Endoscopic ultrasound-guided tissue acquisition of pancreatic masses

Endoscopic ultrasound (EUS) has assumed an increasing role in the management of pancreaticobiliary disease over the past 2 decades but its impact is particularly evident in the management of pancreatic masses. EUS helps improve patients′ outcomes by enhancing tumor detection and staging while providing safe and reliable tissue diagnosis. This review provides an evidence-based approach to the use of EUS for the diagnosis of pancreatic cancer, its staging, and for the determination of resectability compared to other imaging modalities. We will focus on techniques specific to obtaining tissue from solid pancreatic masses and will review best practices in EUS-guided tissue acquisition

Coupling SAR C-band and optical data for soil moisture and leaf area index retrieval over irrigated grasslands

International audienceThe objective of this study was to develop an approach for estimating soil moisture and vegetation parameters in irrigated grasslands by coupling C-band polarimetric Synthetic Aperture Radar (SAR) and optical data. A huge dataset of satellite images acquired from RADARSAT-2 and LANDSAT-7/8, and in situ measurements were used to assess the relevance of several inversion configurations. A neural network (NN) inversion technique was used. The approach for this study was to use RADARSAT-2 and LANDSAT-7/8 images to investigate the potential for the combined use of new data from the new SAR sensor SENTINEL-1 and the new optical sensors LANDSAT-8 and SENTINEL-2. First, the impact of SAR polarization (mono-, dual- and full-polarizations configurations) and the Normalized Difference Vegetation Index (NDVI) calculated from optical data for the estimation error of soil moisture and vegetation parameters was studied. Next, the effect of some polarimetric parameters (Shannon entropy and Pauli components) on the inversion technique was also analyzed. Finally, configurations using in situ measurements of the fraction of absorbed photosynthetically active radiation (FAPAR) and the fraction of green vegetation cover (FCover) were also tested.The results showed that HH polarization is the SAR polarization most relevant to soil moisture estimates. An RMSE for soil moisture estimates of approximately 6 vol.% was obtained even for dense grassland cover. The use of in situ FAPAR and FCover only improved the estimate of the leaf area index (LAI) with an RMSE of approximately 0.37 m²/m². The use of polarimetric parameters did not improve the estimate of soil moisture and vegetation parameters. Good results were obtained for the biomass (BIO) and vegetation water content (VWC) estimates for BIO and VWC values lower than 2 and 1.5 kg/m², respectively (RMSE is of 0.38 kg/m² for BIO and 0.32 kg/m² for VWC). In addition, a high under-estimate was observed for BIO and VWC higher than 2 and 1.5 kg/m², respectively (a bias of -0.65 kg/m² on BIO estimates and -0.49 kg/m² on VWC estimates). Finally, the estimation of vegetation height (VEH) was carried out with an RMSE of 13.45 cm

Endoscopic Unroofing of a Choledochocele

A 42-year-old man with previous laparoscopic cholecystectomy was referred for further evaluation of recurrent acute pancreatitis. Secretin-enhanced magnetic resonance cholangiopancreatography showed a 16 mm × 11 mm T2 hyperintense cystic lesion at the major papilla (Figure 1). Upper endoscopic ultrasound (EUS) showed a 15 mm × 10 mm oval, intramural, subepithelial lesion at the major papilla (Figure 2). Endoscopic retrograde cholangiopancreatography (ERCP) showed an 18-mm bulging lesion at the major papilla with normal overlying mucosa (Figure 3); injected contrast collected into a 16-mm cystic cavity (Figure 4). Findings were suggestive of type A choledochocele. A 10–12-mm freehand precut papillotomy was made with a monofilament needle-knife (Huibregtse Single-Lumen Needle Knife, Cook Medical, Bloomington, IN) using an ERBE VIO electrocautery system (ERBE USA; Marietta, GA). The incision was made as long as safely possible in an attempt to open the choledochocele completely and thus expose its walls and contents. We used a standard pull sphincterotome and ERBE electrocautery to perform the pancreatic sphincterotomy, followed by placement of a pancreatic stent. Biliary sphincterotomy was performed using the same technique (settings for needle-knife and pull sphincterotomies: Endocut I, blend current, effect 2/duration 2/interval 3). Biopsies of the inverted choledochocele showed biliary mucosa and duodenal columnar epithelium with inflammation and fibrosis, and no dysplasia. Follow-up ERCP at 4 weeks showed adequate unroofing of the choledochocele (Figure 5); the pancreatic stent was subsequently removed. The patient reported no recurrence of acute pancreatitis at 6-, 12-, and 18-month follow-up intervals

Obscure Overt Gastrointestinal Bleeding Due To Isolated Small Bowel Angiomatosis

Isolated small bowel angiomatosis is a rare entity with a distinctive endoscopic appearance. A multidisciplinary approach is often required to diagnose and treat these complex lesions. We present 2 cases of isolated small bowel angiomatosis, and illustrate the endoscopic findings that may guide similar diagnoses

Metachronous gastric metastasis from lung primary, with synchronous pancreatic neuroendocrine carcinoma

The finding of gastric metachronous metastasis, several years after the diagnosis of primary lung large cell carcinoma is rare and incidental. Even more extremely rare is the finding of a synchronous primary pancreas cancer. EUS-FNA with immunohistochemistry is useful for diagnosing metastatic lesions and differentiating those from synchronous primary lesions

Life threatening nontraumatic tension gastrothorax

Tension gastrothorax is a rare condition, which poses a diagnostic dilemma and can be mistaken for a tension pneumothorax. Awareness of the risk factors, clinical presentation, and radiology findings of tension gastrothorax can help with the prompt identification and successful management of this life-threatening condition

Crystal structure and chemistry of barium-graphite intercalation compounds

Graphite can accommodate various chemical species between graphene layers to form graphite intercalation compounds (GIC) [1]. Alkali metals can easily lead to bulk stage-1 intercalation compounds by vapor transport but for more electronegative elements, such as alkaline-earth metals or lanthanides, only a superficial intercalation is obtained and other synthesis methods have to be envisaged. Molten alloys, formed between an alkali metal and the targeted metal, have demonstrated their efficiency to prepare bulk and homogeneous GIC from these latter elements, for example the superconducting CaC6 phase [2], but some elements remain difficult to intercalate by this method. More recently, our team developed a method based on the work of Hagiwara et al., consisting in using a LiCl-KCl eutectic molten medium [3], which for example allowed to prepare for the first time a bulk SrC6 compound [4]. This work is focused on the intercalation of barium into graphite from the LiCl-KCl molten salts method. A bulk stage-1 BaC6 compound has been prepared and X-ray diffraction measurements confirmed its crystal structure [5]. Moreover, by varying the experimental conditions, two completely novel phases, denoted α and β, have been isolated. From ion beam analyses, Li0,2K0,6Ba0,35C6 and Li0,2K0,75Ba0,6C6 chemical formulae have been determined for α and β phases, respectively, showing that lithium and potassium are intercalated together with barium. X- ray diffraction led to the determination of the stacking sequence of each compound, and their planar unit cells. Lastly, a reaction mechanism is proposed, which explains the formation of the different phases observed in this study