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Sample records for euo eus euse

  1. Neutron Scattering from Heisenberg Ferromagnets EuO and EuS

    DEFF Research Database (Denmark)

    Als-Nielsen, Jens Aage; Dietrich, O. W.; Passell, L.

    1976-01-01

    Neutron scattering has been used to study the magnetic ordering process in the isotropic exchange coupled ferromagnets EuO and EuS. Quantities investigated include the critical coefficients B and F+ and the critical exponents β, ν, and γ describing respectively the temperature dependence of the r......Neutron scattering has been used to study the magnetic ordering process in the isotropic exchange coupled ferromagnets EuO and EuS. Quantities investigated include the critical coefficients B and F+ and the critical exponents β, ν, and γ describing respectively the temperature dependence...

  2. Pressure-induced phase transition and stability of EuO and EuS with ...

    Indian Academy of Sciences (India)

    Abstract. We have predicted the phase transition pressures and corresponding relative volume changes of EuO and EuS having NaCl-type structure under high pressure using three-body interaction potential (TBIP) approach. In addition, the conditions for relative stability in terms of modified Born criterion has been checked ...

  3. Critical neutron scattering from the Heisenberg ferromagnets EuO and EuS

    DEFF Research Database (Denmark)

    Als-Nielsen, Jens Aage; Dietrich, O. W.; Passell, L.

    1972-01-01

    The magnetic neutron scattering from isotopically enriched powders of EuO and EuS near their Curie temperatures has been studied. Results of the critical exponents for the static properties in standard notation were * Thumbnail image of Spin wave scattering at T...

  4. Critical behavior of the Heisenberg ferromagnets EuO and EuS

    DEFF Research Database (Denmark)

    Als-Nielsen, Jens Aage; Dietrich, O.W.; Kunnmann, W.

    1971-01-01

    Neutron-scattering measurements have been made of the critical parameters of the simple Heisenberg ferromagnets EuO and EuS. Values of the critical exponents β and ν and the amplitudes of B and F describing, respectively, the reduced magnetization and the inverse correlation range (above Tc......) are in good accord with theory. The measured values of the exponent γ, describing the static susceptibility, support the recent prediction that γ≈1.40 in a simple nearest-neighbor Heisenberg ferromagnet. The scaling relation between β, ν, and γ is fulfilled...

  5. Spin-Wave Analysis of Specific Heat and Magnetization in EuO and EuS

    DEFF Research Database (Denmark)

    Dietrich, O. W.; Henderson, A. J.; Meyer, H.

    1975-01-01

    Recent neutron scattering measurements of the spin-wave spectrum have shown that the second-nearest-neighbor exchange constant in EuO is ferromagnetic, in disagreement with previously published results from both specific-heat and magnetization measurements. We undertook a thorough study of the bulk...... data on both EuO and its isomorph EuS, including some previously unpublished specific-heat data. The new analysis resolved the controversy regarding the specific heat, which is actually in good agreement with the neutron scattering results. However, the NMR data are more sensitive to effects other than...

  6. Neutron Scattering from the Heisenberg Ferromagnets EuO and EuS

    DEFF Research Database (Denmark)

    Dietrich, O. W.; Als-Nielsen, Jens Aage; Passell, L.

    1976-01-01

    Inelastic neutron scattering has been used to investigate the spin dynamics of the isotropic Heisenberg ferromagnet EuO over a wide range of wave vectors and over a temperature range extending from 0.14 to 1.9TC. Below the ordering temperature spin-wave renormalization is found to agree well...

  7. Correlation Theory Applied to the Static and Dynamic Properties of EuO and EuS

    DEFF Research Database (Denmark)

    Lindgård, Per-Anker

    1982-01-01

    The paramagnetic scattering was recently measured for EuO.1) It was found that spin‐wave‐like excitations develop for wave vectors approaching the zone boundary. The spectrum was found to be well described by damped harmonic oscillators (also called the two‐pole approximation). This approximation...

  8. EUS Elastography: Advances in Diagnostic EUS of the Pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Tae Hee; Cha, Sang Woo; Cho, Young Deok [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Elastography is an imaging modality for the evaluation of tissue stiffness, which has been used for the analysis of superficial organs, such as those of the breast and prostate. The measurement of tissue elasticity has been reported to be useful for the diagnosis and differentiation of tumors, which are stiffer than normal tissues. Endoscopic ultrasonography elastography (EUS-EG) is a promising imaging technique with a high degree of accuracy for the differential diagnosis of solid pancreatic tumors. Recent introduction of second generation EUS-EG allows for the quantitative analysis of tissue stiffness. Here, we review our knowledge and preliminary experience with the use of EUS-elastography for the diagnosis of pancreatic disease.

  9. Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

    DEFF Research Database (Denmark)

    Iordache, Sevastiţa; Costache, Mădălin Ionuţ; Popescu, Carmen Florina

    2016-01-01

    examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established. RESULTS: For the diagnosis of possible....... The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer. CONCLUSIONS: The proposed...

  10. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology

    DEFF Research Database (Denmark)

    Dumonceau, J-M; Polkowski, M; Larghi, A

    2011-01-01

    This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS...

  11. Spin fluctuations in EuS; Spinfluktuationen in EuS

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, A. [Paul Scherrer Inst. (PSI), Villigen (Switzerland)

    1996-02-01

    Demagnetization effects break the isotropy of spin waves. During spring 1995, Peter Boeni et al. performed polarized neutron measurements on EuS using the triple axis spectrometer IN14 at the ILL in Grenoble, in order to investigate the influence of dipolar interactions on the spin waves. In the following work the analysis of the experimental data is described. (author) 25 figs., 2 tabs., 9 refs.

  12. Impact of EUS-guided FNA on management of gastric carcinoma

    DEFF Research Database (Denmark)

    Hassan, Hazem; Vilmann, Peter; Sharma, Vijay

    2010-01-01

    EUS is an integral part of the pretherapeutic evaluation program for patients with upper GI cancer.......EUS is an integral part of the pretherapeutic evaluation program for patients with upper GI cancer....

  13. Mediastinal restaging: EUS-FNA offers a new perspective

    NARCIS (Netherlands)

    Annema, Jouke T.; Veseliç, Maud; Versteegh, Michel I. M.; Willems, Luuk N. A.; Rabe, Klaus F.

    2003-01-01

    We hypothesized that transoesophageal endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has the potential to be a valuable and accurate new diagnostic technique for mediastinal restaging in non-small cell lung cancer (NSCLC) after induction chemotherapy. The current restaging modalities

  14. Potential value of EUS in pancreatic surveillance of VHL patients

    NARCIS (Netherlands)

    van Asselt, Sophie Josephien; Brouwers, Adrienne H; van Dullemen, Hendrik M; van der Jagt, Eric J; Bongaerts, Alfons H; Koopmans, Klaas P; Kema, Ido; Zonnenberg, Bernard A; Timmers, Henri Jlm; de Herder, Wouter; Sluiter, Wim; de Vries, Elisabeth G E; Links, T P

    Background: Patients with von Hippel-Lindau (VHL) disease are prone to develop pancreatic neuroendocrine tumors (pNETs). However, the best imaging technique for early detection of pNETs in VHL is currently unknown. In a head-to-head comparison, we evaluated endoscopic ultrasound (EUS) and

  15. EUS Needle Identification Comparison and Evaluation study (with videos)

    NARCIS (Netherlands)

    Tang, S.J.; Vilmann, A.S.; Saftoiu, A.; Wang, W.; Streba, C.T.; Fink, P.P.; Griswold, M.; Wu, R.; Dietrich, C.F.; Jenssen, C.; Hocke, M.; Kantowski, M.; Pohl, J.; Fockens, P.; Annema, J.T.; Heijden, E.H.F.M. van der; Havre, R.F.; Pham, K.D.; Kunda, R.; Deprez, P.H.; Mariana, J.; Vazquez-Sequeiros, E.; Larghi, A.; Buscarini, E.; Fusaroli, P.; Lahav, M.; Puri, R.; Garg, P.K.; Sharma, M.; Maluf-Filho, F.; Sahai, A.; Brugge, W.R.; Lee, L.S.; Aslanian, H.R.; Wang, A.Y.; Shami, V.M.; Markowitz, A.; Siddiqui, A.A.; Mishra, G.; Scheiman, J.M.; Isenberg, G.; Siddiqui, U.D.; Shah, R.J.; Buxbaum, J.; Watson, R.R.; Willingham, F.F.; Bhutani, M.S.; Levy, M.J.; Harris, C.; Wallace, M.B.; Nolsoe, C.P.; Lorentzen, T.; Bang, N.; Sorensen, S.M.; Gilja, O.H.; D'Onofrio, M.; Piscaglia, F.; Gritzmann, N.; Radzina, M.; Sparchez, Z.A.; Sidhu, P.S.; Freeman, S.; McCowan, T.C.; Araujo, C.R., Jr. de; Patel, A.; Ali, M.A.; Campbell, G.; Chen, E.; Vilmann, P.

    2016-01-01

    BACKGROUND AND AIMS: EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal

  16. EUS needle identification comparison and evaluation (NICE) study (with videos)

    Science.gov (United States)

    Tang, Shou-jiang; Vilmann, Andreas S.; Saftoiu, Adrian; Wang, Wanmei; Streba, Costin; Fink, Peter P.; Griswold, Michael; Wu, Ruonan; Dietrich, Christoph F.; Jenssen, Christian; Hocke, Michael; Kantowski, Marcus; Pohl, Jürgen; Fockens, Paul; Annema, Jouke T.; van der Heijden, Erik H.F.M.; Havre, Roald Flesland; Pham, Khanh Do-Cong; Kunda, Rastislav; Deprez, Pierre H.; Mariana, Jinga; Vazquez-Sequeiros, Enrique; Larghi, Alberto; Buscarini, Elisabetta; Fusaroli, Pietro; Lahav, Maor; Puri, Rajesh; Garg, Pramod Kumar; Sharma, Malay; Maluf-Filho, Fauze; Sahai, Anand; Brugge, William R.; Lee, Linda S.; Aslanian, Harry R.; Wang, Andrew Y.; Shami, Vanessa M.; Markowitz, Arnold; Siddiqui, Ali A.; Mishra, Girish; Scheiman, James M.; Isenberg, Gerard; Siddiqui, Uzma D.; Shah, Raj J.; Buxbaum, James; Watson, Rabindra R.; Willingham, Field F.; Bhutani, Manoop S.; Levy, Michael J.; Harris, Cynthia; Wallace, Michael B.; Nolsøe, Christian Pállson; Lorentzen, Torben; Bang, Niels; Sørensen, Sten Mellerup; Gilja, Odd Helge; D’Onofrio, Mirko; Piscaglia, Fabio; Gritzmann, Norbert; Radzina, Maija; Sparchez, Zeno Adrian; Sidhu, Paul S.; Freeman, Simon; McCowan, Timothy C.; de Araujo, Cyrillo Rodrigues; Patel, Akash; del Ali, Mohammad A; Campbell, Garth; Chen, Edward; Vilmann, Peter

    2017-01-01

    Background and Aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) or biopsy is widely practiced. Optimal sonographic visualization of the needle is critical for image guided interventions. There are several commercially available needles but no bench-top testing and direct comparison of these needles to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. Methods Descriptive bench-top testing and comparison. Bench-top testing of 8 commonly used EUS-FNA needles (all of 22 gauge in size): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition, (Cook Medical); ClearView (Conmed); EZ Shot2 (Olympus); BNX (Beacon Endoscopic); and 2 new prototype needles that are coated by echogenic polymers by Medi-Globe. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in gastrointestinal ultrasound examination that is unfamiliar with EUS needle devices. Results There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, one prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (p<0.01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%–75% worse, p<0.001). Conclusions All FNA needles have their inherent and different echogenicity, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity. PMID:26873530

  17. Role of EUS-FNA in Recurrent Lung Cancer: Maximum Results with Minimum (minimally invasive) Effort.

    Science.gov (United States)

    Ioncica, Ana M; Bektas, Mehmet; Suzuki, Rei; Saftoiu, Adrian; Artifon, Everson L A; Bhutani, Manoop S

    2013-04-01

    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary lung cancer staging. We describe a 66-year-old male who underwent EUS-FNA for the diagnosis of recurrent lung cancer. Two years after initial radiation therapy followed by complete remission, routine follow-up imaging study revealed a mass in the right hilum. Trans-esophageal EUS revealed a 1.3-cm mass and the result of EUS-FNA was consistent with non-small lung cancer. EUS-FNA can play an important role in diagnosis of recurrent lung cancer as well as primary staging avoiding the more invasive diagnostic technique.

  18. Feasibility Study of EUS-NOTES as a Novel Approach for Pancreatic Cancer Staging and Therapy

    DEFF Research Database (Denmark)

    Săftoiu, Adrian; Bhutani, Manoop S; Vilmann, Peter

    2012-01-01

    Background/Aims: EUS guided Natural Orifice Transluminal Endoscopic Surgery (NOTES) could be a potentially viable approach for pancreatic surgery. EUS-guided access through the stomach wall may prove to be a safe and effective method for accessing the pancreas. The aim of the study was to assess...... the EUS-guided diagnostic and therapeutic procedures during NOTES for both anterior and posterior approach of the pancreas. Methodology: The feasibility of peritoneoscopy through an anterior EUS-guided transgastric approach, as well as direct access to the pancreas through a posterior EUS......-guided transgastric approach was tested for ease of access to the tail of the pancreas. Gastric wound closure was finally performed in several animals using various commercial and prototype endoscopic accessories. Results: The results showed the ability of EUS-NOTES technology to facilitate a transgastric approach...

  19. Microscopic findings in EUS-guided fine needle (SharkCore) biopsies with type 1 and type 2 autoimmune pancreatitis

    DEFF Research Database (Denmark)

    Detlefsen, Sönke; Joergensen, Maiken Thyregod; Mortensen, Michael Bau

    2017-01-01

    The International Consensus Diagnostic Criteria (ICDC) for the diagnosis of autoimmune pancreatitis (AIP) include the histological criterion that is based on either pancreatic core needle biopsies (CNBs) or surgical specimens. However, CNBs are difficult to obtain by endoscopic ultrasound (EUS......). EUS fine-needle aspiration (EUS-FNA) cytology is usually not sufficient for the diagnosis of AIP, but may sometimes contain tissue microfragments. Another approach is EUS-guided histological fine-needle biopsy (EUS-FNB), using needles such as the SharkCore or ProCore needle. Published data regarding...... EUS-guided SharkCore FNB for the diagnosis of AIP are lacking. We aimed to describe our histological findings in one type 1 and two type 2 AIP patients who underwent EUS SharkCore FNB. The EUS-FNBs of two patients fulfilled the histological level 2 ICDC for type 1 AIP or type 2 AIP. The EUS-FNB of one...

  20. EUS-guided biopsy for the diagnosis and classification of lymphoma.

    Science.gov (United States)

    Ribeiro, Afonso; Pereira, Denise; Escalón, Maricer P; Goodman, Mark; Byrne, Gerald E

    2010-04-01

    EUS-guided FNA and Tru-cut biopsy (TCB) is highly accurate in the diagnosis of lymphoma. Subclassification, however, may be difficult in low-grade non-Hodgkin lymphoma and Hodgkin lymphoma. To determine the yield of EUS-guided biopsy to classify lymphoma based on the World Health Organization classification of tumors of hematopoietic lymphoid tissues. Retrospective study. Tertiary referral center. A total of 24 patients referred for EUS-guided biopsy who had a final diagnosis of lymphoma or "highly suspicious for lymphoma." EUS-guided FNA and TCB combined with flow cytometry (FC) analysis. MAIN OUTCOMES MEASUREMENT: Lymphoma subclassification accuracy of EUS guided biopsy. Twenty-four patients were included in this study. Twenty-three patients underwent EUS-FNA, and 1 patient had only TCB. Twenty-two underwent EUS-TCB combined with FNA. EUS correctly diagnosed lymphoma in 19 out of 24 patients (79%), and subclassification was determined in 16 patients (66.6%). Flow cytometry correctly identified B-cell monoclonality in 95% (18 out of 19). In 1 patient diagnosed as having marginal-zone lymphoma by EUS-FNA/FC only, the diagnosis was changed to hairy cell leukemia after a bone marrow biopsy was obtained. EUS had a lower yield in nonlarge B-cell lymphoma (only 9 out of 15 cases [60%]) compared with large B-cell lymphoma (78%; P = .3 [Fisher exact test]). Retrospective, small number of patients. EUS-guided biopsy has a lower yield to correctly classify Hodgkin lymphoma and low-grade lymphoma compared with high-grade diffuse large B-cell lymphoma. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  1. EUS-Guided Needle-Based Confocal Laser Endomicroscopy

    DEFF Research Database (Denmark)

    Bhutani, Manoop S; Koduru, Pramoda; Joshi, Virendra

    2015-01-01

    the gut, providing further diagnostic and staging information. Confocal laser endomicroscopy (CLE) is a novel endoscopic method that enables imaging at a subcellular level of resolution during endoscopy, allowing up to 1000-fold magnification of tissue and providing an optical biopsy. A new procedure...... that has been developed in the past few years is needle-based confocal laser endomicroscopy (nCLE), which involves a mini-CLE probe that can be passed through a 1 9-gauge needle during EUS-FNA. This enables the real-time visualization of tissue at a microscopic level, with the potential to further improve...

  2. Prospective evaluation of EUS-guided fine needle biopsy in pancreatic mass lesions

    DEFF Research Database (Denmark)

    Larsen, M H; Fristrup, C W; Detlefsen, S

    2018-01-01

    Background and study aim : Due to the scarcity of specific data on endoscopic ultrasound (EUS)-guided fine-needle biopsies (SharkCore) FNB in the evaluation of pancreatic lesions, we performed a prospective study of the diagnostic performance of EUS SharkCore FNB in patients with pancreatic lesions...

  3. Diagnostic yield of EUS-guided FNA and cytology in suspected tubercular intra-abdominal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, Rajesh; Mangla, Rakhee; Eloubeidi, Mohamad

    2012-01-01

    Intra-abdominal lymphadenopathy is a common diagnostic challenge faced by clinicians. In the absence of palpable peripheral nodes, tissue is usually obtained from the abdominal nodes by image-guided biopsy or surgery. We speculate that EUS-guided FNA (EUS-FNA) avoids the morbidity of a laparotomy...

  4. Impact of endoscopic ultrasonography (EUS) on surgical decision-making in upper gastrointestinal tract cancer

    DEFF Research Database (Denmark)

    Mortensen, Michael Bau; Edwin, B; Hünerbein, M

    2007-01-01

    BACKGROUND: Endoscopic ultrasonography (EUS) is an integrated part of the pretherapeutic evaluation program for patients with upper gastrointestinal (GI) tract cancer. Whether the clinical impact of EUS differs between surgeons from different countries is unknown. The same applies to the potentia...

  5. Diagnostiek van de exotische waterschimmelziekte EUS: resultaten van een club 5 project.

    NARCIS (Netherlands)

    Haenen, O.L.M.; Roozenburg-Hengst, R.E.M.

    2011-01-01

    In de EU richtlijn 2006/88/EG staat op de lijst van exotische visziekten de ziekte EUS (Epizoötisch Ulceratief Syndroom). Tot nu toe waren slechts weinig laboratoria in Europa in staat deze ziekte aan te tonen. In dit artikel informatie over een project (EUS Club 5) dat daar verandering in heeft

  6. Accuracy and Quality Assessment of EUS-FNA: A Single-Center Large Cohort of Biopsies

    Directory of Open Access Journals (Sweden)

    Benjamin Ephraim Bluen

    2012-01-01

    Full Text Available Introduction. Thorough quality control (QC study with systemic monitoring and evaluation is crucial to optimizing the effectiveness of EUS-FNA. Methods. Retrospective analysis was composed of investigating consecutive patient files that underwent EUS-FNA. QC specifically focused on diagnostic accuracy, impacts on preexisting diagnoses, and case management. Results. 268 patient files were evaluated. EUS-FNA cytology helped establish accurate diagnoses in 92.54% (248/268 of patients. Sensitivity, specificity, PPV, NPV, and accuracy were 83%, 100%, 100%, 91.6%, and 94%, respectively. The most common biopsy site was the pancreas (68%. The most accurate location for EUS-FNA was the esophagus, 13/13 (100%, followed by the pancreas (89.6%. EUS-FNA was least informative for abdominal lymph nodes (70.5%. After FNA and followup, eight false negatives for tumors were found (3%, while 7.5% of samples still lacked a definitive diagnosis. Discussion. QC suggests that the diagnostic accuracy of EUS-FNA might be improved further by (1 taking more FNA passes from suspected lesions, (2 optimizing needle selection (3 having an experienced echo-endoscopist available during the learning curve, and (4 having a cytologist present during the procedure. QC also identified remediable reporting errors. In conclusion, QC study is valuable in identifying weaknesses and thereby augmenting the effectiveness of EUS-FNA.

  7. Esophageal ultrasound (EUS) assessment of T4 status in NSCLC patients.

    Science.gov (United States)

    Kuijvenhoven, Jolanda C; Crombag, Laurence; Breen, David P; van den Berk, Inge; Versteegh, Michel I M; Braun, Jerry; Winkelman, Toon A; van Boven, Wimjan; Bonta, Peter I; Rabe, Klaus F; Annema, Jouke T

    2017-12-01

    Mediastinal and central large vessels (T4) invasion by lung cancer is often difficult to assess preoperatively due to the limited accuracy of computed tomography (CT) scan of the chest. Esophageal ultrasound (EUS) can visualize the relationship of para-esophageally located lung tumors to surrounding mediastinal structures. To assess the value of EUS for detecting mediastinal invasion (T4) of centrally located lung tumors. Patients who underwent EUS for the diagnosis and staging of lung cancer and in whom the primary tumor was detected by EUS and who subsequently underwent surgical- pathological staging (2000-2016) were retrospectively selected from two university hospitals in The Netherlands. T status of the lung tumor was reviewed based on EUS, CT and thoracotomy findings. Surgical- pathological staging was the reference standard. In 426 patients, a lung malignancy was detected by EUS of which 74 subjects subsequently underwent surgical- pathological staging. 19 patients (26%) were diagnosed with stage T4 based on vascular (n=8, 42%) or mediastinal (n=8, 42%) invasion or both (n=2, 11%), one patient (5%) had vertebral involvement. Sensitivity, specificity, PPV and NPV for assessing T4 status were: for EUS (n=74); 42%, 95%, 73%, 83%, for chest CT (n=66); 76%, 61%, 41%, 88% and the combination of EUS and chest CT (both positive or negative for T4, (n=34); 83%, 100%, 100% 97%. EUS has a high specificity and NPV for the T4 assessment of lung tumors located para-esophageally and offers further value to chest CT scan. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. EUS – Fine- Needle Aspiration Biopsy (FNAB in the Diagnosis of Pancreatic Adenocarcinoma: A Review

    Directory of Open Access Journals (Sweden)

    Kalogeraki Alexandra

    2016-03-01

    Full Text Available Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS is a relatively new technology that employs endoscopy and high-frequency ultrasound (US. EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP brushing, CT-guided biopsies, and transabdominal ultrasound (US have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities

  9. Preparation of EuSe nanoparticles from Eu(III) complex containing selenides

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Taka-aki; Tanaka, Atsushi [Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara 630-0192 (Japan); Hasegawa, Yasuchika [Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara 630-0192 (Japan)], E-mail: hasegawa@ms.naist.jp; Kawai, Tsuyoshi [Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara 630-0192 (Japan)

    2008-03-03

    The EuSe nanoparticles were prepared by the thermal reduction of Europium nitrate with new organic selenium compound, tetraphenylphosphonium diphenylphosphinediselenide (PPh{sub 4})(Se{sub 2}P(C{sub 6}H{sub 5}){sub 2}), for the first time. EuSe nanoparticles were identified by the X-ray diffraction (XRD), the transmission electron microscope (TEM) and the energy dispersive X-ray spectroscopy (EDX) measurements. The average size of the EuSe nanoparticles was found to be 19 nm. The energy gap in EuSe nanoparticles of 19 nm was estimated by edge of absorption band, giving the energy gap of 1.86 eV.

  10. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology

    DEFF Research Database (Denmark)

    Dumonceau, Jean-Marc; Deprez, Pierre H; Jenssen, Christian

    2017-01-01

    For pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.Strong recommendation, moderate quality evidence.......In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.Weak recommendation, low quality evidence.In patients with chronic pancreatitis associated with a pancreatic mass......, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.Strong recommendation, low quality evidence.For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change...

  11. Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos)

    DEFF Research Database (Denmark)

    Săftoiu, Adrian; Vilmann, Peter; Dietrich, Christoph F

    2015-01-01

    BACKGROUND: The role of EUS with contrast agents can be expanded through the use of time-intensity curve (TIC) analysis and computer-aided interpretation. OBJECTIVE: To validate the use of parameters derived from TIC analysis in an artificial neural network (ANN) classification model designed......-guided FNA (EUS-FNA), TIC analysis, and ANN processing. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for EUS-FNA, CEH-EUS, and the ANN. RESULTS: After excluding all of the recordings that did not meet the technical and procedural criteria, 112 cases...... rise time, mean transit time, and time to peak. For the ANN, sensitivity was 94.64%, specificity 94.44%, PPV 97.24%, and NPV 89.47%. LIMITATIONS: Only PC and CP lesions were included. CONCLUSION: Parameters obtained through TIC analysis can differentiate between PC and CP cases and can be used...

  12. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study.

    Science.gov (United States)

    Huang, Jason Y; Samarasena, Jason B; Tsujino, Takeshi; Lee, John; Hu, Ke-Qin; McLaren, Christine E; Chen, Wen-Pin; Chang, Kenneth J

    2017-05-01

    Portal hypertension (PH) is a serious adverse event of liver cirrhosis. The hepatic venous pressure gradient or portal pressure gradient (PPG) accurately reflects the degree of PH and is the single best prognostic indicator in liver disease. This is usually obtained by interventional radiology (IR), although it is not routinely performed. Recently, we developed a simple novel technique for EUS-guided PPG measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and IR-PPGM. We present the first human pilot study of EUS-PPGM in patients with liver disease. EUS-PPGM was performed by experienced endosonographers using a linear echoendoscope, a 25-gauge fine-needle aspiration needle, and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted using a transgastric-transduodenal approach. Clinical parameters of PH were evaluated in each patient. Feasibility was defined as successful PPGM in each patient. Safety was based on adverse events captured in a postprocedural interview. Twenty-eight patients underwent EUS-PPGM with 100% technical success and no adverse events. PPG ranged from 1.5 to 19 mm Hg and had excellent correlation with clinical parameters of portal hypertension including the presence of varices (P = .0002), PH gastropathy (P = .007), and thrombocytopenia (P = .036). PPG was increased in patients with high clinical evidence of cirrhosis (P = .005). This novel technique of EUS-PPGM using a 25-gauge needle and compact manometer is feasible and appears safe. Given the availability of EUS and the simplicity of the manometry setup, EUS-guided PPG may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease. Copyright © 2017. Published by Elsevier Inc.

  13. Feasibility study of EUS-NOTES as a novel approach for peroral cholecysto-gastrostomy

    DEFF Research Database (Denmark)

    Saftoiu, Adrian; Vilmann, P; Bhutani, M S

    2013-01-01

    EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery.......EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery....

  14. Fluorescence-Magnetism Functional EuS Nanocrystals with Controllable Morphologies for Dual Bioimaging.

    Science.gov (United States)

    Sun, Yuanqing; Wang, Dandan; Zhao, Tianxin; Jiang, Yingnan; Zhao, Yueqi; Wang, Chuanxi; Sun, Hongchen; Yang, Bai; Lin, Quan

    2016-12-14

    Multiple functions incorporated in one single component material offer important applications in biosystems. Here we prepared a divalent state of rare earth EuS nanocrystals (NCs), which provides luminescent and magnetic properties, using both 1-Dodecanethiol (DT) and oleylamine (OLA) as reducing agents. The resultant EuS NCs exhibit controllable shapes, uniform size, and bright luminescence with a quantum yield as high as 3.5%. OLA as a surface ligand plays an important role in tunable morphologies, such as nanowires, nanorods, nanospheres et al. Another attractive nature of the EuS NCs is their paramagnetism at room temperature. In order to expand the biological applications, the resultant EuS NCs were modified with amphiphilic block copolymer F127 and transferred from oil to water phase. The excellent biocompatibility of EuS NCs is demonstrated as well as preservation of their luminescence and paramagnetic properties. The EuS NCs offer multifunction and great advantages of bright luminescence, paramagnetic, controllable morphologies, and good biocompatibility promising applications in the field of simultaneous magnetic resonance and fluorescence bioimaging.

  15. Low-temperature solvothermal synthesis of EuS hollow microspheres

    Energy Technology Data Exchange (ETDEWEB)

    Peng, Yong; Wang, Hong; Li, Peng; Fu, Yao, E-mail: fuyaozn@126.com; Xing, Mingming; Jiang, Tao; Luo, Xixian, E-mail: luoxixiandl@126.com

    2014-09-15

    Graphical abstract: Synthesis of EuS hollow microspheres at low-temperature via solvothermal method for the first time. - Highlights: • We adopt an improved method to synthesise the (Phen)Eu(Et{sub 2}CNS{sub 2}){sub 3} in deionized water. • We have successfully synthesised the EuS hollow microsphere at 230 °C in acetonitrile. • The price of acetonitrile is more inexpensive, so the price of preparation was reduced. - Abstract: EuS crystals are synthesized by low-temperature solvothermal decomposition of the single source precursor complex (Phen)Eu(Et{sub 2}CNS{sub 2}){sub 3} in acetonitrile. X-ray powder diffraction, scanning electron microscopy, granulocyte diameter statistical analysis, surface energy-dispersive X-ray spectroscopy analysis, and UV–vis absorption spectroscopy are used to characterize the structure and properties of the obtained EuS crystals. The results show that the formed EuS crystals are uniform hollow microspheres with a typical cubic phase structure of rock salt and the average particle size of 2.01 μm. The mechanisms for the thermal decomposition of the precursor complex and the formation of the EuS hollow microspheres are postulated based on the experimental observations and previous reports.

  16. Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA of the Pancreas in a Porcine Model

    Directory of Open Access Journals (Sweden)

    Monica Gaidhane

    2012-01-01

    Full Text Available Backgrounds. Limited effective palliative treatments exist for pancreatic cancer which includes surgery or chemotherapy. Radiofrequency ablation (RFA uses high frequency alternating current to ablate diseased tissue and has been used to treat various tumors. In this study, we evaluated a prototype probe adjusted to the EUS-needle to perform EUS-RFA to permit coagulative necrosis in the pancreas. Methods. Five Yucatan pigs underwent EUS-guided radiofrequency ablation of the head of their pancreas. Using an EUS-needle, RFA was applied with 6 mm and then 10 mm of the probe exposed at specific wattage for preset durations. Results. Only one pig showed moderate levels of pancreatitis (20% proximal pancreatitis. The other animals showed much lower areas of tissue damage. In 3 of the 5 pigs, the proximal pancreas showed greater levels of tissue injury than the distal pancreas, consistent with the proximity of the tissue to the procedure site. In 1 pig, both proximal and distal pancreas showed minimal pancreatitis (1%. There was minimal evidence of fat necrosis in intra-pancreatic and/or extra-pancreatic adipose tissue. Conclusion. EUS-guided RFA of the pancreatic head with the monopolar probe through a 19-gauge needle was well tolerated in 5 Yucatan pigs and with minimal amount of pancreatitis.

  17. Combined EUS-Guided Abdominal Cavity Drainage and Cystogastrostomy for the Ruptured Pancreatic Pseudocyst

    Directory of Open Access Journals (Sweden)

    Ge Nan

    2013-01-01

    Full Text Available Background. Endoscopic-Ultrasonography- (EUS- guided puncture and drainage of pancreatic pseudocyst is currently one of the most widely accepted nonsurgical treatments. To date, this technique has only been used for pancreatic pseudocysts adhesive to the gastric wall. This study introduces the technique of EUS-guided pseudocyst drainage and additional EUS-guided peritoneal drainage for the ruptured pseudocyst. Methods. Transmural puncture and drainage of the cyst were performed with a 19 G needle, cystotome, and 10 Fr endoprosthesis. Intraperitoneal drainage was performed with a nasobiliary catheter when rupture of pseudocyst occurred. The entire procedure was guided by the echoendoscope. Results. A total of 21 patients, 8 men and 13 women, with a mean age of 36 years, were included in this prospective study. All of the pseudocysts were successfully drained by EUS. Peritoneal drainage was uneventfully performed in 4 patients. There were no severe complications. Complete pseudocyst resolution was established in all patients. Conclusion. The technique of EUS-guided transmural puncture and drainage, when combined with abdominal cavity drainage by a nasobiliary catheter, allows successful endoscopic management of pancreatic pseudocysts without adherence to gastric wall.

  18. Comparing the Roles of EUS, ERCP and MRCP in Idiopathic Acute Recurrent Pancreatitis

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Safari

    2016-09-01

    Full Text Available Acute recurrent pancreatitis (ARP is defined as more than two attacks of acute pancreatitis with complete or almost complete resolution of symptoms and signs of pancreatitis between episodes. The initial evaluation fails to detect the cause of ARP in 10%-30% of patients, whose condition is classified as idiopathic ARP. Endoscopic ultrasound (EUS has gained increasing attention as a useful imaging modality for the pancreas and the extrahepatic biliary tree. The close proximity of the pancreas to the digestive tract allows EUS to obtain detailed images of this organ. This review aims to record pancreaticobiliary endoscopic ultrasound (EUS and other imaging modalities in the clinical management of patients with idiopathic ARP.

  19. A multidisciplinary survey on controversies in the use of EUS-guided FNA: assessing perspectives of surgeons, oncologists and gastroenterologists.

    Science.gov (United States)

    Lachter, Jesse; Rosenthal, Yoav; Kluger, Yoram

    2011-11-02

    EUS-guided FNA can help diagnose and differentiate between various pancreatic and other lesions.The aim of this study was to compare approaches among involved/relevant physicians to the controversies surrounding the use of FNA in EUS. A five-case survey was developed, piloted, and validated. It was collected from a total of 101 physicians, who were all either gastroenterologists (GIs), surgeons or oncologists. The survey compared the management strategies chosen by members of these relevant disciplines regarding EUS-guided FNA. For CT operable T2NOM0 pancreatic tumors the research demonstrated variance as to whether to undertake EUS-guided FNA, at p multidisciplinary team who treat patients who need EUS-FNA. Multi-specialty meetings assembled to manage patients with these disorders may be enlightening and may help develop consensus.

  20. Minimally invasive autopsy by using postmortem endoluminal and transluminal endoscopy and EUS.

    Science.gov (United States)

    Denzer, Ulrike W; von Renteln, Daniel; Lübke, Andreas; Heinemann, Axel; Rösch, Thomas; Püschel, Klaus; Karbe, Tom

    2013-11-01

    Virtual autopsy by using CT imaging has been introduced as an alternative to conventional autopsy and has resulted in an increase in acceptance of autopsy by relatives. Because direct inspection and tissue acquisition is not possible by imaging alone, various endoscopic techniques can be considered of complementary usefulness. We present the first series of sequential endoscopic techniques including natural orifice transluminal access for minimally invasive autopsy. University hospital, legal medicine department. Twenty deceased subjects. Various flexible endoscopic modalities including EUS, with biopsy or EUS-guided FNA, were attempted. This included transluminal intra-abdominal endoscopic exploration with tissue sampling in a few cases. Completeness of inspection of the luminal and extraluminal cavity as well as tissue acquisition. Complete upper GI endoscopy was performed in 17 of 20 and EUS in 8 of 8 cases. In addition, transgastric intra-abdominal endoscopy was successfully performed in 5 cases. Adequate histology from biopsy and EUS-guided puncture could be obtained in case of short time intervals post mortem. In 1 case, a rupture of the gastric cardia with bleeding was diagnosed as a significant unexpected finding. New minor pathological findings were revealed on EGD (6/17), GI EUS (3/8), and transgastric inspection (4/5). Limited number of cases for all procedures. Minimally invasive autopsy by using multiple endoscopic techniques for imaging and tissue acquisition is feasible. The significant value of this technique, in combination with virtual autopsy compared with classic autopsy, warrants further evaluation. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  1. EUS Needle Identification Comparison and Evaluation study (with videos).

    Science.gov (United States)

    Tang, Shou-Jiang; Vilmann, Andreas S; Saftoiu, Adrian; Wang, Wanmei; Streba, Costin Teodor; Fink, Peter P; Griswold, Michael; Wu, Ruonan; Dietrich, Christoph F; Jenssen, Christian; Hocke, Michael; Kantowski, Marcus; Pohl, Jürgen; Fockens, Paul; Annema, Jouke T; van der Heijden, Erik H F M; Havre, Roald Flesland; Pham, Khanh Do-Cong; Kunda, Rastislav; Deprez, Pierre H; Mariana, Jinga; Vazquez-Sequeiros, Enrique; Larghi, Alberto; Buscarini, Elisabetta; Fusaroli, Pietro; Lahav, Maor; Puri, Rajesh; Garg, Pramod Kumar; Sharma, Malay; Maluf-Filho, Fauze; Sahai, Anand; Brugge, William R; Lee, Linda S; Aslanian, Harry R; Wang, Andrew Y; Shami, Vanessa M; Markowitz, Arnold; Siddiqui, Ali A; Mishra, Girish; Scheiman, James M; Isenberg, Gerard; Siddiqui, Uzma D; Shah, Raj J; Buxbaum, James; Watson, Rabindra R; Willingham, Field F; Bhutani, Manoop S; Levy, Michael J; Harris, Cynthia; Wallace, Michael B; Nolsøe, Christian Pállson; Lorentzen, Torben; Bang, Niels; Sørensen, Sten Mellerup; Gilja, Odd Helge; D'Onofrio, Mirko; Piscaglia, Fabio; Gritzmann, Norbert; Radzina, Maija; Sparchez, Zeno Adrian; Sidhu, Paul S; Freeman, Simon; McCowan, Timothy C; de Araujo, Cyrillo Rodrigues; Patel, Akash; Ali, Mohammad Adel; Campbell, Garth; Chen, Edward; Vilmann, Peter

    2016-09-01

    EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity. Copyright © 2016 American Society for Gastrointestinal Endoscopy. All rights reserved.

  2. A new alternative for a transjugular intrahepatic portosystemic shunt: EUS-guided creation of an intrahepatic portosystemic shunt (with video).

    Science.gov (United States)

    Buscaglia, Jonathan M; Dray, Xavier; Shin, Eun Ji; Magno, Priscilla; Chmura, Kevin M; Surti, Vihar C; Dillon, Travis E; Ducharme, Richard W; Donatelli, Gianfranco; Thuluvath, Paul J; Giday, Samuel A; Kantsevoy, Sergey V

    2009-04-01

    Transjugular intrahepatic portosystemic shunt (TIPSS) is an effective treatment for portal hypertension and its associated complications. EUS-guided creation of an intrahepatic portosystemic shunt (IPSS) may become a useful alternative to conventional TIPSS. To assess the feasibility of EUS-guided IPSS creation in a live porcine model. Acute and survival experiments in 50-kg pigs. Under linear-array EUS guidance, the hepatic vein (HV) and then the portal vein (PV) were punctured with a 19-gauge FNA needle. A 0.035-inch guidewire was advanced through the needle into the PV lumen. The needle was exchanged over the wire, a metal stent was deployed under EUS and fluoroscopic guidance, and the distal end of the stent was positioned inside the PV and the proximal end within the HV. Eight animals were euthanized after the procedure, and 2 animals were kept alive for 2 weeks. Successful EUS-guided IPSS creation. Portosystemic shunt placement was successful in all animals. Intrahepatic vascular puncture and stent deployment were technically easy. Portosystemic flow through the shunt was documented by portal venogram and EUS Doppler. Necropsy performed after acute and survival experiments revealed no evidence of bleeding or damage to any intraperitoneal organs. There were no complications during the follow-up period in the 2 animals that were kept alive. Experiments were performed in healthy animals with normal PV pressure. EUS-guided IPSS creation is technically feasible and may become an alternative to the currently used method of TIPSS placement.

  3. Multicenter randomized controlled trial comparing the performance of 22 gauge versus 25 gauge EUS-FNA needles in solid masses

    DEFF Research Database (Denmark)

    Vilmann, Peter; S?ftoiu, Adrian; Hollerbach, Stephan

    2013-01-01

    Few randomized studies have assessed the clinical performance of 25-gauge (25G) needles compared with 22-gauge (22G) needles during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy of intra-abdominal lesions. We aimed to compare the diagnostic yield, as well as performance cha...... characteristics of 22G versus 25G EUS biopsy needles by determining their diagnostic capabilities, the number of needle passes as well as cellularity of aspirated tissue specimen....

  4. EUS-Guided Multitransgastric Endoscopic Necrosectomy for Infected Pancreatic Necrosis with Noncontagious Retroperitoneal and Peritoneal Extension.

    Science.gov (United States)

    Koo, Ja Eun; Park, Do Hyun; Oh, Joo; Lee, Young Hee; Moon, Sung-Hoon; Lee, Sang-Soo; Seo, Dong-Wan; Lee, Sung-Koo; Kim, Myung-Hwan

    2010-03-01

    Endoscopic necrosectomy was introduced as a safe and effective treatment modality for infected pancreatic necrosis. Although there have been many reports of endoscopic drainage of retroperitoneal pancreatic necrosis, the optimal endoscopic management of pancreatic necrosis extending to the noncontagious retroperitoneal and peritoneal spaces has yet to be established. We report herein a patient with infected pancreatic necrosis with noncontagious retroperitoneal and peritoneal extension who was treated successfully by endoscopic ultrasound (EUS)-guided multiple cystogastrostomy and endoscopic necrosectomy. EUS-guided multitransgastric necrosectomy may be technically feasible and effective for the management of infected pancreatic necrosis with noncontagious retroperitoneal and peritoneal extension that demonstrates suitable anatomy. Further studies to assess the efficacy and safety of this technique are needed before its routine clinical use can be recommended.

  5. Effective optical Faraday rotations of semiconductor EuS nanocrystals with paramagnetic transition-metal ions.

    Science.gov (United States)

    Hasegawa, Yasuchika; Maeda, Masashi; Nakanishi, Takayuki; Doi, Yoshihiro; Hinatsu, Yukio; Fujita, Koji; Tanaka, Katsuhisa; Koizumi, Hitoshi; Fushimi, Koji

    2013-02-20

    Novel EuS nanocrystals containing paramagnetic Mn(II), Co(II), or Fe(II) ions have been reported as advanced semiconductor materials with effective optical rotation under a magnetic field, Faraday rotation. EuS nanocrystals with transition-metal ions, EuS:M nanocrystals, were prepared by the reduction of the Eu(III) dithiocarbamate complex tetraphenylphosphonium tetrakis(diethyldithiocarbamate)europium(III) with transition-metal complexes at 300 °C. The EuS:M nanocrystals thus prepared were characterized using X-ray diffraction (XRD), transmission electron microscopy (TEM), inductively coupled plasma atomic emission spectroanalysis (ICP-AES), and a superconducting quantum interference device (SQUID) magnetometer. Enhanced Faraday rotations of the EuS:M nanocrystals were observed around 550 nm, and their enhanced spin polarization was estimated using electron paramagnetic resonance (EPR) measurements. In this report, the magneto-optical relationship between the Faraday rotation efficiency and spin polarization is discussed.

