Detection and Characterization of Solid Pancreatic Lesions (Contrast-Enhancement, Elastography, EUS-Guided Fine Needle Aspiration)

AbstractFor detection of small pancreatic tumors and characterization of focal pancreatic masses, endoscopic ultrasound (EUS) is the most sensitive of the imaging procedures currently available. Differential diagnosis between benign and malignant focal pancreatic masses based on the EUS appearance is difficult and frequently requires EUS-guided fine needle aspiration (EUS-FNA) for confirmation of malignancy. New techniques improve the sensitivity, specificity, and accuracy of the differential diagnosis, as well as diagnosis of small pancreatic tumors (less than 2 cm diameter) by using real-time elastography or contrast-enhanced EUS. Nevertheless, EUS-FNA is still required for the final diagnosis in most of the cases, which allows an evidence-based management with referral to either curative surgery or palliative chemoradiotherapy. This article is part of an expert video encyclopedia

Эндоскопическая ультрасонография в диагностике опухолей пищевода и желудка

Clinica Gastroenterologie, Universitatea de Medicină şi Farmacie, Craiova, România, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaEsophageal and gastric tumor pathology is frequently encountered in clinical practice. Recent investigative procedures allow precise diagnosis, differentiation between benign and malignant processes, appreciation of a mural pathologic process and even small therapeutic interventions in early forms of tumors (such as endoscopic resection). Endoscopic ultrasonography is one of the key techniques in tumor pathology of the upper digestive tract diagnosis, allowing positive diagnosis of esophageal cancer and gastric parietal extension and lymph node assessment, defining and determining the submucosal masses and the indication for endoscopic mucosectomiaОпухоли пищевода и желудка встречаются часто в клинической практике. Современные методы диагностики позволяют не только выявлять опухоли, проводить дифференциальную диагностику между доброкачественными и злокачественными поражениями, определять степень инвазивности патологического процесса, но и выполнять эндоскопические резекции опухолей по показаниям. Эндоскопическая ультрасонография является одним из ключевых методов в диагностике опухолей верхних отделов пищеварительного тракта, что позволяет своевременно диагностировать рак пищевода и желудка, распространение опухолевой инфильтрации в подслизистом слое и регионарных лимфоузлах, и определять показания для эндоскопической мукозэктомии

Эндоскопические и цитологические прогностические факторы у больных раком поджелудочной железы

Centrul de Cercetare în Gastroenterologie şi Hepatologie, Universitatea de Medicină şi Farmacie, Craiova, România, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaThe incidence of pancreatic cancer is increasing and is usually diagnosed in advanced stages. The study included 72 patients diagnosed with pancreatic cancer in the Department of Gastroenterology, University of Medicine and Pharmacy, Craiova. We selected only patients who were not undergoing palliative or curative surgery because of advanced disease, comorbidities, poor functional status or patient refusal of surgery. All selected patients received the same type of chemotherapy. Current pre-clinical evaluation by endoscopic ultrasonography and fine aspiration may provide some important information for the prognosis of patients. For the development of a complex system of prognostic extensive randomized studies are needed conducted by multidisciplinary teams as well as modern methods of multivariate analysis.Заболеваемость раком поджелудочной железы увеличивается и, как правило, диагностируется в поздних стадиях заболевания. В исследование были включены 72 пациента из отделения гастроэнтерологии Университета Медицины и Фармации, Крайова (Румыния), которые не были оперированы из-за поздних стадий, сопутствующих заболеваний, плохого функционального состояния пациента или отказа от операции. Все больные получали одинаковую химиотерапию. Обследование с помощью эндоскопической ультрасонографии и аспирационной пункции предоставило важную информацию для прогнозирования течения заболевания. Для разработки комплексной системы прогнозирования необходимы обширные рандомизированные исследования, проведенные междисциплинарными группами с применением современных методов одномерного и многомерного анализа

Роль эластографических методов для неинвазивной оценки распространенных хронических заболеваний печени

