RESUMEN
Solid pseudopapillary tumor of the pancreas is a rare pancreatic tumor that predominantly occurs in young non-Caucasian women. Although most tumors show benign behavior, malignant degeneration may occur. A case of solid pseudopapillary pancreatic tumor in a Caucasian woman is presented that was investigated by endoscopic ultrasonography (EUS), computed tomography, magnetic resonance imaging and EUS-guided fine needle aspiration. The patient underwent surgery and radiological findings are correlated with histopathology. The preoperative diagnosis of solid pseudopapillary tumor of the pancreas is challenging, frequently leading to imaging by multiple different modalities.
RESUMEN
BACKGROUND: Nonoperative therapy with intent to cure may be considered for patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma. However, a more advanced stage of disease must be precluded before such treatment. The potential of EUS for this purpose was evaluated. METHODS: EUS was performed in patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma based on endoscopy, endoscopic biopsies, and CT before esophagectomy. EUS findings were compared with surgical/pathologic evaluation. RESULTS: EUS suggested submucosal invasion in 6 patients and lymph node involvement in 5 patients. By surgical/pathologic evaluation, 5 of 22 patients (23%) had unsuspected submucosal invasion and 1 had lymph node involvement. EUS detected all 5 instances of submucosal invasion and the single instance of lymph node involvement. EUS was falsely positive for submucosal invasion in 1 patient and for lymph node involvement in 4 patients. Sensitivity, specificity, and negative predictive values of preoperative EUS for submucosal invasion were 100%, 94%, and 100%, and for lymph node involvement were 100%, 81%, and 100%, respectively. A nodule or stricture noted by endoscopy was associated with an increased likelihood of submucosal invasion. CONCLUSIONS: In patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma, EUS detected otherwise unsuspected submucosal invasion and lymph node involvement. Patients should be evaluated with EUS when nonoperative therapy is contemplated.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Esófago de Barrett/diagnóstico por imagen , Esófago de Barrett/patología , Endosonografía/métodos , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Anciano , Esófago de Barrett/mortalidad , Esófago de Barrett/cirugía , Biopsia con Aguja , Intervalos de Confianza , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Esofagoscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Membrana Mucosa/patología , Probabilidad , Sistema de Registros , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
This article reviews the radiologic and endoscopic diagnosis of Crohn's disease. Radiographic and endoscopic findings of Crohn's disease are discussed; a practical approach to the selection of radiologic modalities is presented; and the role of endoscopy in diagnosis and treatment is explained.
Asunto(s)
Enfermedad de Crohn/diagnóstico por imagen , Enfermedad de Crohn/patología , Endoscopía Gastrointestinal/métodos , Absceso/diagnóstico por imagen , Absceso/etiología , Absceso/patología , Sulfato de Bario , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/terapia , Endosonografía , Enema , Humanos , Ileostomía , Inflamación , Enfermedades Intestinales/diagnóstico por imagen , Enfermedades Intestinales/etiología , Enfermedades Intestinales/patología , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/patología , Pólipos Intestinales/diagnóstico por imagen , Pólipos Intestinales/etiología , Pólipos Intestinales/patología , Imagen por Resonancia Magnética , Selección de Paciente , Tomografía Computarizada por Rayos XRESUMEN
The importance of ammonia-producing Helicobacter pylori infection as a cause of subclinical encephalopathy in cirrhosis was investigated. In addition, a single psychometric test that can reliably detect subclinical hepatic encephalopathy was sought. Out-patients with cirrhosis and no overt encephalopathy underwent [14C]urea breath testing once and psychometric testing on two separate occasions, with an intervening course of clarithromycin/omeprazole if they had subclinical encephalopathy (two of four psychometric tests abnormal). Subclinical encephalopathy was present in 27 of 69 patients (39%), and Helicobacter pylori infection in 14 of 69 (20%). There was no association between the two conditions (P = 0.769). Subclinical encephalopathy resolved in 75% of treated Helicobacter pylori-positive patients and 37.5% of treated Helicobacter pylori-negative patients (P = 0.285). Number connection test-B had high reproducibility among untreated patients (R = 0.655) and high correlation (P < or = 0.01) with three surrogate gold standards. In stable cirrhotic patients, subclinical hepatic encephalopathy was found to: (1) have a high prevalence, (2) not be associated with Helicobacter pylori infection, and (3) be readily detected with the number connection test-B alone.