  6. EUS-Guided FNA for Diagnosis of Pancreatic Cystic Lesions: a Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Qi-Xian Wang

    2015-06-01

    Full Text Available Background: Preoperative diagnosis of pancreatic cystic lesions (PCLs must be reliable as the current standard treatment, major or total pancreatectomy, dramatically affects quality of life. Additionally, early diagnosis of malignancy is essential to an improved prognosis. The diagnostic accuracy of fluid analysis using endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA has been demonstrated in pancreatic solid lesions. The utility of this technique in the diagnosis of PCLs is still unknown. Methods: A comprehensive search was performed in multiple databases. Studies differentiating benign and malignant PCLs via EUS-FNA were included in this meta-analysis. The quality of diagnostic accuracy studies (QUADAS was adopted to evaluate the selected studies. Pooled sensitivity, specificity, likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristic (sROC curve analyses were conducted. Two main classification types of malignancy were characterized and analyzed. We also generated a subgroup analysis of available clinical factors. Publication bias was evaluated by Begg's and Egger's tests. Results: Sixteen studies containing 1024 subjects have been published. The pooled sensitivity for malignant cytology according to classification 1 was 0.51 (95% CI, 0.45-0.58, and pooled specificity was 0.94 (95% CI, 0.92-0.96. When the detected PCLs were identified as classification 2, suspicious malignancy or potential malignancy, sensitivity and specificity were similar, 0.52 (95% CI, 0.46-0.57 and 0.97 (95% CI, 0.95-0.98 respectively. Conclusion: This meta-analysis demonstrates that EUS-FNA is a reliable clinical tool for the diagnosis of PCLs. However, a more accurate algorithm is needed to reduce various biases and to improve the sensitivity of EUS-FNA in the detection of malignant PCLs.

  7. Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy

    Science.gov (United States)

    Paik, Woo Hyun; Park, Do Hyun; Choi, Jun-Ho; Choi, Joon Hyuk; Lee, Sang Soo; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan; Lee, Jung Bok

    2014-01-01

    AIM: To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS). METHODS: Twenty-eight patients in a prospective case series who underwent EUS-HGS (phase I). Forty-six patients in a matched case-control study (phase II). The simplified technique for fistula dilation was the primary use of a 4 mm balloon catheter with a stainless steel stylet. The stent deployment was modified by deploying the metal stent inside a bile duct (half of the stent) under EUS and fluoroscopic guidance and gently pulling the echoendoscope after full deployment of the stent inside the echoendoscope channel (remaining portion of the stent) under fluoroscopic guidance. This cohort was compared with a matched historical cohort. RESULTS: In phase I, the technical and clinical success with the modified method was 96% (27/28) and 89% (24/27 as per-protocol analysis). The overall adverse event rate was 7%. In phase II, there was no difference in technical and clinical success, stent patency and overall adverse events in each group. However, the procedural time (15.3 ± 5.2 min vs 22.3 ± 6.0 min, P time was shorter and early adverse events were less frequent with our simplified and modified technique. PMID:24803818

  8. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques.

    Science.gov (United States)

    Chen, Yen-I; Kunda, Rastislav; Storm, Andrew C; Aridi, Hanaa Dakour; Thompson, Christopher C; Nieto, Jose; Siddiqui, Ali A; James, Theodore; Irani, Shayan; Bukhari, Majidah; Gutierrez, Olaya Brewer; Agarwal, Amol; Fayad, Lea; Moran, Robert; Alammar, Nuha; Sanaei, Omid; Canto, Marcia I; Singh, Vikesh K; Baron, Todd H; Khashab, Mouen A

    2017-07-24

    Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a developing modality in the management of gastric outlet obstruction (GOO) with several technical approaches including the direct and balloon-assisted techniques. The aim of this study is to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO. Multicenter, retrospective study involving consecutive patients who underwent EUS gastroenterostomy with the direct or balloon-assisted technique for GOO (January 2014-October 2016). The primary outcome is technical success. Secondary outcomes include clinical success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AE). Seventy-seven patients (42.9% female; mean age 63.2 ± 11.5 years) underwent EUS gastroenterostomy for GOO (n=55 DGE and n=22 BAGE). GOO was of malignant and benign etiology in 67.5% and 32.5% of the patients, respectively. Technical success was achieved in 94.5% of the direct and 90.9% of the balloon-assisted approach (p=0.62). Mean procedure time was shorter with the direct technique (35.1±31.2 minutes vs 89.9±33.3 minutes, p<0.001). Clinical success rate was 92.7% for the direct and 90.9% for balloon-assisted modality (p=0.79), with a mean time to oral intake of 1.41±2.75 days. The AE rate was 6.5% with only one severe AE noted. Rate of AE, postprocedure length of stay, need for re-intervention, and survival were similar between the 2 groups. EUS gastroenterostomy is effective and safe in the management of GOO. The direct technique may be the preferred method given its shorter procedure time when compared with balloon-assisted approach. Prospective trials are needed to confirm these findings. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  9. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction.

    Science.gov (United States)

    Chen, Yen-I; Itoi, Takao; Baron, Todd H; Nieto, Jose; Haito-Chavez, Yamile; Grimm, Ian S; Ismail, Amr; Ngamruenphong, Saowanee; Bukhari, Majidah; Hajiyeva, Gulara; Alawad, Ahmad S; Kumbhari, Vivek; Khashab, Mouen A

    2017-07-01

    Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high rates of stent obstruction. EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers sustained patency without tumor ingrowth/overgrowth. The aim of this study is to compare EUS-GE with ES in terms of (1) symptom recurrence and need for re-intervention, (2) technical success (proper stent positioning as determined via endoscopy and fluoroscopy), (3) clinical success (ability to tolerate oral intake without vomiting), and (4) procedure-related adverse events (AEs). Multicenter retrospective study of all consecutive patients who underwent either EUS-GE at four centers between 2013 and 2015 or ES at one center between 2008 and 2010. A total of 82 patients (mean age 66-years ± 13.5 and 40.2% female) were identified: 30 in EUS-GE and 52 in ES. Technical and clinical success was not significantly different: 86.7% EUS-GE versus 94.2% ES (p = 0.2) and 83.3% EUS-GE versus 67.3% ES (p = 0.12), respectively. Symptom recurrence and need for re-intervention, however, was significantly lower in the EUS-GE group (4.0 vs. 28.6%, (p = 0.015). Post-procedure mean length of hospitalization was comparable at 11.3 days ± 6.6 for EUS-GE versus 9.5 days ± 8.3 for ES (p = 0.3). Rates and severity of AEs (as per the ASGE lexicon) were also similar (16.7 vs. 11.5%, p = 0.5). On multivariable analysis, ES was independently associated with need for re-intervention (OR 12.8, p = 0.027). EUS-GE may be ideal for malignant GOO with comparable effectiveness and safety to ES while being associated with fewer symptom recurrence and requirements for re-intervention.

  10. EUS Morphology Is Reliable in Selecting Patients with Mucinous Pancreatic Cyst(s Most Likely to Benefit from Surgical Resection

    Directory of Open Access Journals (Sweden)

    Siddharth Javia

    2017-01-01

    Full Text Available Background and Study Aims. Endoscopic ultrasound (EUS surveillance of patients with mucinous pancreatic cysts relies on the assessment of morphologic features suggestive of malignant transformation. These criteria were derived from the evaluation of surgical pathology in patients with pancreatic cysts who underwent surgery. Reliability of these criteria when evaluated by EUS in identifying lesions which require surgery has still not been established. Patients and Methods. This retrospective cohort study included seventy-eight patients who underwent surgical resection of pancreatic cysts based on EUS-FNA (fine-needle aspiration findings suggestive of mucinous pancreatic cysts with concern for malignancy. Results. Final surgical pathology diagnoses of patients were the following: adenocarcinoma (19, intraductal papillary mucinous neoplasm (IPMN (39, mucinous cystic neoplasm (MCN (13, serous cystadenoma (2, pseudocyst (3, mucinous solid-cystic lesion of indeterminate type (1, and mesenteric cyst (1. Cysts with focal wall thickening ≥ 3 mm (p=0.0008, dilation of pancreatic duct (PD (p=0.0067, and cyst size ≥ 3 cm (p=0.016 had significantly higher risk of adenocarcinoma. None of the patients without any of these morphologic features had cancer. Conclusions. In patients with mucinous pancreatic cyst(s, focal wall thickening, cyst size ≥ 3 cm, and PD dilation as assessed by EUS can help identify advanced mucinous cysts which require surgery and should routinely be evaluated during EUS surveillance.

  11. Optimizing EUS-guided liver biopsy sampling: comprehensive assessment of needle types and tissue acquisition techniques.

    Science.gov (United States)

    Schulman, Allison R; Thompson, Christopher C; Odze, Robert; Chan, Walter W; Ryou, Marvin

    2017-02-01

    EUS-guided liver biopsy sampling using FNA and, more recently, fine-needle biopsy (FNB) needles has been reported with discrepant diagnostic accuracy, in part due to differences in methodology. We aimed to compare liver histologic yields of 4 EUS-based needles and 2 percutaneous needles to identify optimal number of needle passes and suction. Six needle types were tested on human cadaveric tissue: one 19G FNA needle, one existing 19G FNB needle, one novel 19G FNB needle, one 22G FNB needle, and two 18G percutaneous needles (18G1 and 18G2). Two needle excursion patterns (1 vs 3 fanning passes) were performed on all EUS needles. Primary outcome was number of portal tracts. Secondary outcomes were degree of fragmentation and specimen adequacy. Pairwise comparisons were performed using t tests, with a 2-sided P liver biopsy samplings (48 per needle type) were performed. The novel 19G FNB needle had significantly increased mean portal tracts compared with all needle types. The 22G FNB needle had significantly increased portal tracts compared with the 18G1 needle (3.8 vs 2.5, P liver biopsy needle provides superior histologic yield compared with 18G percutaneous needles and existing 19G FNA and core needles. Moreover, the 22G FNB needle may be adequate for liver biopsy sampling. Investigations are underway to determine whether these results can be replicated in a clinical setting. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  12. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology

    DEFF Research Database (Denmark)

    Dumonceau, J-M; Polkowski, M; Larghi, A

    2011-01-01

    -TCB), of submucosal tumors, diffuse esophageal/gastric wall thickening, pancreatic solid masses and cystic-appearing lesions, mediastinal lesions unrelated to lung or esophageal cancer, cancer of the esophagus, stomach, and rectum, lymph nodes of unknown origin, adrenal gland masses, and focal liver lesions. False......-page executive summary of evidence statements and recommendations is provided. A separate Technical Guideline describes the general technique of EUS-guided sampling, particular techniques to maximize the diagnostic yield depending on the nature of the target lesion, and sample processing. The target readership...

  13. Numerical study on microbubble-enhanced heating for various parameters in EUS-FUS

    Science.gov (United States)

    Okita, Kohei; Maezawa, Miyuki; Takagi, Shu; Matsumoto, Yoichiro

    2012-11-01

    Endoscopic ultrasonography guided focused ultrasound surgery (EUS-FUS) have been developed as a less-invasive treatment for pancreatic cancer. In the present study, microbubble-enhanced heating for various parameters in EUS-FUS is investigated numerically. Mass and momentum equations for bubbly mixture are solved to reproduce the propagation of ultrasound of 4.8MHz through the gel containing microbubbles as Sonazoid®. The dynamics of bubble is governed by the equation which considers the elasticity of both shell and surrounding media. Additionally, the heat equation with the time averaged heat source is solved to obtain a temperature distribution. The basic equations are discretized by the 6th-order finite difference method and developed based on FDTD method. The mixture and bubbles are coupled by Euler-Lagrange method. As the results, the temperature around the target increased due to the microbubble oscillation with increasing the initial void fraction fG0 from 10-5 to 10-4%. However, at fG0=10-3%, ultrasounds were too attenuated to heat the target. The heating region moved from the target to the transducer side. By comparing the results with and without shell, the shell of bubble induced the heating around focus. This is because the decrease of the attenuation due to the elasticity of the shell and the increase of the viscous dissipation rate due to the viscosity of the shell.

  14. Eusébio: the construction of a hero in the press

    Directory of Open Access Journals (Sweden)

    João CANAVILHAS

    2015-06-01

    Full Text Available The translation of the football player Eusébio’s body to the National Pantheon was quite controversial in Portugal. The discussion was based on the correctness of having a football player buried in the Pantheon, a place reserved for national heroes. A hero is someone who lives most of the time as the others, but in certain conditions stands to a position of demigod (Rubio, 2001. From that moment, it earns the right to sit in a space reserved for all (pan gods (theos. But how does a football player becomes a god, a sports hero? For his actions, obviously, but mainly by how the media tells the public his exploits. At the time of Eusébio’s death, January 2014 his history had been recovered by the media. Thus an excellent opportunity was presented to study the way journalism has reconstructed the image of a global player whose career was played when football had not the current media coverage. This work studies the news releases published on the day after his death. The hypothesis is that newspapers seek to contextualize semantically the sports phenomenon in a mythological scene. Using content analysis methodology, we tried to find examples of the hero’s construction in a quantitative (repetition of words associated with the universe of the hero and qualitative (discourse to exalt the character analysis.

  15. Comparison of EUS-guided tissue acquisition using two different 19-gauge core biopsy needles: a multicenter, prospective, randomized, and blinded study.

    Science.gov (United States)

    DeWitt, John; Cho, Chang-Min; Lin, Jingmei; Al-Haddad, Mohammad; Canto, Marcia Irene; Salamone, Ashley; Hruban, Ralph H; Messallam, Ahmed A; Khashab, Mouen A

    2015-10-01

    The optimal core biopsy needle for endoscopic ultrasound (EUS) is unknown. The principle aim of this study is to compare outcomes of EUS-fine-needle biopsy (EUS-FNB) with a new 19-gauge EUS histology needle (ProCore, Cook Medical Inc., Winston-Salem, North Carolina, United States) to a conventional 19-gauge Tru-Cut biopsy (EUS-TCB) needle (19G, Quick-Core, Cook Medical Inc.). Patients referred for EUS who require possible histologic biopsy were prospectively randomized to EUS-FNB or EUS-TCB. With the initial needle, ≤ 3 biopsies were obtained until either technical failure or an adequate core was obtained. Patients with suspected inadequate biopsies were crossed over to the other needle and similarly ≤ 3 passes were obtained until adequate cores or technical failure occurred. Technical success, diagnostic histology, accuracy and complication rates were evaluated. Eighty-five patients (mean 58 years; 43 male) were randomized to FNB (n = 44) and TCB (n = 41) with seven patients excluded. Procedure indication, biopsy site, mass size, number of passes, puncture site, overall technical success and adverse events were similar between the two groups. FNB specimens had a higher prevalence of diagnostic histology (85 % vs. 57 %; P = 0.006), accuracy (88 % vs. 62 %; P = 0.02), mean total length (19.4 vs. 4.3 mm; P = 0.001), mean complete portal triads from liver biopsies (10.4 vs. 1.3; P = 0.0004) and required fewer crossover biopsies compared to those of TCB (2 % vs. 65 %; P = 0.0001). Overall technical success and complication rates were comparable. EUS-FNB using a 19-gauge FNB needle is superior to 19-gauge EUS-TCB needle.

  16. Awareness of guidelines and trends in the management of suspected pancreatic cystic neoplasms: survey results among general gastroenterologists and EUS specialists.

    Science.gov (United States)

    Buscaglia, Jonathan M; Shin, Eun Ji; Giday, Samuel A; Kapoor, Sumit; Dunbar, Kerry B; Eloubeidi, Mohamad A; Canto, Marcia I; Jagannath, Sanjay B

    2009-04-01

    Although pancreatic cystic neoplasms are widely recognized, practice habits among physicians and awareness of consensus guidelines are currently unknown. To assess the awareness of guidelines and describe variability in practice habits among 2 groups: (1) "general group" of gastroenterologists and surgeons and (2) "EUS group" of specialists in EUS. An online survey was sent to randomly selected gastroenterologists and surgeons and e-mailed to members of the American Society for Gastrointestinal Endoscopy (ASGE) Special Interest Group in EUS (EUS-SIG). Response rate for the general group was 8.8% (220/2500) and 9.7% for the EUS group (42/431). EUS specialists were mostly in academic practice (66.7% vs 36.3%, P < .001) and reported seeing 21 to 50 cysts per year (54.8% vs 12.3%, P < .001). The majority of the general group (64.1%) was unaware of any published practice guidelines, compared with 33.3% of EUS specialists (P < .001). Awareness of ASGE guidelines was more frequently reported than other guidelines in both groups and yet was still <50% for each group. Both demonstrated moderate consistency with the International Association of Pancreatology guidelines, appropriately answering 66.7% of the questions. For 9-mm lesions, only 25% of the questions were correctly answered in each group. EUS specialists were less likely to refer main-duct intraductal papillary mucinous neoplasms (IPMN) for surgery and more likely to opt for EUS-guided FNA (compared with high-resolution CT, MRCP, or surgery) for 9-mm, 22-mm, and 34-mm branch-duct IPMNs (P EUS specialists. Among all physicians, the greatest variability in practice is in small (<1 cm) lesions.

  17. Extraparietal or lymphatic late relapse of neoplasms: confirmation by means of EUS-FNA key for the treatment.

    Science.gov (United States)

    Ulla-Rocha, Jose Luis; Vilar-Cao, Zenaida; Alvarez-Martinez, Monica; Salgado-Boquete, Laura

    2012-09-01

    After treatment intended to cure systemic neoplasms, a series of monitoring strategies are followed. To analyse our experience in confirming the cases of lymphatic or extraparietal relapse in areas accessible to endoscopic ultrasonography plus fine-needle aspiration (EUS-FNA) in long-term monitoring (>1 year of treatment for the primary neoplasm) and define what implications have been derived with regards histopathological confirmation in relation to treatment. Retrospective analysis was made of all EUS-FNA carried out in our Endoscopy Unit during the period from 1/07/2007 to 28/02/2010 by means of searches in the Endobase (Olympus) database. Medical records of patients and drug therapy were reviewed in order to check the chemotherapy used in each case. From a total of 154 EUS-FNA carried out in our service, we have detected histopathological confirmation of malignancy in primary neoplasm treated with initial curative intention at least 1 year before. Locations were: esophageal extraparietal involvement of a squamous cell carcinoma (one patient), perirectal adenopathy of rectal adenocarcinoma (one patient), multiple lymphatic relapse of melanoma (two patients), perigastric adenopathy relapse of gastric adenocarcinoma (one patient), pancreatic head mass secondary to initial breast ductal carcinoma (one patient). In all cases, this fact has involved a directed treatment: surgery (one patient), radiotherapy (one patient), chemotherapy (four patients). Confirmation by means of EUS-FNA of late relapse in any section of the digestive tract allowed a treatment to be carried out by surgery, radiotherapy, or chemotherapy.

  18. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos).

    Science.gov (United States)

    Romero-Castro, Rafael; Ellrichmann, Mark; Ortiz-Moyano, Carlos; Subtil-Inigo, Jose Carlos; Junquera-Florez, Felix; Gornals, Joan B; Repiso-Ortega, Alejandro; Vila-Costas, Juan; Marcos-Sanchez, Francisco; Muñoz-Navas, Miguel; Romero-Gomez, Manuel; Brullet-Benedi, Enric; Romero-Vazquez, Javier; Caunedo-Alvarez, Angel; Pellicer-Bautista, Francisco; Herrerias-Gutierrez, Juan M; Fritscher-Ravens, Annette

    2013-11-01

    Therapy of gastric varices (GV) is still challenging. Cyanoacrylate (CYA) injection is the recommended treatment for bleeding GV, but has a known adverse event rate, which could be reduced if EUS is used for guidance. Otherwise, EUS-guided coil application (ECA) may be an alternative. To compare CYA and ECA embolization of feeding GV for feasibility, safety, and applicability. Retrospective analysis of a prospectively maintained database. Multicenter study, tertiary referral centers. Thirty consecutive patients with localized GV who received either CYA injection or ECA were included with follow-up for 6 months after treatment. There were 11 patients in the coil group and 19 patients in the CYA group. The GV obliteration rate was 94.7% CYA versus 90.9% ECA; mean number of endoscopy sessions was 1.4 ± 0.1 (range 1-3). Adverse events occurred in 12 of 30 patients (40%) (CYA, 11/19 [57.9%]; ECA, 1/11 [9.1%]; P group) had glue embolism on a CT scan but was asymptomatic. No further adverse events occurred during follow-up. Six patients (20%) died unrelated to the procedures or bleeding. Nonrandomized; EUS expertise necessary. EUS-guided therapy for GV by using CYA or ECA is effective in localized GV. ECA required fewer endoscopies and tended to have fewer adverse events compared with CYA injection. Larger comparative studies are needed to prove these data. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  19. EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles.

    Science.gov (United States)

    Sey, Michael Sai Lai; Al-Haddad, Mohammad; Imperiale, Thomas F; McGreevy, Kathleen; Lin, Jingmei; DeWitt, John M

    2016-02-01

    EUS-guided biopsy of the liver has a variable diagnostic accuracy and specimen adequacy. A new core biopsy needle has been developed that may improve performance. The objective of this study was to compare the diagnostic yield of a new core biopsy needle with the previous standard needle. In this cross-sectional study, consecutive patients who underwent EUS-guided core liver biopsy over a 7-year period for suspected parenchymal disease were prospectively evaluated. Between 2007 and 2011, all biopsies were performed with a 19-gauge Tru-cut biopsy needle (Quick-core [QC]), whereas a novel reverse bevel needle (PC) was used exclusively from 2011 to 2014. All specimens were examined by 1 of 3 experienced, blinded pathologists for the following: presence of visible core, aggregate specimen length, number of complete portal tracts, and specimen adequacy. A total of 75 patients (mean age 51 years, 51 female) underwent liver biopsy by using the QC (n = 45) or PC (n = 30) needle. The QC and PC groups had similar demographics, indications for EUS, indications for liver biopsy, and liver findings on EUS. Compared with those of the QC, biopsies with the PC required fewer passes (median 2 vs 3; P liver biopsy with the QC needle. Compared with the QC needle, EUS-guided core liver biopsy with the PC needle produced longer aggregate length, more complete portal tracts, and more adequate specimens despite fewer passes (Clinical trial registration number: NCT00586313.). Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  20. Differentiation of pancreatic cancer and chronic pancreatitis using computer-aided diagnosis of endoscopic ultrasound (EUS) images: a diagnostic test.

    Science.gov (United States)

    Zhu, Maoling; Xu, Can; Yu, Jianguo; Wu, Yijun; Li, Chunguang; Zhang, Minmin; Jin, Zhendong; Li, Zhaoshen

    2013-01-01

    Differentiating pancreatic cancer (PC) from normal tissue by computer-aided diagnosis of EUS images were quite useful. The current study was designed to investigate the feasibility of using computer-aided diagnostic (CAD) techniques to extract EUS image parameters for the differential diagnosis of PC and chronic pancreatitis (CP). This study recruited 262 patients with PC and 126 patients with CP. Typical EUS images were selected from the sample sets. Texture features were extracted from the region of interest using computer-based techniques. Then the distance between class algorithm and sequential forward selection (SFS) algorithm were used for a better combination of features; and, later, a support vector machine (SVM) predictive model was built, trained, and validated. Overall, 105 features of 9 categories were extracted from the EUS images for pattern classification. Of these features, the 16 were selected as a better combination of features. Then, SVM predictive model was built and trained. The total cases were randomly divided into a training set and a testing set. The training set was used to train the SVM, and the testing set was used to evaluate the performance of the SVM. After 200 trials of randomised experiments, the average accuracy, sensitivity, specificity, the positive and negative predictive values of pancreatic cancer were 94.2±0.1749%,96.25±0.4460%, 93.38±0.2076%, 92.21±0.4249% and 96.68±0.1471%, respectively. Digital image processing and computer-aided EUS image differentiation technologies are highly accurate and non-invasive. This technology provides a kind of new and valuable diagnostic tool for the clinical determination of PC.

  1. Molecular Analysis of Vascular Endothelial Growth Factor (VEGF) Receptors in EUS-guided Samples Obtained from Patients with Pancreatic Adenocarcinoma.

    Science.gov (United States)

    Costache, Madalin Ionut; Iordache, Sevastita; Costache, Cornelia Alexandra; Dragos, Ene; Dragos, Alexandru; Saftoiu, Adrian

    2017-03-01

    Vascular endothelial growth factor (VEGF) and its receptors (VEGF-R1 and VEGF-R2) are the most important angiogenesis stimulating factors in pancreatic cancer. This study aims to assess VEGF-R1 and VEGF-R2 gene expression in EUS-FNA samples and identify prognostic markers in pancreatic adenocarcinoma. This was a retrospective study of prospectively collected data of 88 consecutive patients, with clinical and imaging suspicion of pancreatic neoplasms, based on samples obtained through endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS had an accuracy of 93.2% for the diagnosis of pancreatic cancer. Based on real-time qPCR analysis, VEGF-R1 and VEGF-R2 expressions were present in 90% and 65% of the analysed malignant samples, respectively; 89% of the patients died during the study, with a median survival rate of only 9 months. The survival was correlated with the initial stage and with the presence of VEGF-R1 and VEGF-R2 gene expression. We found that there are significant correlations between death/survival and T stage, N stage, resectability status, VEGF-R1, VEGF-R2 and VEGF-R1/VEGF-R2 coexpression. Using a Cox model regression our study demonstrates that VEGF-R1/VEGF-R2 coexpression might be considered as a poor prognostic factor in pancreatic cancer. EUS is a very effective technique for the diagnosis and staging of pancreatic adenocarcinoma in patients with clinical and imaging suspicion of pancreatic neoplasm, with an accuracy of 93.2%. Furthermore, the role of molecular analysis of EUS-guided FNA samples was established by the assessment of VEGF-R1, VEGF-R2 gene expression, which might be considered prognostic markers in pancreatic cancer.

  2. Usefulness of {sup 18}F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: A meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Tang Shuang [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Huang Gang, E-mail: huang2802@163.com [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Liu Jianjun [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Liu Tao [Department of Orthopedics, Soochow University, Suzhou (China); Treven, Lyndal [Faculty of Public Health, University of Sydney, Sydney (Australia); Song Saoli; Zhang Chenpeng; Pan Lingling [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Zhang Ting [Department of Anesthesiology, Renji Hospital, Shanghai (China)

    2011-04-15

    The aim was to evaluate the diagnostic value of {sup 18}F-fluorodeoxyglucose-positron emission tomography ({sup 18}F-FDG PET), combined {sup 18}F-fluorodeoxyglucose-positron emission tomography/computed tomography ({sup 18}F-FDG PET/CT) and endoscopic ultrasonography (EUS) in diagnosing patients with pancreatic carcinoma. MEDLINE, EMBASE, Cochrane library and some other databases, from January 1966 to April 2009, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of {sup 18}F-FDG PET, PET/CT and EUS for patients with pancreatic cancer were collected. Methodological quality was assessed. The statistic software called 'Meta-Disc 1.4' was used for data analysis. Results: 51 studies were included in this meta-analysis. The pooled sensitivity estimate for combined PET/CT (90.1%) was significantly higher than PET (88.4%) and EUS (81.2%). The pooled specificity estimate for EUS (93.2%) was significantly higher than PET (83.1%) and PET/CT (80.1%). The pooled DOR estimate for EUS (49.774) was significantly higher than PET (32.778) and PET/CT (27.105). SROC curves for PET/CT and EUS showed a little better diagnostic accuracy than PET alone. For PET alone, when interpreted the results with knowledge of other imaging tests, its sensitivity (89.4%) and specificity (80.1%) were closer to PET/CT. For EUS, its diagnostic value decreased in differentiating pancreatic cancer for patients with chronic pancreatitis. In conclusion, PET/CT was a high sensitive and EUS was a high specific modality in diagnosing patients with pancreatic cancer. PET/CT and EUS could play different roles during different conditions in diagnosing pancreatic carcinoma.

  3. Metastatic renal cell carcinoma from a native kidney of a renal transplant patient diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy.

    Science.gov (United States)

    Alastal, Yaseen; Hammad, Tariq A; Rafiq, Ehsan; Nawras, Mohamad; Alaradi, Osama; Nawras, Ali

    2015-01-01

    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy sampling of enlarged lymph nodes is increasingly used to diagnose metastatic tumors, especially of the gastrointestinal tract and the lungs. Herein, we describe the diagnosis of metastatic renal cell carcinoma from a native kidney of a 54 year-old male patient, who had a 5-years history of renal transplant, by EUS-FNA of mediastinal and celiac lymph nodes. Histological and immunohistochemical findings confirmed the origin of metastatic tumor. EUS-FNA with proper cytological evaluation can be useful in the diagnosis of metastatic renal cell carcinoma in renal transplant patients.

  4. Metastatic renal cell carcinoma from a native kidney of a renal transplant patient diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA biopsy

    Directory of Open Access Journals (Sweden)

    Yaseen Alastal

    2015-04-01

    Full Text Available Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA biopsy sampling of enlarged lymph nodes is increasingly used to diagnose metastatic tumors, especially of the gastrointestinal tract and the lungs. Herein, we describe the diagnosis of metastatic renal cell carcinoma from a native kidney of a 54 year-old male patient, who had a 5-years history of renal transplant, by EUS-FNA of mediastinal and celiac lymph nodes. Histological and immunohistochemical findings confirmed the origin of metastatic tumor. EUS-FNA with proper cytological evaluation can be useful in the diagnosis of metastatic renal cell carcinoma in renal transplant patients. 

  5. Ultrasound techniques in the evaluation of the mediastinum, part I: endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques

    NARCIS (Netherlands)

    Dietrich, Christoph Frank; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin Wu; Borst, Mathias Maximilian; Jenssen, Christian

    2015-01-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and

  6. EUS-FNA for a Pancreatic Neuroendocrine Tumor in a Four-Year-Old Daughter of a Woman Exposed to Radiation at Chernobyl

    Science.gov (United States)

    Lachter, Jesse; Arkovitz, Marc S.; Postovski, Sergey; Waldner, Julian M.; Shaoul, Ron; Ishay, Offir Ben; Kluger, Yoram

    2012-01-01

    Pancreatic neoplasms in children are rare. Herein is reported the case of a four-year-old girl whose mother was exposed to radiation at Chernobyl that presented with obstructive jaundice and a mass suspected on CT and diagnosed by endoscopic ultrasound (EUS) with fine needle aspiration (FNA). This child is probably the youngest case of application of linear EUS with biopsy to be described. The diagnosis, management, and followup of children with this rare tumor are discussed. PMID:22762002

  7. EUS-FNA for a Pancreatic Neuroendocrine Tumor in a Four-Year-Old Daughter of a Woman Exposed to Radiation at Chernobyl

    Directory of Open Access Journals (Sweden)

    Jesse Lachter

    2012-01-01

    Full Text Available Pancreatic neoplasms in children are rare. Herein is reported the case of a four-year-old girl whose mother was exposed to radiation at Chernobyl that presented with obstructive jaundice and a mass suspected on CT and diagnosed by endoscopic ultrasound (EUS with fine needle aspiration (FNA. This child is probably the youngest case of application of linear EUS with biopsy to be described. The diagnosis, management, and followup of children with this rare tumor are discussed.

  8. EUS-FNA for a Pancreatic Neuroendocrine Tumor in a Four-Year-Old Daughter of a Woman Exposed to Radiation at Chernobyl.

    Science.gov (United States)

    Lachter, Jesse; Arkovitz, Marc S; Postovski, Sergey; Waldner, Julian M; Shaoul, Ron; Ishay, Offir Ben; Kluger, Yoram

    2012-01-01

    Pancreatic neoplasms in children are rare. Herein is reported the case of a four-year-old girl whose mother was exposed to radiation at Chernobyl that presented with obstructive jaundice and a mass suspected on CT and diagnosed by endoscopic ultrasound (EUS) with fine needle aspiration (FNA). This child is probably the youngest case of application of linear EUS with biopsy to be described. The diagnosis, management, and followup of children with this rare tumor are discussed.

  9. Preoperative diagnosis of a mediastinal granular cell tumor by EUS-FNA: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Bean Sarah M

    2005-06-01

    Full Text Available Abstract We report the first case of a posterior mediastinal granular cell tumor initially diagnosed on cytologic material obtained via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA in a 51-year-old male with a prior history of colon cancer. Aspirates obtained were cellular and composed of polygonal cells with abundant granular cytoplasm and small, round dark nuclei. An immunoperoxidase stain performed on the cell block for antibodies to S-100 protein showed strong, diffuse staining of the cytoplasmic granules. Electron microscopy performed on the cell block revealed numerous cytoplasmic lysosomes. This is the first case report in the English literature of a definitive preoperative diagnosis of a mediastinal granular cell tumor utilizing material obtained via EUS-FNA.

  10. A new descriptor for computer-aided diagnosis of EUS imaging to distinguish autoimmune pancreatitis from chronic pancreatitis.

    Science.gov (United States)

    Zhu, Jianwei; Wang, Lei; Chu, Yining; Hou, Xiaojia; Xing, Ling; Kong, Fanyang; Zhou, Yinghuo; Wang, Yuanyuan; Jin, Zhendong; Li, Zhaoshen

    2015-11-01

    Computer-aided diagnosis of EUS images was quite useful in differentiating pancreatic cancer from normal tissue and chronic pancreatitis. This study investigated the feasibility of using computer-aided diagnostic techniques to extract EUS image parameters to distinguish autoimmune pancreatitis from chronic pancreatitis. A new descriptor, local ternary pattern variance, was introduced to improve the performance of the classification model. Patients with autoimmune pancreatitis (n = 81) or chronic pancreatitis (n = 100) were recruited for this study. Representative EUS images were selected, and 115 parameters from 10 categories were extracted from the region of interest. Distance-between-class and sequential forward selection algorithms were used for their ideal combination of features that allowed a support vector machine predictive model to be built, trained, and validated. The accuracy, sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were used to evaluate the performance of experimental results. Fourteen parameters from 3 categories were selected as an ideal combination of features. The sample set was randomly divided into a training set and a testing set by using two different algorithms-the leave-one-out algorithm and the half-and-half method. The half-and-half method yielded an average (± standard deviation) accuracy of 89.3 ± 2.7%, sensitivity of 84.1 ± 6.4%, specificity of 92.5 ± 3.3%, PPV of 91.6 ± 3.7%, and NPV of autoimmune pancreatitis of 88.0 ± 4.1%. This study shows that, with the local ternary pattern variance textural feature, computer-aided diagnosis of EUS imaging may be valuable to differentiate autoimmune pancreatitis from chronic pancreatitis. Further refinement of such models could generate tools for the clinical diagnosis of autoimmune pancreatitis. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  11. The value of EUS in predicting the response of gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication.

    Science.gov (United States)

    El-Zahabi, Lara M N; Jamali, Faek R; El-Hajj, Ihab I; Naja, Mohammed; Salem, Ziad; Shamseddine, Ali; El-Saghir, Nagi S; Zaatari, Ghazi; Geara, Fady; Soweid, Assaad M

    2007-01-01

    Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is associated with Helicobacter pylori infection, and regression of the tumor has been described after its eradication. To determine the value of EUS, in addition to other clinical/endoscopic features, in predicting the response of low-grade MALT lymphoma to H pylori eradication. A retrospective, single-center study. Twenty-two patients with primary gastric MALT lymphoma were identified through a retrospective review of charts of patients seen at the American University of Beirut Medical Center. Only 19 patients with histopathologically confirmed gastric MALT lymphoma and H pylori infection who had EUS staging were included in the study. Regression of the gastric MALT lymphoma as determined by follow-up endoscopy and mucosal biopsies. Patients with disease restricted to the gastric mucosa had a significantly higher rate of complete remission after H pylori eradication compared with patients who had disease infiltrating into the gastric submucosa (77.8% vs 12.5%, P value .007). There was no statistical difference in terms of the mean follow-up time to achieve such response (P value .212). Age, sex, location of the tumor within the stomach, and endoscopic appearance did not correlate with the probability of complete remission of the MALT lymphoma. The limitations include a retrospective design and a relatively small sample population. EUS determination of the invasion depth of gastric MALT lymphoma helps predict a complete response to H pylori eradication.

  12. Comparison of the diagnostic performance of 2 core biopsy needles for EUS-guided tissue acquisition from solid pancreatic lesions.

    Science.gov (United States)

    Nayar, Manu K; Paranandi, Bharat; Dawwas, Muhammad F; Leeds, John S; Darne, Antony; Haugk, Beate; Majumdar, Debasis; Ahmed, Muna M; Oppong, Kofi W

    2017-05-01

    A new core biopsy needle with a novel tip, opposing bevel, and sheath design has recently been introduced for EUS-guided fine-needle biopsy (FNB). The diagnostic utility of this needle for differentiating solid pancreatic masses is currently unknown. The aim of this study was to compare the diagnostic performance and yield for tissue acquisition from solid pancreatic lesions of the opposing bevel needle with those of a reverse bevel EUS-FNB needle. Consecutive patients with solid pancreatic masses undergoing EUS-FNB using the opposing bevel (n = 101) and the reverse bevel (n = 100) core biopsy needles were included in the study. Final diagnosis was based on positive histology or at least 12 months of follow-up in cases with a negative biopsy. The primary outcome was the diagnostic performance of the 2 needles for malignant pancreatic masses. A secondary outcome was the diagnostic yield. Compared with the reverse bevel needle, using strict criteria the opposing bevel needle provided significantly higher sensitivity (71.1% vs 90.1%; P = .0006) and overall accuracy (74% vs 92%; I = 0.0006) for discriminating malignant from benign solid pancreatic masses. The proportion of samples classified as adequate for histologic analysis was 87% for the reverse bevel needle versus 99% for the opposing bevel needle (p = 0.002) Multivariate analysis controlling the needle gauge and site did not show any significant difference in accuracy and sensitivity between the 2 groups. There were no adverse events in either group. In this first, large, single-center preliminary cohort study, an EUS core biopsy needle with a novel tip, opposing bevel, and sheath design afforded substantially superior tissue yield and diagnostic performance compared with a reverse-bevel needle. If replicated by randomized controlled trials, our findings suggest that similarly designed needles could become the standard of care for EUS-guided tissue acquisition from solid pancreatic masses. Crown Copyright

  13. Fluorescence cytology with 5-aminolevulinic acid in EUS-guided FNA as a method for differentiating between malignant and benign lesions (with video).

    Science.gov (United States)

    Ikeura, Tsukasa; Takaoka, Makoto; Uchida, Kazushige; Shimatani, Masaaki; Miyoshi, Hideaki; Kato, Kota; Ohe, Chisato; Uemura, Yoshiko; Kaibori, Masaki; Kwon, A-Hon; Okazaki, Kazuichi

    2015-01-01

    EUS-guided FNA (EUS-FNA) has been increasingly performed to obtain specimens for the pathological evaluation of patients with GI and pancreaticobiliary masses as well as lymphadenopathies of unknown origin. Photodynamic diagnosis by using 5-aminolebulinic acid (ALA) has been reported to be useful for enabling the visual differentiation between malignant and normal tissue in various cancers. To evaluate the diagnostic accuracy of fluorescence cytology with ALA in EUS-FNA. A prospective study. A single center. A total of 28 consecutive patients who underwent EUS-FNA for the pathological diagnosis of a pancreaticobiliary mass lesion or intra-abdominal lymphadenopathy of unknown origin. Patients were orally administered ALA 3 to 6 hours before EUS-FNA. The sample was obtained via EUS-FNA for fluorescence cytology and conventional cytology. A single gastroenterologist performed the fluorescence cytology by using fluorescence microscopy after the procedure, independently of the conventional cytology by pathologists. The accuracy of fluorescence cytology with ALA in the differentiation between benign and malignant lesions by comparing the results of fluorescence cytology with the final diagnosis. Of the 28 patients included in the study, 22 were considered as having malignant lesions and 6 patients as having benign lesions. Fluorescence cytology could correctly discriminate between benign and malignant lesions in all patients. Therefore, both the sensitivity and specificity of fluorescence cytology were 100% in our study. Fluorescence cytology was performed by only 1 gastroenterologist with a small number of patients. Fluorescence cytology with ALA in EUS-FNA may be an effective and simple method for differentiating between benign and malignant lesions. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  14. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes: experience from region with high prevalence of tuberculosis.

    Science.gov (United States)

    Manucha, Varsha; Kaur, Gagandeep; Verma, Kusum

    2013-12-01

    Utility of EUS-FNA in diagnosing granulomatous lesions of mediastinum in regions with high prevalence of tuberculosis has not yet been evaluated. In the present study, utility and limitations of EUS-FNA of mediastinal lesions from a tertiary care center with high prevalence of tuberculosis were studied. All cases where EUS-FNA had been performed to diagnose mediastinal lymphadenopathy from January 2006 to December 2008 were retrieved from the files of cytopathology laboratory. These were reviewed by the cytopathologist. Two hundred and eighty one EUS-FNA aspirates from 269 patients were evaluated. Satisfactory aspirates were available in 259 cases. A cytological diagnosis of granulomatous lymphadenitis was rendered in 206 cases. Of these, tuberculosis could be established as an etiology in 76 cases and sarcoidosis in 7 cases only. In remaining 123 cases the etiology of granulomatous lymphadenitis could not be established and clinical correlation was suggested. Malignancies were diagnosed or suspected in 24 and 5 cases, respectively. The study highlights that the dilemma of tuberculosis versus sarcoidosis persists in regions with high prevalence of tuberculosis. However, EUS-FNA is useful in diagnosing unsuspected malignancies and confirming the presence of granulomatous lymphadenitis. Copyright © 2011 Wiley Periodicals, Inc., A Wiley Company.

  15. Haematological changes in South Indian fresh water murrel, Channa punctatus have both EUS and A. hydrophila infection.

    Science.gov (United States)

    Podeti, Koteshwar Rao; Benarjee, G

    2017-06-01

    The mixed infection in fishes is a common feature and in this Pathogens like Bacteria, Fungi and Protozoan's are found together to cause ill health to the fishes known as Epizootic Ulcerative Syndrome (EUS). In this syndrome the low temperature and aquatic pollution aggravates the infection in fishes. In the present study the fresh water edible fish, Channa punctatus (Murrel) was found infected with the bacteria namely, Aeromonas hydrophila, Staphylococcus aureus, Pseudomonas aeruginosa and Salmonella salmonicida. The fungi, Aphanomyces invadans was also found. The major objective of this study is to understand the microbial intensity in various organs of fish and hematological variations in both control and EUS infected fish. The highest microbial load of 8.2 ± 0.12 × 107 cfu g-1was observed in the skin where as the lowest load of 3.2 ± 0.8 × 103 cfu g-1 was found in the pancreas. From the microbial diagnosis, A. hydrophila has been isolated from different organs indicating its predominant presence. In comparison with the control the haemotological indices like WBC, MCV, Lymophocytes, Eosinophils and Basophils were found increased in the infected by (17 %), (16 %), (5 %), (58 %) and (27 %) respectively. The variations in microbial load found in fish in the study can be attributed to feeding habits, behavior, fish adaptations among the different fish species. These conditions are being caused by the presence of environmental pollution and are high in heavy native fishes. Thus the results showed that low of Haemoglobin value Packed Cell Volume and Red Blood Corpuscles indicated the presence of anemic conditions in the EUS infected fish found in Warangal.

  16. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP.

    Science.gov (United States)

    Kunda, Rastislav; Pérez-Miranda, Manuel; Will, Uwe; Ullrich, Sebastian; Brenke, Dirk; Dollhopf, Markus; Meier, Michelle; Larghi, Alberto

    2016-11-01

    A novel lumen-apposing, self-expanding metal stent to perform EUS-guided drainage procedures has been recently developed. The aim of this study was to analyze the safety, technical and clinical effectiveness of this device for EUS-guided choledochoduodenostomy (EUS-CD) with palliative intent. Retrospective analysis of all consecutive patients with unresectable malignant distal bile duct obstruction who, between March 2012 and September 2014, underwent EUS-CD using the study devices (AXIOS™ and Hot AXIOS™, Xlumena Inc., Mountain View, CA, USA) after unsuccessful ERCP in seven European centers was carried out. Fifty-seven patients (M/F 31/26; median age 73) underwent EUS-CD using the AXIOS™ stent or the Hot AXIOS™ delivery system. ERCP failure was due to duodenal obstruction in 41 patients (71.9 %) and to inability to cannulate the papilla in the remaining 16 patients (28.1 %). The procedure was technically successful in 56/57 patients (98.2 %), with a mean procedural time of 22.4 min (range 11-65). Clinical success was achieved in 54 of these 56 patients (96.4 %; 94.7 % of the entire cohort). Overall major procedural complication rate was 7 % (two duodenal perforations, one bleeding and one transient cholangitis). During follow-up, 5 out of 54 (9.3 %) patients with clinica success required re-intervention for stent migration in one case and a sump syndrome with transient increase in serum bilirubin concentrations with sludge in the distal duct reservoir in the remaining four patients. Our study shows that EUS-CD using the AXIOS™ and the Hot AXIOS™ devices is a safe procedure, with high technical and clinical success rates.

