The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification

Objective The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). Methods First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. Results A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21%) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29%) experienced worsening of MRRC grade. Thirty-five (24%) initial MRRC grade 2, 72 (45%) initial MRRC grade 3a, and 6 (22%) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). Conclusions MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time

Diagnostic value of endosonography guided fine-needle aspiration in the follow up of celiac adenopathies

La survenue d'une adénopathie coeliaque au cours d'une affection maligne sus ou sous diaphragmatique constitue un tournant évolutif péjoratif où la chirurgie d'exérèse devient le plus souvent contre indiquée. Il importe, dès lors, que la distinction entre l'origine bénigne ou maligne d'une telle adénopathie repose sur des données anatomopathologiques. Le but de cette étude a été d'évaluer la morbidité éventuelle, les performances diagnostiques et l'impact thérapeutique de la biopsie guidée sous échoendoscopie (EE) d'adénopathies coeliaques. Malades et méthodes : entre février 1994 et octobre 1997, 25 patients consécutifs (17 hommes, 8 femmes) ont bénéficié de la biopsie guidée sous échoendoscopie d'une adénopathie cœliaque, dont le diamètre médian était de 24 mm (ex 7-45 mm). Les indications de ce geste ont été dans 40 % des cas le bilan préthérapeutique d'une tumeur primitive connue, dans 44 % des cas,la biopsie d'une masse coeliaque sans diagnostic disponible, et, dans 16 % des cas, la biopsie d'une adénopathie coeliaque apparue en cours de surveillance d'une tumeur primitive déjà traitée. Résultats: Aucune complication n'est survenue. Le prélèvement a été jugé adéquat en vue d'une caractérisation tissulaire dans 20/25 cas (80 %). Sa précision diagnostique a été de 76 % alors qu'en cas d'adénopathie d'origine maligne, la sensibilité a été de 70 % et la spécificité de 100 %. Dans 6 cas (24 %) l'échoendoscopie avec biopsie a permis de redresser le diagnostic erroné de tumeur pancréatique évoqué en tomodensitométrie, au profit de celui d'adénopathie coeliaque en en précisant chaque fois l'origine. Dans 3 cas (12 %), elle a permis de porter le diagnostic d'une affection bénigne et curable (tuberculose sarcoïdose) autrement méconnue. Conclusions: la biopsie guidée sous échoendoscopie d'adénopathies coeliaques est un geste sûr qui permet d'améliorer la spécificité des informations fournies par l'échoendoscopie sans sacrifier de façon importante leur sensibilité. Elle permet ainsi d'éviter certaines interventions chirurgicales d'exérèse envisagées pour des affections malignes déjà dépassées. Ceci semble acquis en cas d'adénopathie coeliaque métastatique d'un cancer de l'œsophage, mais reste à démontrer en pratique dans le cas où la tumeur primitive est pancréatique

Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses

AIM—To assess the feasibility and diagnostic accuracy of endoscopic ultrasound guided fine needle biopsy (EUS-FNAB) in patients with solid pancreatic masses.
METHODS—Ninety nine consecutive patients with pancreatic masses were studied. Histological findings obtained by EUS-FNAB were compared with the final diagnosis assessed by surgery, biopsy of other tumour site or at postmortem examination, or by using a combination of clinical course, imaging features, and tumour markers.
RESULTS—EUS-FNAB was feasible in 90 patients (adenocarcinomas, n = 59; neuroendocrine tumours, n = 15; various neoplasms, n = 6; pancreatitis, n = 10), and analysable material was obtained in 73. Tumour size (⩾ or < 25 mm in diameter) did not influence the ability to obtain informative biopsy samples. Diagnostic accuracy was 74.4% (adenocarcinomas, 81.4%; neuroendocrine tumours, 46.7%; other lesions, 75%; p<0.02). Overall, the diagnostic yield in all 99 patients was 68%. Successful biopsies were performed in six patients with portal hypertension. Minor complications (moderate bleeding or pain) occurred in 5% of cases.
CONCLUSIONS—EUS-FNAB is a useful and safe method for the investigation of pancreatic masses, with a high feasibility rate even when lesions are small. Overall diagnostic accuracy of EUS-FNAB seems to depend on the tumour type.


Keywords: pancreas; tumour; endoscopic ultrasound; fine needle aspiration biops

Achados capilaroscópicos no lúpus eritematoso Capillaroscopy findings in lupus erythematosus

FUNDAMENTOS: A capilaroscopia é método não invasivo e reprodutível capaz de analisar diretamente os capilares na região periungueal, auxiliando no diagnóstico diferencial das doenças do tecido conectivo. OBJETIVOS: Estudar, por meio da capilaroscopia periungueal, pacientes com lúpus eritematoso cutâneo crônico, lúpus eritematoso sistêmico e grupo controle. MÉTODOS: Foram analisados 70 pacientes pela capilaroscopia periungueal, sendo 37 com lúpus eritematoso cutâneo crônico e 33 com forma sistêmica, comparados a 32 indivíduos sadios. RESULTADOS: A presença de capilares ectasiados (p=0,027; p=0,001), enovelados (p=0,001; p=0,007) e em saca-rolhas (p=0,011;p=0,005), além de hemorragias capilares (p=0,004; p=0,001) foram parâmetros capazes de discriminar os dois grupos de pacientes do grupo controle. A variável capilar enovelado demonstrou ser preditiva para o diagnóstico de lúpus eritematoso sistêmico (OR=8,308). As variáveis independentes capilares ectasiados (OR=12,164) e hemorragias capilares (OR=5,652) foram preditoras para lúpus eritematoso cutâneo crônico. CONCLUSÃO: A capilaroscopia é útil na prática clínica, pois pacientes com alterações capilaroscópicas específicas parecem ter maior probabilidade de desenvolver lúpus eritematoso. As variáveis preditoras independentes para lúpus eritematoso sistêmico foram capilares enovelados e para lúpus eritematoso cutâneo crônico foram capilares ectasiados e hemorragias capilares.<br>BACKGROUND: Capillaroscopy is an useful diagnostic tool that is non-invasive, reproducible, able to assess the capillaries in the periungal region and that assists in the differential diagnosis of connective tissue diseases. OBJETIVES: The aim of the study was to distinguish chronic cutaneous lupus erythematosus and systemic lupus erythematosus from controls assessed by nailfold capillaroscopy. METHODS: Seventy patients with lupus erythematosus (37 with chronic cutaneous lupus erythematosus and 33 with systemic lupus erythematosus) were studied by the technique of capillary microscopy and compared to 32 controls. RESULTS: The presence of ectatic (p=0.027; p=0.001), meandering (p=0.001; p=0.007), corkscrew capillaries (p=0.011; p=0.005) and nailfold bleeding (p=0.004; p=0.001) distinguished between the two groups of patients (chronic cutaneous lupus erythematosus and systemic lupus erythematosus) from controls. The variable meandering loops could be predictive for systemic lupus erythematosus (OR=8.308). The independent variables ectatic loops (OR=12.164) end nailfold bleedings (OR=5.652) were predictive for chronic cutaneous lupus erythematosus. CONCLUSIONS: Capillaroscopy can help in the management of patients, since the presence of typical capillaroscopic abnormalities seems to be related to the development of lupus erythematosus. The independent predictive variables for systemic lupus erythematosus were meandering loops, and, for chronic cutaneous lupus erythematosus, ectasic loops and nailfold bleedings