Asunto(s)
Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Encefalopatía Hepática/microbiología , Cirrosis Hepática/complicaciones , Adulto , Anciano , Femenino , Encefalopatía Hepática/complicaciones , Encefalopatía Hepática/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , PsicometríaAsunto(s)
Epilepsias Parciales/complicaciones , Náusea/etiología , Anciano , Anticonvulsivantes/uso terapéutico , Carbamazepina/uso terapéutico , Confusión/etiología , Electroencefalografía , Epilepsias Parciales/diagnóstico , Epilepsias Parciales/tratamiento farmacológico , Epilepsias Parciales/psicología , Humanos , Masculino , RecurrenciaRESUMEN
We have compared apoptosis and proliferation in antral epithelium from individuals not infected with H. pylori (Hp), those with Hp-induced gastritis and those with Hp-induced gastritis containing areas of gastric intestinal metaplasia, the precursor lesion to gastric adenocarcinoma. Antral biopsies from 42 patients were assessed for evidence of Hp infection, severity of gastritis and intestinal metaplasia. Apoptosis was evaluated by the TUNEL assay and proliferation by Ki-67 immunohistochemistry and were expressed as apoptotic (AI) and proliferation (PI) indices. In the 31 Hp-positive (Hp(+)) patients, apoptosis and proliferation were increased compared with the 11 Hp-negative (Hp(-)) patients (AI = 1. 22 +/- 0.13% vs. 0.15 +/- 0.03%, p < 0.0001; PI = 24 +/- 1% vs. 13 +/- 2%, p < 0.0001). Increases were proportional to the severity of the inflammation. Within foci of intestinal metaplasia, in 9 of the Hp(+) patients, apoptosis was significantly reduced compared with surrounding gastritis (AI = 0.20 +/- 0.06% vs. 1.34 +/- 0.23%, p = 0. 0014), whereas proliferation was not altered (PI = 25.4 +/- 4% vs. 24.7 +/- 2%, p = 0.87), resulting in a lower AI/PI ratio in intestinal metaplasia than in surrounding gastritis (0.008 +/- 0.005 vs. 0.054 +/- 0.009, p < 0.02). Hp-induced gastritis is thus associated with increased epithelial apoptosis and proliferation compared with uninfected controls. In intestinal metaplasia, proliferation remains increased but apoptosis reverts to normal levels, and this perhaps contributes to Hp-associated gastric carcinogenesis.
