: tras un seguimiento medio de 37 meses se detectaron 52 CHC (riesgo acumulado del 17 por ciento a los 5 años). El modelo de Cox demostró que por cada año de edad el riesgo de CHC se incrementó un 8 por ciento. El sexo varón (RR: 3,4), la infección por virus C (RR: 4,6), la infección por el virus B (RR: 2,9) y la alteración de la AFP (RR: 2,5) también se mostraron como factores de riesgo. Entre los pacientes etílicos, sólo la edad (incremento del 15 por ciento por cada año transcurrido) y la infección por el virus C (RR: 5,4) fueron factores de riesgo. En los pacientes infectados por el virus C supusieron un mayor riesgo: la edad (S por ciento por cada año), el sexo varón (RR: 3,9), la coinfección por el virus B (RR: 4,9) y la elevación de la AFP (RR: 2,8). El 71 por ciento de los pacientes con CHC tenían infección por el virus C. El etilismo y la duración de la cirrosis no incrementaron el riesgo de aparición del tumor, CONCLUSIONES: el riesgo de aparición del CHC asciende al 17 por ciento tras 5 años de seguimiento en pacientes con cirrosis en grado A/B de Child-Pugh. El virus C es el principal factor de riesgo en nuestro medio. Otros factores demostrados son la edad, el sexo varón, la infección por el virus B y la alteración de la AFP. El etilismo y la duración de la hepatopatía no influye en el riesgo de aparición del tumor (AU)
Subject(s)
Middle Aged , Adult , Adolescent , Aged , Male , Female , Humans , Risk Factors , Multivariate Analysis , Incidence , Carcinoma, Hepatocellular , Liver Cirrhosis , Follow-Up Studies , Liver NeoplasmsABSTRACT
AIM: To assess renal hemodynamics by Doppler analysis of resistive index (RI) in small intrarenal arteries in patients with chronic liver diseases at different stages, and to analyze renal RI in patients with cirrhosis as a function of the absence or presence of ascites and the response to diuretic therapy. METHODS: Prospective cross-sectional study of 24 patients with chronic hepatitis, 39 with compensated cirrhosis, and 34 with ascites. The last group was divided into two subgroups: 1) responders to sodium restriction and a low dose of diuretics, and 2) patients with refractory ascites or those requiring high-dose therapy. RESULTS: Renal RI was increased in patients with cirrhosis and ascites (0.68 +/- 0.06) in comparison with patients with compensated cirrhosis (0.63 +/- 0.03, p < 0.01). Renal RI in the latter group was higher than in patients without cirrhosis (0.61 +/- 0.04, p < 0.05). Renal RI in patients with ascites was lower in subgroup 1 than in subgroup 2 (0.65 +/- 0.05 vs 0.72 +/- 0.06, p < 0.01). CONCLUSIONS: Renal RI increases as liver disease progresses. Patients with cirrhosis and ascites and increased RI require high-dose treatment or do not respond. Further studies are needed to demonstrate the predictive value of renal RI in assessing the effectiveness of diuretic therapy.