8,772 research outputs found

    Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases—A Review of Applications and Perspectives

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    The development of good quality and affordable ultrasound machines has led to the establishment and implementation of numerous point-of-care ultrasound (POCUS) protocols in various medical disciplines. POCUS for major infectious diseases endemic in tropical regions has received less attention, despite its likely even more pronounced benefit for populations with limited access to imaging infrastructure. Focused assessment with sonography for HIV-associated TB (FASH) and echinococcosis (FASE) are the only two POCUS protocols for tropical infectious diseases, which have been formally investigated and which have been implemented in routine patient care today. This review collates the available evidence for FASH and FASE, and discusses sonographic experiences reported for urinary and intestinal schistosomiasis, lymphatic filariasis, viral hemorrhagic fevers, amebic liver abscess, and visceral leishmaniasis. Potential POCUS protocols are suggested and technical as well as training aspects in the context of resource-limited settings are reviewed. Using the focused approach for tropical infectious diseases will make ultrasound diagnosis available to patients who would otherwise have very limited or no access to medical imaging

    Identification of a serum biomarker panel for the differential diagnosis of cholangiocarcinoma and primary sclerosing cholagnitis

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    The non-invasive differentiation of malignant and benign biliary disease is a clinical challenge. Carbohydrate antigen 19-9 (CA19-9), leucine-rich α2-glycoprotein (LRG1), interleukin 6 (IL6), pyruvate kinase M2 (PKM2), cytokeratin 19 fragment (CYFRA21.1) and mucin 5AC (MUC5AC) have reported utility for differentiating cholangiocarcinoma (CCA) from benign biliary disease. Herein, serum levels of these markers were tested in 66 cases of CCA and 62 cases of primary sclerosing cholangitis (PSC) and compared with markers of liver function and inflammation. Markers panels were assessed for their ability to discriminate malignant and benign disease. Several of the markers were also assessed in pre-diagnosis biliary tract cancer (BTC) samples with performances evaluated at different times prior to diagnosis. We show that LRG1 and IL6 were unable to accurately distinguish CCA from PSC, whereas CA19-9, PKM2, CYFRA21.1 and MUC5AC were significantly elevated in malignancy. Area under the receiver operating characteristic curves for these individual markers ranged from 0.73–0.84, with the best single marker (PKM2) providing 61% sensitivity at 90% specificity. A panel combining PKM2, CYFRA21.1 and MUC5AC gave 76% sensitivity at 90% specificity, which increased to 82% sensitivity by adding gamma-glutamyltransferase (GGT). In the pre-diagnosis setting, LRG1, IL6 and PKM2 were poor predictors of BTC, whilst CA19-9 and C-reactive protein were elevated up to 2 years before diagnosis. In conclusion, LRG1, IL6 and PKM2 were not useful for early detection of BTC, whilst a model combining PKM2, CYFRA21.1, MUC5AC and GGT was beneficial in differentiating malignant from benign biliary disease, warranting validation in a prospective trial

    Orthotopic liver transplantation in the mouse

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    25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

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    Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

    Cholangiocarcinoma landscape in Europe: diagnostic, prognostic and therapeutic insights from the ENSCCA Registry

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    189 p.El colangiocarcinoma (CCA) es un cáncer biliar raro y heterogéneo, con una incidencia y mortalidad creciente. Este estudio investiga el curso natural de CCA y sus subtipos en una cohorte paneuropea. El estudio incluyó 2.234 pacientes (hombre:mujer 1,29). El iCCA (n=1.243) se asoció con sobrepeso/obesidad (58,5%) y hepatopatías crónicas, incluyendo la cirrosis (12,6%) y/o hepatitis virales (10,4%); el pCCA (n=592) con la colangitis esclerosante primaria (8,8%); y el dCCA (n=399) con cálculos biliares (10,3%). Al diagnóstico, el 42,2 % de los pacientes tenían enfermedad local, el 29,4 % enfermedad localmente avanzada (LAD) y el 28,4 % enfermedad metastásica (MD). El CEA y el CA19-9 mostraron una baja sensibilidad diagnóstica (69,1% y 40,9% por debajo del punto de corte, respectivamente), pero su elevación se asoció con un mayor riesgo de presentar LAD [OR 2,16; IC95% 1,43-3,27] o MD [OR 5,88; IC95% 3,69-9,25]. Los pacientes sometidos a resección tumoral (50,3 %) mostraron el mejor pronóstico, en particular aquellos con margen de resección negativo (R0) [supervivencia global (SG) = 45,1 meses]; sin embargo, la afectación de los márgenes (R1) [HR 1,92; IC95% 1,53-2,41; SG = 24,7 meses] y la invasión de ganglios linfáticos [HR 2,13; IC95% 1,55-2,94; SG = 23,3 meses] comprometieron la supervivencia. Entre los pacientes con enfermedad irresecable (49,6%), la SG fue de 10,6 meses para los que recibieron terapias anti-cancer, principalmente quimioterapia (26,2%). Los pacientes que recibieron la mejor atención de apoyo (20,6%) tuvieron una SG de 4,0 meses, siendo el iCCA el que peor pronóstico mostraba. El estado funcional [HR 1.52; IC95% 1.01-2.31], la presencia de metástasis [HR 4.03; IC95% 1.82-8.92] y el CA19-9 [HR 2.79; IC95% 1.46-5.33] fueron factores de pronóstico independientes