  17. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017.

    Science.gov (United States)

    Polkowski, Marcin; Jenssen, Christian; Kaye, Philip; Carrara, Silvia; Deprez, Pierre; Gines, Angels; Fernández-Esparrach, Gloria; Eisendrath, Pierre; Aithal, Guruprasad P; Arcidiacono, Paolo; Barthet, Marc; Bastos, Pedro; Fornelli, Adele; Napoleon, Bertrand; Iglesias-Garcia, Julio; Seicean, Andrada; Larghi, Alberto; Hassan, Cesare; van Hooft, Jeanin E; Dumonceau, Jean-Marc

    2017-10-01

    For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the

  18. EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study.

    Science.gov (United States)

    Khashab, Mouen A; El Zein, Mohamad H; Sharzehi, Kaveh; Marson, Fernando P; Haluszka, Oleh; Small, Aaron J; Nakai, Yousuke; Park, Do Hyun; Kunda, Rastislav; Teoh, Anthony Y; Peñas, Irene; Perez-Miranda, Manuel; Kumbhari, Vivek; Van der Merwe, Schalk; Artifon, Everson L; Ross, Andrew S

    2016-12-01

    Background and study aims: How enteroscopy-assisted ERCP (e-ERCP) and endoscopic ultrasound-guided biliary drainage (EUS-BD) compare in patients with surgically altered upper gastrointestinal anatomy is currently unknown. The aims of this study were to compare efficacy and safety of both techniques and study predictors of these outcomes. Patients and methods: This was an international, multicenter comparative cohort study at 10 tertiary centers. Outcomes data included technical success (biliary access with cholangiography and stent placement [when indicated]), clinical success (resolution of biliary obstruction) and adverse events (AEs) (graded according to the ASGE lexicon). Results: A total of 98 patients underwent EUS-BD (n = 49) or e-ERCP (n = 49). Technical success was achieved in 48 (98 %) patients in the EUS-BD group as compared to 32 (65.3 %) patients in the e-ERCP group (OR 12.48, P = 0.001). Clinical success was attained in 88 % of patients in EUS-BD group as compared to 59.1 % in the e-ERCP group (OR 2.83, P = 0.03). Procedural time was significantly shorter in the EUS-BD group (55 min vs 95 min, P < 0.0001). AEs occurred more commonly in the EUS-BD group (20 % vs. 4 %, P = 0.01). However, the majority (90 %) of AEs were mild/moderate. Length of stay was significantly longer in the EUS-BD group (6.6 d vs. 2.4 d, P < 0.0001). Conclusions: EUS-BD can be performed with a higher degree of clinical efficacy and shorter procedure time than e-ERCP in patients with surgically-altered upper gastrointestinal anatomy. Whether or not this approach should be first-line therapy in this patient population is highly dependent on the indication for the procedure, the patient's anatomy, and local practice and expertise.

  19. Understanding of the giant enhancement of the exchange interaction in Bi2Se3-EuS heterostructure.

    Science.gov (United States)

    Kim, Jeongwoo; Kim, Kyoung-Whan; Wang, Hui; Sinova, Jairo; Wu, Ruqian

    We study the unusual magnetic behaviors of EuS-Bi2Se3, such as the enhancement of magnetic ordering, change of magnetic anisotropy and induced magnetic moments, based on the model Hamiltonian and the first-principles calculations. The interplay between topological surfaces states and the magnetic proximity of EuS strengthens the interfacial magnetic ordering and produces large magnetic anisotropy at the interface. Moreover, we find that the magnetic moments at the interfacial EuS and Bi2Se3 layers by the proximity effect are not as dramatically enhanced as reported before. Our results provide the understanding of the unresolved interfacial magnetism and should be useful for the design of novel magnetic materials that involve topological materials. Work was supported as part of the SHINES, an Energy Frontier Research Center funded by the U.S. Department of Energy, Office of Science, Basic Energy Sciences, under Grant No. SC0012670. Calculations were performed on parallel computers at NERSC supercomputer centers.

  20. Mucin (MUC) expression in EUS-FNA specimens is a useful prognostic factor in pancreatic ductal adenocarcinoma

    Science.gov (United States)

    Higashi, Michiyo; Yokoyama, Seiya; Yamamoto, Takafumi; Goto, Yuko; Kitazono, Ikumi; Hiraki, Tsubasa; Taguchi, Hiroki; Hashimoto, Shinichi; Fukukura, Yoshihiko; Koriyama, Chihaya; Mataki, Yuko; Maemura, Kosei; Shinchi, Hiroyuki; Jain, Maneesh; Batra, Surinder K.; Yonezawa, Suguru

    2015-01-01

    Objectives The aim of this study was to further examine the utility of mucin expression profiles as prognostic factors in PDAC. Methods Mucin (MUC) expression was examined by immunohistochemistry (IHC) analysis in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) specimens obtained from 114 patients with PDAC. The rate of expression of each mucin was compared with clinicopathologic features. Results The expression rates of mucins in cancer lesions were MUC1, 87.7%; MUC2, 0.8%; MUC4, 93.0%; MUC5AC, 78.9%; MUC6, 24.6%; and MUC16, 67.5%. MUC1 and MUC4 were positive and MUC2 was negative in most PDACs. Patients with advanced stage of PDAC with MUC5AC expression had a significantly better outcome than those who were MUC5AC-negative (P=0.002).With increasing clinical stage, total MUC6 expression decreased (P for trend=0.001) and MUC16 cytoplasmic expression increased (P for trend=0.02). The prognosis of patients with MUC16 cytoplasmic expression was significantly poorer than those without this expression. Multivariate survival analysis revealed that MUC16 cytoplasmic expression was a significant independent predictor of a poor prognosis after adjusting for the effects of other prognostic factors (P=0.002). Conclusion Mucin expression profiles in EUS-FNA specimens have excellent diagnostic utility and are useful predictors of outcome in patients with PDAC. PMID:25906442

  1. The clinical efficacy and safety of EUS-FNA for diagnosis of mediastinal and abdominal solid tumors – A single center experience

    Directory of Open Access Journals (Sweden)

    Sheng-Shun Yang

    2015-06-01

    Conclusion: EUS-FNA appears to be a very useful tool for obtaining tissue diagnosis for lesions that are inaccessible by the conventional methods and was shown to be a safe and effective technique in the hands of experienced operators. Pathological diagnosis can be obtained for the guidance of clinical management to avoid the more invasive ways, such as surgery or mediastinal scope.

  2. Atypical cytologic diagnostic category in EUS-FNA of the pancreas: follow-up, outcomes, and predictive models.

    Science.gov (United States)

    Alston, Evan; Bae, Sejong; Eltoum, Isam A

    2014-06-01

    The objective of this study was to assess how atypical diagnostic category (ADC) is followed up, its outcomes, and the predictors that are associated with subsequent diagnosis of neoplasm/malignancy. We reviewed pancreatic endoscopic ultrasound fine-needle aspiration (EUS-FNA) with ADC and compared the rate of detection of neoplasms after a repeat FNA, a biopsy/resection, or a clinical follow-up following ADC. Logistic regression was used to determine the factors associated with the diagnosis of a neoplastic or a malignant lesion following ADC. Predictive probability for each case was calculated on the basis of the significant predictors, and whether it improved diagnostic performance was assessed. Of 3832 cases that received pancreatic EUS-FNAs, 187 (4.9%) were ADC. A total of 93 neoplasms (55%), including 61 carcinomas (36%), were detected after an atypical cytologic diagnosis. Similar rates of detecting neoplasms were observed after repeat FNA or biopsy/resection but higher than after clinical follow-up. The presence of a mass, history of alcohol use, and absence of a history of pancreatitis were significant predictors of a higher rate of diagnosis of neoplasm. Weight loss and bile flow obstruction were more likely to be associated with higher rates of carcinoma. Predictive probability demonstrated a wide range of risk and changed the ambiguous diagnosis to informative in 30% of cases. ADC of pancreas is associated with a high risk of benign and malignant neoplasms regardless of the method of follow-up. The presences of a mass, alcohol use, and absence of a history of pancreatitis are significant predictors of a diagnosis of neoplasm, whereas weight loss and bile duct obstruction are significant predictors of ductal carcinoma following an ADC. © 2013 American Cancer Society.

  3. The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: a meta-analysis of prospective studies.

    Science.gov (United States)

    Fuccio, Lorenzo; Hassan, Cesare; Laterza, Liboria; Correale, Loredana; Pagano, Nico; Bocus, Paolo; Fabbri, Carlo; Maimone, Antonella; Cennamo, Vincenzo; Repici, Alessandro; Costamagna, Guido; Bazzoli, Franco; Larghi, Alberto

    2013-10-01

    Differential diagnosis of pancreatic solid masses with EUS-guided FNA (EUS-FNA) is still challenging in about 15% of cases. Mutation of the K-ras gene is present in over 75% of pancreatic adenocarcinomas (PADC). To assess the accuracy of K-ras gene mutation analysis for diagnosing PADC. We systematically searched the electronic databases for relevant studies published. Data from selected studies underwent meta-analysis by use of a bivariate model providing a pooled value for sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve. Meta-analysis of 8 prospective studies. Total of 931 patients undergoing EUS-FNA for diagnosis of pancreatic solid masses. K-ras mutation analysis. Diagnostic accuracy of K-ras mutation analysis and of combined diagnostic strategy by using EUS-FNA and K-ras mutation analysis in the diagnosis of PADC. The pooled sensitivity of EUS-FNA for the differential diagnosis of PADC was 80.6%, and the specificity was 97%. Estimated sensitivity and specificity were 76.8% and 93.3% for K-ras gene analysis, respectively, and 88.7% and 92% for combined EUS-FNA plus K-ras mutation analysis. Overall, K-ras mutation testing applied to cases that were inconclusive by EUS-FNA reduced the false-negative rate by 55.6%, with a false-positive rate of 10.7%. Not repeating EUS-FNA in cases in which mutation testing of the K-ras gene is inconclusive would reduce the repeat-biopsy rate from 12.5% to 6.8%. Small number of studies and between-study heterogeneity. K-ras mutation analysis can be useful in the diagnostic work-up of pancreatic masses, in particular when tissue obtained by EUS-FNA is insufficient, and the diagnosis inconclusive. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  4. EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device.

    Science.gov (United States)

    Dollhopf, Markus; Larghi, Alberto; Will, Uwe; Rimbaş, Mihai; Anderloni, Andrea; Sanchez-Yague, Andres; Teoh, Anthony Yuen Bun; Kunda, Rastislav

    2017-10-01

    In high-risk surgical patients, the treatment of choice of acute cholecystitis is percutaneous transhepatic gallbladder drainage (PTGBD). Recently, a novel endoscopic device containing a lumen-apposing metal stent with an electrocautery (ECE-LAMS) on the tip has been developed. High-risk surgical patients with acute cholecystitis who underwent EUS-guided gallbladder drainage (EUS-GBD) with the novel device were retrospectively retrieved from 7 tertiary care referral centers. Main endpoints were technical and clinical success rates, rate of procedural adverse events, and short- and long-term adverse events. Seventy-five patients (mean age, 75 ± 11 years; 36 men) underwent EUS-GBD. The procedure was technically and clinically successful in 98.7% and 95.9% of cases, respectively. Three patients without resolution of cholecystitis died, and 2 patients had procedure-related adverse events: 1 perforation requiring surgery and 1 major bleeding resolved conservatively. The mean follow-up for the entire cohort was 201 ± 226 days. Seven patients (9.6%) died within the first 30 days; 50 patients (71.4%) were alive at the last date of follow-up. Short- and long-term adverse events occurred in 6 patients: 3 had recurrent cholecystitis, 2 had migration of the stent, and 1 developed Bouveret syndrome, all managed nonsurgically. Overall, 8 adverse events (10.7%) occurred in the entire cohort of patients. The novel ECE-LAMS for high-risk surgical patients with acute cholecystitis is safe, with a high technical and clinical success rate. Future multicenter studies comparing EUS-GBD versus PTGBD are warranted to determine which procedure is safer and clinically more effective for patients with high surgical risk acute cholecystitis. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  5. Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study.

    Science.gov (United States)

    Yang, Dennis; Amin, Sunil; Gonzalez, Susana; Mullady, Daniel; Hasak, Stephen; Gaddam, Srinivas; Edmundowicz, Steven A; Gromski, Mark A; DeWitt, John M; El Zein, Mohamad; Khashab, Mouen A; Wang, Andrew Y; Gaspar, Jonathan P; Uppal, Dushant S; Nagula, Satish; Kapadia, Samir; Buscaglia, Jonathan M; Bucobo, Juan Carlos; Schlachterman, Alex; Wagh, Mihir S; Draganov, Peter V; Jung, Min Kyu; Stevens, Tyler; Vargo, John J; Khara, Harshit S; Huseini, Mustafa; Diehl, David L; Keswani, Rajesh N; Law, Ryan; Komanduri, Srinadh; Yachimski, Patrick S; DaVee, Tomas; Prabhu, Anoop; Lapp, Robert T; Kwon, Richard S; Watson, Rabindra R; Goodman, Adam J; Chhabra, Natasha; Wang, Wallace J; Benias, Petros; Carr-Locke, David L; DiMaio, Christopher J

    2016-04-01

    The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution. This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression. A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P = .0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P = .23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P = .37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P = .61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P = .79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P = .03). TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  6. Preliminary experience comparing routine cytology results with the composite results of digital image analysis and fluorescence in situ hybridization in patients undergoing EUS-guided FNA.

    Science.gov (United States)

    Levy, Michael J; Clain, Jonathan E; Clayton, Amy; Halling, Kevin C; Kipp, Benjamin R; Rajan, Elizabeth; Roberts, Lewis R; Root, Renee M; Sebo, Thomas J; Topazian, Mark D; Wang, Kenneth K; Wiersema, Maurits J; Gores, Gregory J

    2007-09-01

    Studies indicate enhanced diagnostic accuracy for digital image analysis (DIA) and fluorescence in situ hybridization (FISH) versus routine cytology examination (RC) when biliary strictures are evaluated. These tumor markers have not been applied to EUS-guided FNA. Our purpose was to determine the accuracy of RC versus the composite results of DIA/FISH. Patients enrolled with known or suspected malignancy. The final diagnosis was based on strict cytopathologic and imaging criteria and 12-month follow-up. Tertiary referral center. A total of 39 patients were enrolled in whom each diagnostic test was performed on samples from 42 sites to evaluate lymphadenopathy (n=19), pancreatic mass (n=19), esophageal or gastric wall mass (n=3), and thyroid mass (n=1). EUS-guided FNA with RC, DIA, and FISH. Diagnostic accuracy of RC, DIA, and FISH. Malignancy was diagnosed in 30 of 42 patients, including esophageal squamous cell carcinoma, esophageal adenocarcinoma, gastric adenocarcinoma, pancreatic adenocarcinoma, pancreatic mucinous cystic neoplasia, intraductal papillary mucinous neoplasia, metastatic forearm sarcoma, small cell and non-small cell lung cancer, thyroid carcinoma, malignant GI stromal tumor, melanoma, adenocarcinoma of unknown primary, and lymphoma. The sensitivity, specificity, and accuracy of DIA/FISH versus RC for detecting malignancy were 97%, 100%, and 98% versus 87%, 100%, and 90%, respectively. Single-center pilot study. Our findings suggest that DIA and FISH processing of EUS-guided FNA specimens provides higher diagnostic accuracy than RC does. These data suggest that these tumor markers incorporate generic targets as suggested by the high diagnostic sensitivity in this patient cohort with diverse pathologic conditions.

  7. Understanding EUS (Endoscopic Ultrasonography)

    Science.gov (United States)

    ... doctor will tell you when to start this fasting and whether it is advisable to take your ... These risks must be balanced against the potential benefits of the procedure and the risks of alternative ...

  8. EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system : a large retrospective study (with video)

    NARCIS (Netherlands)

    Rinninella, Emanuele; Kunda, Rastislav; Dollhopf, Markus; Sanchez-Yague, Andres; Will, Uwe; Tarantino, Ilaria; Gornals Soler, Joan; Ullrich, Sebastian; Meining, Alexander; Esteban, Josè Miguel; Enz, Thomas; Vanbiervliet, Geoffroy; Vleggaar, FP; Attili, Fabia; Larghi, Alberto

    2015-01-01

    BACKGROUND AND AIMS: A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of

  9. THE INFLUENCE OF HEAT TREATMENT IN THE DIFFERENT GASEOUS MEDIA ON THE OPTICAL PROPERTIES OF FROZEN MELTS EuS AND EuIn2S4IN NaCl-KCl

    Directory of Open Access Journals (Sweden)

    G. V. Nechyporenko

    2015-11-01

    Full Text Available Influence of medium (inert gas, air is studied at heat treatment of molten solutions of EuS and EuIn2S4 in NaCl-KCl of equimolar composition on optical properties. Unlike initial Europium (II sulphides, stiffened melts exhibit an intensive luminescence in spectral interval of 420-450 nanometers due to 5d-4f electronic transitions in Eu2+ions. At transition from EuS to EuIn2S4 the sharp increase in intensity of a luminescence because of solubility increase is observed.Heat treatment in the air medium results in similar result that is especially revealed in case of EuS. Spectral curve of diffuse reflectance lies in the field of negative values of absorption that is caused by luminescence processes, and correlation in their change with increase in intensity of a luminescence is observed. On IR spectra of sample EuS in NaCl-KCl, processed in the air medium, there is a band of high intensity in interval nearby 1360 cm-1, and in case of sample EuIn2S4in NaCl-KCl – in the field of 2900-3000 cm-1. Their occurrence is caused by valence oscillations in SO42-and H-Cl, accordingly. Thermodynamic calculations have shown that solubility of EuSO4 in the NaCl-KCl melt is more than in 4 times above in comparison with EuS. Possibility of management of a luminescence of stiffened melts of Europium (II compounds in saline melts both by change of medium and compound composition is shown.

  10. O significado da salvação na história eclesiástica de Eusébio de Cesaréia

    Directory of Open Access Journals (Sweden)

    Corbellini, Vital

    2006-01-01

    Full Text Available Eusébio de Cesaréia procura realçar, no seu livro História Eclesiástica, a atuação salvífica de Nosso Jesus Cristo, através de seus discípulos, os cristãos. O desígnio divino, percebido como "economia", realizou-se na história pela encarnação do Verbo. A análise dos primeiros dois livros coloca a realidade das provas e perseguições por que ela (a Igreja teria que passar por causa de Cristo, mas ela não seria desamparada pela presença do Salvador, Jesus Cristo, no qual o cristianismo um dia seria vitorioso sobre o paganismo

  11. O significado da salvação na história eclesiástica de Eusébio de Cesaréia

    OpenAIRE

    Corbellini, Vital

    2006-01-01

    Eusébio de Cesaréia procura realçar, no seu livro História Eclesiástica, a atuação salvífica de Nosso Jesus Cristo, através de seus discípulos, os cristãos. O desígnio divino, percebido como "economia", realizou-se na história pela encarnação do Verbo. A análise dos primeiros dois livros coloca a realidade das provas e perseguições por que ela (a Igreja) teria que passar por causa de Cristo, mas ela não seria desamparada pela presença do Salvador, Jesus Cristo, no qual o cristianismo um dia s...

  12. EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video).

    Science.gov (United States)

    Rinninella, Emanuele; Kunda, Rastislav; Dollhopf, Markus; Sanchez-Yague, Andres; Will, Uwe; Tarantino, Ilaria; Gornals Soler, Joan; Ullrich, Sebastian; Meining, Alexander; Esteban, Josè Miguel; Enz, Thomas; Vanbiervliet, Geoffroy; Vleggaar, Frank; Attili, Fabia; Larghi, Alberto

    2015-12-01

    A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting. This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers. Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure. EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  13. Distribución geográfica de la avifauna y la ciencia ciudadana en el País Vasco: una aproximación a través del portal www.ornitho.eus

    Directory of Open Access Journals (Sweden)

    Juan Arizaga

    2017-01-01

    Full Text Available El objetivo de este artículo es analizar la distribución geográfica de las observaciones que se registran en la plataforma www.ornitho.eus, con el fin de describir su patrón de distribución espacial, detectar zonas tanto de alta como de baja densidad de observaciones y establecer directrices para la mejora del esfuerzo de muestreo en el territorio. Para ello se han empleado las observaciones de aves registradas durante un periodo de un año una vez la plataforma se puso en funcionamiento en marzo de 2015 (para los análisis han sido considerados los datos que se obtuvieron entre los meses de junio de 2015 a mayo de 2016. Se obtuvieron un total de 94.222 observaciones: 49.000 (52% observaciones se produjeron en Gipuzkoa, seguidas de 30.213 (32% en Bizkaia y 15.009 (16% en Álava. En términos absolutos hallamos varias zonas con altas densidades de citas: el NE de Gipuzkoa (esto es, el entorno de Txingudi, Donostialdea, Urdaibai, el gran Bilbao, el SO de Gipuzkoa (el entorno de Oñati, la ciudad de Vitoria-Gasteiz, embalses alaveses de Ullibarri-Ganboa y el entorno de Laguardia. Por otro lado, las zonas sin o con menos citas fueron, principalmente, puntos en el interior de Gipuzkoa y Bizkaia y el SO de Álava. Se registró una asociación positiva entre el número de citas en cada cuadrícula y el porcentaje de cobertura de humedales y área urbanizada en la misma.

  14. Usefulness of endoscopic ultrasonography (EUS for selecting carcinoid tumors as candidates to endoscopic resection Utilidad de la ultrasonografía endoscópica (USE para seleccionar tumores carcinoides como candidatos a una resección endoscópica

    Directory of Open Access Journals (Sweden)

    M. J. Varas

    2010-10-01

    Full Text Available Introduction: carcinoid tumors (CTs represent the most common type of neuroendocrine tumors (NETs. Digestive CTs in the gastroduodenal and colorectal tracts may be assessed using endoscopy and echoendoscopy or endoscopic ultrasonography (EUS with the goal of attempting local resection with curative intent without having recourse to surgery. Objective: endpoints in this study included: - Assessing the usefulness of EUS for selecting CTs as candidates to endoscopic excision. - Assessing the effectiveness of local resection (complete carcinoid resection and the safety (complications of the technique involved. Patients and methods: our series included 18 patients (12 males and 6 females with 23 tumors. Sixteen patients (10 males and 6 females were selected, with age ranging from 40 to 81 years (mean: 57 years, biopsied, endoscopically treated digestive carcinoid tumors, and a previous negative extension study. Twenty-one 2-to-20-mm (mean size 8 mm tumors were resected in 23 procedures. After endoscopy plus biopsy and echoendoscopy (EUS, excision was carried out with conventional polypectomy snare mucosectomy and submucosal injection with saline and/or adrenaline in most cases (15, and mucosectomy technique following lesion ligation with elastic bands for six cases. Two cases underwent transanal endoscopic surgery (TEM, one of them following non-curative polypectomy. A total of 23 local procedures were performed with the key goal of assessing efficacy (complete resection: CR and safety (complications. Results: there were no severe complications except for the last gastric mucosectomy for a 6-mm carcinoid, where a miniperforation occurred that was solved by using 3 clips (1/23: 4.3%. EUS sensitivity was 94%. Complete resection was 90.5% (19/21. Conclusions: the endoscopic mucosal resection of selected carcinoid tumors is a safe, effective technique. EUS is the technique of choice to select patients eligible for endoscopic resection (carcinoids smaller

  15. EUO-Based Multifunctional Heterostructures

    Science.gov (United States)

    2015-06-06

    MULTIFUNCTIONAL HETEROSTRUCTURES Final Report (June, 2015) 5 5 A. Melville, T. Mairoser, A. Schmehl, D.E. Shai, E.J. Monkman, J.W. Harter , T. Heeg...Europium Oxide,” J. Appl. Phys. 109 (2011) 07C309. 13 D.E. Shai, A.J. Melville, J.W. Harter , E.J. Monkman, D.W. Shen, A. Schmehl, D.G. Schlom, and...A. Schmehl, D.E. Shai, E.J. Monkman, J.W. Harter , T. Heeg, B. Holländer, J. Schubert, K.M. Shen, J. Mannhart, and D.G. Schlom, “Lutetium-doped EuO

  16. Clinical impact of High-Definition Endoscopic Ultrasonography (EUS in a district hospital Impacto clínico de la introducción de la ultrasonografía endoscópica (USE alta en un hospital de área

    Directory of Open Access Journals (Sweden)

    E. Poves

    2010-12-01

    Full Text Available Objectives: Evaluation of the impact of EUS in clinical practice. Methods: All exploration performed during the first 18 months of implementation of the technique were analyzed. Agreement was assessed by radiographic techniques or surgical specimens in those cases allowed. Results: 277 exploration were performed. There have been only 2 complications and they were related to sedation in both cases. The demand increased gradually, reaching 70 scans per 100,000 inhabitants. Main indications were bile (34.3% and pancreatic processes. No pathology was found in 10% of cases; 29 cases had choledocholithiasis (93% confirmed and treated endoscopically. Chronic pancreatitis was diagnosed in 19 cases (only 15.78% of the cases were diagnosed by computed tomography. 32 patients with idiopathic acute pancreatitis were evaluated: 20 of them had evidence of microlithiasis (80% cholecystectomized and asymptomatic after a mean follow-up of 21.5 months, two cases of choledocholithiasis, 1 with chronic pancreatitis and 9 cases remained free of filial etiology. We performed 56 punctures: 39 samples of pancreas in 33 patients (81.1% of the samples were diagnostic; adenocarcinoma and serous cystadenoma were the most common diagnoses, 13 enlarged nodes and 4 abdominal masses. Conclusions: EUS is a growing demand technique that has low risks and leads to better decision-making in a significant number of patients with different diseases. Therefore, its inclusion in routine clinical practice must be considered.Objetivos: Evaluar el impacto de la introducción de la ecoendoscopia en la práctica clínica. Métodos: Se analizaron todas las exploraciones realizadas en los primeros 18 meses de implantación de la técnica. Se valoró la concordancia mediante técnicas radiológicas o piezas quirúrgicas en los casos en los que fue posible. Resultados: Se realizaron 277 exploraciones. Sólo se han registrado 2 complicaciones y en ambos casos fue en relación con la sedaci

  17. Update on Eus Diagnostics, Infection Trials and Online Slide Collection

    DEFF Research Database (Denmark)

    Boutrup, Torsten Snogdal; Fry, Christian

    2012-01-01

    that Oomycal growth in rainbow trout don’t support a normal pathogenic potential of the organism, but an attenuated strain with lower virulence. Following the above described trials we have collected material for histology, Oomycete reisolation and PCR. From this material, pictures will be uploaded to the EURL...... website. The pictures will show different types of lesions using standard H&E stain and special stains, explanatory text will follow each picture. First we will upload tissue from infected Gouramis, following this; pictures of lesions in rainbow trout....

  18. Enron versus EUSES : A comparison of two spreadsheet corpora

    NARCIS (Netherlands)

    Jansen, B.

    2015-01-01

    Spreadsheets are widely used within companies and often form the basis for business decisions. Numerous cases are known where incorrect information in spreadsheets lead to incorrect decisions. Such cases underline the relevance of research on the professional use of spreadsheets. Recently a new

  19. Enron versus EUSES: A Comparison of Two Spreadsheet Corpora

    OpenAIRE

    Jansen, Bas

    2015-01-01

    Spreadsheets are widely used within companies and often form the basis for business decisions. Numerous cases are known where incorrect information in spreadsheets has lead to incorrect decisions. Such cases underline the relevance of research on the professional use of spreadsheets. Recently a new dataset became available for research, containing over 15.000 business spreadsheets that were extracted from the Enron E-mail Archive. With this dataset, we 1) aim to obtain a thorough understandin...

  20. EU`s research programs - an important source for Norwegian innovation; EUs forskningsprogrammer - en viktig kilde til norsk innovasjon

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-05-01

    This document presents some examples of the Norwegian participation in the research programs of the European Union (EU). By the end of 1997, Norwegian researchers had taken part in the formulation of more than 2400 applications. Over 660 applications with Norwegian participation have been granted support from the EU for common European projects. The examples most directly relating to energy technology and environment are from the following fields: (1) Well technology (CENET project). Utilization of abandoned oil- and gas installations to the benefit of the fisheries, (2) Climate research based on forest observations (FOREST project), (3) Improved methods of analysing and characterising the sea floor (ISACS project), (4) Water-based hydraulic systems, (5) Surface treatment of aluminium, (6) The Arctic environment, (7) Solar cells

  1. EuO and Gd-doped EuO thin films. Epitaxial growth and properties

    Energy Technology Data Exchange (ETDEWEB)

    Sutarto, Ronny

    2009-07-06

    Europium oxide (EuO) based materials exhibit a wealth of spectacular phenomena, including half-metallic ferromagnetism, metal-insulator transition, colossal magneto-resistance, large magneto-optical Kerr effect, tunable ferromagnetic ordering temperatures, and large and long-lived photo-induced conductivity. These extraordinary properties make EuO an ideal candidate for implementation in device applications, in particular, for spintronics. Most of the work in the past has been carried out on bulk EuO, but for device applications it is preferred to have the EuO in thin lm form. A urry of studies have therefore emerged in the last decade in order to explore a wide variety of preparation routes and to investigate the properties of the resulting EuO thin films. A recent highlight is the demonstration that doped EuO films can be fabricated on Si and GaN, thereby exhibiting the expected spin-polarized transport effects. Nevertheless, it is still far from a trivial task to prepare EuO thin films with well de ned properties. For bulk EuO, it is already known that stoichiometry is the key issue, and that the presence of small amounts of defects or impurities quickly lead to very large deviations of the material properties. In fact, to make bulk EuO to be stoichiometric one needs temperatures as high as 1800 C. It is obvious that such high temperatures are not compatible with device engineering processes. The preparation of thin films must therefore involve much lower temperatures, preferably not higher than 400-500 C. The consequences are very dear. It turned out that many of the recent studies on EuO thin films are suffering from sample quality problems, due to the presence of, e.g., trivalent Eu species (Eu{sub 3}O{sub 4}, Eu{sub 2}O{sub 3}), oxygen vacancies, or even Eu metal clusters. Controlled doping of the EuO with trivalent rare-earth ions is also not trivial, since most often even the actual doping concentrations were not known. In fact, one could also question in

  2. Growth and characterization of Sc-doped EuO thin films

    Science.gov (United States)

    Altendorf, S. G.; Reisner, A.; Chang, C. F.; Hollmann, N.; Rata, A. D.; Tjeng, L. H.

    2014-02-01

    The preparation of 3d-transition metal-doped EuO thin films by molecular beam epitaxy is investigated using the example of Sc doping. The Sc-doped EuO samples display a good crystalline structure, despite the relatively small ionic radius of the dopant. The Sc doping leads to an enhancement of the Curie temperature to up to 125 K, remarkably similar to previous observations on lanthanide-doped EuO.

  3. Electronic transport through EuO spin-filter tunnel junctions

    KAUST Repository

    Jutong, Nuttachai

    2012-11-12

    Epitaxial spin-filter tunnel junctions based on the ferromagnetic semiconductor europium monoxide (EuO) are investigated by means of density functional theory. In particular, we focus on the spin transport properties of Cu(100)/EuO(100)/Cu(100) junctions. The dependence of the transmission coefficient and the current-voltage curves on the interface spacing and EuO thickness is explained in terms of the EuO density of states and the complex band structure. Furthermore, we also discuss the relation between the spin transport properties and the Cu-EuO interface geometry. The level alignment of the junction is sensitively affected by the interface spacing, since this determines the charge transfer between EuO and the Cu electrodes. Our calculations indicate that EuO epitaxially grown on Cu can act as a perfect spin filter, with a spin polarization of the current close to 100%, and with both the Eu-5d conduction-band and the Eu-4f valence-band states contributing to the coherent transport. For epitaxial EuO on Cu, a symmetry filtering is observed, with the Δ1 states dominating the transmission. This leads to a transport gap larger than the fundamental EuO band gap. Importantly, the high spin polarization of the current is preserved up to large bias voltages.

  4. Effect of pressure on the phonon properties of europium ...

    Indian Academy of Sciences (India)

    Unknown

    phonon density of states and compared them with the first order Raman scattering results. The calculation of ... raman et al 1974). The structural phase transition pre- ssures for EuO, EuS, EuSe and EuTe are 30–40 GPa,. 22 GPa, 15 GPa and 10 GPa, respectively. ... †Paper presented at the 5th IUMRS ICA98, October 1998,.

  5. Lutetium-doped EuO films grown by molecular-beam epitaxy

    Energy Technology Data Exchange (ETDEWEB)

    Melville, A.; Heeg, T. [Department of Materials Science and Engineering, Cornell University, Ithaca, New York 14853 (United States); Mairoser, T.; Schmehl, A. [Zentrum fuer elektronische Korrelationen und Magnetismus, Universitaet Augsburg, Universitaetsstrasse 1, D-86159 Augsburg (Germany); Shai, D. E.; Monkman, E. J.; Harter, J. W. [Laboratory of Atomic and Solid State Physics, Department of Physics, Cornell University, Ithaca, New York 14853 (United States); Hollaender, B.; Schubert, J. [Peter Gruenberg Institute, PGI 9-IT, JARA-FIT, Research Centre Juelich, D-52425 Juelich (Germany); Shen, K. M. [Laboratory of Atomic and Solid State Physics, Department of Physics, Cornell University, Ithaca, New York 14853 (United States); Kavli Institute at Cornell for Nanoscale Science, Ithaca, New York 14853 (United States); Mannhart, J. [Max Planck Institute for Solid State Research, D-70569 Stuttgart (Germany); Schlom, D. G. [Department of Materials Science and Engineering, Cornell University, Ithaca, New York 14853 (United States); Kavli Institute at Cornell for Nanoscale Science, Ithaca, New York 14853 (United States)

    2012-05-28

    The effect of lutetium doping on the structural, electronic, and magnetic properties of epitaxial EuO thin films grown by reactive molecular-beam epitaxy is experimentally investigated. The behavior of Lu-doped EuO is contrasted with doping by lanthanum and gadolinium. All three dopants are found to behave similarly despite differences in electronic configuration and ionic size. Andreev reflection measurements on Lu-doped EuO reveal a spin-polarization of 96% in the conduction band, despite non-magnetic carriers introduced by 5% lutetium doping.

  6. EUS-FNA for the detection of left adrenal metastasis in patients with lung cancer

    NARCIS (Netherlands)

    Schuurbiers, O.C.J.; Tournoy, K.G.; Schoppers, H.J.; Dijkman, B.; Timmers, H.J.L.M.; Geus-Oei, L.F. de; Grefte, J.M.M.; Rabe, K.F.; Dekhuijzen, P.N.R.; Heijden, H.F. van der; Annema, J.T.

    2011-01-01

    In patients with lung cancer, enlarged or (18)Fluoro-deoxyglucose positron emission tomography ((18)FDG-PET) positive left adrenal glands are suspected for distant metastases and require tissue confirmation for a definitive assessment. The aim of this study was to assess the sensitivity of

  7. Algumas faces de outros eus. Honra e patronagem na antropologia do Mediterrâneo

    Directory of Open Access Journals (Sweden)

    Ana Claudia D. R. Marques

    1999-04-01

    Full Text Available A antropologia do Mediterrâneo mostra-se um campo fecundo para a discussão do exercício antropológico em geral, pela forma particularmente instigante em que neste campo se confundem objeto e sujeito de um discurso acadêmico. Em Anthropology Through the Looking Glass, Michael Herzfeld salienta aspectos, sobretudo políticos, embutidos em construções conceptuais mediterranistas e antropológicas como um todo. Inspirada em seu trabalho, a autora propõe distinguir alguns pressupostos que parecem orientar nossas práticas, acadêmicas e quotidianas, a partir de certos elementos recorrentes em análises centradas nos temas "mediterrânicos" por excelência da honra e da patronagem. Recorre aos trabalhos reunidos em Patrons and Clients in Mediterranean Societies e Honor and Shame, referências fundamentais da antropologia do Mediterrâneo, no intuito de reiterar riscos envolvidos nas construções simplificadoras de princípios culturais, com poder explicativo questionável, bem como de enfatizar a importância da pluralidade de elementos locais destacados e de perspectivas adotadas, fatores que podem dificultar simplificações e promover o enriquecimento das concepções que produzimos acerca dos outros e de nós mesmos.Mediterranean anthropology has proven to be a fertile area for discussing anthropological practice in general, due to the particularly novel way in which academic discourse's object and subject merge in the region. In Anthropology Through the Looking Glass, Michael Herzfeld brings to the fore aspects (above all political embedded in both Mediterranean and anthropological conceptual frameworks. Taking inspiration from his work, the author sets out to delineate some of the presuppositions, which appear to guide our academic and quotidian practices, starting with certain elements prevalent in analyses centering on the emblematically 'Mediterranean' themes of honor and patronage. The author turns to the works collected in Patrons and Clients in Mediterranean Societies and Honor and Shame - core texts in Mediterranean anthropology - in order to reiterate the risks involved in reducing cultural principles to simplifying formulas of questionable explanatory power, as well as to emphasize the importance of maintaining plurality in both the local elements selected and the perspectives adopted - factors which can work to inhibit simplifications, promoting instead the enrichment of the concepts we produce concerning others and ourselves.

  8. EUS-guided FNA of a portal vein thrombus in hepatocellular ...

    African Journals Online (AJOL)

    Portal vein thrombosis is a relatively rare but well-known complication of cirrhosis that has a prevalence of between 1% and 5.7%. On the contrary, in case of hepatocellular carcinoma (HCC), it is a much more frequent complication. In this paper, we presented three cases that had liver cirrhosis, mass and portal vein ...

  9. Tips to overcome technical challenges in EUS-guided tissue acquisition

    DEFF Research Database (Denmark)

    Vilmann, Peter; Seicean, Andrada; Săftoiu, Adrian

    2014-01-01

    . The endosonographic technique can be improved when several tips and tricks useful to overcome challenges of FNA are known. Technical challenges of FNA are related to the characteristics of the lesion and its surroundings, sonographic imaging, and limitations related to the needle. Several tips and tricks necessary...

  10. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part v - EUS-Guided Therapeutic Interventions (short version)

    DEFF Research Database (Denmark)

    Fusaroli, P; Jenssen, C.; Hocke, Martine

    2016-01-01

    The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis...

  11. Planlægning og formulering af 4 forskningsprojekter under EUs femte rammeprogram

    DEFF Research Database (Denmark)

    De Chiffre, Leonardo

    Denne projektansøgning, som instituttet har taget initiativ til, omhandler reduktion af støj og vibrationer fra transmissionssystemer i køretøjer, såvel biler som industrikøretøjer, traktorer m.v. I projektet vil der blive udviklet en metode til kontrol og forudsigelse af vibrations- og støjkarak...

  12. EUS Needle Identification Comparison and Evaluation study (with videos)

    DEFF Research Database (Denmark)

    Tang, Shou-Jiang; Vilmann, Andreas Slot; Saftoiu, Adrian

    2016-01-01

    Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson...

  13. Growth of EuO films on Si using Pulsed Laser Deposition

    Science.gov (United States)

    Jain, Vivek S.; Rimal, Gaurab; Tang, Jinke

    Epitaxial monolayers of europium monoxide (EuO) deposited on silicon (Si) wafers are suited for spintronic applications such as adding spin filter tunneling and spin current to Si technology, and for probing phenomena like Anomalous Hall effect and Topological Hall effect. However, the innate chemical reactivity of europium (Eu) and Si prevents a direct synthesis of EuO by pulsed laser deposition technique, without significant contamination of the EuO/Si interface and degradation of the EuO thin film. Silicon oxides (SiO2-δ) on the surface of Si substrates, partial pressure of oxygen (O2) gas and water vapors in the vacuum chamber act as contaminants. Techniques like standard wet etching process, thermal annealing, and decomposition of SiO2-δ by the bombardment of metal ions, and their effectiveness is studied using the X-Ray diffraction (XRD) system. Our goal is one-process in situ integration of spin-functional magnetic oxides seamless on Si wafers. Also the mechanism for the ferromagnetic order in oxygen-deficient europium monoxide (EuO1-x) at temperatures higher than 69K (the Curie temperature of stoichiometric EuO) remains controversial. We have investigated the magnetization of EuO1-x thin films prepared via PLD as a function of (emu) vs (K) Wyoming EPSCoR.

  14. Electronic structure and magnetism of EuO films on the nanometer scale

    Energy Technology Data Exchange (ETDEWEB)

    Klinkhammer, Juergen

    2013-06-28

    This thesis deals with thin films of the ferromagnetic semiconductor EuO. These are prepared by molecular beam epitaxy under ultra high vacuum conditions and their properties are investigated in-situ by means of low energy electron diffraction, magneto-optical Kerr effect (MOKE), scanning tunneling microscopy (STM) and scanning tunneling spectroscopy (STS). The experiments are carried out in a low temperature STM apparatus with a base temperature of 5.3 K. The development of a highly sensitive MOKE instrument is in the technical focus of this work. EuO is grown in (100) orientation on a ferromagnetic Ni(100) single crystal as well as on single crystalline graphene on Ir(111). An antiferromagnetic coupling between the magnetic moments of the Ni(100) and the EuO(100) film turns out. The 3.3nm thin stoichiometric films of EuO on graphene show a Curie temperature T{sub c}=75 K, which is increased with respect to films of the same thickness grown on other substrates and even with respect to bulk EuO. Point defects in EuO films are analyzed with help of atomically resolved STM images. The defect concentration can be quantified using highly-resolved STM topography images. The mobility of the oxygen vacancies is shown by a series of topography STM images and a mobility of the vacancies along the EuO left angle 011 right angle directions is found. Investigations of the electronic structure of the EuO(100) surface are performed by STM and STS, which require a high sample quality, i.e, a topographically very well ordered and flat surface with a minimum of defects. The ultra thin films of EuO on graphene described in thesis are of such high quality. A local n-doping and an upward band bending is found at the oxygen vacancy sites. Tunneling spectroscopy maps of the ferromagnetic EuO(100) surface show standing wave patterns, which are the characteristic fingerprint of the surface state in EuO(100). The energy vs. momentum space of the surface state is explored by evaluating the

  15. see Wagh Apoorva G 1171 Abezgauz L see Kuperkar K 1003 ...

    Indian Academy of Sciences (India)

    through multi-resolution analysis. 459. Ahmed Moustafa. Analysis of small-signal intensity modu- .... 1135. Goodkind John see Blackburn Elizabeth. 673. Goswami Debabrata see Samineni Prathyush. 1345. Gour Atul. Pressure-induced phase transition and stability of EuO and EuS with NaCl structure. 181. Goyal P S.

  16. Effect of Gd doping and O deficiency on the Curie temperature of EuO

    KAUST Repository

    Jutong, Nuttachai

    2015-01-27

    The effect of Gd doping and O deficiency on the electronic structure, exchange interaction, and Curie temperature of EuO in the cubic and tetragonal phases is studied by means of density functional theory. For both defects, the Curie temperature is found to exhibit a distinct maximum as a function of the defect concentration. The existence of optimal defect concentrations is explained by the interplay of the on-site, RKKY, and superexchange contributions to the magnetism.

  17. The EU system for emissions trading after year 2012; EU:s system foer handel med utslaeppsraetter efter 2012

    Energy Technology Data Exchange (ETDEWEB)

    Normand, Mathias; Mjureke, David (eds.)

