Endoscopic ultrasound guided fine needle aspiration allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy

BACKGROUND : Abdominal lymphadenopathy in HIV remains a challenge due to inaccessibility of lymph nodes and multitude of causes. The diagnostic yield of EUS FNA in HIV-infected patients with abdominal lymphadenopathy in the setting of high tuberculosis (TB) prevalence was assessed. METHODS : Prospective cohort study was conducted in tertiary referral centres recruiting symptomatic HIV+ patients (N=31, mean age 38.5 years, mean CD4 count 124 cells/μl, WHO stage 3-4 with abdominal lymphadenopathy. EUS was performed to assess lymph node characteristics and FNA aspirate subjected to cytological analysis, microbial culture and PCR. RESULTS : EUS appearance of lymph nodes was highly variable. Mycobacterial infections were the most common cause of lymphadenopathy in this cohort. Of the 31 patients 21/31 67.7 % had mycobacterial infections; 17 (80.9 %) of these were tuberculosis. Cytology failed to identify 23.8% and culture 38.1% of cases. PCR identified 16/17 (94.1%) of these cases. EUS-FNA altered the management of more than half of the patients. CONCLUSIONS : Mycobacterial disease was the commonest cause of lymphadenopathy in HIV but a third of patients had reactive lymphadenopathy. By combining the appearance of EUS FNA and cytological aspirate we could develop a diagnostic algorithm with a high PPV and NPV to identify patients in whom further analysis with PCR would be useful. PCR was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.South African Gastroenterological Society (SAGES)/Astra Zeneca Fellowship in Gastroenterologyhttp://www.journals.elsevier.com/ultrasound-in-medicine-and-biology/hb201

6-thioguanine treatment in inflammatory bowel disease: A critical appraisal by a European 6-TG working party

Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6-12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity. Copyright (c) 2006 S. Karger AG, Basel

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) guideline

Main Recommendations 1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available. Strong recommendation, moderate quality evidence. 2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers. Weak recommendation, moderate quality evidence. 3 ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible. Strong recommendation, low quality evidence. 4 ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events. Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD. Strong recommendation, high quality of evidence. 6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery. Strong recommendation, low quality evidence. 7 ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP. Weak recommendation, low quality evidence.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Agreement on endoscopic ultrasonography-guided tissue specimens: Comparing a 20-G fine-needle biopsy to a 25-G fine-needle aspiration needle among academic and non-academic pathologists

Background and Aim: A recently carried out randomized controlled trial showed the benefit of a novel 20-G fine-needle biopsy (FNB) over a 25-G fine-needle aspiration (FNA) needle. The current study evaluated the reproducibility of these findings among expert academic and non-academic pathologists. Methods: This study was a side-study of the ASPRO (ASpiration versus PROcore) study. Five centers retrieved 74 (59%) consecutive FNB and 51 (41%) FNA samples from the ASPRO study according to randomization; 64 (51%) pancreatic and 61 (49%) lymph node specimens. Samples were re-reviewed by five expert academic and five non-academic pathologists and rated in terms of sample quality and diagnosis. Ratings were compared between needles, expert academic and

The MeerKAT Galaxy Cluster Legacy Survey: I. Survey overview and highlights

Please abstract in the article.The South African Radio Astronomy Observatory (SARAO), the National Research Foundation (NRF), the National Radio Astronomy Observatory, US National Science Foundation, the South African Research Chairs Initiative of the DSI/NRF, the SARAO HCD programme, the South African Research Chairs Initiative of the Department of Science and Innovation.http://www.aanda.orghj2022Physic

Fulminanting necrotising enterocolitis: Outcome and prognostic factors

In order to determine the outcome of infants with fulminant necrotising entercolitis (NEC), the records of 128 surgically-treated neonates were reviewed. Fifty-two were found to have severe, rapid-onset disease. The 30-day survival was determined and correlated with birth weight, gestational age, laboratory and radiological findings, and extent of disease. Seven patients did not respond to resuscitative measures and were treated by percutaneous drainage with a uniformly fatal outcome. For patients who could be made fit for surgery, the only absolute predictor of survival was extent of disease. Pannecrosis occurred in 19 patients and all of these died. Conversely, patients who had resectable disease had a 30-day survival of 61%. Pan-necrosis could not be determined preoperatively by radiological findings. Patients with severe, rapid-onset NEC and evidence of gangrene who respond to resuscitation should have active surgical management, as approximately one-half of them have resectable disease and a reasonable short-term outcome may be expected. Patients who do not respond to resuscitative measures and those with a surgical finding of pan-necrosis had a uniformly fatal outcome in this study, and if resources are limited, it is reasonable to withdraw active management in this group of patients.Articl

An adaptation of the Moyers mixed dentition space analysis for a Western Cape Caucasian population.

200 dental plaster casts of Western Cape Caucasoid subjects, all of whom were under the age of 21 years, were used in this study. Mesio-distal measurements (MD lengths) were obtained of all the teeth, disregarding the third molars. This data was used to develop regression equations, for maxillary and for mandibular arches, to enable the prediction of the mesio-distal lengths of the canine and two premolars. The study identified the sum of the MD lengths of the permanent lower incisors as the best predictor. It appears that separate predictions for male and female are not warranted. The equations and the predicted values were compared with those of Moyers (1973 and 1988) and some significant differences were found. The Prediction Tables will be useful in analysis of the mixed dentition phase in patients from this population group.Articl