    Complications of right lobe living donor liver transplantation

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    Background/Aims: Right lobar living donor liver transplantation (LDLT) has been controversial because of donor deaths and widely variable reports of recipient and donor morbidity. Our aims were to ensure full disclosure to donors and recipients of the risks and benefits of this procedure in a large University center and to help explain reporting inconsistencies. Methods: The Clavien 5-tier grading system was applied retrospectively in 121 consecutive adult right lobe recipients and their donors. The incidence was determined of potentially (Grade III), actually (Grade IV), or ultimately fatal (Grade V) complications during the first post-transplant year. When patients had more than one complication, only the seminal one was counted, or the most serious one if complications occurred contemporaneously. Results: One year recipient/graft survival was 91%/84%. Within the year, 80 (66%) of the 121 recipients had Grade III (n = 54) Grade IV (n = 16), or Grade V (n = 10) complications. The complications involved the graft's biliary tract (42% incidence), graft vasculature (15%), or non-graft locations (9%). Complications during the first year did not decline with increased team experience, and adversely affected survival out to 5 years. All 121 donors survive. However, 13 donors (10.7%) had Grade III (n = 9) or IV (n = 4) complications of which five were graft-related. Conclusions: Despite the satisfactory recipient and graft survival at our and selected other institutions, and although we have not had a donor mortality to date, the role of right lobar LDLT is not clear because of the recipient morbidity and risk to the donors. © 2009 European Association for the Study of the Liver

    Human liver flukes

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    Liver fluke infections occur in people worldwide. In some low-income regions, a combination of ecological, agricultural, and culinary factors leads to a very high prevalence of infection but, in higher-income regions, infections are uncommon. Infection is associated with substantial morbidity and several liver fluke species are recognised as biological carcinogens. Here, we review the epidemiology, clinical significance, and diagnostic and treatment strategies of human infection with these pathogens

    Distal cholangiocarcinoma - from novel biomarkers to clinical management and outcome

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    Cholangiocarcinoma is an aggressive malignacy arising from the biliary tree. Anatomical subtypes ofcholangiocarcinoma differs in tumor biology and clinical management. Distal cholangiocarcinoma (dCCA)originates from the common bile duct. Radical resection is the only curative treatment, for dCCA it entails apancreatoduodenectomy (Whipple procedure). Other periampullary cancers treated with pancreatoduodenectomyinclude pancreatic cancer (PC), ampullary cancer (AC) and duodenal cancer (DC). There is a high rate ofrecurrence after resection for dCCA. This thesis aimed to evaluate the clinical management of dCCA but alsoimprove understanding of the tumor biology and identify novel biomarkers.In paper I, the outcome and prognostic factors of patients treated with pancreatoduodenectomy for dCCA from2008 through 2015 at Skane University Hospital were evaluated. We found the median survival to be 22 monthswhich was worse than most previous studies. The presence of lymph node metastasis was confirmed as animportant prognostic factor.In paper II, the expression of secreted protein acidic and rich in cysteine (SPARC) in resected dCCA speciemns,paired lymph node metastases and normal bile ducts were evaluated using immunohistochemistry (IHC). Wefound SPARC to be expressed in the stromal compartment of dCCA in 80% of samples. Stromal expression wasretained in 68% of lymph node metastases. There was no significant correlation between SPARC expression andsurvival.In paper III, bottom-up mass spectrometry (MS) followed by verification using parallel reaction monitoring (PRM)was used to identify differentially expressed proteins between dCCA samples and normal bile ducts. Bioinformaticanalysis highlighted stromal alterations in dCCA. Forty-six proteins were verified using PRM. Thrombospondin-2(THBS2) was further validated using IHC. We found THBS2 to be upregulated in dCCA epithelial and stromalcompartments. Stromal THBS2 expression was present in 72% of paired lymph node metastases. There was acorrelation between stromal THBS2 expression and poor disease-free survival.In paper IV, we studied the utility of serum THBS2 as a diagnostic biomarker for dCCA and PC. THBS2 levelswere similar in dCCA and PC. THBS2 + CA 19–9 had an area under the curve of 0.92 in differentiating dCCA +PC from healthy donors. THBS2 did not provide utility is discriminating benign disease however, it was diagnosisdependent.In paper V, we used Swedish National Registry for Pancreatic and Periampullary Cancer to study national trendsin frequency of tumor origin, survival, histopathological evaluation and diagnostic accuracy for patients withperiampullary cancers. We found PC diagnosis to be more common in unresected patients. Survival was better forAC and DC then dCCA or PC. Median survival was 33 months for dCCA. Regional differences in tumor originfrequency and histopathological outcomes were identified. Clinical rate of misdiagnosis was 15 % for PC and 23%for non-pancreatic periampullary cancers
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