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3.
Clin Nucl Med ; 42(11): 890-892, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28806244

RESUMO

A 73-year-old man presented with fatigue and weight loss. He had CT-proven splenic mass with fistulous connection to the greater curvature of the stomach, which suggested abscess. FDG PET/CT confirmed gastrosplenic fistula in addition to active lymph nodes in the gastrohepatic ligament and epigastric region. Pathological examination after the biopsy of the spleen was consistent with diffuse large B-cell lymphoma. Chemotherapy was administered with close clinical follow-up and resulted in the resolution of fistula without requirement for surgery.


Assuntos
Fístula/diagnóstico por imagem , Fístula/etiologia , Fluordesoxiglucose F18 , Linfoma/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Baço , Estômago , Idoso , Humanos , Masculino
4.
Clin Gastroenterol Hepatol ; 15(6): 820-826, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28528939

RESUMO

Endoscopic image-enhancement technologies provide opportunities to visualize normal and abnormal tissues within the gastrointestinal (GI) tract in a manner that complements conventional white light endoscopic imaging. The additional information that is obtained enables the endoscopist to better identify, delineate, and characterize lesions and can facilitate targeted biopsies or, in some cases, eliminate the need to send samples for histologic analysis. Some of these technologies have been available for more than a decade, but despite this fact, there is limited use of these technologies by endoscopists. Lack of formalized training in their use and a scarcity of guidelines on implementation of these technologies into clinical practice are contributing factors. In November 2014, the American Gastroenterological Association's Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image-enhancement technologies. This article represents the third of 3 separate documents generated from the workshop and discusses the published literature pertaining to training and outlines a proposed framework for the implementation of endoscopic image-enhancement technologies in clinical practice. There was general agreement among participants in the workshop on several key considerations. Training and competency assessment for endoscopic image-enhancement technologies should incorporate competency-based education paradigms. To facilitate successful training, multiple different educational models that can cater to variations in learning styles need to be developed, including classroom-style and self-directed programs, in-person and web-based options, image and video atlases, and endoscopic simulator programs. To ensure safe and appropriate use of these technologies over time, refresher courses, skill maintenance programs, and options for competency reassessment should be established. Participants also generally agreed that although early adopters of novel endoscopic image-enhancement modalities can successfully implement these technologies by pursuing training and ensuring self-competency, widespread implementation is likely to require support from GI societies and buy-in from other key stakeholders including payors/purchasers and patients. Continued work by manufacturers and the GI societies in providing training programs and patient education, working with payors and purchasers, and creating environments and policies that motivate endoscopists to adopt new practices is essential in creating widespread implementation.


Assuntos
Endoscopia Gastrointestinal/educação , Endoscopia Gastrointestinal/métodos , Aumento da Imagem/métodos , Preceptoria/métodos , Humanos , Competência Profissional
9.
Gastrointest Endosc ; 79(1): 8-14, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24239254

RESUMO

Multiple endoscopic methods are available to treat symptomatic internal hemorrhoids. Because of its low cost, ease of use, low rate of adverse events, and relative effectiveness, RBL is currently the most widely used technique.


Assuntos
Hemorroidas/terapia , Fotocoagulação a Laser/instrumentação , Proctoscópios , Escleroterapia/instrumentação , Criocirurgia/instrumentação , Diatermia/instrumentação , Eletrocoagulação/instrumentação , Humanos , Raios Infravermelhos/uso terapêutico , Ligadura/instrumentação
10.
Pancreas ; 43(1): 22-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24326364

RESUMO

OBJECTIVES: We evaluated whether pancreatic main duct fluid can provide protein biomarkers with prognostic value. METHODS: Mass spectrometry proteomics was applied to as little as 20µL of fluid collected at the time of tumor surgical resection. Biomarker proteins identified for 27 patients were correlated with clinical outcomes. RESULTS: Thirteen patients had pancreatic ductal adenocarcinomas, 4 had intraductal papillary mucinous neoplasm with in situ adenocarcinoma, 5 had ampullary adenocarcinomas, 2 had intraductal papillary mucinous neoplasms, and 3 had benign diseases. In pathologic stage II or higher pancreatic ductal adenocarcinoma, moderate or high expression of S100A8 or S100A9 proteins was associated with a median disease recurrence-free survival of 5.8 months compared with 17.3 months in patients with low expression (P = 0.002). Median overall survival was 12.6 versus 27 months for patients with moderate to high versus low S100A8 and A9 expression (P = 0.02). CONCLUSIONS: This analysis suggests distinct proteomic signatures for pancreatic cancer. Patients in our study with elevated levels of S100A8 or A9 in the ductal fluid, a near absence of pancreatic enzymes, and high levels of mucins were found to have significantly worse prognosis. Although further validation is needed to corroborate these findings, analysis of pancreatic ductal fluid is a promising tool for identifying biomarkers of interest.