    2007-01-15

    The Government has instructed the Swedish Energy Agency and the Swedish Environmental Protection Agency to put forward a proposal for how the EU Emissions Trading Scheme (EU ETS) should be developed after 2012, subject to the overall objective of continuing to reduce emissions with the aim of achieving the long-term objectives of the Convention on Climate Change. In its Council Conclusions (7619/1/05) the EU has interpreted the long-term objectives of the Convention on Climate Change as aiming to achieve emission reductions of 15-30 % in the industrialised countries by 2020. According to Council Conclusions (13435/05), the EU has also decided that the Emissions Trading Scheme should continue after 2012. The starting point for this report is that, after 2012, the Scheme will be a key instrument in achieving cost-efficient emission reductions, not only within the EU but also globally, and regardless of whether, with effect from 2013, the Scheme has become a part of an international climate regime, or is serving as a transition to some future new international climate regime. The purpose of this report is to provide a proposal for how the Emissions Trading Scheme should be developed after 2012. The aim is to construct a system that helps to reduce global emissions of greenhouse gases (maintaining climate integrity), that assists measures being taken where they are cheapest (cost efficiency), that is accepted by parties concerned and by the general public (confidence inspiring), and which does not adversely affect the competitiveness of business or industry (competition-neutral). The Agencies recommend that Sweden should adopt the following standpoints concerning development of the EU Emissions Trading Scheme after 2012. (Recommended changes to the system presuppose a harmonised implementation throughout the EU.): In connection with international negotiations, Sweden should press for the Emissions Trading Scheme to be developed in such a way as to make it possible to achieve emission reductions in line with Council Conclusions (7619/1/05) in the form of total emission reductions of the order of 15-30 % in the industrialised countries by 2020. Sweden should press for the Scheme to be linked with other trading schemes, subject to retention of climate integrity. Linking can strengthen global climate policy ties and influence countries not having internationally binding climate commitments towards participating in some climate policy agreement. Linking also helps to counter international distortion of competition. There should be considerable opportunities for the use of CDM (or equivalent) credits in the Scheme, given that the EU has strict commitments on emission reductions. In order to ensure the system's climate integrity and competition neutrality, efforts should be aimed at ensuring that the total quantity of allowances in the Trading Scheme is decided directly at EU level (i.e. top-down), instead of as today starting from national allocation plans (i.e. bottom-up). Sweden should promote continued expansion of the Scheme to other sectors and for other gases. In 2013, it should be expanded to include emissions of carbon dioxide and PFC from primary and secondary aluminium production, carbon dioxide from certain chemical industry sectors, nitrous oxide from certain chemical industry sectors and methane from active coal mines. The European road transport sector can be included in the Scheme. However, this will pose challenges in respect of the effects on industrial competitiveness and developments within the road transport sector. In order to be able to adopt a firm position in the matter of how the road transport sector should be treated in relation to the EU ETS, Sweden should initiate in-depth studies of consequences of different options, including a separate trading scheme for the European transport sector. Purely biofuelled combustion installations should be excluded from the Scheme, and the monitoring requirements for pure biofuel streams in combustion installations that partly use biofuels should be abolished. Sweden should press for a broad and harmonised definition of the term 'combustion installation', bearing in mind the possible consequences for small installations. Efforts should be made to encourage auction procedures as the basis of allowance allocation for all sectors within the Scheme. However, until competitors outside the EU encounter some form of cost in connection with their carbon dioxide emissions, industry covered by the Scheme can continue to be allocated free allowances, preferably according to benchmarks common to the entire EU. The electricity and district heating sectors within the EU should not be allocated free allowances. These sectors' allowances should be distributed to the market by means of auctions that are open to all parties within the EU ETS. New entrants of the electricity and district heating sectors should be required to purchase their allowances on the market. Until auction procedures are introduced for existing industrial participants in the scheme, new entrants in the industrial sector should be allocated free allowances in accordance with common EU benchmarks where possible. Any surpluses from reserves kept for new entrants should be cancelled. If reserves are maintained for free allocation to new entrants, allocation of allowances to plants that have closed should cease.

  18. European Union energy policy for sustainable development Nonlinear distribution proposed for EUs 20-20-20 energy goals

    Energy Technology Data Exchange (ETDEWEB)

    Tolon Becerra, A.; Lastra Bravo, X.; Pinedo Contreras, F. J.; Fernandez Montero, S.

    2011-07-01

    There is worldwide concern for the high consumption of energy from fossil fuels, the limited fossil fuel resources, the climate change and global warming and their possible long-term consequences and the population growth. Even more when energy is the main intermediate good necessary for economic growth and development in any country. This usually translates into better quality of life, and thereby, higher primary energy consumption in all sectors, transport, industry, services, household, etc. In this context, the European Union (EU) seeks to reach a balance between sustainable development, competitiveness and secure supply. The current EU energy policy is based on three interrelated pillars or basic goals: the promotion of energy efficiency, the application of greenhouse gas mitigation policies and the increase of share of energy from renewable energy sources. In this paper, a methodology for nonlinear distribution of dynamic targets is proposed and applied to EU energy policy goals. (Author)

  19. Recoilless fractions calculated with the nearest-neighbour interaction model by Kagan and Maslow

    Science.gov (United States)

    Kemerink, G. J.; Pleiter, F.

    1986-08-01

    The recoilless fraction is calculated for a number of Mössbauer atoms that are natural constituents of HfC, TaC, NdSb, FeO, NiO, EuO, EuS, EuSe, EuTe, SnTe, PbTe and CsF. The calculations are based on a model developed by Kagan and Maslow for binary compounds with rocksalt structure. With the exception of SnTe and, to a lesser extent, PbTe, the results are in reasonable agreement with the available experimental data and values derived from other models.

  20. Reduction of the deposition temperature of high quality EuO films on Yttria Stabilized Zirconia by incorporating an MgO buffer layer

    Energy Technology Data Exchange (ETDEWEB)

    Moder, Iris [Group of Nanomaterials and Microsystems, Physics Department, Universitat Autònoma de Barcelona, Campus UAB, Torre C3-222, 08193 Bellaterra (Spain); Garcia, Gemma, E-mail: gemma.garcia@uab.cat [Group of Nanomaterials and Microsystems, Physics Department, Universitat Autònoma de Barcelona, Campus UAB, Torre C3-222, 08193 Bellaterra (Spain); Santiso, José [Centre d' Investigació en Nanociència i Nanotecnologia, CIN2 (CSIC/ICN), Campus UAB, 08193 Bellaterra, Barcelona (Spain); Moodera, Jagadeesh S.; Miao, Guoxing X. [Francis Bitter Magnet Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States); Lopeandía, Aitor F. [Group of Nanomaterials and Microsystems, Physics Department, Universitat Autònoma de Barcelona, Campus UAB, Torre C3-222, 08193 Bellaterra (Spain); Rodríguez-Viejo, Javier [Group of Nanomaterials and Microsystems, Physics Department, Universitat Autònoma de Barcelona, Campus UAB, Torre C3-222, 08193 Bellaterra (Spain); MATGAS Research Centre, Campus UAB, 08193 Bellaterra (Spain)

    2013-03-01

    High quality stoichiometric EuO ferromagnetic thin films have been grown by Molecular Beam Epitaxy (MBE) on MgO coated-Yttria Stabilized Zirconia (YSZ) (100) substrates. The proof is made that introducing an MgO buffer layer, that avoid oxygen transfer from YSZ to EuO, allows the preparation of high quality stoichiometric EuO films at reduced deposition temperature compared with films directly deposited onto YSZ, maintaining similar Eu flux and oxygen partial pressure. Structure and texture were characterized by X-ray diffraction showing out-of plane and in-plane ordering for films deposited onto MgO buffer layers. The crystallographic quality was corroborated by a Curie temperature around 69 K and a magnetization moment close or equal to 6.49 · 10{sup −23} J/T (7 μ{sub B}), corresponding to bulk EuO single crystal values. - Highlights: ► EuO films were epitaxially grown on MgO coated Yttria Stabilized Zirconia. ► Deposition temperature was reduced compared to bare Yttria Stabilized Zirconia. ► Epitaxial texture was confirmed by in-plane X-ray diffraction. ► Composition of the heterostructure was defined by X-ray Photoelectron Spectroscopy. ► Single crystal like EuO magnetic moment and coercive field were measured.

  1. Large Spin-Valley Polarization in Monolayer MoTe2 on Top of EuO(111)

    KAUST Repository

    Zhang, Qingyun

    2015-12-08

    The electronic properties of monolayer MoTe2 on top of EuO(111) are studied by first-principles calculations. Strong spin polarization is induced in MoTe2, which results in a large valley polarization. In a longitudinal electric field this will result in a valley and spin-polarized charge Hall effect. The direction of the Hall current as well as the valley and spin polarizations can be tuned by an external magnetic field. Copyright © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. MOLECULAR OPEN-SHELL CONFIGURATION-INTERACTION CALCULATIONS USING THE DIRAC-COULOMB HAMILTONIAN - THE F6-MANIFOLD OF AN EMBEDDED EUO69- CLUSTER

    NARCIS (Netherlands)

    VISSER, O; VISSCHER, L; AERTS, PJC; NIEUWPOORT, WC

    1992-01-01

    We present results of all-electron molecular relativistic (Hartree-Fock-Dirac) and nonrelativistic (Hartree-Fock) calculations followed by a complete open shell configuration interaction (COSCI) calculation on an EuO6(9-) cluster in a Ba2GdNbO6 crystal. The results include the calculated energies of

  3. Recent advances in endoscopic ultrasonography-guided biliary interventions

    Science.gov (United States)

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-01-01

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives. PMID:26327757

  4. The risk evaluation of difficult substances in USES 2.0 and EUSES. A decision tree for data gap filling of Kow, Koc and BCF

    NARCIS (Netherlands)

    Beelen P van; ECO

    2000-01-01

    This report presents a decision tree for the risk evaluation of the so-called "difficult" substances with the Uniform System for the Evaluation of Substances (USES). The decision tree gives practical guidelines for the regulatory authorities to evaluate notified substances like organometallic

  5. 22G versus 25G biopsy needles for EUS-guided tissue sampling of solid pancreatic masses: a randomized controlled study.

    Science.gov (United States)

    Woo, Young Sik; Lee, Kwang Hyuck; Noh, Dong Hyo; Park, Joo Kyung; Lee, Kyu Taek; Lee, Jong Kyun; Jang, Kee-Taek

    2017-12-01

    No comparative study of 22-gauge biopsy needles (PC22) and 25-gauge biopsy needles (PC25) has been conducted. We prospectively compared the diagnostic accuracy of PC22 and PC25 in patients with pancreatic and peripancreatic solid masses. We conducted a randomized noninferiority clinical study from January 2013 to May 2014 at Samsung Medical Center. A cytological and histological specimen of each pass was analyzed separately by an experienced pathologist. The primary outcome was to assess the diagnostic accuracy using the PC22 or PC25. Secondary outcomes included the optimal number of passes for adequate diagnosis, core specimen yield, sample adequacy, and complication rates. Diagnostic accuracy of combining cytology with histology in three cumulative passes was 97.1% (100/103) for the PC22 and 91.3% (94/103) for the PC25 group. Thus, noninferiority of PC25 to PC22 was not shown with a 10% noninferiority margin (difference, -5.8%; 95% CI, -12.1 to -0.5%). In a pairwise comparison with each needle type, two passes was non-inferior to three passes in the PC22 (96.1% vs. 97.1%; difference, -0.97%; 95% CI -6.63 to 4.69%) but noninferiority of two passes to three passes was not shown in the PC25 group (87.4% vs. 91.3%; difference, -3.88%; 95% CI, -13.5 to 5.7%). Non-inferiority of PC25 to PC22 diagnostic accuracy was not observed for solid pancreatic or peripancreatic masses without on-site cytology. PC22 may be a more ideal device because only two PC22 needle passes was sufficient to establish an adequate diagnosis, whereas PC25 required three or more needle passes.

  6. Size dependence of Eu-O charge transfer process on luminescence characteristics of YBO3:Eu3+ nanocrystals.

    Science.gov (United States)

    Sharma, Prashant K; Dutta, Ranu K; Pandey, Avinash C

    2010-07-15

    Well-crystallized pure hexagonal phase YBO(3):Eu(3+) nanoparticles are prepared by the reverse micelles method. Vacuum ultraviolet photoluminescence (VUVPL) spectroscopy showed size-dependent nonlinear luminescence enhancement with remarkably improved chromaticity (0.62, 0.34), as compared to the commercial bulk YBO(3):Eu(3+) phosphor (0.56, 0.39). The quenching concentration of Eu(3+) doping and the ratio of red ((5)D(0)-->(7)F(2)) to orange ((5)D(0)-->(7)F(1)) emission was found significantly enhanced with the decrease in particle size, making it an ideal VUV phosphor for plasma display panels. The possible explanation for size dependence of the Eu-O charge transfer process via lowering of the structural symmetry is proposed in detail.

  7. Ab-initio calculation of EuO doped with 5% of (Ti, V, Cr and Fe): GGA and SIC approximation

    Science.gov (United States)

    Rouchdi, M.; Salmani, E.; Bekkioui, N.; Ez-Zahraouy, H.; Hassanain, N.; Benyoussef, A.; Mzerd, A.

    2017-12-01

    In this research, a simple theoretical method is proposed to investigate the electronic, magnetic and optical properties of Europium oxide (EuO) doped with 5% of (Ti, V, Cr and Fe). For a basic understanding of these properties, we employed Density-Functional Theory (DFT) based calculations with the Korringa-Kohn-Rostoker code (KKR) combined with the Coherent Potential Approximation (CPA). Also we investigated the half-metallic ferromagnetic behavior of EuO doped with 5% of (Ti, V, Cr and Fe) within the self-interaction-corrected Generalized Gradient Approximation (GGA-SIC). Our calculated results revealed that the Eu0.95TM0.05O is ferromagnetic with a high transition temperature. Moreover, the optical absorption spectra revealed that the half metallicity has been also predicted.

  8. Spin-selective measurement of the unoccupied density of 5d-states of EuO by resonant inelastic X-ray scattering (RIXS)

    CERN Document Server

    Wittkop, C

    2000-01-01

    In the framework of this thesis it was successfully shown that a spin- selective measurement of the unoccupied density od states by means of resonant inelastic X-ray scattering is possible. Especially for this studies were performed on the unoccupied 5d conduction band of EuO. As essential results it can be stated that a temperature- dependent shift of the 5d arrow up to the 5d arrow down density of states is present.

  9. Standard criteria versus Rosemont classification for EUS-diagnosis of chronic pancreatitis Criterios estándar versus clasificación de Rosemont para el diagnóstico ecoendoscópico de pancreatitis crónica

    Directory of Open Access Journals (Sweden)

    Cristina Jimeno-Ayllón

    2011-12-01

    Full Text Available Aim: to study the possible differences in the final diagnosis of chronic pancreatitis by using standard classification described by Wiersema et al. and the new classification proposed recently by Rosemont. Material and methods: forty-seven patients with the diagnosis of chronic pancreatitis were included in this study. The parenchymal and ductal criteria were studied, the patients were divided in two groups for Wiersema criteria: 4 criteria diagnosis by standard criteria. But 27.66% patients with less than 4 standard criteria would be suggestive according to Rosemont classification (p Objetivo: analizar las posibles diferencias en el diagnóstico final de pancreatitis crónica empleando los criterios estándar descritos por Wiersema y cols. y la nueva clasificación propuesta recientemente en Rosemont. Material y métodos: se incluyen 47 pacientes con diagnóstico de pancreatitis crónica. Se estudian los criterios parenquimatosos y ductales, dividiendo a los pacientes en 2 grupos según los criterios de Wiersema: < 4 criterios, no diagnóstico de pancreatitis crónica, ≥ 4 criterios, diagnóstico de pancreatitis crónica. Se estudiaron nuevamente dichos pacientes aplicando la clasificación de Rosemont: páncreas normal, indeterminado, sugestivo y diagnóstico de pancreatitis crónica. Se analizaron estos datos con la prueba estadística Chi-cuadrado con un intervalo de confianza de 95%. Resultados: en los pacientes con pancreatitis crónica el criterio presente con mayor frecuencia es la lobularidad en 66% de los casos seguido de la dilatación del Wirsung y la presencia de calcificaciones en 57,4% respectivamente. Se observó una asociación estadísticamente significativa entre los resultados de ambas clasificaciones (p < 0,05. La mayor asociación se encontró para pacientes que presentaban más de 4 criterios estándar y diagnóstico definitivo de pancreatitis crónica según la clasificación de Rosemont. Sin embargo, los pacientes que presentaron menos de 4 criterios estándar fueron sugestivos de pancreatitis crónica mediante el empleo de la clasificación de Rosemont en un 27,66% de los casos (p < 0,05. Conclusión: estos resultados muestran que no existen diferencias estadísticamente significativas para los pacientes que presentan ≥ 4 criterios diagnósticos según los criterios estándar. No obstante, 27,66% pacientes con menos de 4 criterios estándar serían sugestivos de pancreatitis crónica según la clasificación de Rosemont (p < 0,05. Por tanto, esta nueva clasificación sería útil para pacientes con elevada sospecha de pancreatitis crónica que presenten < 4 criterios estándar pero con presencia de criterios de mayor importancia como las calcificaciones intraparenquimatosas, la lobularidad o las litiasis intraductales.

  10. The role of gastrointestinal endosonography in diagnostic and therapeutic interventional procedures

    DEFF Research Database (Denmark)

    Mortensen, M B

    1999-01-01

    Over the past 15 years endoscopic ultrasonography (EUS) has become an integrated part of gastrointestinal imaging. The more recent development of echoendoscopes and needles for EUS guided fine needle aspiration has stimulated the interest in interventional EUS procedures, both for diagnostic...

  11. Clinical yield of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration for incidental pancreatic cysts in kidney transplant evaluation.

    Science.gov (United States)

    Rejeski, Jared; Rogers, Jeffrey; Hauser, Matthew; Mishra, Girish

    2017-07-01

    For several reasons, including an elevated risk for malignancy after transplant, kidney transplant candidates undergo a thorough evaluation prior to transplantation. Further assessment of incidentally discovered pancreatic cysts on routine abdominal imaging has been assumed to be prudent, and the preferred method has been endoscopic ultrasound (EUS) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The clinical utility of EUS/EUS-FNA with respect to transplant decision-making has not been evaluated. Kidney transplant candidates undergoing EUS/EUS-FNA for further evaluation of one or more pancreatic cysts were identified. The clinical yield of the EUS/EUS-FNA was determined via retrospective chart review. After exclusion criteria were applied, a total of 15 cases were identified at a high-volume transplant center over a 71-month period. EUS/EUS-FNA was deemed to have a clinically relevant impact in 73.3% of cases. Kidney transplant candidates are a unique group with respect to the need to clarify the etiology of pancreatic cysts. EUS/EUS-FNA frequently provides information that is clinically relevant to the determination of transplant status. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Incidence of bacteremia in cirrhotic patients undergoing upper endoscopic ultrasonography.

    Science.gov (United States)

    Fernández-Esparrach, Gloria; Sendino, Oriol; Araujo, Isis; Pellisé, Maria; Almela, Manel; González-Suárez, Begoña; López-Cerón, María; Córdova, Henry; Sanabria, Erwin; Uchima, Hugo; Llach, Josep; Ginès, Àngels

    2014-01-01

    The incidence of bacteremia after endoscopic ultrasonography (EUS) or EUS-guided fine-needle aspiration (EUS-FNA) is between 0% and 4%, but there are no data on this topic in cirrhotic patients. To prospectively assess the incidence of bacteremia in cirrhotic patients undergoing EUS and EUS-FNA. We enrolled 41 cirrhotic patients. Of these, 16 (39%) also underwent EUS-FNA. Blood cultures were obtained before and at 5 and 30 min after the procedure. When EUS-FNA was used, an extra blood culture was obtained after the conclusion of radial EUS and before the introduction of the sectorial echoendoscope. All patients were clinically followed up for 7 days for signs of infection. Blood cultures were positive in 16 patients. In 10 patients, blood cultures grew coagulase-negative Staphylococcus, Corynebacterium species, Propionibacterium species or Acinetobacterium Lwoffii, which were considered contaminants (contamination rate 9.8%, 95% CI: 5.7-16%). The remaining 6 patients had true positive blood cultures and were considered to have had true bacteremia (15%, 95% CI: 4-26%). Blood cultures were positive after diagnostic EUS in five patients but were positive after EUS-FNA in only one patient. Thus, the frequency of bacteremia after EUS and EUS-FNA was 12% and 6%, respectively (95% CI: 2-22% and 0.2-30%, respectively). Only one of the patients who developed bacteremia after EUS had a self-limiting fever with no other signs of infection. Asymptomatic Gram-positive bacteremia developed in cirrhotic patients after EUS and EUS-FNA at a rate higher than in non-cirrhotic patients. However, this finding was not associated with any clinically significant infections. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  13. Transgastric pure-NOTES peritoneoscopy and endoscopic ultrasonography for staging of gastrointestinal cancers

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Vilmann, Peter; Meisner, Søren

    2012-01-01

    and intraperitoneal endoscopic ultrasonography (ip-EUS) with intraluminal EUS (il-EUS) for peritoneal evaluation. METHODS: This was a feasibility and survival study where il-EUS followed by ip-EUS and peritoneoscopy was performed in 10 pigs subjected to TG pure NOTES. A score was given with regard to achieved...... visualisation of predefined anatomical structures. Survival was assessed at postoperative day (POD) 14. RESULTS: All animals survived until POD 14. Median total procedural time was 94 min (range 74-130 min). Median time for il-EUS, ip-EUS and peritoneoscopy was 11 min (range 7-14 min), 13 min (range 8-20 min...

  14. Preoperative routine evaluation of bilateral adrenal glands by endoscopic ultrasound and fine-needle aspiration in patients with potentially resectable lung cancer.

    Science.gov (United States)

    Uemura, S; Yasuda, I; Kato, T; Doi, S; Kawaguchi, J; Yamauchi, T; Kaneko, Y; Ohnishi, R; Suzuki, T; Yasuda, S; Sano, K; Moriwaki, H

    2013-01-01

    The aim of the current study was to assess the detection rate of the right adrenal gland and the diagnostic ability of endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) for the diagnosis of adrenal metastasis in potentially resectable lung cancer. This retrospective cohort study included a consecutive series of 150 patients undergoing EUS/EUS - FNA for staging of lung cancer. The detection rate of the right adrenal gland by EUS and the diagnostic accuracies of computed tomography (CT), positron emission tomography-CT (PET-CT), and EUS/EUS - FNA for the diagnosis of adrenal metastasis were evaluated. The right adrenal gland was visualized by EUS in 131 patients (87.3 %); the left adrenal gland was visualized in all patients. Findings suggestive of metastasis in either one of the adrenal glands or in both were observed in 6 patients (4.0 %) by CT, in 5 patients (3.3 %) by PET-CT, and in 11 patients (7.3 %) by EUS. EUS - FNA was performed simultaneously in the 11 patients, and in 4 patients the diagnosis of metastasis was established. The accuracy for the diagnosis of adrenal metastasis was 100 % for EUS/EUS - FNA, 96.0 % for CT, and 97.0 % for PET-CT (P = 0.1146). As well as the left adrenal gland, the right adrenal gland was also usually visible by EUS. EUS/EUS - FNA provided an accurate diagnosis of adrenal metastasis, although the prevalence of adrenal metastasis was relatively low in these patients with potentially resectable lung cancer. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Impact of introduction of endoscopic ultrasound on volume, success, and complexity of endoscopic retrograde cholangiopancreatography in a tertiary referral center.

    Science.gov (United States)

    Yandrapu, Harathi; Elhanafi, Sherif; Chowdhury, Farhanaz; Liu, Jiayang; Onate, Eduardo J; Dwivedi, Alok; Othman, Mohamed O

    2017-01-01

    Endoscopic ultrasound (EUS) is commonly used to examine pancreaticobiliary disorders. We hypothesize that the introduction of EUS service may change the pattern and the complexity of endoscopic retrograde cholangiopancreatographies (ERCPs) performed. The aim of this study is to assess the impact of introducing EUS on the volume, success, and complexity of ERCP. This is a single-center retrospective data review of ERCP procedures done "before" and "after" the introduction of EUS (before EUS and after EUS). Patients' demographics, ERCP indications, types of sedation, therapeutic interventions, outcomes, complications, and complexity of ERCP were collected. The categorical and continuous variables were compared using Fisher's exact test and the unpaired t-test, respectively. Multivariable logistic regression analysis was used to compare ERCP outcomes. A total of 945 ERCPs performed over a 3-year period between January 2010 and January 2013 (411 and 534 in the "before EUS" and "after EUS" time periods, respectively) were included in this study. There was a 30% relative increase in the volume of ERCPs after the introduction of EUS. ERCP success rate was higher after the introduction of EUS, even after adjusting the complexity grade [odds ratio (OR) = 4.54, P = 0.001]. Significant increase in the complexity of ERCP was observed after the introduction of EUS service. The OR of performing grade 4 ERCP was 4.44 (P = 0.0005) after the introduction of EUS. The introduction of a new EUS service in our tertiary referral university medical center is associated with an increase in the volume, success, and complexity of ERCP procedures. EUS expertise may be valuable for better ERCP outcomes.

  16. Endoscopic ultrasonography: Transition towards the future of gastro-intestinal diseases.

    Science.gov (United States)

    De Lisi, Stefania; Giovannini, Marc

    2016-02-07

    Endoscopic ultrasonography (EUS) is a technique with an established role in the diagnosis and staging of gastro-intestinal tumors. In recent years, the spread of new devices dedicated to tissue sampling has improved the diagnostic accuracy of EUS fine-needle aspiration. The development of EUS-guided drainage of the bilio-pancreatic region and abdominal fluid collections has allowed EUS to evolve into an interventional tool that can replace more invasive procedures. Emerging techniques applying EUS in pancreatic cancer treatment and in celiac neurolysis have been described. Recently, confocal laser endomicroscopy has been applied to EUS as a promising technique for the in vivo histological diagnosis of gastro-intestinal, bilio-pancreatic and lymph node lesions. In this state-of-the-art review, we report the most recent data from the literature regarding EUS devices, interventional EUS, EUS-guided confocal laser endomicroscopy and EUS pancreatic cancer treatment, and we also provide an overview of their principles, clinical applications and limitations.

  17. Contrast-enhanced harmonic endoscopic ultrasound imaging: basic principles, present situation and future perspectives.

    Science.gov (United States)

    Alvarez-Sánchez, María-Victoria; Napoléon, Bertrand

    2014-11-14

    Over the last decade, the development of stabilised microbubble contrast agents and improvements in available ultrasonic equipment, such as harmonic imaging, have enabled us to display microbubble enhancements on a greyscale with optimal contrast and spatial resolution. Recent technological advances made contrast harmonic technology available for endoscopic ultrasound (EUS) for the first time in 2008. Thus, the evaluation of microcirculation is now feasible with EUS, prompting the evolution of contrast-enhanced EUS from vascular imaging to images of the perfused tissue. Although the relevant experience is still preliminary, several reports have highlighted contrast-enhanced harmonic EUS (CH-EUS) as a promising noninvasive method to visualise and characterise lesions and to differentiate benign from malignant focal lesions. Even if histology remains the gold standard, the combination of CH-EUS and EUS fine needle aspiration (EUS-FNA) can not only render EUS more accurate but may also assist physicians in making decisions when EUS-FNA is inconclusive, increasing the yield of EUS-FNA by guiding the puncture with simultaneous imaging of the vascularity. The development of CH-EUS has also opened up exciting possibilities in other research areas, including monitoring responses to anticancer chemotherapy or to ethanol-induced pancreatic tissue ablation, anticancer therapies based on ultrasound-triggered drug and gene delivery, and therapeutic adjuvants by contrast ultrasound-induced apoptosis. Contrast harmonic imaging is gaining popularity because of its efficacy, simplicity and non-invasive nature, and many expectations are currently resting on this technique. If its potential is confirmed in the near future, contrast harmonic imaging will become a standard practice in EUS.

  18. A new method for evaluating gastric ulcer healing by endoscopic ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Niwa, Y.; Nakazawa, S.; Tsukamoto, Y. (and others) (Ichinomiya Municipal Hospital (JP))

    1991-01-01

    The authors observed the quantitative estimation of the transmural changes associated with gastric ulcer healing by using endoscopic ultrasonography (EUS). It was possible to diagnose the depth of ulcer by EUS. 48 patients were divided into three treatment groups. Group A (n=16) was treated with 800 mg cimetidine daily, group B (n=22) with 20 mg omeprazole daily, and group C (n=10) with 400 mg cimetidine + 300 mg gefarnate daily. EUS was performed before and after 2, 4 and 8 weeks of treatment. The groups were compared from the viewpoints of endoscopic findings and contraction rate of the length and the cross-sectional area of the ulcer in EUS pictures. The best healing of both the endoscopic and EUS findings was seen in group B. By estimating the changes inside the ulcer, EUS may provide useful information for choice of anti-ulcer agents. 21 refs., 5 figs., 3 tabs.

  19. Is There a Difference in Diagnostic Accuracy and Clinical Impact between Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography?

    DEFF Research Database (Denmark)

    Ainsworth, Alan Patrick; Rafaelsen, Søren Rafael; Wamberg, Peter

    2003-01-01

    BACKGROUND AND STUDY AIMS: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS: The test performance and potential clinical impact of EUS...... difference, P > 0.05). Had EUS or MRCP been performed as the first investigation in the 75 patients who had a presumed high probability for needing therapeutic ERCP, only 15 and nine patients, respectively, would have avoided ERCP. In this group of patients, one patient needed other diagnostic investigations...... endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially. CONCLUSIONS: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP...

  20. Endoscopic ultrasound duplex scanning for measurement of portal venous flow. Validation against transit time ultrasound flowmetry in pigs

    DEFF Research Database (Denmark)

    Hansen, E F; Strandberg, C; Bendtsen, F

    1999-01-01

    with that of transit time ultrasound (TTU) in healthy pigs. The ability of EUS to detect changes in the portal venous flow after pharmacologic intervention was also investigated. METHODS: Six anaesthetized pigs were studied. Portal venous flow was measured simultaneously by EUS duplex scanning, using a Pentax FG-32UA......BACKGROUND: Endoscopic ultrasound (EUS) is a new technique that makes it possible to measure portal venous flow when transabdominal ultrasound fails. As the technique has not been evaluated previously, we compared simultaneous measurements of portal venous flow using EUS Doppler...... administration. RESULTS: Portal venous flow measured by EUS flowmetry and TTU flowmetry correlated significantly (R = 0.92, P flow after terlipressin measured by EUS and TTU...

  1. [A Case of Intra-abdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration].

    Science.gov (United States)

    Oh, Cho Rong; Kim, Mi Jin; Lee, Kwang Hyuck

    2015-07-01

    Paragonimiasis has been continuously decreasing in Korea. However, it still occurs by ingesting raw or incompletely cooked fresh water crab or crayfish. The diagnosis of paragonimiasis is challenging because of its rarity. It may be confused with other inflammatory disease or carcinomatosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has lower risk of complications such as bleeding, perforation than percutaneous fine needle aspiration. EUS-FNA is more accurate and popular method to find mucosal or submucosal tumors and the lesions of several organs. Benign and malignant tumors, infectious diseases have been diagnosed by EUS-FNA, but there was no report describing the use of EUS-FNA for diagnosing paragonimiasis. Herein, we present a 47-year-old male patient with paragonimiasis diagnosed by EUS-FNA. Imaging studies revealed mass lesions in the lung and peritoneal cavity, which was eventually confirmed as paragonimiasis using EUS-FNA.

  2. Contrast-enhanced endoscopic ultrasonography: advance and current status

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Sung Il [Dept. of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of); Lee, Dong Ki [Dept. of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    Endoscopic ultrasonography (EUS) technology has undergone a great deal of progress along with the color and power Doppler imaging, three-dimensional imaging, electronic scanning, tissue harmonic imaging, and elastography, and one of the most important developments is the ability to acquire contrast-enhanced images. The blood flow in small vessels and the parenchymal microvasculature of the target lesion can be observed non-invasively by contrast-enhanced EUS (CE-EUS). Through a hemodynamic analysis, CE-EUS permits the diagnosis of various gastrointestinal diseases and differential diagnoses between benign and malignant tumors. Recently, mechanical innovations and the development of contrast agents have increased the use of CE-EUS in the diagnostic field, as well as for the assessment of the efficacy of therapeutic agents. The advances in and the current status of CE-EUS are discussed in this review.

  3. Isolated Pyogenic Pancreatic Abscess Successfully Treated via Endoscopic Ultrasound-guided Drainage.

    Science.gov (United States)

    Lee, Jung Yeop; Kim, Tae Hyeon; Chon, Hyung Ku

    2017-05-25

    An isolated pyogenic pancreatic abscess (IPPA) without pancreatitis is extremely rare but can occur in patients with uncontrolled diabetes. This pathologic condition poses a clinical challenge in diagnosis and management because it can be confused easily with a malignancy. Endoscopic ultrasound (EUS) may be a useful diagnostic modality for indeterminate pancreatic lesions and IPPA. Here, we report two cases with elevated carbohydrate antigen 19-9 levels and pancreatic masses on cross sectional imaging. The patients were subsequently diagnosed with IPPA by EUS. EUS-guided drainage was performed successfully and the patients' clinical symptoms and radiologic findings improved. In our experience, EUS and EUS-guided drainage are crucial steps for the diagnosis and management of patients with an indeterminate pancreatic lesion. In addition, EUS-guided drainage has excellent technical and clinical outcomes for the treatment of IPPA.

  4. The role of endoscopic ultrasound for evaluating portal hypertension in children being assessed for intestinal transplantation.

    Science.gov (United States)

    McKiernan, Patrick J; Sharif, Khalid; Gupte, Girish L

    2008-11-27

    Intestinal transplant is an established treatment of irreversible intestinal failure, unless complicated by advanced intestinal failure-associated liver disease, when liver-bowel transplant may be necessary. Finding at least moderate hepatic fibrosis or gastroesophageal varices (GOV) at oesophago-gastroduodenoscopy (OGD) has been an indication for combined transplantation. Endoscopic ultrasound (EUS) is a sensitive method for detection of GOV. We hypothesized that EUS would detect early GOV and decrease the need for liver biopsy. Sixteen children, median age 13 months (range, 7-88), being assessed for intestinal transplant underwent simultaneous OGD and EUS. In 9 of 16 patients the results of OGD and EUS were concordant, that is, both positive (2) or both negative (7) for GOV. In seven patients, GOV were only identified by EUS. Liver biopsy was avoided in four of these cases. EUS is superior to OGD for detecting GOV in children with intestinal failure-associated liver disease and results in fewer liver biopsies being necessary.

  5. Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

    Science.gov (United States)

    Yoshinaga, Shigetaka; Oda, Ichiro; Nonaka, Satoru; Kushima, Ryoji; Saito, Yutaka

    2012-01-01

    Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection. PMID:22720122

  6. Endoscopic ultrasound practice survey in latin america.

    Science.gov (United States)

    Drigo, Juliana Marques; Castillo, Cecilia; Wever, Wallia; Obaldía, José Ricardo Ruíz; Fillipi, Sheila; Ribeiro, Manoel C S A; Rossini, Lucio G B

    2013-10-01

    Endoscopic ultrasound (EUS) has become an important imaging modality for the diagnosis, staging and treatment of gastrointestinal disorders. However, no official data exists regarding clinical EUS practice in Latin America (LA). This study assessed current EUS practice and training. A direct mail survey questionnaire was sent to 268 Capítulo Latino Americano de Ultrasonido Endoscópico members between August 2012 and January 2013. The questionnaire was sent out in English, Spanish and Portuguese languages and was available through the following site: http://www.cleus-encuesta.com. Responses were requested only from physicians who perform EUS. A total of 70 LA physicians answered the questionnaire until January 2013. Most of the participants were under 42 years of age (53%) and 80% were men. Most participants (45.7%) perform EUS in Brazil, 53% work in a private hospital. The majority (70%) also perform endoscopic retrograde cholangiopancreatography. A total 42% had performed EUS for 2 years or less and 22.7% for 11 years or more. Only 10% performed more than 5000 EUS. The most common indication was an evaluation of pancreatic-biliary-ampullary lesions. Regarding training, 48.6% had more than 6 months of dedicated hands-on EUS and 37% think that at least 6 months of formal training is necessary to acquire competence. Furthermore, 64% think that more than 50 procedures for pancreatic-biliary lesions are necessary. This survey provides insight into the status of EUS in LA. EUS is performed mostly by young endoscopists in LA. Diagnostic upper EUS is the most common EUS procedure. Most endosonographers believe that formal training is necessary to acquire competence.

  7. Endoscopic ultrasonography-guided placement of a transhepatic portal vein stent in a live porcine model

    OpenAIRE

    Park, Tae Young; Seo, Dong Wan; Kang, Hyeon-Ji; Cho, Min Keun; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

    2016-01-01

    Background and Objectives: Percutaneous portal vein (PV) stent placement is used to manage PV occlusion or stenosis caused by malignancy. The use of endoscopic ultrasonography (EUS) has expanded to include vascular interventions. The aim of this study was to examine the technical feasibility and safety of EUS-guided transhepatic PV stent placement in a live porcine model. Materials and Methods: EUS-guided transhepatic PV stent placement was performed in six male miniature pigs under general a...

  8. Endoscopic ultrasound-guided sampling of solid pancreatic masses: 22-gauge aspiration versus 25-gauge biopsy needles

    OpenAIRE

    Yang, Min Jae; Yim, Hyunee; Hwang, Jae Chul; Lee, Dakeun; Kim, Young Bae; Lim, Sun Gyo; Kim, Soon Sun; Kang, Joon Koo; Yoo, Byung Moo; Kim, Jin Hong

    2015-01-01

    Background Biopsy needles have recently been developed to obtain both cytological and histological specimens during endoscopic ultrasound (EUS). We conducted this study to compare 22-gauge (G) fine needle aspiration (FNA) needles, which have been the most frequently used, and new 25G fine needle biopsy (FNB) needles for EUS-guided sampling of solid pancreatic masses. Methods We conducted a retrospective cohort study of all EUS-guided sampling performed between June 2010 and October 2013. Duri...

  9. Endoscopic ultrasound features of chronic pancreatitis

    DEFF Research Database (Denmark)

    Rana, Surinder Singh; Vilmann, Peter

    2015-01-01

    of this fact and abundant literature, the exact role of EUS in the diagnosis of chronic pancreatitis (CP) is still not established. The EUS features to diagnose CP have evolved over a period from a pure qualitative approach to more advanced and complicated scoring systems incorporating multiple parenchymal...... and ductal EUS features. The rosemont criteria have attempted to define precisely each EUS criterion and thus have good inter-observer agreement. However, initial studies have failed to demonstrate any significant improvement in the inter-observer variability and further validation studies are needed...

  10. New endoscopic ultrasonography techniques for pancreaticobiliary diseases

    Directory of Open Access Journals (Sweden)

    Ken Kamata

    2016-07-01

    Full Text Available Endoscopic ultrasonography (EUS is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.

  11. Crystal growth of nanoscaled europium selenide having characteristic crystal shapes

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Atsushi; Adachi, Taka-aki [Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara 630-0192 (Japan); Hasegawa, Yasuchika, E-mail: hasegawa@ms.naist.j [Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara 630-0192 (Japan); Kawai, Tsuyoshi [Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara 630-0192 (Japan)

    2009-12-04

    Tetrapod-shaped EuSe nanocrystals were prepared through the thermal reduction of europium chloride an organic selenide complex, n-hexadecylamine, and two additives oleic acid and oleylamine. The obtained EuSe nanoparticles were characterized by X-ray diffraction (XRD). The crystal grain size from the XRD spectrum was estimated to be 50 nm. In contrast, observation of the transmission electron microscope (TEM) gave larger sized EuSe (average size: 200 nm). Anisotropic crystal-growth of EuSe nanocrystals was achieved by addition of a small amount of oleic acid in the crystal growth process.

  12. Algorithms for combining menstrual and ultrasound estimates of gestational age: consequences for rates of preterm and postterm birth.

    Science.gov (United States)

    Blondel, Béatrice; Morin, Isabelle; Platt, Robert W; Kramer, Michael S; Usher, Robert; Bréart, Gérard

    2002-06-01

    We compared rates of preterm and postterm birth according to six algorithms for gestational age (GA) estimates based on last menstrual period (LMP) and early ultrasound (EUS): LMP alone, LMP if the discrepancy between the two estimates was within 14 days and otherwise EUS (14-day rule), a 10-day rule, a seven-day rule, a three-day rule and EUS alone. In a sample of 44,623 births in a Canadian tertiary hospital, the choice of algorithms makes a substantial impact on both preterm and postterm birth rates, even when EUS was used for discrepancies over two weeks.

  13. New endoscopic ultrasonography techniques for pancreticobiliary diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kamata, Ken; Kitano, Masayuki; Omoto, Shunsuke; Kadosaka, Kumpei; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hajime; Kudo, Masatoshii [Dept. of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka (Japan)

    2016-07-15

    Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.

  14. Endoscopic ultrasound with fine needle aspiration and biopsy in lung cancer and isolated mediastinal lymphadenopathy.

    LENUS (Irish Health Repository)

    Nadarajan, P

    2010-03-01

    Endoscopic ultrasound with fine-needle aspiration and biopsy (EUS-FNAB) is well established in diagnosing and staging lung cancer in patients with mediastinal adenopathy. EUS-FNAB is highly sensitive, less invasive and has lower complication rates when compared to surgical staging of mediastinal nodes. In this study we describe our experience of EUS-FNAB in lung cancer and other causes of mediastinal lymphadenopathy. EUS-FNAB was performed for assessment of PET positive mediastinal lymph nodes between January 2007 and March 2009 in AMNCH. The endpoints of our study were sensitivity and specificity of EUS-FNAB, morbidity and length of hospital stay. Thirty four patients underwent EUS-FNAB during the study period for both diagnosis and staging. Thirty patients had positive lymph node invasion and 4 had no evidence of malignant invasion. In these 4 patients negative cytology was confirmed on mediastinoscopy giving EUS-FNAB a sensitivity and specificity of 100%. EUS-FNAB upstaged the disease in 12 patients. EUS-FNAB is a reliable tool for mediastinal staging in lung cancer, significantly reducing the need for surgical staging procedures in patients with suspected mediastinal involvement.

  15. Effect of the time of day and queue position in the endoscopic schedule on the performance characteristics of endoscopic ultrasound-guided fine-needle aspiration for diagnosing pancreatic malignancies.

    Science.gov (United States)

    Korenblit, Jason; Tholey, Danielle M; Tolin, Joanna; Loren, David; Kowalski, Thomas; Adler, Douglas G; Davolos, Julie; Siddiqui, Ali A

    2016-01-01

    Recent reports have indicated that the time of day may impact the detection rate of abnormal cytology on gynecologic cytology samples. The aim of this study was to determine if procedure time or queue position affected the performance characteristics of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosing solid pancreatic malignancies. We conducted a retrospective study evaluating patients with solid pancreatic lesions in whom EUS-FNA was performed. Three timing variables were evaluated as surrogate markers for endoscopist fatigue: Procedure start times, morning versus afternoon procedures, and endoscopy queue position. Statistical analyses were performed to determine whether the timing variables predicted performance characteristics of EUS-FNA. We identified 609 patients (mean age: 65.8 years, 52.1% males) with solid pancreatic lesions who underwent EUS-FNA. The sensitivity of EUS-FNA was 100% for procedures that started at 7 AM while cases that started at 4 PM had a sensitivity of 81%. Using start time on a continuous scale, each elapsed hour was associated with a 1.9% decrease in EUS-FNA sensitivity (P = 0.003). Similarly, a 10% reduction in EUS-FNA sensitivity was detected between morning and afternoon procedures (92% vs. 82% respectively, P = 0.0006). A linear regression comparing the procedure start time and diagnostic accuracy revealed a decrease of approximately 1.7% in procedure accuracy for every hour later a procedure was started. A 16% reduction in EUS-FNA accuracy was detected between morning and afternoon procedures (100% vs. 84% respectively, P = 0.0009). When the queue position was assessed, a 2.4% reduction in accuracy was noted for each increase in the queue position (P = 0.013). Sensitivity and diagnostic accuracy of EUS-FNA for solid pancreatic lesions decline with progressively later EUS starting times and increasing numbers of procedures before a given EUS, potentially from endoscopist fatigue and cytotechnologist

  16. A case of abdominal pain and abnormal location of gallstone diagnosed by endoscopic ultrasound

    Directory of Open Access Journals (Sweden)

    Narendra Singh Choudhary

    2017-01-01

    Full Text Available A 50-year-old male came to us with pain abdomen; endoscopic ultrasound. (EUS made a diagnosis of cholecystoduodenal fistula which was later on confirmed on gastroscopy and surgery. We present interesting images of EUS; a calculus is visualized outside gallbladder with inflammatory changes of duodenal wall.