Centrul de Cercetare în Gastroenterologie şi Hepatologie, Universitatea de Medicină şi Farmacie, Craiova, România, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaLiver biopsy is considered the procedure of choice at many centers for evaluation of hepatic fibrosis, despite the complications and discomfort suffered by patients. Modern non-invasive imaging methods for assessing liver fibrosis include ultrasound elastography and magnetic resonance imaging (MRI). Since the introduction of magnetic resonance in medical practice, it has become a method of choice for the diagnosis and characterization of liver pathology (tumoral or diffuse type). Unidirectional elastography is the first imaging method for quantifying liver fibrosis introduced in clinical practice and the latest noninvasive method for assessing liver fibrosis. Being a new and promising method for assessing liver fibrosis, it is necessary to prove through extensive studies its real role in noninvasive assessment of hepatic fibrosi; and possibly in association with serological markers, it can completely replace liver biopsyВо многих центрах биопсия печени считается процедурой выбора для оценки фиброза печени, несмотря на сложности и неудобства для пациентов. Ультразвуковая эластография и магнитно-резонансная томография являются современными неинвазивными методами визуализации при оценке фиброза печени. С момента внедрения магнитно-резонансная томография стала методом выбора в диагностике и характеристике диффузных и опухолевых патологий печени. Однонаправленная эластография является первым методом количественной визуализации и оценки фиброза печени в клинической практике. На основе широких исследований остается доказать, что она может играть первостепенную роль в неинвазивной оценке фиброза печени и, возможно, этот метод может полностью заменить биопсию печени

Impact of Intermediate Hyperglycemia and Diabetes on Immune Dysfunction in Tuberculosis

Supplementary Data: Supplementary materials are available at Clinical Infectious Diseases online at https://academic.oup.com/cid/article/72/1/69/5857148#274319223 . Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.Copyright © The Author(s) 2020. Background: People with diabetes have an increased risk of developing active tuberculosis (TB) and are more likely to have poor TB-treatment outcomes, which may impact on control of TB as the prevalence of diabetes is increasing worldwide. Blood transcriptomes are altered in patients with active TB relative to healthy individuals. The effects of diabetes and intermediate hyperglycemia (IH) on this transcriptomic signature were investigated to enhance understanding of immunological susceptibility in diabetes-TB comorbidity. Methods: Whole blood samples were collected from active TB patients with diabetes (glycated hemoglobin [HbA1c] ≥6.5%) or IH (HbA1c = 5.7% to <6.5%), TB-only patients, and healthy controls in 4 countries: South Africa, Romania, Indonesia, and Peru. Differential blood gene expression was determined by RNA-seq (n = 249). Results: Diabetes increased the magnitude of gene expression change in the host transcriptome in TB, notably showing an increase in genes associated with innate inflammatory and decrease in adaptive immune responses. Strikingly, patients with IH and TB exhibited blood transcriptomes much more similar to patients with diabetes-TB than to patients with only TB. Both diabetes-TB and IH-TB patients had a decreased type I interferon response relative to TB-only patients. Conclusions: Comorbidity in individuals with both TB and diabetes is associated with altered transcriptomes, with an expected enhanced inflammation in the presence of both conditions, but also reduced type I interferon responses in comorbid patients, suggesting an unexpected uncoupling of the TB transcriptome phenotype. These immunological dysfunctions are also present in individuals with IH, showing that altered immunity to TB may also be present in this group. The TB disease outcomes in individuals with IH diagnosed with TB should be investigated further.European Union’s Seventh Framework Programme (FP7 2007-2013 - Health) under grant agreement No 305279

The Angle of Progression at Station 0 and in Magnetic Resonance and Transperineal Ultrasound Assessment

The transperineal ultrasound (TPU) value of the angle of progression (AOP) during fetal head engagement, at station 0, is a critical cut-off for current obstetrical practice, especially when intrapartum instrumental interventions are required. Still, controversial measurements were reported in previous high resolution imagistic studies. Our TPU and direct “gold-standard” magnetic resonance (MRI) measurements confirm that station 0 corresponds to a 120° AOP, concordantly. Based on these findings, the fact that an AOP of 120° or greater was previously strongly associated with vaginal delivery may be due to the achievement of head engagement in labor