Assuntos
Biomarcadores Tumorais/metabolismo , Calgranulina A/metabolismo , Calgranulina B/metabolismo , Mucinas/metabolismo , Neoplasias Pancreáticas/metabolismo , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Mucinoso/patologia , Carcinoma in Situ/metabolismo , Carcinoma in Situ/patologia , Carcinoma Ductal Pancreático/metabolismo , Carcinoma Ductal Pancreático/patologia , Carcinoma Papilar/metabolismo , Carcinoma Papilar/patologia , Humanos , Estimativa de Kaplan-Meier , Espectrometria de Massas/métodos , Recidiva Local de Neoplasia , Suco Pancreático/metabolismo , Neoplasias Pancreáticas/patologia , Prognóstico , Proteoma/metabolismo , Proteômica/métodos
11.
Ann Intern Med ; 159(11): 793-4, 2013 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-24297203
12.
Gastrointest Endosc ; 78(6): 805-815, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24119509

RESUMO

Over the last decade, WCE has established itself as a valuable test for imaging the small intestine. It is a safe and relatively easy procedure to perform that can provide valuable information in the diagnosis of small-bowel conditions. Its applications still remain limited within the esophagus and colon. Future developments may include improving visualization within the esophagus and developing technologies that may allow manipulation of the capsule within the GI tract and biopsy capabilities.


Assuntos
Cápsulas Endoscópicas , Endoscopia por Cápsula , Gastroenteropatias/diagnóstico , Pólipos Intestinais/diagnóstico , Endoscopia por Cápsula/efeitos adversos , Endoscopia por Cápsula/instrumentação , Doença Celíaca/diagnóstico , Colo , Doença de Crohn/diagnóstico , Doenças do Esôfago/diagnóstico , Esôfago , Gastroenteropatias/complicações , Hemorragia Gastrointestinal/etiologia , Humanos , Neoplasias Intestinais/diagnóstico , Intestino Delgado
13.
Curr Gastroenterol Rep ; 15(10): 347, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23996593

RESUMO

Determining the etiology of a solid pancreatic lesion is a critical first step toward developing an appropriate treatment plan for patients with a benign or malignant pancreatic mass. Technological advances in cross-sectional and endoscopic imaging modalities offer pancreatic imaging options with degrees of resolution that were not available even 15-20 years ago. In most cases, the nature of a solid pancreatic mass can be determined using computerized tomography, magnetic resonance imaging, and endoscopic ultrasound with fine-needle aspiration. Knowledge about the basics of these modalities, as well as their strengths and limitations, plays an important role in understanding how patients with solid pancreatic masses should be evaluated.


Assuntos
Pancreatopatias/diagnóstico , Adenocarcinoma/patologia , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Endossonografia/métodos , Humanos , Imagem por Ressonância Magnética/métodos , Estadiamento de Neoplasias , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X
19.
Gastrointest Endosc ; 77(3): 319-27, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23410693

RESUMO

Biliary and pancreatic stents are used in a variety of benign and malignant conditions including strictures and leaks and in the prevention of post-ERCP pancreatitis.Both plastic and metal stents are safe, effective, and easy to use. SEMSs have traditionally been used for inoperable malignant disease. Covered SEMSs are now being evaluated for use in benign disease. Increasing the duration of patency of both plastic and metal stents remains an important area for future research.


Assuntos
Doenças Biliares/cirurgia , Pancreatopatias/cirurgia , Stents , Colangiopancreatografia Retrógrada Endoscópica , Desenho de Equipamento , Humanos , Metais , Plásticos , Stents/efeitos adversos , Stents/economia
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