  17. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, R.; Vilmann, P.; Sud, R.

    2010-01-01

    Patients with suspected tuberculosis without pulmonary lesions and with mediastinal lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate mediastinal and abdominal lesions. The aim...... of the present study was to evaluate the role of EUS-FNA in isolated mediastinal lymphadenopathy in patients suspected of having tuberculosis....

  18. Safety and Utility of Single-Session Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography for the Evaluation of Pancreatobiliary Diseases

    Science.gov (United States)

    Kawakubo, Kazumichi; Kuwatani, Masaki; Haba, Shin; Kudo, Taiki; Abe, Yoko; Kawahata, Shuhei; Onodera, Manabu; Ehira, Nobuyuki; Yamato, Hiroaki; Eto, Kazunori; Sakamoto, Naoya

    2014-01-01

    Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis, which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate. PMID:24827632

  19. Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance

    Science.gov (United States)

    Kudo, Taiki; Kawakami, Hiroshi; Kuwatani, Masaki; Eto, Kazunori; Kawahata, Shuhei; Abe, Yoko; Onodera, Manabu; Ehira, Nobuyuki; Yamato, Hiroaki; Haba, Shin; Kawakubo, Kazumichi; Sakamoto, Naoya

    2014-01-01

    AIM: To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a cohort of pancreatic cancer patients. METHODS: Of 213 patients with pancreatic cancer evaluated between April 2007 and August 2011, 82 were thought to have resectable pancreatic cancer on the basis of cross-sectional imaging findings. Of these, 54 underwent EUS-FNA before surgery (FNA+ group) and 28 underwent surgery without preoperative EUS-FNA (FNA- group). RESULTS: All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cytology and histology findings was 98.1% (53/54) and 77.8% (42/54), respectively, and the total accuracy was 98.1% (53/54). One patient developed mild pancreatitis after EUS-FNA but was successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+ and FNA- groups, the median relapse-free survival (RFS) was 742 and 265 d, respectively (P = 0.0099), and the median overall survival (OS) was 1042 and 557 d, respectively (P = 0.0071). RFS and OS were therefore not inferior in the FNA+ group. These data indicate that the use of EUS-FNA did not influence RFS or OS, nor did it increase the risk of peritoneal recurrence. CONCLUSION: In patients with resectable pancreatic cancer, preoperative EUS-FNA is a safe and accurate diagnostic method. PMID:24707146

  20. Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses

    DEFF Research Database (Denmark)

    Seicean, A; Badea, R; Moldovan-Pop, A

    2015-01-01

    Purpose: The global accuracy of fine-needle aspiration guided by endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85 %. The use of contrast agents during EUS to highlight vessels and the necrotic parts of pancreatic masses may improve biopsy guidance. Our aim was to assess w...

  1. Comparison of Histologic Core Portions Acquired from a Core Biopsy Needle and a Conventional Needle in Solid Mass Lesions: A Prospective Randomized Trial.

    Science.gov (United States)

    Lee, Ban Seok; Cho, Chang-Min; Jung, Min Kyu; Jang, Jung Sik; Bae, Han Ik

    2017-07-15

    The superiority of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) over EUS-guided fine needle aspiration (EUS-FNA) remains controversial. Given the lack of studies analyzing histologic specimens acquired from EUS-FNB or EUS-FNA, we compared the proportion of the histologic core obtained from both techniques. A total of 58 consecutive patients with solid mass lesions were enrolled and randomly assigned to the EUS-FNA or EUS-FNB groups. The opposite needle was used after the failure of core tissue acquisition using the initial needle with up to three passes. Using computerized analyses of the scanned histologic slide, the overall area and the area of the histologic core portion in specimens obtained by the two techniques were compared. No significant differences were identified between the two groups with respect to demographic and clinical characteristics. Fewer needle passes were required to obtain core specimens in the FNB group (pcore (11.8%±19.5% vs 8.0%±11.1%, p=0.376) or in the diagnostic accuracy (80.6% vs 81.5%, p=0.935) between two groups. The proportion of histologic core and the diagnostic accuracy were comparable between the FNB and FNA groups. However, fewer needle passes were required to establish an accurate diagnosis in EUS-FNB.

  2. Transesophageal ultrasonography for lung cancer staging

    DEFF Research Database (Denmark)

    Konge, Lars; Annema, Jouke; Vilmann, Peter

    2013-01-01

    Accurate mediastinal nodal staging is essential for patients with resectable non-small-cell lung cancer and is achieved by combined endobronchial ultrasound and transesophageal endoscopic ultrasound (EUS). Training requirements for EUS-guided fine-needle aspiration (FNA) for lung cancer staging...

  3. Endosonographic examination of thyroid gland among patients with nonthyroid cancers.

    Science.gov (United States)

    Alkhatib, Amer A; Mahayni, Abdulah A; Chawki, Ghaleb R; Yoder, Leon; Elkhatib, Fateh A; Al-Haddad, Mohammad

    2016-01-01

    There is limited endosonographic literature regarding thyroid gland pathology, which is frequently visualized during upper endoscopic ultrasound (EUS). Our objective was to assess the prevalence of benign and malignant thyroid lesions encountered during routine upper EUS within a cancer center setting. The data were prospectively collected and retrospectively analyzed. All upper EUS procedures performed between October 2012 and July 2014 were reviewed at a large referral cancer center. Data collected included patient demographics, preexisting thyroid conditions, thyroid gland dimensions, the presence or absence of thyroid lesions, and EUS morphology of lesions if present, and interventions performed to characterize thyroid lesions and pathology results when applicable. Two hundred and forty-five EUS procedures were reviewed. Of these, 100 cases reported a detailed endosonographic examination of the thyroid gland. Most of the thyroid glands were endosonographically visualized when the tip of the scope was at 18 cm from the incisors. Twelve cases showed thyroid lesions, out of which three previously undiagnosed thyroid cancers were visualized during EUS (two primary papillary thyroid cancers and one anaplastic thyroid cancer). Transesophageal EUS-guided fine needle aspiration of thyroid lesions was feasible when the lesion was in the inferior portion of the thyroid gland, and the tip of the scope was at 18 cm or more from the incisors. Routine EUS examination may detect unexpected thyroid lesions including malignant ones. We encourage endosonographers to screen the visualized portions of the thyroid gland during routine withdrawal of the echoendoscope.

  4. Efficacy of an artificial neural network-based approach to endoscopic ultrasound elastography in diagnosis of focal pancreatic masses

    DEFF Research Database (Denmark)

    Săftoiu, Adrian; Vilmann, Peter; Gorunescu, Florin

    2012-01-01

    By using strain assessment, real-time endoscopic ultrasound (EUS) elastography provides additional information about a lesion's characteristics in the pancreas. We assessed the accuracy of real-time EUS elastography in focal pancreatic lesions using computer-aided diagnosis by artificial neural...

  5. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses

    DEFF Research Database (Denmark)

    Săftoiu, A; Vilmann, P; Gorunescu, F

    2011-01-01

    Endoscopic ultrasound (EUS) elastography represents a new imaging procedure that might characterize the differences of hardness and strain between diseased tissue and normal tissue. The aim of this study was to assess the efficiency of EUS elastography for the differentiation of focal masses...

  6. Impact of upper gastrointestinal endoscopic ultrasound in children

    DEFF Research Database (Denmark)

    Bjerring, Ole Steen; Durup, Jesper; Qvist, Niels

    2008-01-01

    Abstract The impact and feasibility of upper gastrointestinal endoscopic ultrasound (EUS) in younger children are unknown. We retrospectively reviewed the EUS procedures we had performed in children younger than 16 years with regard to feasibility, safety, and impact on further treatment. In all,...

  7. Predictors of Malignancy and Recommended Follow-Up for Patients with Negative Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspected Pancreatic Lesions

    Directory of Open Access Journals (Sweden)

    Bret J Spier

    2009-01-01

    Full Text Available BACKGROUND: Endoscopic ultrasound (EUS with fine-needle aspiration (FNA can characterize and diagnose pancreatic lesions as malignant, but cannot definitively rule out the presence of malignancy. Outcome data regarding the length of follow-up in patients with negative or nondiagnostic EUS-FNA of pancreatic lesions are not well-established.

  8. Diagnostic Yield and Safety of Endoscopic Ultrasound Guided Fine Needle Aspiration of Central Mediastinal Lung Masses

    Directory of Open Access Journals (Sweden)

    Enrique Vazquez-Sequeiros

    2013-01-01

    Full Text Available Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. Design: Retrospective review of a prospectively maintained database; noncomparative. Setting: Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. Main Outcome Measurement: EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85% patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6% had a benign lung mass (hamartoma, while the remaining 61 patients (61/62 = 98.4% had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%. The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%. Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.

  9. Endoscopic ultrasound-guided celiac plexus block and neurolysis.

    Science.gov (United States)

    Yasuda, Ichiro; Wang, Hsiu-Po

    2017-05-01

    Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is widely used for reducing pain originating from upper abdominal organs. It is mainly indicated to treat pancreatic cancer pain, but also to relieve pain as a result of chronic pancreatitis. Real-time guidance and color Doppler imaging by EUS made the procedure easier and safer, resulting in greater pain relief. Currently, two techniques are used for EUS-CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the celiac axis. In the bilateral technique, the neurolytic agent is injected on both sides of the celiac axis. In addition, EUS-guided direct celiac ganglia neurolysis (EUS-CGN) was introduced recently. Pain relief is achieved by EUS-CPN in 70-80% of patients with pancreatic cancer and in 50-60% of those with chronic pancreatitis. The bilateral technique may be more efficient than the central technique, although the central technique is easier and possibly safer. Moreover, EUS-CGN may provide greater pain relief than conventional EUS-CPN. Procedure-related complications include transient pain exacerbation, transient hypotension, transient diarrhea, and inebriation. Although most complications are not serious, major adverse events such as retroperitoneal bleeding, abscess, and ischemic complications occasionally occur. © 2017 Japan Gastroenterological Endoscopy Society.

  10. Diagnostic potential of endoscopic ultrasonography-elastography for gastric submucosal tumors: A pilot study.

    Science.gov (United States)

    Tsuji, Yuichiro; Kusano, Chika; Gotoda, Takuji; Itokawa, Fumihide; Fukuzawa, Masakatsu; Sofuni, Atsushi; Matsubayashi, Jun; Nagao, Toshitaka; Itoi, Takao; Moriyasu, Fuminori

    2016-03-01

    Qualitative diagnosis for gastric submucosal tumors (SMT) is not easy. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in combination with EUS-elastography (EUS-EG) is reported useful for qualitatively diagnosing pancreatic tissues. We prospectively studied whether EUS-EG could be useful in qualitative diagnosis of gastric SMT. We prospectively registered 25 consecutive patients with gastric SMT diagnosed by esophagogastroduodenoscopy and carried out qualitative evaluations using EUS-EG (May 2013 to March 2015) followed by histopathological diagnosis using EUS-FNA or endoscopic mucosal cutting biopsy. Elastic scores of gastric SMT were compared to the cytological diagnosis. Of 25 patients, 22 had a confirmed cytological diagnosis. Regarding the Giovannini elastic score, of three patients with aberrant pancreas, one was score 1 and two were score 2; of eight patients with leiomyoma, seven were score 2 and one was score 3. Both of two patients with schwannoma were score 4. Of nine patients with gastrointestinal stromal tumor, six were score 4 and three were score 5. Gastrointestinal stromal tumor (GIST) is harder than other types of gastric SMT, and our study's findings suggested the usefulness of EUS-EG, which can also assess tumor hardness of gastric SMT. EUS-EG might be helpful for the differential diagnosis of gastric SMT, especially to differentiate GIST from other SMT. © 2015 Japan Gastroenterological Endoscopy Society.

  11. Endoscopic Ultrasound Fine-Needle Aspiration Characteristics of Primary Adenocarcinoma versus Other Malignant Neoplasms of The Pancreas

    Directory of Open Access Journals (Sweden)

    Veronika Gagovic

    2012-01-01

    Full Text Available BACKGROUND: Endoscopic ultrasound (EUS with fine-needle aspiration (FNA is often used to assist in the evaluation of pancreatic lesions and may help to diagnose benign versus malignant neoplasms. However, there is a paucity of literature regarding comparative EUS characteristics of various malignant pancreatic neoplasms (primary and metastatic.

  12. Multi-scalar influence of weather and climate on very large-fires in the Eastern United States

    Science.gov (United States)

    John T. Abatzoglou; Renaud Barbero; Crystal A. Kolden; Katherine C. Hegewisch; Narasimhan K. Larkin; Harry Podschwit

    2014-01-01

    A majority of area burned in the Eastern United States (EUS) results from a limited number of exceptionally large wildfires. Relationships between climatic conditions and the occurrence of very large-fires (VLF) in the EUS were examined using composite and climate-niche analyses that consider atmospheric factors across inter-annual, sub-seasonal and synoptic temporal...

  13. Creating a Law about Religion under Constantine the Great The Case of the Edict against the Heretics (Eus. Vita Const. 3, 63–66). Beiträge zur Rechtsgeschichte Österreichs|Beiträge zur Rechtsgeschichte Österreichs Band 2 / 2013 recht [durch] setzen / Making Things Legal Gesetzgebung und prozessuale Wirklichkeit in den europäischen Rechtstraditionen|

    OpenAIRE

    Minale, Valerio Massimo

    2014-01-01

    During the Christianization of the Roman Empire the matter of the relationships between State and Church became essential. In this context, one of the most interesting aspects concerns the fight against the phenomenon of heresy in its many forms. A meaningful attempt was undertaken by the first Christian emperor, Constantine the Great. He tried to find a solution to the divisions which were starting to trouble the ecclesiastical community and therefore the majority of the people. He tried to ...

  14. Contaminação fecal da ostra Crassostrea rhizophorae e da água de cultivo do estuário do Rio Pacoti (Eusébio, Estado do Ceará: Isolamento e identificação de Escherichia coli e sua susceptibilidade a diferentes antimicrobianos

    Directory of Open Access Journals (Sweden)

    Regine Helena Silva dos Fernandes Vieira

    2008-06-01

    Full Text Available This study has been designed to assess the microbiological quality of oyster Crassostrea rhizophorae and of the water used in farms located at the Pacoti River estuary, Ceará State, by means of the MPN of total coliforms (Ct and thermtolerant coliforms (CT. The database consisted of 15 samples collected from June to November, 2006. The water was kept within the limits set up by the current legislation. MPN values were in the ranges of <1.8 18,000 Ct per 100 ml and <1.8 2,000 CT per 100 ml, for the water, and <1.8 3,500 Ct per gram and <1.8 2,800 CT per gram for the oyster itself. Twenty-five strains isolated from the cultivation water and identified as Escherichia coli were tested for susceptibility to a few antimicrobians and proved resistant to ampicillin, nitrofurantoin, tetracycline, sulfazotrin, nalidixic acid, ciprofloxacin and imipenem. From the oysters, four strains were identified as E. coli and proved resistant to tetracycline and imipenem. From the afore-mentioned results, it can be concluded that: Pacoti River waters have received a clean bill of health according to the national legislation; the majority of water-isolated E.coli strains (59.43% were sensitive to the currently used antimicrobians, except for imipenem to which 80% of the identified E. coli strains proved resistant; sensitivity of the oyster-isolated E. coli strains was found to be high to most of the tested antimicrobians. In all, it is suggested that more clear management measures be made available so as to allow for microbiological quality evaluation of raw-consumed mollusks.

  15. Quiste de duplicación gástrico: diagnóstico por punción-aspiración guiada por ecoendoscopia Adult gastric duplication cyst: diagnosis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA

    Directory of Open Access Journals (Sweden)

    S. Seijo Ríos

    2008-09-01

    Full Text Available Los quistes de duplicación son anomalías congénitas infrecuentes del tracto gastrointestinal que pueden localizarse a cualquier nivel desde la boca hasta al ano. Los quistes de duplicación gástricos son los más excepcionales y constituyen tan sólo el 4-8% de todos ellos. Su patogénesis es controvertida y hoy en día aun existen múltiples teorías que tratan de explicar su mecanismo etiopatogénico. En la mayoría de los casos el diagnóstico se realiza en la primera infancia y tan sólo en una pequeña proporción se identifican en la edad adulta como un hallazgo incidental, ya que estas entidades suelen ser asintomáticas fuera de la infancia. Casi en la mitad de los casos se asocia a otras malformaciones congénitas y es de vital importancia realizar un minucioso diagnóstico diferencial con otras entidades, en especial neoplasias con componente quístico. Aunque es extremadamente inusual, se ha publicado la degeneración neoplásica de estas lesiones, lo que hace más importante su preciso diagnóstico y estudio citohistológico. En este artículo se presenta el caso de un quiste de duplicación gástrico diagnosticado en la edad adulta, mediante ultrasonografía endoscópica asociado a punción-aspirativa, técnica que ha sido recientemente propuesta como la más eficaz para el diagnóstico.Duplication cysts are rare gastrointestinal congenital abnormalities. They can occur anywhere throughout the gastrointestinal tract, and gastric duplication cysts are most uncommon, representing only 4-8% of all gastrointestinal duplication cysts. Nowadays several theories try to explain the pathogenic mechanisms involved. These cysts are usually diagnosed during early childhood, and very rarely are detected in adults, mostly incidentally due to a lack of symptoms. Close to 50% of gastric cysts are associated with other abnormalities. It is extremely important that a meticulous differential diagnosis is performed regarding other diseases, mainly malignancies with a cystic component. Although extremely uncommon, a malignant transformation of these lesions has been reported, which highlights the importance of a correct diagnosis. Herein we report the case of a duplication cyst in an adult, which was detected by endoscopic ultrasound-guided fine-needle aspiration, recently proposed as the most accurate technique for the identification of these lesions.

  16. Clearance of materials from dismantling of nuclear facilities in Sweden - a study on whether the EU recommendations are applicable in Sweden; Friklassning av material fraan rivning av kaerntekniska anlaeggningar i Sverige - en utredning om EU:s rekommenderade regler aer tillaempbara i Sverige

    Energy Technology Data Exchange (ETDEWEB)

    Hamrefors, Gunilla [Westinghouse Electric Sweden AB, Vaesteraas (Sweden)

    2004-02-01

    The report presents a study on whether the EU recommendations on clearance of metals, buildings and building rubble from the dismantling of nuclear facilities are applicable in Sweden. Analyses are made to estimate the amounts of waste that would be released from dismantling of the Swedish nuclear power plants and to what degree the costs of the licence holders would be influenced. A summary and evaluation of different methods and equipments for measurement is also given. The main conclusion is that the EU recommendations are applicable in Sweden.

  17. Endosonography guided management of pancreatic fluid collections

    DEFF Research Database (Denmark)

    Vilmann, Andreas S; Menachery, John; Tang, Shou-Jiang

    2015-01-01

    and regulatory approval of improved and novel endoscopic devices specifically designed for transmural drainage of fluid and necrotic debris (access and patency devices), the authors predict continuing evolution in the management of PFCs. We believe that EUS will become an indispensable part of procedures used...... complications of pancreatitis can include acute peri-pancreatic fluid collection, acute necrotic collection, pseudocyst formation, and walled-off necrosis. Interventional endoscopic ultrasound (EUS) has been increasing utilized in managing these local complications. After performing a PubMed search, the authors...... manually applied pre-defined inclusion criteria or a filter to identify publications relevant to EUS and pancreatic collections (PFCs). The authors then reviewed the utility, efficacy, and risks associated with using therapeutic EUS and involved EUS devices in treating PFCs. Due to the development...

  18. Endoscopic Doppler ultrasound for measurement of azygos blood flow. Validation against thermodilution and assessment of pharmacological effects of terlipressin in portal hypertension

    DEFF Research Database (Denmark)

    Hansen, Erik Feldager; Bendtsen, Flemming; Brinch, K

    2001-01-01

    administration of terlipressin, the azygos blood flow, as measured by EUS Doppler, decreased significantly by 23% from 915 to 704 ml/min (P = 0.014) and the portal venous flow decreased by 28% from 1170 to 789 ml/min (P = 0.03). No effects of placebo were detected. CONCLUSIONS: These results show that EUS......BACKGROUND: Endoscopic ultrasound (EUS) is a new modality allowing real-time flow measurements by means of the Doppler technique. The aim of the study was to evaluate azygos blood flow measurements by endoscopic ultrasound. METHODS: Measurements of azygos blood flow by EUS and by the thermodilution....... RESULTS: The EUS Doppler and thermodilution measurements correlated significantly (R=0.81, P Doppler measurements of the azygos blood flow was 14.8%. After...

  19. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study

    DEFF Research Database (Denmark)

    Mortensen, M B; Pless, T; Durup, J

    2001-01-01

    BACKGROUND AND STUDY AIMS: Several studies have evaluated the accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) in the upper gastrointestinal tract, but so far no studies have specifically evaluated the clinical impact of EUS-FNAB in upper gastrointestinal tract......% in esophageal, gastric, and pancreatic cancer, respectively. The staging-related clinical impact was similar for all three types of cancer (11-12.5%), whereas the diagnosis-related impact was highest in pancreatic cancer patients (86%). EUS-FNAB was inadequate in 13% and gave false-negative results in 5......%. The overall sensitivity, specificity and accuracy for EUS-FNAB were 80%, 78% and 80%, respectively. No complications related to the biopsy procedure were seen. CONCLUSIONS: If EUS-FNAB was performed only in cases where a positive malignant result would change patient management, then approximately one out...

  20. Impact of Positron Emission Tomography and Endoscopic Ultrasound Length of Disease Difference on Treatment Planning in Patients with Oesophageal Cancer.

    Science.gov (United States)

    Foley, K G; Morgan, C; Roberts, S A; Crosby, T

    2017-11-01

    Treatment decision making and planning in patients with oesophageal cancer are guided by radiological measurement of length of disease (LoD). This study aimed to investigate differences in positron emission tomography (PET) and endoscopic ultrasound (EUS) LoD. Their prognostic significance was also assessed. LoD was measured from PET and EUS staging investigations by one observer for each modality. Bland-Altman analysis and Wilcoxon signed rank tests assessed agreement and differences in measurements. In terms of radiotherapy planning, the proportion of cases with a clinically significant difference of more than 2 cm between PET and EUS was also calculated. Univariable and multivariable analysis assessed association with overall survival. A P-value measure LoD compared with EUS. The median PET and EUS LoD was 6.4 and 8.0 cm, respectively. PET and EUS LoD was significantly different (Z = -7.021, P LoD was more than 2 cm longer than PET LoD in 61 cases (38.1%). In eight cases (5.0%), PET LoD was more than 2 cm longer than EUS LoD. Both variables had prognostic significance in univariable analysis, but were not independent predictors of overall survival. There are significant differences in PET and EUS measurement of LoD. This could affect clinical decision making and radiotherapy treatment planning. Clinically significant differences between EUS and PET LoD could lead to a risk of geographical miss in up to 38.1% of cases if the PET/CT measurement alone had been used for radiotherapy planning. These results highlight the continued benefit of EUS in the oesophageal cancer staging and treatment pathway. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  1. Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats.

    Science.gov (United States)

    LaPallo, Brandon K; Wolpaw, Jonathan R; Chen, Xiang Yang; Carp, Jonathan S

    2014-08-15

    The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2-8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. Copyright © 2014 the American Physiological Society.

  2. Use of Endoscopic Ultrasound to Guide Adalimumab Treatment in Perianal Crohn's Disease Results in Faster Fistula Healing.

    Science.gov (United States)

    Wiese, Dawn M; Beaulieu, Dawn; Slaughter, James C; Horst, Sara; Wagnon, Julie; Duley, Caroline; Annis, Kim; Nohl, Anne; Herline, Alan; Muldoon, Roberta; Geiger, Tim; Wise, Paul E; Schwartz, David A

    2015-07-01

    Perianal disease is a manifestation of Crohn's disease (CD) that has poor long-term treatment outcomes. The aim was to determine if rectal endoscopic ultrasound (EUS)-guided therapy with adalimumab (ADA) can improve outcomes for patients with perianal fistulizing CD. This is a randomized prospective study comparing serial EUS guidance of fistula treatment versus standard of care in fistulizing perianal CD. At enrollment, all patients underwent a rectal EUS and an EUA with seton placement and/or I&D. Treatment was maximized with immunomodulators, antibiotics, and ADA induction. Surgical interventions were determined by the surgeon's discretion in the control group and assisted by every 12th week EUS in the intervention group. Primary and secondary endpoints where complete drainage cessation at week 48 was fistula status per EUS, respectively. Twenty patients were enrolled: 11 control and 9 EUS guidance. At 24 weeks, 7/9 (78%) in EUS group and 3/11 (27%) in control group had drainage cessation (P = 0.04). This significant difference was lost at week 48 (P = 0.44). Three patients in the EUS and 1 in the control group had additional surgical intervention. Those in the EUS group had more rapid escalation of ADA dosing (P = 0.003). There was no difference in the change in PDAI at week 48 versus baseline (P = 0.81). Rectal EUS-guided ADA therapy for CD perianal fistulas showed an initial benefit at 24 weeks, which was lost at week 48. This is likely due to small sample size and higher fistula closure in the controls. However, the faster rate of fistula resolution is a clinically significant finding.

  3. Efficacy of endoscopic ultrasound-guided fine-needle aspiration for schwannoma: six cases of a retrospective study.

    Science.gov (United States)

    Takasumi, Mika; Hikichi, Takuto; Takagi, Tadayuki; Suzuki, Rei; Watanabe, Ko; Nakamura, Jun; Sugimoto, Mitsuru; Kikuchi, Hitomi; Konno, Naoki; Waragai, Yuichi; Asama, Hiroyuki; Obara, Katsutoshi; Ohira, Hiromasa

    2017-08-09

    Schwannomas are difficult to diagnose using imaging alone. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective and safe tissue sampling technique. Nevertheless, few reports have described EUS-FNA for schwannoma. This study evaluates the efficacy of EUS-FNA for diagnosing schwannoma. This retrospective study examined six consecutive schwannoma patients who were diagnosed as having schwannoma either from EUS-FNA results or from surgically resected specimens. The primary endpoint was diagnostic accuracy of EUS-FNA for schwannoma. The secondary endpoint was EUS-FNA safety. Based on cytomorphologic features and immunocytochemistry results after EUS-FNA, 4 out of 6 patients (66.7%) were diagnosed with schwannoma. The diagnoses before EUS-FNA were the following: 3 cases of gastric subepithelial lesion (SEL, suspicious for gastrointestinal stromal tumor), 1 case of intraperitoneal tumor, 1 case of retroperitoneal tumor, and 1 case of pancreatic tumor, with sizes of 15-44 mm (median 36 mm). No case was diagnosed as schwannoma solely based on image findings. Two cases of gastric SELs could not be diagnosed as schwannoma by EUS-FNA before surgery. Inadequate sampling and a lack of additional material for immunohistochemical studies could have engendered less-definite diagnoses in those cases. No procedural adverse events occurred. The diagnostic accuracy rate of EUS-FNA for schwannoma is somewhat low. However, tissue samples were obtained safely using this method. Moreover, it is an important procedure for diagnosing schwannoma, which cannot be diagnosed solely from image findings.

  4. Experience with emergency ultrasound training by Canadian emergency medicine residents.

    Science.gov (United States)

    Kim, Daniel J; Theoret, Jonathan; Liao, Michael M; Kendall, John L

    2014-05-01

    Starting in 2008, emergency ultrasound (EUS) was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College) emergency medicine (EM) training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5) EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Survey response rate was 95% (37/39). EUS was part of the formal residency curriculum for 86% of respondents (32/37). Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37]) was an ultrasound course, 73% (27/37) of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37]) made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs. [West J Emerg Med. 2014;15(3):306-311.].

  5. Definition and classification of evaluation units for tertiary structure prediction in CASP12 facilitated through semi-automated metrics.

    Science.gov (United States)

    Abriata, Luciano A; Kinch, Lisa N; Tamò, Giorgio E; Monastyrskyy, Bohdan; Kryshtafovych, Andriy; Dal Peraro, Matteo

    2017-10-16

    For assessment purposes, CASP targets are split into evaluation units. We herein present the official definition of CASP12 evaluation units (EUs) and their classification into difficulty categories. Each target can be evaluated as one EU (the whole target) or/and several EUs (separate structural domains or groups of structural domains). The specific scenario for a target split is determined by the domain organization of available templates, the difference in server performance on separate domains versus combination of the domains, and visual inspection. In the end, 71 targets were split into 96 EUs. Classification of the EUs into difficulty categories was done semi-automatically with the assistance of metrics provided by the Prediction Center. These metrics account for sequence and structural similarities of the EUs to potential structural templates from the Protein Data Bank, and for the baseline performance of automated server predictions. The metrics readily separate the 96 EUs into 38 EUs that should be straightforward for template-based modeling (TBM) and 39 that are expected to be hard for homology modeling and are thus left for free modeling (FM). The remaining 19 borderline evaluation units were dubbed FM/TBM, and were inspected case by case. The article also overviews structural and evolutionary features of selected targets relevant to our accompanying article presenting the assessment of FM and FM/TBM predictions, and overviews structural features of the hardest evaluation units from the FM category. We finally suggest improvements for the EU definition and classification procedures. © 2017 Wiley Periodicals, Inc.

  6. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of kidney lesions: A review.

    Science.gov (United States)

    Lopes, Roberto Iglesias; Moura, Renata Nobre; Artifon, Everson

    2015-03-16

    Traditionally, treatment of renal lesions is indicated based only on imaging features. Although controversy exists about tissue sampling from small renal masses, renal biopsy is indicated in some cases. In this review, we discuss the rationale for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and summarize the recent advances in this field, providing recommendations for the practicing clinician. The use of EUS-FNA appears to be a safe and feasible means of confirming or excluding malignancy. EUS allows assessment and biopsy of masses or lesions within both kidneys and related complications are rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity and a short hospital stay. Nevertheless, EUS-FNA of renal masses should be indicated only in selected cases, in which there is potential to decrease unnecessary treatment of small renal masses and to best select tumors for active surveillance and minimally invasive ablative therapies. Additionally, some renal lesions may be ineligible for EUS-guided biopsy because of anatomical limitations. EUS-FNA renal biopsy will probably be best applied to central anterior renal masses, while tumors on the posterior aspect of the kidney, percutaneous access will probably be superior.

  7. Endoscopic ultrasonography-guided placement of a transhepatic portal vein stent in a live porcine model.

    Science.gov (United States)

    Park, Tae Young; Seo, Dong Wan; Kang, Hyeon-Ji; Cho, Min Keun; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

    2016-01-01

    Percutaneous portal vein (PV) stent placement is used to manage PV occlusion or stenosis caused by malignancy. The use of endoscopic ultrasonography (EUS) has expanded to include vascular interventions. The aim of this study was to examine the technical feasibility and safety of EUS-guided transhepatic PV stent placement in a live porcine model. EUS-guided transhepatic PV stent placement was performed in six male miniature pigs under general anesthesia using forward-viewing echoendoscope. Under EUS guidance, the left intrahepatic PV was punctured with a 19-gauge fine-needle aspiration (FNA) needle and a 0.025 inch guidewire inserted through the needle and into the main PV. The FNA needle was then withdrawn and a needle-knife inserted to dilate the tract. Under EUS and fluoroscopic guidance, a noncovered metal stent was inserted over the guidewire and released into the main PV. A PV stent was placed successfully in all six pigs with no technical problems or complications. The patency of the stent in the main PV was confirmed using color Doppler EUS and transhepatic portal venography. Necropsy of the first three animals revealed no evidence of bleeding and damage to intra-abdominal organs or vessels. No complications occurred in the remaining three animals during the 8 weeks observation period. EUS-guided transhepatic PV stent placement can be both technically feasible and safe in a live animal model.

  8. Role of spinal metabotropic glutamate receptors in regulation of lower urinary tract function in the decerebrate unanesthetized rat.

    Science.gov (United States)

    Yoshiyama, Mitsuharu; de Groat, William C

    2007-06-08

    The role of spinal metabotropic glutamate receptors (mGluRs) in control of lower urinary tract functions was evaluated in rats using an mGluR antagonist administered via the intrathecal route. Cystometrograms in combination with external urethral sphincter (EUS) EMG recordings were performed on 13 decerebrate unanesthetized Sprague-Dawley female rats (n=6 for spinal cord intact rats; n=7 for spinal cord transected rats). In spinal cord intact rats, a group I/II mGluR antagonist, (+/-)-alpha-methyl-4-carboxyphenylglycine (MCPG), at doses of 3-30 microg, changed neither bladder nor EUS EMG activity, whereas a larger dose (100 microg) produced a significant facilitation of EUS EMG activity (41% increase in the peak activity) with little effect on bladder contractions. In chronically spinal cord transected rats, MCPG (3-100 microg) had no effect on bladder and EUS EMG activity. The results suggest that group I/II mGluRs are likely to be involved in inhibition of the excitatory pathway to the EUS but not involved in the control of the bladder. The lack of effect of MCPG on the EUS EMG activity in chronic spinal cord transected rats indicates that mGluR-mediated inhibitory control of the EUS was eliminated after spinal cord injury.

  9. The utility and yield of endoscopic ultrasonography for suspected choledocholithiasis in common gastroenterology practice.

    Science.gov (United States)

    Quispel, Rutger; van Driel, Lydi M W J; Veldt, Bart J; van Haard, Paul M M; Bruno, Marco J

    2016-12-01

    Endoscopic ultrasonography (EUS) is an established diagnostic modality for diagnosing common bile duct (CBD) stones. Its use has led to a reduction in the number of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed for suspected choledocholithiasis. We aimed to explore the role of EUS in detecting CBD stones and/or sludge in common gastroenterology practice. We reviewed case records of 268 consecutive patients who underwent (EUS) procedures performed to confirm or rule out the presence of CBD stones and/or sludge between November 2006 and January 2011 in the Reinier de Graaf Hospital, Delft, The Netherlands, which is a nonacademic community hospital. On the basis of EUS findings, 169 of 268 (63%) patients did not undergo ERCP and were therefore not exposed to its risk of complications. Patients with positive findings on EUS (n=99) all underwent ERCP and endoscopic sphincterotomy. Only 57 of 99 (58%) had positive findings at ERCP. The main contributing factors to this finding seem to be time interval between EUS and ERCP and the type of CBD content (i.e. sludge, one CBD stone or more than one CBD stone) described. In our common gastroenterology practice, EUS plays an important role in selecting patients suspected to have CBD stones or sludge for ERCP. Much is to be learned about the probability of spontaneous passage of CBD stones and sludge into the duodenum.

  10. [Identification of insulinomas by endoscopic ultrasonography].

    Science.gov (United States)

    Ardengh, José Celso; Valiati, Loana Heuko; Geocze, Stephan

    2004-01-01

    The aim of this study is to compare EUS and the others diagnostics tests in the correct localization of insulinomas. We prospectively investigated 30 patients with endoscopic ultrasound with a clinical diagnosis of insulinomas prior to surgical exploration. They were submitted to abdominal ultrasonography, spiral computed tomography and four patients were submitted to magnetic ressonance before EUS. Surgery was the gold standard for tumor localization. Twenty-six tumors were benign (86.6%) and four were malign (13.4%). The median size tumors detected by EUS was 1.5 cm. The overall sensitivity of EUS in identifying insulinomas was 86.6% compared to 33% for CT, 40% to MRI and 90.9% to IUS. In 12 patients we were able to perform EUS-guided fine needle aspiration. Insulinoma was diagnosed in ten cytological specimens (83.3%). Tumors located in the head and body of the pancreas were seen by EUS in all patients, respectively but those located in the tail were diagnosed only in 55.5% of the cases. EUS has a high sensibility in the identification and localization of pancreatic insulinomas and should replace traditional methods of image when clinical suspicion is high.

  11. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video).

    Science.gov (United States)

    Peñas-Herrero, Irene; de la Serna-Higuera, Carlos; Perez-Miranda, Manuel

    2015-01-01

    Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been introduced as an alternative to percutaneous transhepatic gallbladder drainage for the treatment of acute cholecystitis in non-surgical candidates. A systematic review of the English language literature through PubMed search until June 2014 was conducted. One hundred and fifty-five patients with acute cholecystitis treated with EUS-GBD in eight studies and 12 case reports, and two patients with EUS-GBD for other causes were identified. Overall, technical success was obtained in 153 patients (97.45%) and clinical success in 150 (99.34%) patients with acute cholecystitis. Adverse events developed in less than 8% of patients, all of them managed conservatively. EUS-GBD has been performed with plastic stents, nasobiliary drainage tubes, standard or modified tubular self-expandable metal stents (SEMS) and lumen-apposing metal stents (LAMS) by different authors with apparently similar outcomes. No comparison studies between stent types for EUS-GBD have been reported. EUS-GBD is a promising novel alternative intervention for the treatment of acute cholecystitis in high surgical risk patients. Feasibility, safety and efficacy in published studies from expert centers are very high compared to currently available alternatives. Further studies are needed to establish the safety and long-term outcomes of this procedure in other practice settings before EUS-GBD can be widely disseminated. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  12. Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma.

    Science.gov (United States)

    Hu, Jinlong; Liu, Xiang; Ge, Nan; Wang, Sheng; Guo, Jintao; Wang, Guoxin; Sun, Siyu

    2017-06-01

    Endoscopic ultrasound (EUS) and endoscopic resection play an important role in gastric submucosal tumor. However, there were few articles regarding EUS and endoscopic resection of gastric schwannomas. Our aim was to evaluate the role of EUS and endoscopic resection in treating gastric schwannomas.We retrospectively reviewed 14 patients between March 2012 and April 2016 with gastric schwannomas and who received EUS and endoscopic resection. EUS characteristics, endoscopic resection, tumor features, and follow-up were evaluated in all the patients.Fourteen patients were enrolled in the present study. The patients' ages ranged from 25 to 72 years (mean age, 52.6 years). On EUS, all tumors were originating from muscularis propria and hypoechoic. Ten tumors have the extraluminal growth patterns and 4 tumors have the intraluminal growth patterns. Marginal halos were observed in 7 lesions. No cystic change and calcification were found inside the lesions. Complete endoscopic resection was performed in all the patients with no complications occurring in any patients. No recurrence or metastases was found in all patients during the follow-up period.Gastric schwannoma has some characteristics on EUS, but it is difficult to differentiate gastric schwannoma from gastrointestinal stromal tumor. Endoscopic resection is an effective and safe treatment for gastric schwannoma with an excellent follow-up outcome.

  13. Digital image analysis of endoscopic ultrasonography is helpful in diagnosing gastric mesenchymal tumors.

    Science.gov (United States)

    Kim, Gwang Ha; Kim, Kwang Baek; Lee, Seung Hyun; Jeon, Hye Kyung; Park, Do Youn; Jeon, Tae Yong; Kim, Dae Hwan; Song, Geun Am

    2014-01-08

    Endoscopic ultrasonography (EUS) is a valuable imaging tool for evaluating subepithelial lesions in the stomach. However, there are few studies on differentiation between gastrointestinal stromal tumors (GISTs) and benign mesenchymal tumors, such as leiomyoma or schwannoma, with the use of EUS. In addition, there are limitations in the analysis of the characteristic features of such tumors due to poor interobserver agreement as a result of subjective interpretation of EUS images. Therefore, the aim of this study was to evaluate the role of digital image analysis in distinguishing the features of GISTs from those of benign mesenchymal tumors on EUS. We enrolled 65 patients with histopathologically proven gastric GIST, leiomyoma or schwannoma on surgically resected specimens who underwent EUS examination at our endoscopic unit from January 2007 to September 2010. After standardization of the EUS images, brightness values including the mean (Tmean), indicative of echogenicity, and the standard deviation (TSD), indicative of heterogeneity, in the tumors were analyzed. The Tmean and TSD were significantly higher in GIST than in leiomyoma and schwannoma (p schwannoma when the critical values of Tmean and TSD were 65 and 75, respectively. The presence of at least 1 of these 2 findings in a given tumor resulted in a sensitivity of 94%, specificity of 80%, positive predictive value of 94%, negative predictive value of 80%, and accuracy of 90.8% for predicting GIST. Digital image analysis provides objective information on EUS images; thus, it can be useful in diagnosing gastric mesenchymal tumors.

  14. Chronic Pancreatitis-Like Change in BRCA2 Mutation Carriers.

    Science.gov (United States)

    Mizrahi, Meir; Tseng, Jennifer F; Wong, Daniel; Tung, Nadine; Eskander, Mariam F; Berzin, Tyler M; Pleskow, Douglas K; Sawhney, Mandeep S

    Pancreatic intraepithelial neoplasia lesions can appear as chronic pancreatitis-like changes on endoscopic ultrasound (EUS). The aim of our study was to determine if BRCA2 mutation carriers were more likely than noncarriers to demonstrate chronic pancreatitis-like changes on EUS. Patients with BRCA2 mutations referred for EUS were identified (cases) from an endoscopy database. Controls were matched with cases in a 2:1 ratio for sex, date EUS was performed, endoscopist, and echoendoscope. Data were extracted from medical records, EUS reports, and EUS images. Rosemont classification was used to categorize chronic pancreatitis-like changes. During the study period, 37 BRCA2 mutation carriers and 92 controls underwent EUS. Compared with controls, BRCA2 mutation carriers had a higher prevalence of solid pancreas lesions (16.2% vs 1.08%; P = 0.005), pancreatic cysts (21.6% vs 6.1%; P = 0.01), Rosemont "consistent with chronic pancreatitis" definition changes (13.5% vs 1%; P = 0.002), and Rosemont "suggestive of chronic pancreatitis" definition changes (16.2% vs 2.1%; P = 0.003). After adjusting for age, alcohol use, and smoking, BRCA2 mutation carriers were almost 25 times more likely to demonstrate chronic pancreatitis-like changes. Chronic pancreatitis-like changes, along with solid and cystic pancreatic lesions, were significantly more common in BRCA2 mutation carriers than in noncarriers.

  15. Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Percutaneous Ultrasound-Guided Fine Needle Aspiration in Diagnosis of Focal Pancreatic Masses.

    Science.gov (United States)

    Okasha, Hussein Hassan; Naga, Mazen Ibrahim; Esmat, Serag; Naguib, Mohamed; Hassanein, Mohamed; Hassani, Mohamed; El-Kassas, Mohamed; Mahdy, Reem Ezzat; El-Gemeie, Emad; Farag, Ali Hassan; Foda, Ayman Mohamed

    2013-10-01

    Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer. A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2). EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%). EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate.

  16. Usefulness of endoscopic ultrasound-guided sampling using core biopsy needle as a percutaneous biopsy rescue for diagnosis of solid liver mass: Combined histological-cytological analysis.

