Role of Endoscopic Ultrasound in Staging and Vascular Assessment of Pancreatic Cancer.

Introduction Computed tomography (CT) of the abdomen with contrast stands as the gold standard for assessing pancreatic cancer, encompassing both staging and vascular analysis. However, not all patients are suitable candidates for contrast-enhanced CT (CECT) scans due to factors such as contrast agent allergies, pregnancy, renal impairment, radiation risks, and limited tissue sampling capability in CECT scans of the abdomen. In light of these challenges, this study evaluated the diagnostic capabilities of endoscopic ultrasound (EUS) compared to CECT for staging and vascular assessment of pancreatic cancer. Methods Fifty patients diagnosed with pancreatic cancer underwent evaluations using both CECT scans and EUS, focusing on staging and vascular invasion assessment. Vascular evaluation was carried out using a categorization system based on EUS findings, classifying them into three types based on the tumor-vessel relationship: Type 1 indicating clear invasion or encasement of a vessel by a tumor or contact with a vessel wall exceeding 180 degrees, Type 2 representing abutment, wherein a tumor contacts a vessel wall but at an angle less than 180 degrees, and Type 3 implying clear non-invasion, where a discernible distance exists between a tumor and a vessel. In this categorization, Type 1 and Type 2 indicated signs of vascular invasion, while Type 3 indicated vascular non-invasion. These findings were subsequently compared to the results from CECT scans. The endoscopist performing EUS was blinded to the CT outcomes prior to the examination. Results Regarding pancreatic cancer staging, EUS exhibited remarkable sensitivity, specificity, and accuracy rates of 100% according to the T criterion.As for vascular invasion assessment, EUS demonstrated sensitivity, specificity, and accuracy of 100%, 95.93%, and 96%, respectively, for venous invasion. For arterial invasion, the figures were 95.65% sensitivity, 100% specificity, and an overall accuracy of 99.5%. Conclusion EUS is an effective modality for evaluating both staging and vascular invasion in pancreatic cancer, boasting exceptional sensitivity, specificity, and accuracy rates. The findings are robust enough to consider EUS a viable alternative to CT scans in evaluation, with the added advantage of EUS offering tissue sampling capability.

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study.

The magnification technique offered by surgical loupe is a new method that enhances visualization and helps head and neck surgeons with recurrent laryngeal nerve (RLN) and parathyroid glands identification. This study aimed to assess the safety and efficacy of using binocular surgical loupes in thyroidectomy procedures. Material and Methods: Eighty patients with thyroid nodules who underwent thyroidectomy procedure were divided randomly into two comparable groups, group A subjected to thyroidectomy by using binocular magnification loupe, group B underwent conventional thyroidectomy without using magnification. Patients' demographics, operation time, and postoperative morbidities were recorded. All cases had preoperative and postoperative vocal cords assessment by video laryngoscopy. Pathology, laboratory, and radiology investigations were also conducted. Results: Out of 80 patients, there were 58 females and 22 males. Benign thyroid pathology was found in 74 patients and malignant pathology in 6 patients. The mean operating time was 106 min in group A compared to 138.5 min in group B. The mean amount of intraoperative bleeding was 30 ml in group A while 50 ml in group B. There were no cases of the external branch of the superior laryngeal nerve in both groups; there was better identification in group A. There was only one patient who suffered from a temporary RLN injury in group A, while three cases of temporary and one case of permanent RLN injury were recorded in group B. Permanent hypoparathyroidism was diagnosed in only one patient in group B. Conclusion: The utilization of binocular surgical loupe magnification in thyroid surgery is considered a safe and effective maneuver that has the advantages of decreasing the overall operating time and significantly reducing postoperative complications.

[Analysis and management of the pre-analytical risks in hemostasis]. / Analyse et gestion des risques de la phase pré-analytique en hémostase.

Risk analysis consists in identification, scoring and ranking of risks in order to manage the major risks. The aim of the study is to determine the risk analysis of the pre-analytical step of routine hemostasis in Hematological laboratory of CHU Ibn Rochd-Casablanca, Morocco. MATERIAL AND METHODS: The identification of pre-analytical activities of routine hemostasis was extensively realized according to a "by-proccess" methodology. According to "5M" analysis, we identified the risks associated with these activities. Therefore, the scoring of each risk was realized according to «AMDEC¼ methodology, by the staff of hematological laboratory. Risks were classified according to their severity and the major were identified using "Pareto diagram". RESULTS: Forty eight risks were identified in 15 activities. Identity monitoring (13.7%), pre-analytical storage of samples (13.4%), pre-analytical treatment, including centrifugation (12.9%) and transport to the laboratory (11.3%) represented the activities that exhibited the highest level of risk. Using "Pareto diagram", we retained 19 major risks, related to medical prescription, identity monitoring, transport to the laboratory, pre-analytical treatment of samples and IT processing. DISCUSSION AND CONCLUSION: Risk analysis allowed the identification of 19 major risks out of 48 identified risks, related to the pre-analytical step of routine hemostasis. These 19 major risks needed a plan to reduce their criticity.

Role of oxidative stress and outcome of various surgical approaches among patients with bullous lung disease candidate for surgical interference.

BACKGROUND: Bullous lung disease is characterized by formation of blebs, bullae and emphysema. We investigate the role of oxidative stress in the pathogenesis of bullous lung disease and compare between conventional thoracotomy versus video assisted thoracoscopic approach in surgical management of such patients. METHODS: This study was a prospective case control study and it was carried out on 21 patients (16 males and 5 females) with bullous lung disease selected as candidate for surgical interference. This was in addition to 21 apparently healthy age and sex matched subjects selected as control group. Plasma levels of α1-antitrypsin were estimated using commercially available ELISA assay kit, while plasma levels of malondialdehyde (MDA), ß-carotene, vitamin A, vitamin C and vitamin E were estimated using spectrophotometric methods. Conventional thoracotomy approach was done in thirteen patients, while, videothoracoscopic approach was done in eight patients. RESULTS: There were significant higher plasma levels of MDA (P<0.001) and lower plasma levels of ß-carotene (P<0.01), vitamin A, vitamin C and vitamin E (P<0.001 for each) among patients with bullous lung disease when compared with the control group. There was non-significant difference regarding the air leakage and the hospital stay among patients with bullous lung disease who managed via conventional thoracotomy approach when compared with those managed via videothoracoscopic approach. CONCLUSIONS: This study proves that the oxidative stress plays an important role in the pathogenesis of bullous lung disease. Also there are no significant outcome differences between conventional thoracotomy versus video assisted thoracoscopic approach in surgical treatment of such patients.