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

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

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

A time-dependent model for improved biogalvanic tissue characterisation

Measurement of the passive electrical resistance of biological tissues through biogalvanic characterisation has been proposed as a simple means of distinguishing healthy from diseased tissue. This method has the potential to provide valuable real-time information when integrated into surgical tools. Characterised tissue resistance values have been shown to be particularly sensitive to external load switching direction and rate, bringing into question the stability and efficacy of the technique. These errors are due to transient variations observed in measurement data that are not accounted for in current electrical models. The presented research proposes the addition of a time-dependent element to the characterisation model to account for losses associated with this transient behaviour. Influence of switching rate has been examined, with the inclusion of transient elements improving the repeatability of the characterised tissue resistance. Application of this model to repeat biogalvanic measurements on a single ex vivo human colon tissue sample with healthy and cancerous (adenocarcinoma) regions showed a statistically significant difference (p 0.05) between tissue types was found when measurements were subjected to the current model, suggesting that the proposed model may allow for improved biogalvanic tissue characterisation