    Science.gov (United States)

    Lee, Yun Nah; Moon, Jong Ho; Kim, Hee Kyung; Choi, Hyun Jong; Choi, Moon Han; Kim, Dong Choon; Lee, Tae Hee; Lee, Tae Hoon; Cha, Sang-Woo; Kim, Sang Gyune; Kim, Young Seok

    2015-07-01

    Endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA) is one of the alternative methods for tissue sampling of liver solid mass. However, the diagnostic efficacy using cytology alone was limited. In this study, we evaluate the diagnostic accuracy of EUS-guided fine needle biopsy (EUS-FNB) as a percutaneous biopsy rescue for liver solid mass. The EUS-FNB using core biopsy needle for liver solid mass was performed prospectively for patients who were failure to acquire a tissue or achieve a diagnosis using percutaneous liver biopsy. The primary outcome was the diagnostic accuracy of EUS-FNB for malignancy and specific tumor type. The secondary outcomes were the median numbers of passes required to establish a diagnosis, the proportions of patients in whom immunohistochemical (IHC) stain was possible and obtained adequate specimen, and safety of EUS-FNB. Twenty-one patients (12 women; mean age, 63 years [range, 37-81]) underwent EUS-FNB for solid liver masses. The median number of needle passes was 2.0 (range, 1-5). On-site cytology and cytology with Papanicolaou stain showed malignancy in 16 patients (76.2%) and 17 patients (81.0%), respectively. In histology with HE stain, 19 patients (90.5%) were diagnosed malignancy and optimal to IHC stain. The overall diagnostic accuracy for malignancy and specific tumor type were 90.5% and 85.7%, respectively. No complications were seen. EUS-FNB with core biopsy needle for solid liver mass may be helpful in the management of patients who are unable to diagnose using percutaneous liver biopsy. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  17. Diagnostic ability and factors affecting accuracy of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid lesions: Japanese large single center experience.

    Science.gov (United States)

    Haba, Shin; Yamao, Kenji; Bhatia, Vikram; Mizuno, Nobumasa; Hara, Kazuo; Hijioka, Susumu; Imaoka, Hiroshi; Niwa, Yasumasa; Tajika, Masahiro; Kondo, Shinya; Tanaka, Tsutomu; Shimizu, Yasuhiro; Yatabe, Yasushi; Hosoda, Waki; Kawakami, Hiroshi; Sakamoto, Naoya

    2013-08-01

    Several studies have investigated the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic lesions, but they have included only limited patient populations. This study aimed to clarify the diagnostic accuracy of EUS-FNA in a large number of pancreatic lesions, and to describe the factors that influence it. From March 1997 to May 2010, 944 consecutive patients who had undergone EUS-FNA for pancreatic solid lesions were evaluated retrospectively. Factors affecting EUS-FNA accuracy were then analyzed. A total of 996 solid pancreatic lesions were sampled by EUS-FNA. The overall sampling adequacy and diagnostic accuracy of these lesions were 99.3 % (989/996) and 91.8 % (918/996), respectively. The sensitivity and specificity for differentiating malignant from benign lesions were 91.5 % (793/867) and 97.7 % (126/129), respectively. The diagnostic performance was significantly higher when both cytological and cell-block examinations were carried out than with only cytological examination. In multivariate analysis, final diagnosis, location of lesion, lesion size, availability of on-site cytopathological evaluation, and experience of EUS-FNA procedure were independent factors affecting the accuracy of EUS-FNA. On-site cytopathological evaluation and lesion size were found to be the most weighted factors affecting diagnostic accuracy. EUS-FNA for pancreatic solid lesions yielded a high accuracy and low complication rate. Both cytological and cell-block preparations and on-site cytopathological evaluation contributed to improve the accuracy. The diagnostic ability of EUS-FNA was less for smaller lesions, and repeated procedures may be needed if malignancy is suspected.

  18. Quantitative Evaluation of Electrodes for External Urethral Sphincter Electromyography during Bladder-to-Urethral Guarding Reflex

    Science.gov (United States)

    Steward, James E.; Clemons, Jessica D.; Zaszczurynski, Paul J.; Butler, Robert S.; Damaser, Margot S.; Jiang, Hai-Hong

    2009-01-01

    Purpose Accuracy in the recording of external urethral sphincter (EUS) electromyography (EMG) is an important goal in the quantitative evaluation of urethral function. This study aim was to quantitatively compare electrode recordings taken during tonic activity and leak point pressure (LPP) testing. Methods Several electrodes, including the surface electrode (SE), concentric electrode (CE), and wire electrode (WE), were placed on the EUS singly and simultaneously in six female Sprague-Dawley rats under urethane anesthesia. The bladder was filled via a retropubic catheter while LPP testing and EUS EMG recording were done. Quantitative baseline correction of the EUS EMG signal was performed to reduce baseline variation. Amplitude and frequency of one-second samples of the EUS EMG signal were measured before LPP (tonic activity) and during peak LPP activity. Results The SE, CE, and WE signals demonstrated tonic activity before LPP and an increase in activity during LPP, suggesting that the electrodes accurately recorded EUS activity during tonic activity and during the bladder-to-EUS guarding reflex, regardless of the size or location of detection areas. SE recordings required significantly less baseline correction than both CE and WE recordings. The activity in CE-recorded EMG was significantly higher than that of the SE and WE both in single and simultaneous recordings. Conclusions These electrodes may be suitable for testing EUS EMG activity. The SE signal had significantly less baseline variation and the CE detected local activity more sensitively than the other electrodes, which may provide insight into choosing an appropriate electrode for EUS EMG recording. PMID:19680661

  19. Carrier States in Ferromagnetic Semiconductors and Diluted Magnetic Semiconductors—Coherent Potential Approach—

    Directory of Open Access Journals (Sweden)

    Masao Takahashi

    2010-06-01

    Full Text Available The theoretical study of magnetic semiconductors using the dynamical coherent potential approximation (dynamical CPA is briefly reviewed. First, we give the results for ferromagnetic semiconductors (FMSs such as EuO and EuS by applying the dynamical CPA to the s-f model. Next, applying the dynamical CPA to a simple model for A1−xMnxB-type diluted magnetic semiconductors (DMSs, we show the results for three typical cases to clarify the nature and properties of the carrier states in DMSs. On the basis of this model, we discuss the difference in the optical band edges between II-V DMSs and III-V-based DMSs, and show that two types of ferromagnetism can occur in DMSs when carriers are introduced. The carrier-induced ferromagnetism of Ga1−xMnxAs is ascribed to a double-exchange (DE-like mechanism realized in the magnetic impurity band/or in the band tail.

  20. Electric-field-induced extremely large change in resistance in graphene ferromagnets

    Science.gov (United States)

    Song, Yu

    2018-01-01

    A colossal magnetoresistance (∼100×10^3% ) and an extremely large magnetoresistance (∼1×10^6% ) have been previously explored in manganite perovskites and Dirac materials, respectively. However, the requirement of an extremely strong magnetic field (and an extremely low temperature) makes them not applicable for realistic devices. In this work, we propose a device that can generate even larger changes in resistance in a zero-magnetic field and at a high temperature. The device is composed of graphene under two strips of yttrium iron garnet (YIG), where two gate voltages are applied to cancel the heavy charge doping in the YIG-induced half-metallic ferromagnets. By calculations using the Landauer–Büttiker formalism, we demonstrate that, when a proper gate voltage is applied on the free ferromagnet, changes in resistance up to 305×10^6% (16×10^3% ) can be achieved at the liquid helium (nitrogen) temperature and in a zero magnetic field. We attribute such a remarkable effect to a gate-induced full-polarization reversal in the free ferromagnet, which results in a metal-state to insulator-state transition in the device. We also find that the proposed effect can be realized in devices using other magnetic insulators, such as EuO and EuS. Our work should be helpful for developing a realistic switching device that is energy saving and CMOS-technology compatible.

  1. The role of CT and endoscopic ultrasound in pre-operative staging of pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kala, Zdenek [Department of Surgery, Faculty Hospital Brno, Jihlavska 20, 639 00 Brno (Czech Republic)]. E-mail: zdkala@tiscali.cz; Valek, Vlastimil [Department of Radiology, Faculty Hospital Brno, Jihlavska 20, 639 00 Brno (Czech Republic)]. E-mail: v.valek@fnbrno.cz; Hlavsa, Jan [Department of Surgery, Faculty Hospital Brno, Jihlavska 20, 639 00 Brno (Czech Republic)]. E-mail: hlavsjan@seznam.cz; Hana, Kyselova [Department of Radiology, St. Annas Faculty Hospital, Pekarska 53, 656 91 Brno (Czech Republic); Vanova, Anna [Pedagogical Faculty of Masaryk University, Porici 9, 603 00 (Czech Republic)

    2007-05-15

    Purpose: The aim of our study was to compare the accuracy of computed tomography and endoscopic ultrasound (EUS) in pre-operative staging of pancreatic cancer. Methods: Comparative retrospective study of 86 patients with pancreatic cancer. CT was done in 55 patients, 41 patients were examined by EUS. Each patient underwent surgery and had proven pancreatic cancer by histology. CT and EUS results were correlated to per-operative and histological findings. The main attention was paid to the description of peri-pancreatic lymphadenopathy, para-aortic lymphadenopathy, peri-coeliac lymphadenopathy and tumor relationship to superior mesenteric vein, superior mesenteric artery, portal vein, inferior caval vein and common hepatic artery. A description rate was defined as number of pre-operative findings where the structures and relationships mentioned above were described. Results: The description rates of peri-pancreatic lymph nodes were 11 (20%) at CT and 36 (88.0%) at EUS. Para-aortic lymphadenopathy was described in 9 (16.0%) cases at CT and none at EUS. Peri-coeliac lymphadenopathy was mentioned only one time (2.0%) at CT contrary to 12 (29.0%) at EUS. Relationship of the tumor to the mesenteric vessels was well depicted in nine (16.0%) at CT versus nine (22.0%) at EUS. Portal vein relationship was well described in two (4.0%) at CT and seven (17%) cases at EUS. This description rate in vena cava inferior was one (2%) at CT and three (7.0%) at EUS, in hepatic artery it was one (2%) at CT and six (15%) at EUS. In the group of CT, resectability or non-resectability were well predicted in 33 (60%) patients and wrong predicted in 22 (40%) patients. In the group of EUS, resectability or non-resectability were well predicted in 34 (83%) patients and wrong predicted in 7 (17%) patients. Conclusion: According to our study, EUS is more accurate in prediction of local PC resectability than CT.

  2. Electron tunneling transport across heterojunctions between europium sulfide and indium arsenide

    Science.gov (United States)

    Kallaher, Raymond L.

    This dissertation presents research done on utilizing the ferromagnetic semiconductor europium sulfide (EuS) to inject spin polarized electrons into the non-magnetic semiconductor indium arsenide (InAs). There is great interest in expanding the functionality of modern day electronic circuits by creating devices that depend not only on the flow of charge in the device, but also on the transport of spin through the device. Within this mindset, there is a concerted effort to establish an efficient means of injecting and detecting spin polarized electrons in a two dimensional electron system (2DES) as the first step in developing a spin based field effect transistor. Thus, the research presented in this thesis has focused on the feasibility of using EuS, in direct electrical contact with InAs, as a spin injecting electrode into an InAs 2DES. Doped EuS is a concentrated ferromagnetic semiconductor, whose conduction band undergoes a giant Zeeman splitting when the material becomes ferromagnetic. The concomitant difference in energy between the spin-up and spin-down energy bands makes the itinerant electrons in EuS highly spin polarized. Thus, in principle, EuS is a good candidate to be used as an injector of spin polarized electrons into non-magnetic materials. In addition, the ability to adjust the conductivity of EuS by varying the doping level in the material makes EuS particularly suited for injecting spins into non-magnetic semiconductors and 2DES. For this research, thin films of EuS have been grown via e-beam evaporation of EuS powder. This growth technique produces EuS films that are sulfur deficient; these sulfur vacancies act as intrinsic electron donors and the resulting EuS films behave like heavily doped ferromagnetic semiconductors. The growth parameters and deposition procedures were varied and optimized in order to fabricate films that have minimal crystalline defects. Various properties and characteristics of these EuS films were measured and compared to

  3. Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies

    DEFF Research Database (Denmark)

    Larsen, Soeren S; Vilmann, Peter; Krasnik, Mark

    2005-01-01

    BACKGROUND: Up to 45% of operations with curative intent for non-small-cell lung cancer (NSCLC) can be regarded as futile, apparently because the stage of the disease is more advanced than expected preoperatively. During the past decade several studies have evaluated the usefulness of endoscopic...... and subsequent thoracotomy) 104 patients from one hospital were randomly assigned to either a conventional workup (CWU), including EUS-FNA only for selected patients, or a strategy where all patients were offered EUS-FNA (routine EUS-FNA) in addition to CWU. Patients were followed up for a median period of 1...

  4. Endoscopic ultrasound duplex scanning for measurement of portal venous flow. Validation against transit time ultrasound flowmetry in pigs

    DEFF Research Database (Denmark)

    Hansen, Erik Feldager; Strandberg, C; Bendtsen, F

    1999-01-01

    BACKGROUND: Endoscopic ultrasound (EUS) is a new technique that makes it possible to measure portal venous flow when transabdominal ultrasound fails. As the technique has not been evaluated previously, we compared simultaneous measurements of portal venous flow using EUS Doppler...... with that of transit time ultrasound (TTU) in healthy pigs. The ability of EUS to detect changes in the portal venous flow after pharmacologic intervention was also investigated. METHODS: Six anaesthetized pigs were studied. Portal venous flow was measured simultaneously by EUS duplex scanning, using a Pentax FG-32UA...... echoendoscope connected to a Hitachi EUB 515-A ultrasound scanner, and by TTU with a Cardiomed CM 4000 flowmeter probe placed on the portal vein. Terlipressin, 1 mg, and placebo were administered in a blind, randomized, crossover design. Measurements were taken at base line and 30 min after each drug...

  5. Upper Endoscopy

    Medline Plus

    Full Text Available ... Endoscopic Submucosal Dissection (ESD) Endoscopic Ultrasound (EUS) Procedures F - Z GI Bleeding Manometry Photodynamic Therapy (PDT) Polypectomy ... Gastrointestinal Glossary of Terms Home / Clinical Topics / Procedures F - Z / Upper Endoscopy (EGD) Upper Endoscopy (EGD) The ...

  6. Esophageal Endosonography for the Diagnosis of Intrapulmonary Tumors

    DEFF Research Database (Denmark)

    Korevaar, Daniël A; Colella, Sara; Spijker, René

    2017-01-01

    BACKGROUND: Biopsy-based diagnosis in patients with paraesophageal intrapulmonary tumors suspected of lung cancer is crucial for adequate treatment planning. OBJECTIVE: To evaluate the performance of transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the diagnosis...... of intrapulmonary tumors located near or adjacent to the esophagus. METHODS: We performed a systematic review (PROSPERO, CRD42016033737) and searched MEDLINE, Embase, BIOSIS Previews, and Web of Science on September 22, 2016, without date or language restrictions. We included studies that evaluated the yield and....../or sensitivity of EUS-FNA for diagnosing intrapulmonary tumors. Yield was defined as the number of patients in whom EUS-FNA made a biopsy-proven diagnosis (malignant or nonmalignant) relative to the total number of patients on whom EUS-FNA was performed. Sensitivity was defined as the number of patients in whom...

  7. Case report

    African Journals Online (AJOL)

    abp

    2012-09-23

    Sep 23, 2012 ... cell size (Figure 4), associated to some lipoblasts (Figure 5), in a fibromyxoid ... The typical findings of EUS reveal the tumor as an hyperechoic neoplasm in the ... in association with other numerical or structural alterations.

  8. Endoscopic Ultrasound and Related Technologies for the Diagnosis and Treatment of Pancreatic Disease - Research Gaps and Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop.

    Science.gov (United States)

    Lee, Linda S; Andersen, Dana K; Ashida, Reiko; Brugge, William R; Canto, Mimi I; Chang, Kenneth J; Chari, Suresh T; DeWitt, John; Hwang, Joo Ha; Khashab, Mouen A; Kim, Kang; Levy, Michael J; McGrath, Kevin; Park, Walter G; Singhi, Aatur; Stevens, Tyler; Thompson, Christopher C; Topazian, Mark D; Wallace, Michael B; Wani, Sachin; Waxman, Irving; Yadav, Dhiraj; Singh, Vikesh K

    A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to address the research gaps and opportunities in pancreatic endoscopic ultrasound (EUS). The event occurred on July 26, 2017 in 4 sessions: (1) benign pancreatic diseases, (2) high-risk pancreatic diseases, (3) diagnostic and therapeutics, and (4) new technologies. The current state of knowledge was reviewed, with identification of numerous gaps in knowledge and research needs. Common themes included the need for large multicenter consortia of various pancreatic diseases to facilitate meaningful research of these entities; to standardize EUS features of different pancreatic disorders, the technique of sampling pancreatic lesions, and the performance of various therapeutic EUS procedures; and to identify high-risk disease early at the cellular level before macroscopic disease develops. The need for specialized tools and accessories to enable the safe and effective performance of therapeutic EUS procedures also was discussed.

  9. Conventional Versus Rosemont Endoscopic Ultrasound Criteria for Chronic Pancreatitis: Comparing Interobserver Reliability and Intertest Agreement

    Directory of Open Access Journals (Sweden)

    Bruce Kalmin

    2011-01-01

    Full Text Available BACKGROUND: The Rosemont criteria (RC were recently proposed by expert consensus to standardize endoscopic ultrasound (EUS features and thresholds for diagnosing chronic pancreatitis (CP; however, they are cumbersome and are not validated.

  10. Projecting policy‐relevant metrics for high summertime ozone pollution events over the eastern United States due to climate and emission changes during the 21st century

    National Research Council Canada - National Science Library

    Rieder, Harald E; Fiore, Arlene M; Horowitz, Larry W; Naik, Vaishali

    2015-01-01

    Over the eastern United States (EUS), nitrogen oxides (NO x ) emission controls have led to improved air quality over the past two decades, but concerns have been raised that climate warming may offset some of these gains...

  11. Advances in endoscopic ultrasound imaging of colorectal diseases

    DEFF Research Database (Denmark)

    Cârțână, Elena Tatiana; Gheonea, Dan Ionuț; Săftoiu, Adrian

    2016-01-01

    in colorectal cancer, the monitoring of disease activity in inflammatory bowel disease based on quantification of bowel wall vascularization, and differentiating between benign and malignant subepithelial tumours. Recent reports suggest that EUS elastography enables highly accurate discrimination of colorectal......The development of endoscopic ultrasound (EUS) has had a significant impact for patients with digestive diseases, enabling enhanced diagnostic and therapeutic procedures, with most of the available evidence focusing on upper gastrointestinal (GI) and pancreatico-biliary diseases. For the lower GI...... developments other EUS applications for colorectal diseases have been also envisaged and are currently under investigation, including beyond-rectum tumour staging by means of the newly developed forward-viewing radial array echoendoscope. Due to its high resolution, EUS might be also regarded as an ideal...

  12. Projecting policy‐relevant metrics for high summertime ozone pollution events over the eastern United States due to climate and emission changes during the 21st century

    National Research Council Canada - National Science Library

    Rieder, Harald E; Fiore, Arlene M; Horowitz, Larry W; Naik, Vaishali

    2015-01-01

    Over the eastern United States (EUS), nitrogen oxides (NO x ) emission controls have led to improved air quality over the past two decades, but concerns have been raised that climate warming may offset some of these...

  13. Endoscopic ultrasound in gastroenterology: from diagnosis to therapeutic implications.

    Science.gov (United States)

    Mekky, Mohamed A; Abbas, Wael A

    2014-06-28

    Since its advent in 1980, the scope of endoscopic ultrasound (EUS) has grown to include a wide range of indications, and it is now being incorporated as an integral part of everyday practice in the field of gastroenterology. Its use is extending from an adjuvant imaging aid to utilization as a therapeutic tool for various gastrointestinal disorders. EUS was first used to visualize remote organs, such as the pancreas and abdominal lymph nodes. When fine needle aspiration was introduced, the indications for EUS expanded to include tissue sampling for diagnostic purposes. At the same time, the needle can be used to convey a potential therapy to the internal organs, allowing access to remote sites. In this review, we aim to highlight the expanding spectrum of EUS indications and uses in the field of gastroenterology.

  14. Endoscopic ultrasound and pancreas divisum

    DEFF Research Database (Denmark)

    Rana, Surinder S; Gonen, Can; Vilmann, Peter

    2012-01-01

    cholangiopancreatography is the gold standard for its diagnosis, but is invasive and associated with significant adverse effects. Endoscopic ultrasound (EUS) allows the detailed evaluation of the pancreaticobiliary ductal system without injecting contrast in these ducts. Moreover, it provides detailed images...

  15. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography

    NARCIS (Netherlands)

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian; Dietrich, Christoph Frank

    2015-01-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable

  16. Endoscopic Ultrasound-Guided Intratumoural Therapy for Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Brian M Yan

    2008-01-01

    Full Text Available Pancreatic cancer is the second most frequent gastrointestinal malignancy and carries a dismal prognosis. The current standard of care includes resection, if possible, as well as systemic chemoradiation therapy. Endoscopic ultrasound (EUS is an established technique for the diagnosis and staging of pancreatic adenocarcinoma. Interventional EUS via fine needle injection (FNI for the treatment of pancreatic cancer is a rapidly expanding field. The present article reviews the up-to-date developments in EUS FNI for intratumoural pancreatic cancer therapy, including antitumoural agents, immunotherapy, ablative techniques and new delivery systems. The therapeutic modalities discussed are currently under development and will hopefully reach clinical practice if benefit is demonstrated through clinical trials. EUS FNI may be an exciting new technique for the delivery of desperately needed novel therapies for pancreatic cancer.

  17. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, R.; Vilmann, P.; Sud, R.

    2010-01-01

    Patients with suspected tuberculosis without pulmonary lesions and with mediastinal lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate mediastinal and abdominal lesions. The aim...

  18. Predicting residual rectal adenocarcinoma in the surgical specimen after preoperative brachytherapy with endoscopic ultrasound.

    Science.gov (United States)

    Romagnuolo, Joseph; Parent, Josée; Vuong, Té; Bélanger, Mélanie; Michel, René P; Belliveau, Paul J; Trudel, Judith L

    2004-07-01

    A novel brachytherapy (BT) protocol evaluated at McGill University has shown promise in terms of downstaging and achieving high tumour sterilization rates in rectal cancer. Endoscopic ultrasound (EUS) has emerged as the imaging modality of choice for local staging of rectal cancer. However, external beam radiotherapy appears to decrease the accuracy of EUS from 85% to 40%. The aim of the present study was to prospectively evaluate the accuracy of EUS in assessing the response of rectal cancer to BT. Thirty-three patients with locally advanced (stage T2 or T3) operable rectal carcinomas were included in an experimental protocol involving a novel conformal technique, using three-dimensional planning, to administer high-dose rate preoperative BT. The 18 patients who were able to have a post-BT EUS exam arranged within two weeks before surgery (eg, four to eight weeks post-BT) were included in this study. Tumour (T)- and lymph node (N)-staging on radial EUS, as well as interpretation of the residual tumour, were assessed prospectively. Pathologists were blinded to the post-BT EUS results. The mean age was 70 years (SD +/- 11; range, 52 to 93 years) and 78% of the patients were male. Pre-BT EUS indicated that 16 patients (89%) were stage T3, and two were stage T2. Five patients (28%) had positive nodes (N1) by ultrasound. With BT, the mean maximal wall thickness on EUS decreased from 14 mm to 9.4 mm (Pspecificity, and positive and negative predictive values of post-BT EUS in predicting residual tumour were 82%, 29%, 64% and 50%, respectively. The post-BT EUS accurately predicted the T-stage in eight (44%) patients; most errors were due to overstaging. Rectal cancer T-staging by EUS post-BT is inaccurate, and although it appears sensitive in predicting the presence or absence of residual tumor in rectal adenocarcinoma after preoperative BT, the low predictive values in this setting limit its utility at this time.

  19. Design and Stability of an On-Orbit Attitude Control System Using Reaction Control Thrusters

    Science.gov (United States)

    Hall, Robert A.; Hough, Steven; Orphee, Carolina; Clements, Keith

    2016-01-01

    NASA is providing preliminary design and requirements for the Space Launch System Exploration Upper Stage (EUS). The EUS will provide upper stage capability for vehicle ascent as well as on-orbit control capability. Requirements include performance of on-orbit burn to provide Orion vehicle with escape velocity. On-orbit attitude control is accommodated by a on-off Reaction Control System (RCS). Paper provides overview of approaches for design and stability of an attitude control system using a RCS.

  20. Evaluation of a new endoscopic ultrasound-guided multi-fiducial delivery system: a prospective non-survival study in a live porcine model.

    Science.gov (United States)

    Draganov, Peter V; Chavalitdhamrong, Disaya; Wagh, Mihir S

    2013-11-01

    Endoscopic ultrasound (EUS) is an excellent tool for implanting fiducials for gastrointestinal malignancies, but a dedicated delivery system for EUS-guided fiducial placement is not available. The aim of the present study was to evaluate the performance characteristics of a new dedicated EUS-guided multi-fiducial delivery system. This was a prospective live porcine study using prototype 22-G EUS needles preloaded with four fiducials. Primary outcomes were technical success and accuracy of fiducial placement. Secondary outcomes were ease of passage of delivery system, ease of deployment, EUS visualization of the needle, visual appearance of fiducials on EUS, fluoroscopy and computed tomography (CT) scans, time taken for fiducial placement and adverse events. Outcomes were scored on a predetermined 5-point Likert scale (1 = best, 5 = worst). Fiducial deployment was successful in 43 out of 45 needles (95.6%). All 172 fiducials (43 needles, four fiducials each)were successfully deployed on target. Fiducial placement accuracy score was 1.30 ± 0.64. All needles passed with ease (score 1.0 ± 0.0). Ease of fiducial deployment score was 1.85 ± 1.02. Mean scores for EUS visualization of the needle and fiducial were 1.02 ± 0.15 and 2.10 ± 0.91, respectively. Fluoroscopic and CT visualization of fiducials was excellent. Time for placement of four fiducials was new EUS-guided multi-fiducial delivery system provided quick, easy, and accurate fiducial deployment without adverse events. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  1. Targeted next generation sequencing of endoscopic ultrasound acquired cytology from ampullary and pancreatic adenocarcinoma has the potential to aid patient stratification for optimal therapy selection

    OpenAIRE

    Gleeson, Ferga C.; Kerr, Sarah E.; Kipp, Benjamin R.; Voss, Jesse S.; Minot, Douglas M.; Tu, Zheng Jin; Henry, Michael R; Graham, Rondell P; Vasmatzis, George; Cheville, John C.; Lazaridis, Konstantinos N.; Michael J. Levy

    2016-01-01

    Background & Aims Less than 10% of registered drug intervention trials for pancreatic ductal adenocarcinoma (PDAC) include a biomarker stratification strategy. The ability to identify distinct mutation subsets via endoscopic ultrasound fine needle aspiration (EUS FNA) molecular cytology could greatly aid clinical trial patient stratification and offer predictive markers. We identified chemotherapy treatment na?ve ampullary adenocarcinoma and PDAC patients who underwent EUS FNA to assess multi...

  2. Preoperative diagnosis of lymph node metastasis in thoracic esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Eguchi, Reiki; Yamada, Akiyoshi; Ueno, Keiko; Murata, Yoko [Tokyo Women`s Medical Coll. (Japan)

    1996-10-01

    From 1994 to 1995, to evaluate the utility of preoperative CT, EUS (endoscopic ultrasonography) and US in the diagnosis of lymph node metastasis in thoracic esophageal cancer, 94 patients with thoracic esophageal cancer who underwent esophagectomy were studied clinicopathologically. The sensitivity of EUS diagnosis of upper mediastinal lymph node metastasis (85%), left-sided paragastrin lymph node metastasis (73-77%), and especially lower paraesophageal lymph node metastasis (100%) were good. But due to their low-grade specificity in EUS diagnosis, their overall accuracy was not very good. On the other hand, the overall accuracy of the CT diagnosis of lymph node metastasis was fine. However, sensitivity, the most important clinical factor in the CT diagnosis of lymph node metastasis was considerably inferior to EUS. The assessment of the diagnosis of lymph node metastasis around the tracheal bifurcation and the pulmonary hilum and the left para-cardial lesion by CT or EUS was poor. It was concluded that lymph node metastasis of these area must be the pitfall in preoperative diagnosis. The average diameter of the lymph nodes and the proportion of cancerous tissue in the lymph nodes diagnosed as metastatic lymph nodes by CT was larger than that of the false negative lymph nodes. However, the lymph nodes diagnosed as true positives by EUS showed no such tendency. This must be the reason the sensitivity of the EUS diagnosis and specificity of the CT diagnosis were favorable, but the specificity of the EUS diagnosis and especially the sensitivity of the CT diagnosis were not as good. (author)

  3. Contrast-enhanced endoscopic ultrasound in discrimination between benign and malignant mediastinal and abdominal lymph nodes.

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    Hocke, Michael; Menges, Markus; Topalidis, Theodor; Dietrich, Christoph F; Stallmach, Andreas

    2008-04-01

    Enlarged lymph nodes in the mediastinum reflect neoplastic, infectious or other diseases. The classification of these nodes is crucial in the management of the patient. Currently, only invasive measures obtaining tissue samples reach satisfying specificity. Contrast-enhanced endoscopic ultrasound (EUS) may offer a non-invasive alternative. A total of 122 patients (age: 63 +/- 15 years, 92 males, 30 females) with enlarged mediastinal and/or paraaortic lymph nodes diagnosed by CT scan were included in the study. EUS-guided fine needle aspiration was performed and cytologic specimens were diagnosed as representing a malignant or benign process in case of Papanicolau IV and V, or Papanicolau I and II, respectively. Based on cytology results, the investigated lymph nodes were classified as neoplastic (n = 48) or non-neoplastic lymph nodes. Using the B-mode criteria the preliminary diagnosis was confirmed in 64 out of 74 benign lymph nodes (specificity 86%). Regarding malignant lymph nodes 33 of 48 were confirmed (sensitivity 68%). Using the advanced contrast-enhanced EUS criteria the diagnosis was confirmed in 68 of 74 benign lymph nodes (specificity 91%). However, in case of malignant lymph nodes the number of correct diagnoses dropped to 29 of 48 lymph nodes (sensitivity 60%). The contrast-enhanced EUS criteria to identify benign lymph nodes and node enlargement in malignant lymphoma do not differ. If those ten patients with malignant lymphoma are excluded, the sensitivity of the contrast enhanced EUS for malignant lymph nodes rises to 73%. Contrast-enhanced EUS improves the specificity in diagnosing benign lymph nodes as compared to B-mode EUS. It does not improve the correct identification of malignant lymph nodes and cannot replace EUS-guided fine-needle aspiration.

  4. Correlation between Endosonographic and Doppler Ultrasound Features of Portal Hypertension in Patients with Cirrhosis

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    A. Wiechowska-Kozłowska

    2012-01-01

    Full Text Available Purpose. Endoscopic ultrasound (EUS permits the detailed visualization of clinically significant features of portal hypertension; however, it is an invasive procedure that is not widely available. The aim of this cross-sectional study was to determine whether a correlation exists between the features of portal hypertension detected using both Doppler ultrasound and EUS in subjects with liver cirrhosis. Materials and Methods. Analyzed cohort included 42 patients who underwent a detailed Doppler ultrasound focusing on the parameters of blood flow in the portal/splenic vein as well as an endoscopic/EUS procedure that included the assessment of the size and localization of “deep” varices. Results. The size of “deep” oesophageal varices detected with EUS exhibited no correlation with the parameters assessed by Doppler ultrasound. However, the size of the “deep” gastric varices detected using EUS correlated with the time averaged maximum velocity (Tmax as well as Vmin, Vmax for the portal vein using Doppler ultrasound and exhibited a correlation with the Vmax and Tmax for the splenic vein. No significant correlation was determined between the diameter of the azygous vein and the thickness of the gastric wall when seen on EUS versus the parameters measured with Doppler ultrasound. Conclusion. EUS provides important information regarding the features of portal hypertension, and in the case of “deep” oesophageal varices exhibits a limited correlation with the parameters detected by Doppler ultrasound. Thus, despite its invasiveness, EUS is a method that provides a reliable and unique assessment of the features of portal hypertension in patients with liver cirrhosis.

  5. The Role of Endoscopic Ultrasound in the Diagnostic Assessment of Subepithelial Lesions of the Upper Gastrointestinal Tract

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    Francisca Dias de Castro

    2016-11-01

    Conclusion: EUS is the method of choice in the study of subepithelial lesions of the upper gastrointestinal tract, in most cases defining a diagnosis. The need for a definitive diagnosis or therapeutic approaches can be based on ultrasound risk features, presented, in the majority, at presentation. This study shows that EUS is capable of safely and accurately define those subepithelial lesions that can be managed only with surveillance ultrasound while waiting for better results with fine needle aspiration.

  6. Utility of core biopsy with concurrent ROSE FNA in the diagnosis of pancreatic tumor-does the biopsy add any diagnostic benefit?

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    Yan, Lei; Ikemura, Kenji; Park, Ji-Weon

    2018-02-01

    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound-guided core-needle biopsy (EUS-CNB) are widely used for diagnosis of pancreatic tumors. The aim of our study was to compare the diagnostic performance of ROSE EUS-FNA and EUS-CNB for diagnosis of pancreatic malignancy during the same EUS. Patients who underwent both FNA and CNB during the same EUS for pancreatic solid lesion were reviewed retrospectively. Sample adequacy, diagnostic yield (defined as percentage of definitive diagnosis), sensitivity and specificity for malignancy were compared between FNA and CNB. A total of 48 patients with solid pancreatic lesions were evaluated. The proportions of adequate samples were 48/48 (100%) for FNA and 45/48 (93.7%) for core biopsy (P = .24). The diagnostic yield was 42/48 (87.5%) and 33/48 (68.7%) for FNA and CNB respectively (P = .046). The incremental increase in diagnostic yield by combining both methods was 2/48 (4%). The diagnostic yield for malignancy was 30/32 (93.7%) for FNA and 23/32 (71.8%) for CNB (P = .043). The sensitivity for the diagnosis of malignancy for FNA and CNB were 90.6% and 69%, respectively (P = .045). The specificity was 100% for both methods. The sensitivity for diagnosing malignancy increased to 93.8% when the two methods were combined. The difference in diagnostic yield was not associated with lesion size or location. EUS-guided FNA is a superior method of assessing solid pancreatic lesion and pancreatic malignancy with better diagnostic yield and higher sensitivity than EUS-CNB. © 2017 Wiley Periodicals, Inc.

  7. Endoscopic Ultrasound in Endocrinology: Imaging of the Adrenals and the Endocrine Pancreas.

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    Kann, Peter Herbert

    2016-01-01

    Endoscopic ultrasound (EUS) imaging of adrenal glands and its application to diagnostic procedures of adrenal diseases has been reported since 1998. It can be considered a relevant advantage in the field of adrenal diseases. Indeed, EUS allows the detection of adrenal lesions (even very small ones) and their characterization, the assessment of malignancy criteria, the early detection of neoplastic recurrences, the preoperative identification of morphologically healthy parts of the glands, the differentiation of extra-adrenal from adrenal tumors, and of the pathological entities associated with adrenal insufficiency, and the fine-needle aspiration biopsy (EUS-FNA) of suspicious lesions. At the same time, its clinical relevance depends on the experience of the endosonographer. Moreover, EUS is also by far the best and most sensitive imaging technique to detect and assess the follow-up of pancreatic manifestation of MEN1 disease. It furthermore enables the preoperatively localization of insulinomas and critical structures in their neighborhood, and may be relevant in planning surgical strategy. A positive EUS in a case of insulinoma furthermore confirms the endocrine diagnosis, especially considering the differential diagnosis of hypoglycemia factitia by oral antidiabetics. It can be supplemented by EUS-FNA. Again, it has to be considered that EUS may reveal false positive and false negative results, and the quality of the findings largely depends on the endosonographer's skills and experience. The most important technical details together with the advantages and limitations of EUS, and the pathognomonic characteristic of benign and malignant disorders of the adrenals and pancreas are presented here. © 2016 S. Karger AG, Basel.

  8. Role of endoscopic ultrasound in diagnosis and management of hepatocellular carcinoma

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    Koduru P

    2015-10-01

    Full Text Available Pramoda Koduru,1 Rei Suzuki,2 Sundeep Lakhtakia,3 Mohan Ramchandani,3 Dadang Makmun,4 Manoop S Bhutani,1 1Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Department of Gastroenterology and Rheumatology, Fukushima University School of Medicine, Fukushima, Japan; 3Asian Institute of Gastroenterology, Hyderabad, India; 4University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia Abstract: Hepatocellular carcinoma (HCC is an aggressive tumor and a leading cause of cancer-related deaths globally. The mortality rate remains high despite many advances in treatment. HCC is frequently diagnosed late in its course due to lack of classical symptoms at earlier stages. Endoscopic ultrasound (EUS has emerged as an important diagnostic tool for the diagnostic evaluation, staging, and treatment of gastrointestinal tract disorders. EUS-guided fine needle aspiration has been a valuable addition to EUS by being able to obtain tissue under direct visualization. Here, we review the potential role of EUS in the diagnosis and management of HCC. EUS seems to be a safe and reliable alternative method for obtaining tissue for diagnosis of liver cancer, especially for lesions that are inaccessible by traditional methods. EUS could play an important role in the diagnosis and management of HCC. Keywords: endoscopic ultrasound, fine needle aspiration, hepatocellular carcinoma, hepatoma

  9. Pancreatic splenosis mimicking neuroendocrine tumors: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration.

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    Ardengh, José Celso; Lopes, César Vivian; Kemp, Rafael; Lima-Filho, Eder Rios; Venco, Filadelfo; Santos, José Sebastião dos

    2013-01-01

    Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis. From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules.

  10. PANCREATIC SPLENOSIS MIMICKING NEUROENDOCRINE TUMORS: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration

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    Jose Celso ARDENGH

    2013-03-01

    Full Text Available Context Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. Objective To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA of pancreatic nodules suspicious for pancreatic splenosis. Method From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. Results A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6% cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7, young (mean age: 42 years and asymptomatic (8. Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. Conclusion Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules.

  11. Practice patterns in FNA technique: A survey analysis

    Science.gov (United States)

    DiMaio, Christopher J; Buscaglia, Jonathan M; Gross, Seth A; Aslanian, Harry R; Goodman, Adam J; Ho, Sammy; Kim, Michelle K; Pais, Shireen; Schnoll-Sussman, Felice; Sethi, Amrita; Siddiqui, Uzma D; Robbins, David H; Adler, Douglas G; Nagula, Satish

    2014-01-01

    AIM: To ascertain fine needle aspiration (FNA) techniques by endosonographers with varying levels of experience and environments. METHODS: A survey study was performed on United States based endosonographers. The subjects completed an anonymous online electronic survey. The main outcome measurements were differences in needle choice, FNA technique, and clinical decision making among endosonographers and how this relates to years in practice, volume of EUS-FNA procedures, and practice environment. RESULTS: A total of 210 (30.8%) endosonographers completed the survey. Just over half (51.4%) identified themselves as academic/university-based practitioners. The vast majority of respondents (77.1%) identified themselves as high-volume endoscopic ultrasound (EUS) (> 150 EUS/year) and high-volume FNA (> 75 FNA/year) performers (73.3). If final cytology is non-diagnostic, high-volume EUS physicians were more likely than low volume physicians to repeat FNA with a core needle (60.5% vs 31.2%; P = 0.0004), and low volume physicians were more likely to refer patients for either surgical or percutaneous biopsy, (33.4% vs 4.9%, P < 0.0001). Academic physicians were more likely to repeat FNA with a core needle (66.7%) compared to community physicians (40.2%, P < 0.001). CONCLUSION: There is significant variation in EUS-FNA practices among United States endosonographers. Differences appear to be related to EUS volume and practice environment. PMID:25324922

  12. Helpfulness of rectoanal endosonography in diagnosis of sexual abuse in a child.

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    Rostion, Carmen Gloria; Galaz, María Isabel; Contador, Mónica; Aldunate, Margarita; Benavides, Sandra; Harz, Carlos

    2016-07-01

    Clinical importance of sexual abuse in children has rapidly expanded in recent years, but despite of it, the lack of medical signs in the vast majority of sexual abuse cases, makes it difficult to assess. Given that, owing to our prior experience in endosonography (EUS) of the anal canal in child with anorectal malformations, we wanted to test EUS as a diagnostic method of sexual abuse in a child. The purpose of our study is to present our experience in the use of anorectal EUS among children with suspected sexual abuse. We present 40 consecutive patients (34 boys and 6 girls, age: 10months-13years) recruited from April 2010 to December 2012, with suspected sexual abuse those made a transrectal EUS. The procedure was well-tolerated in all patients without complications. Rectoanal EUS findings were normal in 27 patients and showed a partial interruption in the external anal sphincter in 8, scars in 2, double rail image in 2, and rectal wall hematoma in 1. The interpretation of findings in children depends of historical, physical, and laboratory findings. We believe that anal EUS is another aid in the constellation of clinical factors that could help in diagnostic of sexual abuse. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Histological diagnosis of gastric submucosal tumors: A pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy.

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    Ikehara, Hisatomo; Li, Zhaoliang; Watari, Jiro; Taki, Masato; Ogawa, Tomohiro; Yamasaki, Takahisa; Kondo, Takashi; Toyoshima, Fumihiko; Kono, Tomoaki; Tozawa, Katsuyuki; Ohda, Yoshio; Tomita, Toshihiko; Oshima, Tadayuki; Fukui, Hirokazu; Matsuda, Ikuo; Hirota, Seiichi; Miwa, Hiroto

    2015-10-10

    To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) without cytology and mucosal cutting biopsy (MCB) in the histological diagnosis of gastric submucosal tumor (SMT). We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥ 1 cm in diameter. who underwent both EUS-FNAB and MCB were investigated. The histological diagnoses were gastrointestinal stromal tumors (n = 7), leiomyoma (n = 6), schwannoma (n = 2), aberrant pancreas (n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors' mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method (P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUS-FNAB (P = 0.03). No complications were found in either method. MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUS-FNAB should be performed for SMTs with extraluminal growth.

  14. [Application of endoscopic ultrasound in diagnostics of biliary lithiasis].

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    Mesihović, Rusmir; Gribajcević, Mehmed; Masić, Izet

    2006-01-01

    Endoscopic ultrasound (EUS) and Magnetic Endoscopic Cholangiopancreatography (MRCP) are important supplementary methods used for endoscopic extraction of common bile duct stones. The technical characteristics of both methods are excellent. If EUS is used for diagnostic purposes in diagnostic of biliary tree disorders there are almost no adverse consequences compared with other indication for this method. Nevertheless, the results are related to experience of physician. Advance of EUS compared to MRCP is its sensitivity and specificity even in cases where stones are small and dilation of biliary tract is minor. The role of EUS and ERCP in reveal of biliary tree stones and disorders is clearly defined. Comparasion of these two methods should be prospective and used in cases where definitive diagnosis is unclear. If EUS reveal stones in biliary tree then ERCP should be done in same session. Beside its role in excluding biliary pancreatitis, EUS can be used for examination of patient with acute and recurrent pancreatitis and is excellent for revealing ductal and parenchymal abnormalities of pancreas.

  15. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent.

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    Kamata, Ken; Takenaka, Mamoru; Kitano, Masayuki; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hajime; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Kudo, Masatoshi

    2017-01-28

    To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.