Asunto(s)
Mucosa Gástrica/patología , Infecciones por Helicobacter/patología , Helicobacter pylori , Neoplasias Gástricas/microbiología , Adolescente , Adulto , Anciano , Apoptosis , División Celular , Transformación Celular Neoplásica , Progresión de la Enfermedad , Femenino , Mucosa Gástrica/microbiología , Infecciones por Helicobacter/complicaciones , Humanos , Etiquetado Corte-Fin in Situ , Intestinos/patología , Masculino , Metaplasia/etiología , Persona de Mediana Edad , Neoplasias Gástricas/patologíaAsunto(s)
Ampolla Hepatopancreática , Cateterismo/métodos , Neoplasias del Conducto Colédoco/terapia , Divertículo del Colon/terapia , Duodenoscopios , Cuidados Paliativos , Adenocarcinoma/complicaciones , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Cateterismo/instrumentación , Colangiopancreatografia Retrógrada Endoscópica , Colestasis/diagnóstico , Colestasis/etiología , Colestasis/terapia , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Neoplasias del Conducto Colédoco/complicaciones , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/secundario , Divertículo del Colon/complicaciones , Divertículo del Colon/diagnóstico , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/terapia , Humanos , Masculino , Persona de Mediana Edad , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
Most of the major advances in the screening for gastrointestinal cancers this year were in the area of colorectal cancer screening. Currently, screening is recommended for the prevention of colorectal cancer in average and high-risk populations. For average risk populations, large randomized trials support the use of screening fecal occult blood testing, and case-control studies support the use of screening sigmoidoscopy. This year, several investigators have addressed issues related to the probability of identifying advanced lesions in the proximal colon following a positive screening flexible sigmoidoscopy. Similarly, two studies identified that villous histology in an index polyp was associated with an increased risk of recurrent colonic polyps. Additionally, two large trials provided new insight about the prevalence of mutations in the MLH1 or MSH2 mismatch-repair genes among patients with colorectal cancer. Lastly, a case-control study from Sweden provided the best evidence to date that surveillance colonoscopies for patients with long-standing ulcerative colitis may reduce cancer-related mortality. Although further work is needed, these studies have served to advance our knowledge of colorectal cancer screening substantially.
Asunto(s)
Neoplasias Colorrectales/prevención & control , Neoplasias Gastrointestinales/prevención & control , Tamizaje Masivo , HumanosRESUMEN
This article provides an in-depth review of the radiologic and endoscopic imaging techniques used in the evaluation and management of inflammatory bowel disease (IBD). The use of imaging studies to diagnose IBD and to differentiate ulcerative colitis from Crohn's disease is discussed. The evaluation of suspected complications associated with IBD, including strictures and fistulous disease, as well as surveillance for colorectal cancer are also addressed.
Asunto(s)
Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedad Aguda , Sulfato de Bario , Colangiopancreatografia Retrógrada Endoscópica , Enfermedad Crónica , Colitis Ulcerosa/diagnóstico , Colonoscopía , Medios de Contraste , Enfermedad de Crohn/diagnóstico , Diagnóstico Diferencial , Diagnóstico por Imagen/métodos , Endosonografía , Enema , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Morphologic changes of the vascular endothelium are common in patients with systemic sclerosis and Raynaud's phenomenon. The aim of this study was to evaluate the endothelium-dependent vasodilatation and endothelium-independent vasodilatation and to examine the effects of short-term estrogen administration on vascular responses in these patients. METHODS AND RESULTS: The study included 12 female patients with systemic sclerosis and Raynaud's phenomenon (aged 49+/-14 years) and 12 age- and sex-matched healthy control subjects. With the use of high-resolution ultrasound imaging, brachial artery diameter was measured at rest, during reactive hyperemia (endothelium-dependent response), and after administration of sublingual nitroglycerin (endothelium-independent dilatation). Intima-media thickness of the common carotid artery was also measured. Baseline diameter was similar in patients and control subjects; intima-media thickness was significantly higher in patients (0.83+/-0.3 vs 0.46+/-0.2 mm, P= .002) than in control subjects. Flow-mediated dilatation was reduced in patients (3.6%+/-7% vs 11.9%+/- 4.6%, P = .003); endothelium-independent dilatation also was reduced in patients with Raynaud's phenomenon (14%+/-7% vs 23%+/-6%, P= .003). Vascular responses in 10 patients were examined 15 minutes after administration of conjugated estrogens (25 mg intravenously); there was a significant increase of endothelium-dependent dilatation after estrogen administration (1.7%+/-4% to 6.3%+/-4%, P= .01), whereas endothelium-independent dilatation did not change (13.4%+/-8% to 15.5%+/-7%, not significant). CONCLUSIONS: Endothelium-dependent vasodilatation and endothelium-independent vasodilatation are impaired in patients with Raynaud's phenomenon secondary to systemic sclerosis, whereas intima-media thickness is increased. Short-term estrogen administration can improve endothelial dysfunction in this group of patients.