  16. Endoscopic ultrasound: valuable tool for diagnosis of biliary complications in liver transplant recipients?

    Science.gov (United States)

    Hüsing, Anna; Cicinnati, Vito R; Beckebaum, Susanne; Wilms, Christian; Schmidt, Hartmut H; Kabar, Iyad

    2015-06-01

    Biliary complications after liver transplantation (LT) are still common and are an important cause of mortality and morbidity. Until now, endoscopic retrograde cholangiopancreatography (ERCP) has been considered the gold standard for diagnosing such complications. The aim of this study was to evaluate the diagnostic yield and therapeutic impact of endoscopic ultrasound (EUS) in the management of biliary complications after LT. Thirty-seven liver transplant patients who presented with clinical, biochemical, sonographic, and/or histological evidence of biliary complications, and who first received EUS followed by ERCP, were enrolled into this prospective observational study. Subsequently, we evaluated the value of EUS in detecting and classifying biliary complications after LT. Thirty-seven biliary complications were detected in 32 patients. Endoscopic ultrasound showed an overall sensitivity and accuracy of 94.6 % each. In cases of biliary cast and ischemic cholangiopathy, EUS was found to be diagnostically superior to ERCP and has had, in these cases, a significant impact on clinical decision-making. However, EUS was less reliable when diagnosing anastomotic strictures. EUS can complement ERCP to improve diagnosis of biliary complications after LT and help guide treatment strategies to address these complications.

  17. Maximizing the endosonography: The role of contrast harmonics, elastography and confocal endomicroscopy.

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    Seicean, Andrada; Mosteanu, Ofelia; Seicean, Radu

    2017-01-07

    New technologies in endoscopic ultrasound (EUS) evaluation have been developed because of the need to improve the EUS and EUS-fine needle aspiration (EUS-FNA) diagnostic rate. This paper reviews the principle, indications, main literature results, limitations and future expectations for each of the methods presented. Contrast-enhanced harmonic EUS uses a low mechanical index and highlights slow-flow vascularization. This technique is useful for differentiating solid and cystic pancreatic lesions and assessing biliary neoplasms, submucosal neoplasms and lymph nodes. It is also useful for the discrimination of pancreatic masses based on their qualitative patterns; however, the quantitative assessment needs to be improved. The detection of small solid lesions is better, and the EUS-FNA guidance needs further research. The differentiation of cystic lesions of the pancreas and the identification of the associated malignancy features represent the main indications. Elastography is used to assess tissue hardness based on the measurement of elasticity. Despite its low negative predictive value, elastography might rule out the diagnosis of malignancy for pancreatic masses. Needle confocal laser endomicroscopy offers useful information about cystic lesions of the pancreas and is still under evaluation for use with solid pancreatic lesions of lymph nodes.

  18. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis

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    Gonzalo Labarca

    2016-01-01

    Full Text Available Introduction. Endobronchial ultrasound (EBUS is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients were included; two were randomized controlled trials (RCTs and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89% and the specificity was 99% (CI 98–100%. For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4% and specificity improved to 100% (CI 99-100%. Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.

  19. Impact of endoscopic ultrasonography on the management of a prospective cohort of 700 consecutive patients referred for diagnostic endoscopic ultrasonography Impacto de la ultrasonografía endoscópica en el manejo terapéutico de una cohorte prospectiva de 700 pacientes consecutivos referidos para USE diagnóstica

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    F. González-Panizo

    2011-02-01

    Full Text Available Background: endoscopic ultrasonography (EUS is a high accuracy technique for the study of many digestive diseases. The degree of knowledge about the impact of EUS on the management of these patients is inadequate. Aim: to determine the therapeutic impact of endoscopic ultrasonography (EUS on a prospective cohort of patients. Methods: all patients referred for EUS over a period of 2 years were prospectively evaluated in order to asses: 1. EUS provides new information not previously known; 2. theoretic impact of EUS on patient management; 3. real impact of EUS on final therapy; 4. changes in the aggressiveness of the therapeutic decision after EUS. Results: 700 patients were included. Preoperative assessment of digestive tumors was the commonest indication. EUS provided "new information" in the 89% of the patients. With regard to endoscopist opinion, these findings should alter the management in 79% of patients ("theoretic impact". However, EUS prompted a change in the management in 67% of patients ("real impact". Final therapy post-EUS was less aggressive in 34% of patients. Changes in therapeutic decision were associated with EUS findings, alcohol intake and age ≥ 57 years old. Conclusions: 1 EUS findings, advanced age, and alcohol intake are associated with a change in the management in 2 out of every 3 patients referred for EUS. 2 Therapeutic decision (post-EUS is less aggressive in a third of these patients, what should represent a significant economic saving.Antecedentes: la ultrasonografía endoscópica (USE es una técnica de gran precisión para el estudio de diferentes patologías digestivas. El grado de conocimiento sobre el impacto de la USE en el tratamiento de estos pacientes es escaso. Objetivo: determinar el impacto terapéutico de la USE en una cohorte prospectiva de pacientes. Material y métodos: estudio que evalúa de forma prospectiva a todos los pacientes remitidos para USE en un periodo de 2 años. Se analiza: a si la USE

  20. Randomized controlled trial of comparison of the adequacy, and diagnostic yield of endoscopic ultrasound guided fine needle aspiration with and without a stylet in Indian patients: A prospective single blind study

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    Sandeep Nijhawan

    2014-01-01

    Full Text Available Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA is done using EUS-FNA needle with an internal stylet by most of the endosonographers. There is no data to suggest that it improves the quality of cytology specimen, and it is tedious and time-consuming. Aim: To compare EUS-FNA specimens obtained with stylet and without stylet for adequacy of the specimen, amount of blood on the slide, number of passes and diagnostic yield. Materials and Methods: Patients undergoing EUS-FNA of solid lesions by one experienced endosonographer at an Indian tertiary center from October 2013 to July 2014 were included. Totally, 115 consecutive patients with 128 lesions were randomized to undergo EUS-FNA with or without stylet. Cytology slides were evaluated by a single pathologist blinded to FNA technique. Results: EUS-FNA was done with stylet in 66 lesions (Group 1 and without stylet in 62 lesions (Group 2. Site of lesion was lymph node in 67 (52.3%, pancreas in 43 (33.6%, liver in 8 (6.2%, gastrointestinal subepithelial lesion in 4 (3.1% and others in 6 (4.9%. The average size of the lesion was 23.7 ± 14.8. When outcomes of two groups were compared, there was no statistically significant difference in adequacy of smears (P = 1.00, amount of blood on slides (P = 0.92, number of passes (P = 0.49 and diagnostic yield (P = 0.86. Conclusions: There was no significant difference in adequacy of the specimen, amount of blood on the slide, number of passes and diagnostic yield between with and without a stylet groups. The use of a stylet does not confer any advantage during EUS-FNA.

  1. Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy.

    Science.gov (United States)

    Choudhary, Narendra S; Puri, Rajesh; Saigal, Sanjiv; Bhangui, Prashant; Saraf, Neeraj; Shah, Vinit; Nasa, Mukesh; Sarin, Haimanti; Guleria, Mridula; Sud, Randhir; Soin, Arvinder S

    2016-11-01

    Diagnosis of metastatic disease is important in patients with cirrhosis and hepatocellular carcinoma (HCC) to prevent futile liver transplantation. Some of these patients have metastatic lymphadenopathy; however, it is difficult to perform percutaneous fine-needle aspiration due to presence of collateral and anatomic location. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of lymph nodes offers several advantages like real-time vision, proximity to target, and avoidance of collaterals. The aim of this study was to look for metastatic lymphadenopathy by EUS-guided FNA (EUS-FNA) in prospective liver transplant recipients with HCC. A prospective study was conducted from January 2013 to January 2016 at a tertiary care center. All prospective liver transplant recipients with HCC had PET-CT and bone scan to look for metastatic disease. EUS-FNA was done in patients with abdominal or mediastinal lymphadenopathy and no evidence of extrahepatic disease. Data is shown as median (25-75 interquartile range). EUS-guided FNA was done for 50 patients (42 abdominal and 8 mediastinal lymph nodes), age 57 (53-62) years, Child-Turcotte-Pugh 7 (6-9), and model for end-stage liver disease 10 (7-16). FNA material was adequate in 92% patients, metastasis in 15 (30%), granulomatous lymphadenopathy in 4 (8%), and reactive change in 27 patients (54%). The material was inadequate for diagnosis in 4 (8%) patients. Thus, EUS-guided FNA precluded transplantation in 30% of patients with lymphadenopathy, and 4 (8%) patients received anti-tubercular therapy before liver transplantation. In patients with HCC and lymphadenopathy, EUS-guided FNA detected metastatic disease and precluded liver transplantation in approximately one third of patients.

  2. Bedside endosonography and endosonography-guided fine-needle aspiration in critically ill patients: a way out of the deadlock?

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    Fritscher-Ravens, A; Sriram, P V; Pothman, W P; Füllekrug, B; Jäckle, S; Thonke, F; Soehendra, N

    2000-05-01

    Endosonography and endosonography-guided fine-needle aspiration (EUS-FNA) are now established diagnostic techniques, which are performed electively in endoscopy suites. We report here the bedside use of EUS-FNA in three critically ill patients in an intensive-care unit, with a significant impact on the outcome. A mediastinal abscess after percutaneous dilational tracheotomy was aspirated in one patient, leading to appropriate antibiotic therapy and complete recovery. A paratracheal hematoma compressing the right main bronchus was aspirated in a patient with polytrauma, relieving the pressure effects. The third patient, who had end-stage dilated cardiomyopathy and was being evaluated for cardiac transplantation, was found to have an apical lung lesion suspicious for bronchogenic carcinoma. EUS was performed to exclude mediastinal metastasis and allow simultaneous resection at the time of transplantation. Although a metastasis was excluded by EUS-FNA, the patient died while awaiting surgery. We conclude that bedside EUS-FNA is a feasible procedure, and in experienced hands it can offer an alternative in life-threatening situations.

  3. Revealing the magnetic proximity effect in EuS/Al bilayers through superconducting tunneling spectroscopy

    Science.gov (United States)

    Strambini, E.; Golovach, V. N.; De Simoni, G.; Moodera, J. S.; Bergeret, F. S.; Giazotto, F.

    2017-10-01

    A ferromagnetic insulator in contact with a superconductor is known to induce an exchange splitting of the singularity in the Bardeen-Cooper-Schrieffer (BCS) density of states (DoS). The magnitude of the splitting is proportional to the exchange field that penetrates into the superconductor to a depth comparable with the superconducting coherence length and which ranges in magnitude from a few to a few tens of tesla. We study this magnetic proximity effect in EuS/Al bilayers and show that the domain structure of the EuS affects the positions and the line shapes of the exchange-split BCS peaks. Remarkably, a clear exchange splitting is observed even in the unmagnetized state of the EuS layer, suggesting that the domain size of the EuS is comparable with the superconducting coherence length. Upon magnetizing the EuS layer, the splitting increases while the peaks change shape. Conductance measurements as a function of bias voltage at the lowest temperatures allowed us to relate the line shape of the split BCS DoS to the characteristic domain structure in the ultrathin EuS layer. These results pave the way to engineering triplet superconducting correlations at domain walls in EuS/Al bilayers. Furthermore, the hard gap and large splitting observed in our tunneling spectroscopy measurements make EuS/Al an excellent candidate for substituting strong magnetic fields in experiments studying Majorana bound states.

  4. New criteria to differentiate between mucinous cystic neoplasm and serous cystic neoplasm in pancreas by endoscopic ultrasound: A preliminarily confirmed outcome of 41 patients

    Science.gov (United States)

    Zhang, Wengang; Linghu, Enqiang; Chai, Ningli; Li, Huikai

    2017-01-01

    Background and Objectives: The ability to distinguish between mucinous cystic neoplasm (MCN) and serous cystic neoplasm (SCN) in the pancreas preoperatively by endoscopic ultrasound (EUS) remains a clinical challenge. To address this problem, we have developed new criteria using EUS findings and cyst fluid carcinoembryonic antigen (CEA) in the clinic. In this study, the validity and reliability of these criteria were assessed. Materials and Methods: Between April of 2015 and May of 2016, a total of 59 patients with pancreatic cystic neoplasms underwent EUS and ultimately received surgery in our hospital. Of the 59 patients, 21 were pathologically verified to have MCN while 20 were verified to have SCN in the pancreas. For these 41 patients with MCN or SCN, EUS findings and cyst fluid CEA were reviewed. Results: For the 41 patients reviewed, the new criteria were found to identify MCN with 85.71% sensitivity (95% confidence interval [CI], 64%–97%), 80.00% specificity (CI, 56%-94%), and 82.93% accuracy (CI, 68%–93%). Conclusion: These new criteria were preliminarily found to produce excellent results, with 82.93% accuracy determined for the differential diagnosis between MCN and SCN by EUS. However, a further prospective study with a larger population must be carried out to fully assess these new criteria. PMID:28440237

  5. Electrical stimulation of sacral dermatomes can suppress aberrant urethral reflexes in felines with chronic spinal cord injury.

    Science.gov (United States)

    McCoin, Jaime L; Bhadra, Narendra; Gustafson, Kenneth J

    2013-01-01

    Uncoordinated reflex contractions of the external urethral sphincter (EUS) are a major component of voiding dysfunction after neurologic injury. Patterned stimulation of sacral afferent pathways can reduce abnormal EUS reflexes after acute spinal cord injury (SCI); however, effectiveness following chronic SCI is unknown. Four adult male cats were implanted with bilateral extradural sacral root electrodes to allow bladder activation and underwent subsequent spinal transection (T10-12). Nine weeks after SCI urethral and bladder pressures were recorded with and without sacral afferent stimulation. Surface electrodes were applied to sacral and lumbar dermatomes and stimulus amplitude set below the muscle fasciculation threshold. The stimulation pattern was varied by on/off times of fixed frequency at each location. Reflexive EUS contractions were observed in all animals after chronic SCI. Patterned sacral dermatome stimulation reduced EUS reflex rate and amplitude in two of four cats. Suppression was dependent on both the stimulus location and pattern. Sacral locations and a stimulation pattern of (0.75 sec on, 0.25 sec off, 20 Hz) were effective in both responder animals. Patterned sacral dermatome stimulation can reduce abnormal urethral reflexes following chronic SCI. Reflex suppression is dependent on both the stimulation location and stimulus pattern. Reduction of reflexive EUS activity after chronic SCI with this non-destructive and non-invasive approach may provide an advance for the treatment of detrusor-sphincter-dyssynergia. Copyright © 2012 Wiley Periodicals, Inc.

  6. Field observations of fish species susceptible to epizootic ulcerative syndrome in the Zambezi River basin in Sesheke District of Zambia.

    Science.gov (United States)

    Songe, Mwansa M; Hang'ombe, Mudenda B; Phiri, Harris; Mwase, Maxwell; Choongo, Kennedy; Van der Waal, Ben; Kanchanakhan, Somkiat; Reantaso, Melba B; Subasinghe, Rohana P

    2012-01-01

    A field investigation was conducted in the Sesheke District of Zambia along the Zambezi River to determine the fish species susceptible to epizootic ulcerative syndrome (EUS), a newly confirmed disease in Southern Africa. A total of 2,132 fishes were inspected for gross EUS-like lesions, of which 188 (8.82%; 95% CI=7.67-10.1%) were found with typical characteristic lesions of EUS. Of these 188 samples, 156 were found to have mycotic granulomas on histopathological analysis, representing 83.0% (95% CI=76.7-87.9%) of the initially identified in the laboratory through gross examination. The following 16 species of fish were examined and found with EUS lesions; Clarias ngamensis, Clarias gariepinus, Barbus poechii, Tilapia sparrmanii, Serranochromis angusticeps, Brycinus lateralis, Micralestes acutidens, Sargochromis carlottae, Hydrocynus vittatus, Phryngochromis acuticeps, Schilbe intermedius, Hepsetus odoe, Labeo lunatus, Oreochromis andersonii, Barbus unitaeniatus, and Barbus paludinosus. T. sparrmanii did not show any lesions, while the Clarias species were found to be the most afflicted with EUS. These results could be useful to fish farmers and organizations interested in improving aquaculture in the area.

  7. Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass.

    Science.gov (United States)

    Ngamruengphong, Saowanee; Nieto, Jose; Kunda, Rastislav; Kumbhari, Vivek; Chen, Yen-I; Bukhari, Majidah; El Zein, Mohamad Hassan; Bueno, Renata P; Hajiyeva, Gulara; Ismail, Amr; Chavez, Yamile Haito; Khashab, Mouen A

    2017-06-01

    Background and aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) is technically challenging. We describe our multicenter experience using lumen-apposing metal stents (LAMSs) to create an endoscopic ultrasound-guided transgastric fistula (EUS-TG) to facilitate peroral ERCP in these patients. Patients and methods Thirteen patients with RYGB who underwent EUS-TG at three tertiary centers were included. EUS was used to guide puncture of the excluded stomach from the gastric pouch or jejunum; a LAMS was placed across the transgastric fistula. ERCP was performed via a duodenoscope passed through the LAMS. Results The technical success of EUS-TG was 100 % (13/13). ERCP through the LAMS was successful and clinical success was achieved in all patients. LAMS dislodgement during ERCP occurred in two patients and the stent was successfully repositioned without sequelae. After removal of the LAMS, the fistula was closed in 92 % of patients, either by endoscopic closure devices or argon plasma coagulation. None of the patients experienced procedure-related adverse events. Conclusion EUS-TG is an effective and safe method of accessing the excluded stomach and performing ERCP in patients with RYGB. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Inhibitory effect of the nucleus reticularis pontis oralis on the pontine micturition center and pontine urine storage center in decerebrate cats.

    Science.gov (United States)

    Sugaya, Kimio; Nishijima, Saori; Miyazato, Minoru; Oda, Masami; Ogawa, Yoshihide

    2006-10-01

    The influence of the nucleus reticularis pontis oralis (PoO) on the pontine micturition center (PMC) and pontine urine storage center (PUSC) was examined in decerebrate cats by electrical and chemical stimulations of the PMC, PUSC or PoO. Microinjection of carbachol into the rostral and dorsolateral part of the PoO rapidly inhibited reflex micturition and external urethral sphincter (EUS) activity. After confirming the inhibition of reflex micturition and EUS activity by microinjection of carbachol into the PoO, intravenous injection of atropine sulfate or its microinjection into the PoO recovered both reflex micturition and EUS activity. Microinjection of carbachol into the PMC evoked micturition and then inhibited reflex micturition, but intravenous injection of atropine or its microinjection into the PoO recovered reflex micturition. After confi rming the inhibition of reflex micturition and EUS activity by microinjection of carbachol into the PoO, electrical stimulation of the PUSC enhanced EUS activity, but electrical stimulation of the PMC failed to evoke micturition. However, electrical stimulation of the PMC evoked micturition after microinjection of atropine into the PoO. These results suggest that the PoO strongly inhibits the PMC and less strongly inhibits the PUSC. Therefore, the PoO seems to be the pontine micturition inhibitory area.

  9. Endoscopic Ultrasound-Guided Drainage without Fluoroscopic Guidance for Extraluminal Complicated Cysts

    Directory of Open Access Journals (Sweden)

    Hyeong Seok Nam

    2016-01-01

    Full Text Available Background. Endoscopic ultrasound- (EUS- guided drainage is generally performed under fluoroscopic guidance. However, improvements in endoscopic and EUS techniques and experience have led to questions regarding the usefulness of fluoroscopy. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance. Methods. Patients who had undergone nonfluoroscopic EUS-guided drainage of extraluminal complicated cysts were enrolled. Drainage was performed via a transgastric, transduodenal, or transrectal approach. Single or double 7 Fr double pigtail stents were inserted. Results. Seventeen procedures were performed in 15 patients in peripancreatic fluid collections (n=13 and pelvic abscesses (n=4. The median lesion size was 7.1 cm (range: 2.8–13.0 cm, and the mean time spent per procedure was 26.2±9.8 minutes (range: 16–50 minutes. Endoscopic drainage was successful in 16 of 17 (94.1% procedures. There were no complications. All patients experienced symptomatic improvement and revealed partial to complete resolution according to follow-up computed tomography findings. Two patients developed recurrent cysts that were drained during repeat procedures, with eventual complete resolution. Conclusion. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts.

  10. Dilation of Malignant Strictures in Endoscopic Ultrasound Staging of Esophageal Cancer and Metastatic Spread of Disease

    Directory of Open Access Journals (Sweden)

    Shawn M. Hancock

    2011-01-01

    Full Text Available Background. Dilation of malignant strictures in endoscopic ultrasound (EUS staging of esophageal cancer is safe, but no data exists regarding the subsequent development of metastases. Aim. Compare the rates of metastases in esophageal cancer patients undergoing EUS staging who require esophageal dilation in order to pass the echoendoscope versus those who do not. Methods. We reviewed consecutive patients referred for EUS staging of esophageal cancer. We evaluated whether dilation was necessary in order to pass the echoendoscope, and for the subsequent development of metastases after EUS at various time intervals. Results. Among all patients with similar stage (locally advanced disease, defined as T3, N0, M0 or T1-3, N1, M0, there was no difference between the dilated and nondilated groups in the rates of metastases at 3 months (14% versus 10%, =1.0, 6 months (28% versus 20%, =0.69, 12 months (43% versus 40%, =1.0, or ever during a mean followup of 15 months (71% versus 55%, =0.48. Conclusions. Dilation of malignant strictures for EUS staging of esophageal cancer does not appear to lead to higher rates of distant metastases.

  11. Presence of intratumoral anechoic foci predicts an increased number of endoscopic ultrasound-guided fine-needle aspiration passes required for the diagnosis of pancreatic adenocarcinoma.

    Science.gov (United States)

    Cheng, Tsu-Yao; Wang, Hsiu-Po; Jan, I-Shiow; Chen, Jiann-Hwa; Lin, Jaw-Town

    2007-03-01

    For reduction in cost, time and risk of complications, the number of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) passes should be minimized. Previous studies have shown that tumor differentiation and site of aspiration will affect the number of passes in patients with pancreatic cancer. There have been no reports that EUS features of pancreatic malignancies per se will influence the number of passes. Our aim was to prospectively assess various factors that would affect the number of passes in patients with pancreatic cancer. Between May 2003 and December 2004, 41 patients with presumed pancreatic cancer were studied. EUS-guided FNA was performed with an Olympus GF-UC2000P echoendoscope and a 22-gauge needle. On-site assessment of the specimen by a cytopathologist was available during the procedure. Adenocarcinomas were confirmed in 25 patients. Pancreatic adenocarcinomas with intratumoral anechoic foci required a higher number of diagnostic passes than those without anechoic change (3.40 vs 2.27, P anechoic foci was not a rare finding under detailed EUS investigation of pancreatic cancer. Both the existence of intratumoral anechoic foci and the differentiation of the cancer are significant predictive factors for the number of diagnostic EUS-FNA passes.

  12. Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses.

    Science.gov (United States)

    Nakai, Yousuke; Isayama, Hiroyuki; Chang, Kenneth J; Yamamoto, Natsuyo; Hamada, Tsuyoshi; Uchino, Rie; Mizuno, Suguru; Miyabayashi, Koji; Yamamoto, Keisuke; Kawakubo, Kazumichi; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tanaka, Mariko; Tada, Minoru; Fukayama, Masashi; Koike, Kazuhiko

    2014-07-01

    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic masses is an established procedure for obtaining a pathological specimen. However, application of suction during EUS-FNA is still controversial and the efficacy of the slow-pull technique was recently reported for new core biopsy needles. The purpose of this study was to compare the suction and slow-pull techniques using regular FNA needles. The diagnostic yield of the suction and slow-pull techniques was retrospectively studied for patients who underwent EUS-FNA for pancreatic solid lesions. A total of 367 passes (181 by suction and 186 by the slow-pull technique) were performed during 97 EUS-FNA procedures for 93 patients with pancreatic solid lesions. The slow-pull technique resulted in lower scores for cellularity (≥2 for 37.5 % vs. 76.7 %) but scores for contamination with blood were lower (≥2 for 25.0 % vs. 66.7 %) and sensitivity of diagnosis of malignancy was higher (90.0 % vs. 67.9 %) when a 25-gauge FNA needle was used. There were no significant differences between the two techniques when a 22-gauge needle was used. In multivariate analysis of 82 cases with malignancy, the slow-pull technique (odds ratio (OR) 1.92, P = 0.028), tumor size ≥25 mm (OR 4.64, P suction technique in EUS-FNA of pancreatic solid masses, especially with a 25-gauge FNA needle.

  13. Clinical analysis for the application of endoscopic ultrasonography in the diagnosis of patients with a retroperitoneal space-occupying lesion.

    Science.gov (United States)

    Wang, Yue-Hua; Ding, Xiang-Wu; Chen, De-Jie

    2012-01-01

    To report our experience and to evaluate the application of endoscopic ultrasonography (EUS) in the qualitative diagnosis of retroperitoneal space-occupying lesions. Twenty-six patients with retroperitoneal space-occupying lesions confirmed by CT or MRI were studied. All the patients underwent endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) at the Department of Gastroenterology, Xiangyang Central Hospital, Hubei Province, China from August 2009 to August 2011. Different parameters were evaluated, such as complications of EUS-FNA, the ratio of definite pathological diagnosis, and the pathologic types of all the specimens. Of the 26 patients, 24 had definite pathological diagnosis; the ratio of histodiagnosis was 92.3%. There were no complications such as hemorrhage, infection, or injury to the abdominal viscera in the process of EUS-FNA. Eight patients had benign tumors, with a ratio of 33.3%, and 16 patients had malignant tumors, with a ratio of 66.7%. Two patients had no definite pathological diagnosis because of the shortness of tissue sample. Eight patients did not undergo operation due to the diagnosis of benign tumors. The EUS-FNA has the advantage of lower complications, and higher diagnostic ratio, which is valuable in the qualitative diagnosis of retroperitoneal space-occupying lesions.

  14. Conditioning stimulus can influence an external urethral sphincter contraction evoked by a magnetic stimulation.

    Science.gov (United States)

    Wefer, Bjoern; Reitz, André; Knapp, Peter A; Bannowsky, Andreas; Juenemann, Klaus-Peter; Schurch, Brigitte

    2005-01-01

    To study the effect of a conditioning stimulus on an external urethral sphincter (EUS)contraction evoked by a magnetic stimulation at different time intervals. Seven healthy male volunteers underwent EUS pressure measurement. At baseline, magnetic stimulation of the lumbosacral spinal cord above the motor threshold was performed and evoked EUS pressure responses were recorded. The lumbosacral magnetic stimulation was repeated with same intensity, while a selective electrical dorsal penile nerve stimulation below the bulbocavernosus reflex (BCR) threshold was preceding at five different intervals (10, 20, 30, 50, 100 msec). The protocol was performed with empty and full bladder (BLA), and baseline responses were statistically compared to those with combined stimulation. When the dorsal penile nerve electrical stimulation preceded the lumbosacral magnetic stimulation by 20 msec (P=0.0048), 50 msec (P=0.0039), or 100 msec (P=0.0002), the amplitudes of the EUS pressure response with empty BLA were significantly reduced compared to lumbosacral magnetic stimulation alone. With a filled BLA, the amplitudes of the EUS were significantly reduced only at an interval of 50 msec (Pstimulation seems to have the capacity to inhibit the external urethral sphincter contraction induced by a magnetic stimulation. The inhibitory effect seems to depend on the latency between the peripheral and lumbosacral stimulation as well as on the degree of BLA filling. It remains to be proved if the neuromodulative effect of the conditional stimulus occurs at a spinal or supraspinal level. Copyright (c) 2005 Wiley-Liss, Inc.

  15. N-losses and energy use in a scenario for conversion to organic farming

    DEFF Research Database (Denmark)

    Dalgaard, Tommy; Kjeldsen, Chris; Hutchings, Nick

    2002-01-01

    is not straightforward, and different scenarios for conversion to organic farming might lead to reduced or increased N-losses and E-use. This paper presents a scenario tool that uses a Geographical Information System in association with models for crop rotations, fertilisation practices, N-losses, and E...... reduction at the 95% level. We therefore recommend further research in how conversion to organic farming or other changes in the agricultural practice might help to reduce N-surpluses and E-uses. In that context, the presented scenario tool would be useful......The aims of organic farming include the recycling of nutrients and organic matter and the minimisation of the environmental impact of agriculture. Reduced nitrogen (N)-losses and energy (E)-use are therefore fundamental objectives of conversion to organic farming. However, the case...

  16. How to improve the efficacy of endoscopic ultrasound-guided celiac plexus neurolysis in pain management in patients with pancreatic cancer: analysis in a single center.

    Science.gov (United States)

    Si-Jie, Hao; Wei-Jia, Xu; Yang, Di; Lie, Yao; Feng, Yang; Yong-Jian, Jiang; Ji, Li; Chen, Jin; Liang, Zhong; De-Liang, Fu

    2014-02-01

    Visceral pain secondary to pancreatic cancer is often difficult to control and poses a challenge to the physician. We retrospectively analyzed the efficacy and safety of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with unresectable pancreatic cancer. Forty-one patients with severe pain despite treatment with opioids underwent EUS-CPN with absolute alcohol. Patients scored their pain on a scale of 0 to 10 and were interviewed after the procedure. Of the 41 patients, 33, 37, and 25 patients reported improvement in their pain within 3 days, at 1 week, and at 3 months, respectively, following the procedure. Of all the patients, 19 patients reported substantial improvement and 4 patients showed complete disappearance of pain. Complication appeared in 2 patients with transient hypotension. In our study, EUS-CPN is a safe and effective form of treatment for intractable pain secondary to advanced pancreatic cancer.

  17. Endoscopic ultrasound-guided evaluation of the pleura and cases of pleural effusion

    Science.gov (United States)

    Sharma, Malay; Rameshbabu, Chittapuram Srinivasan

    2017-01-01

    The most efficient and cost-effective approach for the diagnosis of pleural exudates remains uncertain and is a subject of controversy. Essential factors to be considered include the respective diagnostic yields of thoracocentesis, closed pleural biopsy, and thoracoscopy. The role of endoscopic ultrasound (EUS) of the esophagus as a modality for the evaluation of pleural exudates has not yet been evaluated. The applied anatomy of the pleura has been discussed. The techniques involved in the EUS imaging of different aspects of the pleura in normal cases and in cases with pleural effusion are elaborated. The practical application of this knowledge can be useful in EUS-guided sampling of the pleural wall, pleural nodules, and in cases of pleural effusion. PMID:28869229

  18. Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis

    Science.gov (United States)

    Minaga, Kosuke; Kitano, Masayuki; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Miyata, Takeshi; Omoto, Shunsuke; Kadosaka, Kumpei; Yoshikawa, Tomoe; Kudo, Masatoshi

    2016-01-01

    Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis. PMID:27122677

  19. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

    DEFF Research Database (Denmark)

    Saftoiu, Adrian; Vilmann, Peter

    2009-01-01

    Early diagnosis of pancreatic cancer remains a difficult task, and multiple imaging tests have been proposed over the years. The aim of this review is to describe the current role of endoscopic ultrasound (EUS) for the diagnosis and staging of patients with pancreatic cancer. A detailed search...... of MEDLINE between 1980 and 2007 was performed using the following keywords: pancreatic cancer, endoscopic ultrasound, diagnosis, and staging. References of the selected articles were also browsed and consulted. Despite progress made with other imaging methods, EUS is still considered to be superior...... for the detection of clinically suspected lesions, especially if the results of other cross-sectional imaging modalities are equivocal. The major advantage of EUS is the high negative predictive value that approaches 100%, indicating that the absence of a focal mass reliably excludes pancreatic cancer...

  20. ULTRASONIDO ENDOSCÓPICO EN PATOLOGÍAS DEL PÁNCREAS

    Directory of Open Access Journals (Sweden)

    LÁZARO ANTONIO ARANGO M., DR.

    2015-09-01

    En este artículo se revisarán algunos casos de enfermedades evaluadas con este método, que muestran por qué el EUS, es una herramienta clave para el médico de urgencias y de consulta externa, el internista, el cirujano, el médico del servicio hospitalario y el personal de salud en general, al momento de definir, clasificar y orientar el manejo de determinadas patologías en el tubo digestivo. El EUS es una importante ayuda y no debe ser extraña al personal médico, debe tenerla presente junto a las demás pruebas diagnósticas en patología pancreática. Se señalarán los aspectos más relevantes en cada caso y las indicaciones del EUS.

  1. Endoscopic Ultrasound-guided Drainage of Walled-off Necrosis in Children With Fully Covered Self-expanding Metal Stents.

    Science.gov (United States)

    Nabi, Zaheer; Lakhtakia, Sundeep; Basha, Jahangeer; Chavan, Radhika; Ramchandani, Mohan; Gupta, Rajesh; Kalapala, Rakesh; Darisetty, Santosh; Talukdar, Rupjyoti; Reddy, Duvuur Nageshwar

    2017-04-01

    Endoscopic ultrasound (EUS)-guided drainage with fully covered self-expanding metallic stents (FCSEMS) has been successfully used in adult patients. The utility of FCSEMS in children with walled-off necrosis (WON) is, however, unknown. The aim of present study was to evaluate the feasibility, safety, and efficacy of EUS drainage of WON using FCSEMS in children. We retrospectively evaluated the data of children (18 years or younger) who underwent EUS drainage of WON using FCSEMS at our institution. All FCSEMS were removed between 1 and 3 months. Feasibility, safety, and efficacy were analysed. Twenty-one children (20 boys, mean age 14.9 ± 2.34 years, range 9-18 years) underwent EUS-guided drainage of WON with FCSEMS. The median size of WON was 88 mm (55-148 mm). The median interval between onset of acute pancreatitis and EUS guided drainage was 58 days (range 30-288 days). The technical and clinical success rates were 100% and 95%, respectively. Nasocystic tube was placed in 3 children for lavage. Endoscopic necrosectomy was not required in any of the children. There were no major complications. Minor complications included bleeding (2), stent migration (1), and difficulty in removal of stent (1). After a median follow-up of 360 days (range: 30-1020 days), there was 1 recurrence of WON. EUS drainage of WON using specially designed FCSEMS is safe and efficacious in children. The utility of FCSEMS in children should be further explored and compared with plastic stents.

  2. Identifying Patients Most Likely to Have a Common Bile Duct Stone After a Positive Intraoperative Cholangiogram

    Science.gov (United States)

    Conway, Jason; Mishra, Girish; Baillie, John; Gilliam, John; Fernandez, Adolfo; Evans, John

    2014-01-01

    The false-positive rates of a positive intraoperative cholangiogram (IOC) are as high as 60%. Endoscopic retrograde cholangiopancreatography (ERCP) for stone removal is required after a positive IOC. It is unclear which clinical factors identify patients most likely to have a stone after a positive IOC. This study was conducted to identify factors predictive of common bile duct (CBD) stone(s) on ERCP after a positive IOC. A retrospective review of our endoscopic database identified all ERCP and/or endoscopic ultrasound (EUS) procedures performed for a positive IOC between August 2003 and August 2009. Collected data included patient demographics; indication for cholecystectomy; IOC findings; blood tests before and after cholecystectomy, including liver function tests, complete blood count, and amylase and lipase measurements; and ERCP and/or EUS results. Patients who had a negative EUS for CBD stones and no subsequent ERCP were contacted by phone to see if they eventually required an ERCP. Univariate and multi-variable analyses were performed. A total of 114 patients were included in the study. IOC findings included a single stone, multiple stones, nonpassage of contrast into the duodenum, dilated CBD, and poor visualization of the bile duct. Eighty-four percent of patients had ERCP only, 9% had EUS only, and 7% had EUS followed by ERCP. Sixty-five patients (57%) had CBD stones on ERCP or EUS. Older age, multiple stones, dilated CBD on IOC, and elevated postcholecystectomy bilirubin levels were the clinical variables with statistically significant differences on univariate analysis. On multivariable analysis, older age and elevated postcholecystectomy total bilirubin levels correlated with the presence of CBD stones on ERCP. Fifty-seven percent of patients referred for endoscopic evaluation after a positive IOC had CBD stones on ERCP. Patients with CBD stones after a positive IOC were more likely to be older with elevated post-cholecystectomy total serum bilirubin

  3. Intra-channel stent release technique for fluoroless endoscopic ultrasound-guided lumen-apposing metal stent placement: changing the paradigm.

    Science.gov (United States)

    Anderloni, Andrea; Attili, Fabia; Carrara, Silvia; Galasso, Domenico; Di Leo, Milena; Costamagna, Guido; Repici, Alessandro; Kunda, Rastislav; Larghi, Alberto

    2017-01-01

    Background Recently, a novel lumen-apposing fully covered self-expanding metal stent (LA-FCSEMS) mounted on an electrocautery-enhanced delivery system has been developed to perform endoscopic ultrasound (EUS)-guided transluminal drainage. From early experience, however, release of the proximal flange of the stent has mostly been done using endoscopic view guidance to ensure proper positioning. Aim We describe a new technique that we have named the Intra-Channel Stent Release Technique (ICSRT) to perform stent placement under complete EUS control, without the use of either fluoroscopic or endoscopic views. Material and methods Data on all consecutive patients who underwent EUS-guided drainage using the new ICSRT between June 2014 and April 2016 were retrospectively retrieved from two institution databases. All EUS procedures were performed by experienced endoscopists with the patient under conscious or deep sedation. The total procedure and stent deployment time, and adverse events related to stent positioning with the ICSRT were evaluated. Results One hundred consecutive patients (51 women; mean age ± SD, 66 ± 15.2 years, range 34 - 95) underwent EUS-guided transluminal drainage with the Hot AXIOS™ device using the new ICSRT. The procedure was technically successful in all but one patient (1 %). The mean total procedural time was 21.9 minutes (range 7 - 50), while the mean time for stent placement was 3.2 minutes (range 1 - 15). No major adverse events occurred. Discussion The ICSRT has been used to deploy the newly developed lumen-apposing FCSEMS under complete EUS guidance without fluoroscopic and/or endoscopic assistance. The technique appears to be safe and highly effective and should be learned by all interventional endosonographers in order to be able to perform drainage in all clinical scenarios.

  4. A pilot proof-of-concept study of a modified device for one-step endoscopic ultrasound-guided biliary drainage in a new experimental biliary dilatation animal model.

    Science.gov (United States)

    Lee, Tae Hoon; Choi, Jun Hyuck; Lee, Sang Soo; Cho, Hyun Deuk; Seo, Dong Wan; Park, Sang-Heum; Lee, Sung Koo; Kim, Myung-Hwan; Park, Do Hyun

    2014-05-21

    To evaluate the technical feasibility of a modified tapered metal tip and low profile introducer for one-step endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) in a new experimental biliary dilatation porcine model. A novel dedicated device for one-step EUS-guided biliary drainage system (DEUS) introducer has size 3F tapered catheter with size 4F metal tip for simple puncture of the intestinal wall and liver parenchyma without graded dilation. A self-expandable metal stent, consisting of both uncovered and nitinol-covered portions, was preloaded into DEUS introducer. After establishment of a biliary dilatation model using endoscopic hemoclips or band ligation with argon plasma coagulation in 9 mini-pigs, EUS-BD using a DEUS was performed following 19-G needle puncture without the use of fistula dilation devices. One-step EUS-BD was technically successful in seven pigs [7/9 (77.8%) as intention to treat] without the aid of devices for fistula dilation from the high body of stomach or far distal esophagus to the intrahepatic (n = 2) or common hepatic (n = 5) duct. Primary technical failure occurred in two cases that did not show adequate biliary dilatation. In seven pigs with a successful bile duct dilatation, the technical success rate was 100% (7/7 as per protocol). Median procedure time from confirmation of the dilated bile duct to successful placement of a metallic stent was 10 min (IQR; 8.9-18.1). There were no immediate procedure-related complications. Modified tapered metal tip and low profile introducer may be technically feasible for one-step EUS-BD in experimental porcine model.

  5. The usefulness of endoscopic ultrasonography in differentiation between benign and malignant gastric ulcer

    Directory of Open Access Journals (Sweden)

    Roganović Branka

    2016-01-01

    Full Text Available Background/Aim. Gastric ulcer may be benign or malignant. In terms of therapy and patient’s prognosis early detection of malignancy is very important. The aim of this study was to assess the usefulness of endoscopic ultrasound (EUS in differentiation between benign and malignant gastric ulcer. Methods. A prospective study included 20 consecutive adult patients with malignant gastric ulceration and 20 consecutive adult patients with benign gastric ulceration. All the patients underwent EUS. A total of 6 parameters were analyzed: ulcer width, ulcer depth, the thickness of the gastric wall along the edge of ulceration (T0, the thickness of the gastric wall 2 cm from the edge of ulceration (T2, loss of layering structure of the gastric wall, and the presence of regional lymph nodes. EUS criteria for malignancy and a point-score of malignancy were defined. The critical value of total point-score was also calculated showing the best reliability parameters. Results. There are 4 criteria for malignancy of gastric ulceration: T0 > 10 mm, T2 > 5 mm, EUS visualization of at least one lymph node, loss of layering structure of the gastric wall. Furthermore, T2 > 5 mm was the only EUS independent predictor of ulcer malignancy. The total point score of ≥ 4 was the cut-off pointscore value which gave the best reliability parameters in the assessment of malignant ulcers: sensitivity of 70%, specificity of 95%, positive predictive value of 93.3%, negative predictive value of 76% and accuracy of 82.5%. Conclusion. According to the results obtained in this study, we can conclude that EUS is usefull in differentiation between benign and malignant gastric ulcer.

  6. [Utility of rapid on-site cytology in endoscopic ultrasonography-guided fine needle aspiration of pancreatic masses].

    Science.gov (United States)

    Furuhata, Ayako; Shirahase, Hiroyuki; Shirai, Takao; Hirata, Masahiro; Yoshizawa, Akihiko; Haga, Hironori; Nakaizumi, Akihiko

    2012-05-01

    Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is a safe and effective method for obtaining samples for cytological diagnosis. Pancreatic cancer is extremely serious and often extremely aggressive, so early detection and diagnosis is important. Therefore, we actively perform EUS FNA for pathological diagnosis of cancer of digestive organs, especially the pancreas. EUS-FNA was performed in 67 patients (39 male, 28 female, median age 63.3 years) from January 2007 to December 2010 in Kyoto University Hospital. To eliminate both quantitatively and qualitatively inadequate samples, we performed EUS-FNA with rapid on-site cytology. Two squash preparations of the collected cells from biopsy were retrieved. One was stained on-site with Giemsa for rapid cytology to evaluate the quantity and quality of the cell collection. If necessary, second or third trials were carried out to obtain appropriate samples for final cytology diagnosis. The other was wet-fixed and used for Papanicolaou staining. All 11 cases of inflammatory disease were diagnosed as negative on cytology. Solid-pseudopapillary neoplasm (1 case) and Endocrine neoplasms (3 cases) were correctly diagnosed on cytology. In pancreatic cancer, 49 of 52 cases (94%) were diagnosed as positive, but 3 cases (6%) were false-negative on cytology. The number of centesis for sampling was once in 21 cases, twice in 26 cases and more than twice in 20 cases. In this study of EUS-FNA, sensitivity was 94% and specificity was 100%. Results of our examination suggest that the combination of EUS-FNA and rapid on-site cytology is a highly specific and sensitive test for detection of pancreatic cancer, and may contribute to reduce excessive centesis.

  7. Local staging of rectal carcinoma using the first prototype model of MR endoscope; Comparison with endoscopic ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Tsuneya; Suzuki, Takashi; Shirai, Masato; Kashiwagi, Akihito; Kobayashi, Seibi; Murano, Akihiko; Sasaki, Fumio (Aichi Cancer Center, Nagoya (Japan). Hospital)

    1994-02-01

    Twenty one patients undergoing surgical treatment for rectal carcinoma were examined by means of the first prototype model of MR endoscope (designed and provided by Yokokawa Medical Co. and Olympus Opt. Co., Tokyo, Japan) for the staging before surgery. The same patients also underwent the staging with endoscopic ultrasonography (EUS) before surgery. As a surface coil at the tip of antenna probe was accurately positioned on the cancerous lesion using non-magnetic fiberscope, all lesions were detected by MR endoscopy. The whole rectal wall was apparent as 3 or 5 layers on images obtained with 3D fast SPGR method of MR endoscopy. The diagnostic accuracies in detection of rectal wall infiltration by MR endoscopy were 100% (2/2) in the cases in which cancerous invasion was detected in the submucosa by MR endoscopy, 50% (3/6) in those of the muscularis propria, 83% (10/2) in those of perirectal fat, 100% (1/1) in those of the adjacent organs and 76% (16/21) in all cases. The diagnostic accuracies in detection of rectal wall infiltration by EUS were 100% (3/3) in the cases in which the cancerous invasion was detected in the submucosa by EUS, 57% (4/7) in those of the muscularis propria, 90% (9/10) in those of perirectal fat, 100% (1/1) in those of the adjacent organs and 81% (17/21) in all cases. The sensitivity of MR endoscopy in detection of lymph node infiltration was 85.7%; specificity, 61.5%; and accuracy, 70%. EUS showed the same sensitivity, specificity and accuracy. These findings suggest that MR endoscopy may be as accurate as EUS in the preoperative staging of rectal carcinoma. In comparison with EUS, MR endoscopy has multiplanar capabilities and wide scanning area. But, MR endoscopy needs MRI apparatus and MR imaging cannot be acquired in real time. The improvement of MR endoscope is desired. (author).

  8. Experimental infection of Aphanomyces invadans and susceptibility in seven species of tropical fish

    Directory of Open Access Journals (Sweden)

    Seyedeh F. Afzali

    2015-09-01

    Full Text Available Aim: Epizootic ulcerative syndrome (EUS causes by aquatic oomycete fungus, Aphanomyces invadans is a dangerous fish disease of a wide range of fresh and brackish water, wild and farmed fish throughout the world. The objective of the present study was to determine the susceptibility of a number of tropical fish species to the EUS and compare the severity of infection between experimental groups. Materials and Methods: Snakehead, Channa striata (Bloch, 1793; snakeskin gourami, Trichopodus pectoralis (Regan, 1910; koi carp, Cyprinus carpio (Linnaeus, 1758; broadhead catfish, Clarias macrocephalus (Günther, 1864; goldfish, Carassius auratus (Linnaeus, 1758; climbing perch, Anabas testudineus (Bloch, 1792; and Nile tilapia, Oreochromis niloticus (Linnaeus, 1758 were challenged by intramuscular injection using zoospores of Aphanomyces invadans (NJM9701. The infected fish skins and muscles were examined for EUS histopathological characteristics, and the results on the severity of lesions and mortality were analyzed using SPSS program. Results: All zoospore-injected fish were shown to be susceptible to the EUS infection except Nile tilapia. Although, the general histopathological pattern was similar in the zoospore-injected group, but there were some variation in granulomatous reaction, that is the presence or absence of giant cells, and time of mortality were detected. The result of statistical analysis showed that there was a significant difference between species, (c2=145.11 and p<0.01. Conclusion: Gourami, koi carp, and catfish were demonstrated to be highly susceptible while goldfish and climbing perch were found to be moderately susceptible to the EUS infection. These findings suggested that the cellular response of fish to mycotic infection and granulomatous reaction varied in different fish species, which could not be an indicator of susceptibility or resistant to the EUS itself, although it was shown that the granulation rate and the level of

  9. Clinical impact of endoscopic ultrasound-fine needle aspiration of left adrenal masses in established or suspected lung cancer

    DEFF Research Database (Denmark)

    Bodtger, Uffe; Vilmann, Peter; Clementsen, Paul

    2009-01-01

    INTRODUCTION: Correct lung cancer staging is pivotal for optimal allocation to surgical and nonsurgical treatment. A left adrenal gland (LAG) mass is found in 5 to 16%, and malignancy preclude surgery. Endoscopic ultrasound (EUS) is superior to other imaging procedures in visualizing LAG, but the......INTRODUCTION: Correct lung cancer staging is pivotal for optimal allocation to surgical and nonsurgical treatment. A left adrenal gland (LAG) mass is found in 5 to 16%, and malignancy preclude surgery. Endoscopic ultrasound (EUS) is superior to other imaging procedures in visualizing LAG...

  10. Evaluating emergency ultrasound training in India

    Directory of Open Access Journals (Sweden)

    Gupta Amit

    2010-01-01

    Full Text Available Background : In countries with fully developed emergency medicine systems, emergency ultrasound (EUS plays an important role in the assessment and treatment of critically ill patients. Methods : The authors sought to introduce EUS to a group of doctors working in the emergency departments (EDs in India through an intensive 4-day adult and pediatric ultrasound course held at the Apex Trauma Center and EM division of the All India Institute of Medical Sciences in New Delhi. The workshop was evaluated with a survey questionnaire and a hands-on practical test. The questionnaire was designed to assess the current state of EUS in India′s EDs, and to identify potential barriers to the incorporation of EUS into current EM practice. The EUS course consisted of a general introductory didactic session followed by pediatric, abdominal and trauma, cardiothoracic, obstetrical and gynecologic, and vascular modules. Each module had a didactic session followed by hands-on applications with live models and/or simulators. A post-course survey questionnaire was given to the participants, and there was a practical test on the final day of the course. The ultrasound images taken by the participants were digitally recorded, and were subsequently graded for their accuracy by independent observers, residency, and/or fellowship trained in EUS. Results : There were a total of 42 participants who completed the workshop and took the practical examination; 32 participants filled in the course evaluation survey. Twenty-four (75% participants had no prior experience with EUS, 5 (16% had some experience, and 3 (9% had significant experience. During the practical examination, 38 of 42 participants (90% were able to identify Morison′s pouch on the focused abdominal sonography for trauma (FAST examination, and 32 (76% were able to obtain a parasternal long axis cardiac view and identify the left ventricle. The inferior vena cava was identified as it crosses the diaphragm into

  11. A novel fusion imaging system for endoscopic ultrasound

    DEFF Research Database (Denmark)

    Gruionu, Lucian Gheorghe; Saftoiu, Adrian; Gruionu, Gabriel

    2016-01-01

    BACKGROUND AND OBJECTIVE: Navigation of a flexible endoscopic ultrasound (EUS) probe inside the gastrointestinal (GI) tract is problematic due to the small window size and complex anatomy. The goal of the present study was to test the feasibility of a novel fusion imaging (FI) system which uses...... time was 24.6 ± 6.6 min, while the time to reach the clinical target was 8.7 ± 4.2 min. CONCLUSIONS: The FI system is feasible for clinical use, and can reduce the learning curve for EUS procedures and improve navigation and targeting in difficult anatomic locations....

  12. Endoscopic Ultrasound-guided Drainage of Pancreatic Pseudocysts

    DEFF Research Database (Denmark)

    Ng, Pui Yung; Nytoft Rasmussen, Ditlev; Vilmann, Peter

    2013-01-01

    OBJECTIVE: Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pancreatic pseudocysts (PPC). However, data on the clinical outcome and complication rates are conflicting. Our study aims to evaluate the rates of technical success, treatment success and complications......-up of 45 weeks, the treatment success was 75%. The medium term complications appeared in 25% of cases, which included three cases each of stent clogging, stent migration, infection and six cases of recurrence. There was no mortality. CONCLUSION: EUS-guided drainage is an effective treatment for PPC...

  13. Subharmonic and Endoscopic Contrast Imaging of Pancreatic Masses: A Pilot Study.

    Science.gov (United States)

    Forsberg, Flemming; Stanczak, Maria; Lyshchik, Andrej; Loren, David; O'Kane, Patrick; Siddiqui, Ali; Kowalski, Thomas E; Miller, Cynthia; Fox, Traci; Liu, Ji-Bin; Eisenbrey, John R

    2017-07-06

    To use subharmonic imaging (SHI) to depict the vascularity of pancreatic masses compared to contrast-enhanced endoscopic ultrasound (EUS) and pathologic results. Sixteen patients scheduled for biopsy of a pancreatic mass were enrolled in an Institutional Review Board-approved study. Pulse-inversion SHI (transmitting/receiving at 2.5/1.25 MHz) was performed on a LOGIQ 9 system (GE Healthcare, Milwaukee, WI) with a 4C transducer, whereas contrast harmonic EUS (transmitting/receiving at 4.7/9.4 MHz) was performed with a radial endoscope (GF-UTC180; Olympus Corporation, Tokyo, Japan) connected to a ProSound SSD α-10 scanner (Hitachi Aloka, Tokyo, Japan). Two injections of the contrast agent Definity (Lantheus Medical Imaging, North Billerica, MA) were administrated (0.3-0.4 and 0.6-0.8 mL for EUS and SHI, respectively). Contrast-to-tissue ratios (CTRs) in the mass and an adjacent vessel were calculated. Four physicians independently scored the images (benign to malignant) for diagnostic accuracy and inter-reader agreement. One patient dropped out before imaging, leaving 11 adenocarcinomas, 1 gastrointestinal stromal tumor with pancreatic infiltration, and 3 benign masses. Marked subharmonic signals were obtained in all patients, with intratumoral blood flow clearly visualized with SHI. Significantly greater CTRs were obtained in the masses with SHI than with EUS (mean ± SD, 1.71 ± 1.63 versus 0.63 ± 0.89; P = .016). There were no differences in the CTR in the surrounding vessels or when grouped by pathologic results (P > .60). The accuracies for contrast EUS and SHI were low (<53%), albeit with a greater κ value for SHI (0.34) than for EUS (0.13). Diagnostic accuracy of contrast EUS and transabdominal SHI for assessment of pancreatic masses was quite low in this pilot study. However, SHI had improved tumoral CTRs relative to contrast EUS. © 2017 by the American Institute of Ultrasound in Medicine.

  14. Contrast-enhanced harmonic endoscopic ultrasound

    DEFF Research Database (Denmark)

    Săftoiu, A; Dietrich, C F; Vilmann, P

    2012-01-01

    Second-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, and improving staging and guidance of therapeutic procedures. Although...... contrast-enhanced harmonic EUS based on a very low mechanical index (0.08 - 0.12). Quantification techniques based on dynamic contrast-enhanced ultrasound have been recommended for perfusion imaging and monitoring of anti-angiogenic treatment, mainly based on time-intensity curve analysis. Most...

  15. La medicina en el Nuevo Reino de Granada en la segunda mitad del siglo XVIII

    Directory of Open Access Journals (Sweden)

    Andres Soriano Lleras

    1964-04-01

    Full Text Available El 18 de enero de 1751 don Pedro de Euse Henry y don Iván Llaques "reconocieron una mulatilla y negrita que padecía de lepra ... y afirmaron que ese achaque era incurable. Firman la diligencia Matheo Alvarez del Pino, Pedro Ignacio Sánchez, Pedro de Euse, Iván Llaques y Francisco Joseph Solórzano. En otro reconocimiento de fecha 19 de abril figura otro examen y lo firma también el médico Llaques". Era catalán y ejerció en Medellín hasta 1760.

  16. Endoscopic ultrasound-guided radiofrequency ablation of the pancreas

    DEFF Research Database (Denmark)

    Silviu, Ungureanu Bogdan; Daniel, Pirici; Claudiu, Mărgăritescu

    2015-01-01

    ultrasound (EUS)-guided radiofrequency ablation (RFA) probe through a 19G needle in order to achieve a desirable necrosis area in the pancreas. Radiofrequency ablation of the head of the pancreas was performed on 10 Yorkshire pigs with a weight between 25 kg and 35 kg and a length of 40-70 cm. Using an EUS...... analysis revealed increased values of amylase, alkaline phosphatase, and gamma-glutamyl transpeptidase on the 3rd day but a decrease on the 5th day. After necropsy and isolation of the pancreas, the ablated area was easily found, describing a solid necrosis. The pathological examination revealed...

  17. Endoscopic ultrasound in the diagnosis and staging of lung cancer

    DEFF Research Database (Denmark)

    Colella, Sara; Vilmann, Peter; Konge, Lars

    2014-01-01

    We reviewed the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound guided fine needle aspiration (EUS-FNA) in the pretherapeutic assessment of patients with proven or suspected lung cancer. EUS-FNA and EBUS-TBNA have been shown to have...... a good diagnostic accuracy in the diagnosis and staging of lung cancer. In the future, these techniques in combination with positron emission tomography/computed tomographic may replace surgical staging in patients with suspected and proven lung cancer, but until then surgical staging remains the gold...

  18. Pancreatic pseudocyst drainage performed with a new prototype forward-viewing linear echoendoscope

    Directory of Open Access Journals (Sweden)

    Cristina Fernández-de-Castro

    Full Text Available Interventional endoscopy is a field that continues to grow rapidly. A novel prototype forward-viewing echoendoscope (FV-EUS has been recently developed in an attempt to overcome some of the limitations of conventional curved linear-array echoendoscopes (OV-EUS. We present a case of a successful endoscopic ultrasound-guided drainage of a pancreatic pseudocyst using a forward-viewing echoendoscope. Although the use of this newly developed echoendoscope has not yet become widespread, its unique characteristics can help to easily perform routine therapeutic procedures and contribute to the expansion of interventional endoscopic ultrasound.

  19. Sonoelastography of the distal third of the Achilles tendon in asymptomatic volunteers: correlation with anthropometric data, ultrasound findings and reproducibility of the method.

    Science.gov (United States)

    Capalbo, Emanuela; Peli, Michela; Stradiotti, Paola

    2016-08-01

    Evaluating prospectively elastosonographyc (EUS) findings of distal third of Achilles tendon in asymptomatic volunteers and correlating with subject characteristics and ultrasound (US) findings and, subsequently, calculating reproducibility of method. 70 consecutives Achilles tendons were examined with US and EUS in 35 asymptomatic volunteers. Mean age 42.3 years (±7.6), 22 were female (mean age 41 ± 8.7) and 13 were male (mean age 42.5 ± 11.4). Information about population was collected (anthropometric data, sport activity, taken therapy and associated conditions/pathologies). Statistically significant correlation was found between BMI and EUS findings (p = 0.007) and between EUS aspect and US diagnosis (p = 0.039) both to the right tendon. Possible influence of smoking (p = 0.063 to right) and associated conditions (p = 0. 059 to left), has been found. The multivariate analysis showed that EUS results are correlated only with BMI (high BMI corresponds to the best EUS results), independently from smoke and associated conditions on right side. No correlations have emerged for the left tendon. The 22.8 % of the volunteers took on chronic therapies, none statistically significant correlation. In the past, 80 % of subjects played sports (7.4 % agonistic and 92.6 % non-agonistic). The 22.9 % of volunteers played sporadic or no activity. The 60 % of volunteers has played sports that may lead overload of the Achilles tendon. The 61.5 % of subjects with BMI ≥ 25 was active little or nothing; 63.6 % of the subjects with BMI tendons and 42.9 % tendinosic. Rate of tendinosic tendons was similar in both left and right (40 and 45.7 %, respectively). Statistically significant correlation was found between EUS aspect and US diagnosis on the right tendon but not on the left Correlation between thickness and EUS aspect was calculated: no correlation was found. Interoperator correlation was excellent (k = 0.89 for left tendon and k = 0.91 for

  20. Evidence-based diagnosis and staging of pancreatic cancer.

    Science.gov (United States)

    Michl, Patrick; Pauls, Sandra; Gress, Thomas M

    2006-04-01

    Only 20% of patients who present with pancreatic cancer will be amenable to potentially curative resection. Therefore, it is necessary to reliably identify patients who might benefit from major surgical intervention by employing the appropriate staging methods. In this review, the pros and cons of each imaging technique are discussed and an algorithm for single and combined use of the different imaging modalities is proposed. To date, contrast-enhanced multi-detector row helical CT (MDR-CT) together with endoscopic ultrasound (EUS) remain the first staging methods of choice. MDR-CT has a high sensitivity for identifying vascular invasion and EUS is able to detect lesions as small as 2-3 mm. ERCP is performed mainly in patients with biliary obstruction with the option for therapeutic intervention during the same session. MRI with MR-angiography, MRCP, PET/CT and staging laparoscopy are additional modalities which might give further information in cases of equivocal findings by MDR-CT and EUS. The role of tumour markers such as CA 19-9 and CEA is reserved for monitoring and diagnosing post-surgery recurrence. Cytological or histological confirmation should usually be performed in patients that are not eligible for surgery prior to the commencement of palliative radio- or chemotherapy. In the routine clinical setting, MDR-CT and EUS play the predominant roles by providing the most cost-effective and accurate means for diagnosing and staging most cases of pancreatic cancer.

  1. Domain Modeling: NP_056515.2 [SAHG[Archive

    Lifescience Database Archive (English)

    Full Text Available NP_056515.2 chr2 X-Ray Crystal Structure of Protein SAV1430 from Staphylococcus aur...eus. Northeast Structural Genomics Consortium Target ZR18. c2ffma_ chr2/NP_056515.2/NP_056515.2_apo_35-118.pdb swppa 0 ...

  2. Impact assessment of the European biofuel directive on land use and biodiversity

    NARCIS (Netherlands)

    Hellmann, F.; Verburg, P.H.

    2010-01-01

    This paper presents an assessment of the potential impact of the EUs biofuel directive on European land use and biodiversity. In a spatially explicit analysis, it is determined which ecologically valuable land use types are likely to be directly replaced by biofuel crops. In addition, it is

  3. Role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis and management of pancreatic cancer; comparison with multidetector row computed tomography, magnetic resonance imaging and endoscopic ultrasonography.

    Science.gov (United States)

    Ergul, N; Gundogan, C; Tozlu, M; Toprak, H; Kadıoglu, H; Aydin, M; Cermik, T F

    2014-01-01

    We aimed to analyze the contribution of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging to the diagnosis and management of pancreatic cancer compared with multidetector row computed tomography (MDCT), magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS). We retrospectively scanned the data of 52 patients who were referred for FDG PET/CT imaging for evaluation of pancreatic lesions greater than 10mm. The diagnostic performances of 4 imaging methods and the impact of PET/CT on the management of pancreatic cancer were defined. Pancreatic adenocarcinoma was diagnosed in 33 of 52 patients (63%), 15 patients had benign diseases of pancreas (29%), and 4 patients were normal (8%). Sensitivity and NPV of EUS and PET/CT were equal (100%) and higher than MDCT and MRI. Specificity, PPV and NPV of PET/CT were significantly higher than MDCT. However, sensitivities of two imaging methods were not significantly different. There was no significant difference between PET/CT and MRI and EUS for these values. When the cut-off value of SUVmax was 3.2, the most effective sensitivity and specificity values were obtained. PET/CT contributed to the management of pancreatic cancer in 30% of patients. FDG PET/CT is a valuable imaging method for the diagnosis and management of pancreatic cancer, especially when applied along with EUS as first line diagnostic tools. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  4. Economic analysis of combined endoscopic and endobronchial ultrasound in the evaluation of patients with suspected non-small cell lung cancer.

    LENUS (Irish Health Repository)

    Harewood, Gavin C

    2010-03-01

    Lung cancer remains the most common cause of cancer-related death in the United States. This study evaluated the costs of alternative diagnostic evaluations for patients with suspected non-small cell lung cancer (NSCLC). Researchers used a cost-minimization model to compare various diagnostic approaches in the evaluation of patients with NSCLC. It was less expensive to use an initial endoscopic ultrasound (EUS) with fine needle aspiration (FNA) to detect a mediastinal lymph node metastasis ($18,603 per patient), compared with combined EUS FNA and endobronchial ultrasound (EBUS) with FNA ($18,753). The results were sensitive to the prevalence of malignant mediastinal lymph nodes; EUS FNA remained least costly, if the probability of nodal metastases was <32.9%, as would occur in a patient without abnormal lymph nodes on computed tomography (CT). While EUS FNA combined with EBUS FNA was the most economical approach, if the rate of nodal metastases was higher, as would be the case in patients with abnormal lymph nodes on CT. Both of these strategies were less costly than bronchoscopy or mediastinoscopy. The pre-test probability of nodal metastases can determine the most cost-effective testing strategy for evaluation of a patient with NSCLC. Pre-procedure CT may be helpful in assessing probability of mediastinal nodal metastases.

  5. A comparison of endoscopic ultrasound guided biopsy and positron emission tomography with integrated computed tomography in lung cancer staging

    DEFF Research Database (Denmark)

    Larsen, S S; Vilmann, P; Krasnik, K

    2009-01-01

    -stage ≥ IIIA(N2), corresponding to T4- and/or N2-N3- and/or M1 disease. Diagnostic values of PET/CT and EUS-FNA, with regard to the diagnosis of advanced lung cancer, were assessed and compared. RESULTS: The sensitivity of PET/CT and EUS-FNA were respectively 60% and 60% for T4 disease, 56% versus 100% for N2......BACKGROUND AND STUDY AIMS: Exact staging of patients with non-small-cell lung cancer (NSCLC) is important to improve selection of resectable and curable patients for surgery. Positron emission tomography with integrated computed tomography (PET/CT) and endoscopic ultrasound guided fine needle...... aspiration biopsy (EUS-FNA) are new and promising methods, but indications in lung cancer staging are controversial. Only few studies have compared the 2 methods. The aim of this study was to assess and compare the diagnostic values of PET/CT and EUS-FNA for diagnosing advanced lung cancer in patients, who...

  6. A Comparison of Endoscopic Ultrasound Guided Biopsy and Positron Emission Tomography with Integrated Computed Tomography in Lung Cancer Staging

    DEFF Research Database (Denmark)

    Larsen, Stine Schmidt; Vilmann, P; Krasnik, K

    2009-01-01

    -stage ≥ IIIA(N2), corresponding to T4- and/or N2-N3- and/or M1 disease. Diagnostic values of PET/CT and EUS-FNA, with regard to the diagnosis of advanced lung cancer, were assessed and compared. RESULTS: The sensitivity of PET/CT and EUS-FNA were respectively 60% and 60% for T4 disease, 56% versus 100% for N2......BACKGROUND AND STUDY AIMS: Exact staging of patients with non-small-cell lung cancer (NSCLC) is important to improve selection of resectable and curable patients for surgery. Positron emission tomography with integrated computed tomography (PET/CT) and endoscopic ultrasound guided fine needle...... aspiration biopsy (EUS-FNA) are new and promising methods, but indications in lung cancer staging are controversial. Only few studies have compared the 2 methods. The aim of this study was to assess and compare the diagnostic values of PET/CT and EUS-FNA for diagnosing advanced lung cancer in patients, who...

  7. EURL activities in 2011

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen; Skall, Helle Frank; Nicolajsen, Nicole

    2012-01-01

    The duties of the EURL are described in Council Directive 2006/88/EC (Annex VI). The duties mainly concern fish diseases listed as exotic diseases: EHN and EUS; and fish diseases listed as non-exotic diseases: ISA, VHS, IHN, and KHV disease....

  8. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis

    DEFF Research Database (Denmark)

    Wyse, Jonathan M; Battat, Robert; Sun, Siyu

    2017-01-01

    OBJECTIVES: The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN). METHODS: Six important clinical...... of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare....

  9. Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol

    Directory of Open Access Journals (Sweden)

    Julia K. LeBlanc

    2013-01-01

    Full Text Available Background. The dose of alcohol used in EUS-CPN is not standardized. The objective was to compare the safety of 20 mL alcohol versus 10 mL alcohol during EUS-CPN for patients with pancreatic cancer-related pain. Methods. 20 patients were selected to receive 10 mL or 20 mL of alcohol during EUS-CPN. Followup was done at baseline, 24 hours, and weekly. Health-related quality of life (HRQoL was assessed at baseline, week 2, week 4, and every 4 weeks thereafter until pain returned. Results. There were no major complications in both groups. Minor self-limited adverse effects were seen in 6 (30% subjects and included lightheadedness in 1 (5%, transient diarrhea in 2 (10%, and transient nausea and vomiting in 3. Pain relief was similar in both groups: 80% in the 10 mL group and 100% in the 20 mL group (. The mean (± SD duration of pain relief in the 10 mL and 20 mL groups was and weeks, respectively. 30% of patients in each group had complete pain relief. Conclusions. EUS-CPN using 20 mL of alcohol is safe. Similar clinical outcomes were seen in both groups. Further investigations to confirm these findings are warranted.

  10. Celiac plexus neurolysis in pancreatic cancer: the endoscopic ultrasound approach.

    Science.gov (United States)

    Seicean, Andrada

    2014-01-07

    Pain in pancreatic cancer is often a major problem of treatment. Administration of opioids is frequently limited by side effects or insufficient analgesia. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) represents an alternative for the palliative treatment of visceral pain in patients with pancreatic cancer. This review focuses on the indications, technique, outcomes of EUS-CPN and predictors of pain relief. EUS-CPN should be considered as the adjunct method to standard pain management. It moderately reduces pain in pancreatic cancer, without eliminating it. Nearly all patients need to continue opioid use, often at a constant dose. The effect on quality of life is controversial and survival is not influenced. The approach could be done in the central position of the celiac axis, which is easy to perform, or in the bilateral position of the celiac axis, with similar results in terms of pain alleviation. The EUS-CPN with multiple intraganglia injection approach seems to have better results, although extended studies are still needed. Further trials are required to enable more confident conclusions regarding timing, quantity of alcohol injected and the method of choice. Severe complications have rarely been reported, and great care should be taken in choosing the site of alcohol injection.

  11. The allocation of scarce resources in miscellaneous cases

    NARCIS (Netherlands)

    Hamsvoort, van der C.P.C.M.

    2006-01-01

    Key words: sustainable development, environmental utilization space (EUS),      auctions, conservation contracting, information asymmetry, agricultural land

  12. Three-dimensional endoanal ultrasonography of external anal sphincter defects in patients with faecal incontinence: correlation with symptoms and manometry

    NARCIS (Netherlands)

    Wasserberg, N.; Mazaheri, A.; Petrone, P.; Tulchinsky, H.; Kaufman, H.S.

    2011-01-01

    AIM: Anal sphincter anatomy on two-dimensional endoanal -ultrasonography (EUS) does not always correlate with the clinical data. The purpose of this study was to determine whether three-dimensional (3D) measurements yield a better correlation. METHOD: The study group included consecutive patients

  13. upper gastrointestinal endoscopy findings in patients referred with ...

    African Journals Online (AJOL)

    2014-08-01

    Aug 1, 2014 ... the precursor of fibre-optic endoscope. Since then endoscopes and endoscopy have undergone great technical developments to the current new dimension in imaging of endoscopic ultrasonography (EUS) by combining ultrasonography and endoscopy (3). These developments have enhanced the safety ...

  14. Familia eta eskola testuinguruen eragina haurren errendimendu akademikoan

    OpenAIRE

    Garai Mota, Eztizen

    2016-01-01

    [eus] Egun, adin txikikoenekin batera eskolako testuinguruan barneratzean, irakasleek familiak haurren garapen psikologikoan eta pertsonalean zuzenean eragiten duela hautematen dute. Izan ere, seme alaben hezkuntzan familiak duen hezteko estiloak eta inplikazio mailak, seme alabek bizitzak eta hezkuntza akademikoak planteatzen dizkieten erronkei aurre egiteko dituzten jarreretan eragingo du, euren errendimendu akademikoa baldintzatuz. Horren ondorioz, lan honetan, bilaketa bibliografiko baten...

  15. Paper til panelet Identitet, etnicitet, minoritet

    DEFF Research Database (Denmark)

    Nielsen, Niels Jul

    2012-01-01

    Med udgangspunkt i et igangværende forskningsprojekt om aktuel polsk arbejdsmigration til Danmark (i kølvandet på EUs østudvidelse) fremlægges, diskuteres og problematiseres, hvordan 'polskhed' sættes i spil i mødet mellem danske og polske arbejdstagere, arbejdsgivere og arbejdere, fagforeninger ...

  16. Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer

    DEFF Research Database (Denmark)

    Konge, Lars; Vilmann, P; Clementsen, P

    2012-01-01

    Fine-needle aspiration (FNA) guided by endoscopic ultrasonography (EUS) is important in mediastinal staging of non-small cell lung cancer (NSCLC). Training standards and implementation strategies of this technique are currently under discussion. The aim of this study was to explore the reliability...

  17. Strategies for Stimulating Discussion

    Science.gov (United States)

    2017-06-01

    practices describe ways to facilitate communication during discussion. Use constructive questioning strategies . Facilitators serve to ensure the...lecture and group discussion teaching strategies in developing critical thinking skills. Communication Education, 45, 212-227. Gilmore, T. N., & Schall, E...U.S. Army Research Institute for the Behavioral and Social Sciences Research Report 2008 Strategies for Stimulating Discussion

  18. A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections : a prospective cohort study

    NARCIS (Netherlands)

    Walter, Daisy; Will, Uwe; Sanchez-Yague, Andres; Brenke, Dirk; Hampe, Jochen; Wollny, Helge; López-Jamar, Jose Miguel Esteban; Jechart, Gertrud; Vilmann, Peter; Gornals, Joan B; Ullrich, Sebastian; Fähndrich, Martin; de Tejada, Alberto Herreros; Junquera, Félix; Gonzalez-Huix, Ferran; Siersema, Peter D; Vleggaar, FP

    BACKGROUND AND STUDY AIMS: A novel large-diameter, lumen-apposing, self-expanding metal stent with bilateral flanges was recently developed for endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic pancreatic fluid collections (PFCs). The aim of this study was to evaluate the

  19. Learning to Be

    DEFF Research Database (Denmark)

    Hansen, Finn Thorbjørn

    2002-01-01

    På baggrund af en nylig OECD-report om kompetencer for Lifelong Learning samt Eus memorandum for Lifelong Learning peges der på behovet for en mere filosofisk og eksistentiel tilgang til dette begreb. Med henvisning til bl.a. filosofihistorikeren Pierre Hadot og eksistensfilosoffen Gabriel Marcel...

  20. Korner errutinen azterketa goi errendimenduko emakumezkoen futbolean

    OpenAIRE

    Lizaso Alcibar, Eneritz

    2015-01-01

    [EUS] Lan honen abiapuntua, goi errendimenduko emakumezkoen futbol partida batean ematen diren korner errutina ezberdinak aztertu eta horietatik eraginkorrenak diren ekintza eta jokaldiak identifikatzea izan da. Ikerlanean, hiru denboralditan zehar (2012-2013; 2013-2014; 2014-2015), Espainiako emakumezkoen futboleko lehenengo mailako, hau da Superligako taldeek 51 partidutan burututako korner jaurtiketak aztertu dira. Horretarako erabili den metodologia, bideo analisi eta analisi notazion...

  1. Linear endoscopic ultrasound for clinically suspected bile duct stones

    Directory of Open Access Journals (Sweden)

    Lien-Fu Lin

    2012-06-01

    Conclusion: Linear EUS is sensitive for the detection of CBDS. It detected 56% of CBDS in a high-risk group and 14.2% in an intermediate-risk group and therefore is a useful assessment tool in patients with high or intermediate risk of CBDS.

  2. Pseudomona sp-ren bidez kate ertaineko gantz azidoen esterasa ekoizteko bio-erreaktore baten operazio baldintzen eta zinetikaren azterketa

    OpenAIRE

    Manso Fraile, Mireia

    2016-01-01

    [EUS] Proiektu honen helburua esterasaren lorpena aztertzeaz gain, lorpenerako erabilitako Pseudomona putida mikroorganismoaren hartzidura aztertzea da, ondoren mikroorganismo horri dagokion parametro zinetikoak lortzeko eta erreaktore baten diseinua egin ahal izateko. Horrekin batera, hartziduran eragin dezaketen faktoreak aztertuko dira (tenperatura, aparra, aireztapena, pH …) kontrol eta monitoriazioan kontutan izateko. Horrez guztiaz gain eta prozesua erreaktorean aztertzeaz gain, matraze...

  3. Gaur egungo haurrentzako ipuinen ilustrazioak. Genero ikuspegitik begirada bat

    OpenAIRE

    Ugarte Elosegui, Itziar

    2015-01-01

    [EUS] Ipuinak haurren egunerokotasunean erabiliak diren baliabideak dira eta hauen funtzio hezitzailea ukaezina da. Hala ere, genero berdintasunari dagokionez, ipuinek eta bertako irudien funtzioa eztabaidagarri bihurtzen da, tradizionalki genero estereotipoak transmititu dituztela eta genero jendarteratzean duten eragina kontuan izanik. Lan honetan, beraz, gaur eguneko ilustrazioek iruditegi parekideago bat sortzera bidean, genero estereotipoak transmititzen jarraitzen duten eta emakume eta ...

  4. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging--a prospective trial

    NARCIS (Netherlands)

    Szlubowski, Artur; Zieliński, Marcin; Soja, Jerzy; Annema, Jouke T.; Sośnicki, Witold; Jakubiak, Magdalena; Pankowski, Juliusz; Cmiel, Adam

    2010-01-01

    This prospective study aimed to assess the diagnostic yield of the combined approach - endobronchial (EBUS) and endoscopic (EUS) ultrasound-guided needle aspiration (combined ultrasound-needle aspiration (CUS-NA)) in the radiologically normal mediastinum in non-small-cell lung cancer (NSCLC)

  5. Süss Judutarra filma. III. Reich-eko zine propagandako trilogia antisemita

    OpenAIRE

    Díaz Ugarte, Eneko

    2016-01-01

    [EUS] Alemaniar III. Reich-eko garaian ikusentzuneko porpagandaren arloan hanibat film estreinatu ziren. Horietako bat Adibide modura hartuz, Süss Judutarra, lanean Goebbelsek Der Angriff egunkarian argitaratutako judutarren dekalogoa eta NSDAPko 25 puntuetan agertzen den antisemitismoa filman nola islatzen den aztertuko da.

  6. The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of common bile duct calculi: a critically appraised topic.

    Science.gov (United States)

    McMahon, Colm J

    2008-01-01

    The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the investigation of common bile duct (CD) calculi were evaluated using "evidence-based practice" (EBP) methods. A focused clinical question was constructed. A structured search of primary and secondary evidence was performed. Retrieved studies were appraised for validity, strength and level of evidence (Oxford/CEBM scale: 1-5). Retrieved literature was divided into group A; MRCP slice thickness >or=5 mm, group B; MRCP slice thickness = 3 mm or 3D-MRCP sequences. Six studies were eligible for inclusion (3 = level 1b, 3 = level 3b). Group A: sensitivity and specificity of MRCP and EUS were (40%, 96%) and (80%, 95%), respectively. Group B: sensitivity and specificity of MRCP and EUS were (87%, 95%) and (90%, 99%), respectively. MRCP should be the first-line investigation for CD calculi and EUS should be performed when MRCP is negative in patients with moderate or high pre-test probability.

  7. Minimally invasive diagnostics and immunotherapy of lung cancer

    NARCIS (Netherlands)

    Talebian-Yazdi, M.

    2017-01-01

    This thesis deals with aspects of diagnostics and immunotherapy of lung cancer. The first aim of this thesis is to investigate how the implementation of minimally invasive endoscopic ultrasound techniques (EUS and EBUS) in the staging algorithm of NSCLC can be optimized. The second aim of this

  8. Una libera università in un Stato di massima sicurezza

    DEFF Research Database (Denmark)

    Schmid, Herman

    2008-01-01

    En presentation og analyse af Roskilde universitetscenter som et produkt af den danske velfærdsstatsmodel og dette eksperiments nutidige betydning set i lyset af EUs ambitioner at udvikle et europæisk marked for universitetsuddannelse og forskning...

  9. Efficacy of an artificial neural network-based approach to endoscopic ultrasound elastography in diagnosis of focal pancreatic masses

    DEFF Research Database (Denmark)

    Mortensen, Michael Bau

    2012-01-01

    Săftoiu A, Vilmann P, Gorunescu F, Janssen J, Hocke M, Larsen M, Iglesias-Garcia J, Arcidiacono P, Will U, Giovannini M, Dietrich CF, Havre R, Gheorghe C, McKay C, Gheonea DI, Ciurea T; European EUS Elastography Multicentric Study Group. Clin Gastroenterol Hepatol. 2012 Jan;10(1):84-90...

  10. The role of contrast-enhanced endoscopic ultrasound in pancreatic adenocarcinoma

    DEFF Research Database (Denmark)

    Saftoiu, Adrian; Vilmann, Peter; Bhutani, Manoop S

    2016-01-01

    Contrast-enhanced endoscopic ultrasound (CE-EUS) allows characterization, differentiation, and staging of focal pancreatic masses. The method has a high sensitivity and specificity for the diagnosis of pancreatic adenocarcinoma which is visualized as hypo-enhanced as compared to the rest of the p......Contrast-enhanced endoscopic ultrasound (CE-EUS) allows characterization, differentiation, and staging of focal pancreatic masses. The method has a high sensitivity and specificity for the diagnosis of pancreatic adenocarcinoma which is visualized as hypo-enhanced as compared to the rest...... of the parenchyma while chronic pancreatitis and neuroendocrine tumors are generally either iso-enhanced or hyper-enhanced. The development of contrast-enhanced low mechanical index harmonic imaging techniques used in real time during endoscopic ultrasound (EUS) allowed perfusion imaging and the quantification...... contrast agents for early detection, tridimensional and fusion techniques for enhanced staging and resectability assessment but also novel applications of perfusion imaging for monitoring ablative therapy, improved local detection through EUS-guided sampling of portal vein flow or enhanced drug delivery...

  11. The Utility of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Infectious Diseases—Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Mauro Ajaj Saieg

    2013-01-01

    Full Text Available Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA is a fast and minimally invasive methodology with a crucial impact on patients’ management. It has an important and established role in the diagnosis and staging of mediastinal and abdominal malignancies, but little is discussed in the literature on the usefulness of this technique in the diagnosis of infectious diseases. In the current report, we present three different cases where EUS was essential for reaching the diagnosis of tuberculosis and paracoccidiodomicosis in cases otherwise seen as malignant. In conclusion, EUS was successful not only in obtaining enough cells for morphological analysis, but also for the production of cell blocks and assessment of the presence of the microorganisms by special stains. EUS allied to fine needle biopsy was an important tool in determining diagnoses of enlarged lymph nodes, revealing the diagnosis of infectious diseases in cases otherwise seen as malignant. The wide use of this methodology in cases such as those reported here cannot only rule out malignancy, but also aid critically ill patients by installing early proper therapy without the need for aggressive interventions.

  12. Histological confirmation of epizootic ulcerative syndrome in two ...

    African Journals Online (AJOL)

    Epizootic ulcerative syndrome (EUS) is a fish disease caused by an infection of the oomycete, Aphanomyces invadans. During a fish biodiversity assessment of Lake Liambezi, Zambezi Region, Namibia, in August 2011, two Barbus haasianus and three Barbus unitaeniatus with circular ulcerative skin lesions were collected ...

  13. Influence of tumor characteristics on the accuracy of endoscopic ultrasonography in staging cancer of the esophagus and esophagogastric junction

    NARCIS (Netherlands)

    Heeren, PAM; van Westreenen, HL; Geersing, GJ; van Dullemen, HM; Plukker, JTM

    2004-01-01

    Background and Study Aims: Endoscopic ultrasonography (EUS) is the most accurate method of assessing the locoregional extent of cancer of the esophagus and esophagogastric junction. The aim of this study was to evaluate the influence of tumor-related factors such as length and location on the

  14. An ugly duckling becomes a swan {hor_ellipsis}: How an organization becomes customer focused through listening

    Energy Technology Data Exchange (ETDEWEB)

    Asercion, R.E.; Myer, V.J. [Boeing Computer Services Co., Richland, WA (United States)

    1995-04-01

    The story we`re about to tell is true and the names have not been changed to protect the innocent because BCS Richland, Inc. (BCSR), a subsidiary of the Boeing Company, is proud of its metamorphosis from the ugly duckling of computer support to the shining swan-like star of the Help Desk industry. The transformation occurred in the midst of an all but antiquated computer technology environment, rapid technology changes, low employee morale, and high amount of customer frustration. BCSR, located at the Hanford site in the southeastern corner of Washington State, provides information resource management and computer support to the Department of Energy (DOE) complex located at the site. The primary mission of DOE is environmental restoration and waste clean-up. End User Support (EUS), an organization within BCSR, is tasked with all aspects of microcomputer support, both hardware and software. EUS efficiently and effectively supports approximately 12,000 computer users across the entire 560 square mile site. With a small staff of 50 consultants and technicians, EUS provides support to a diverse customer base that includes engineers and scientists, as well as financial personnel, managers, and clerical support. But it wasn`t always this way. BCSR management recognized it and empowered the EUS staff to make the necessary changes. Here`s how they did it.

  15. Effect of a 5-HT1A receptor agonist (8-OH-DPAT on the external urethral sphincter activity in the rat

    Directory of Open Access Journals (Sweden)

    Shih-Ching Chen

    2012-02-01

    Conclusion: The influences of 8-OH-DPAT on EUS burst activity and urodynamics were exactly detected by the sophisticated EMG analytic design, and the results could be a reference for the pharmacological treatment of patients with lower urinary tract dysfunction.

  16. NCBI nr-aa BLAST: CBRC-LAFR-01-0754 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-LAFR-01-0754 ref|NP_926566.1| hypothetical protein gll3620 [Gloeobacter violac...eus PCC 7421] dbj|BAC91561.1| gll3620 [Gloeobacter violaceus PCC 7421] NP_926566.1 0.39 30% ...

  17. NCBI nr-aa BLAST: CBRC-LAFR-01-1309 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-LAFR-01-1309 ref|NP_926566.1| hypothetical protein gll3620 [Gloeobacter violac...eus PCC 7421] dbj|BAC91561.1| gll3620 [Gloeobacter violaceus PCC 7421] NP_926566.1 0.18 30% ...

  18. NCBI nr-aa BLAST: CBRC-DRER-02-0083 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-DRER-02-0083 ref|NP_925841.1| hypothetical protein glr2895 [Gloeobacter violac...eus PCC 7421] dbj|BAC90836.1| glr2895 [Gloeobacter violaceus PCC 7421] NP_925841.1 0.083 40% ...

  19. NCBI nr-aa BLAST: CBRC-OANA-01-0155 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-OANA-01-0155 ref|NP_927250.1| hypothetical protein glr4304 [Gloeobacter violac...eus PCC 7421] dbj|BAC92245.1| glr4304 [Gloeobacter violaceus PCC 7421] NP_927250.1 3.0 26% ...

  20. NCBI nr-aa BLAST: CBRC-FRUB-02-0745 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-FRUB-02-0745 ref|NP_923716.1| hypothetical protein gll0770 [Gloeobacter violac...eus PCC 7421] dbj|BAC88711.1| gll0770 [Gloeobacter violaceus PCC 7421] NP_923716.1 1e-106 48% ...

  1. NCBI nr-aa BLAST: CBRC-PHAM-01-1431 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-PHAM-01-1431 ref|NP_927297.1| WD repeat-containing protein [Gloeobacter violac...eus PCC 7421] dbj|BAC92292.1| WD-repeat protein [Gloeobacter violaceus PCC 7421] NP_927297.1 0.013 33% ...

  2. NCBI nr-aa BLAST: CBRC-LAFR-01-0849 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-LAFR-01-0849 ref|NP_926566.1| hypothetical protein gll3620 [Gloeobacter violac...eus PCC 7421] dbj|BAC91561.1| gll3620 [Gloeobacter violaceus PCC 7421] NP_926566.1 0.15 31% ...

  3. NCBI nr-aa BLAST: CBRC-LAFR-01-0579 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-LAFR-01-0579 ref|NP_926566.1| hypothetical protein gll3620 [Gloeobacter violac...eus PCC 7421] dbj|BAC91561.1| gll3620 [Gloeobacter violaceus PCC 7421] NP_926566.1 3.9 30% ...

  4. NCBI nr-aa BLAST: CBRC-SARA-01-0491 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available CBRC-SARA-01-0491 ref|NP_925838.1| hypothetical protein gll2892 [Gloeobacter violac...eus PCC 7421] dbj|BAC90833.1| gll2892 [Gloeobacter violaceus PCC 7421] NP_925838.1 3e-16 37% ...

  5. The role of endoscopic ultrasound elastography in diagnosis of ...

    African Journals Online (AJOL)

    Subjects: Thirty patients had a solid-appearing pancreatic mass at conventional ultrasound, EUS and CT abdomen were included in the study. Results: A total of 30 patients were included in the study. The age of the Patients ranged between 38 and 70 years with a mean value of 54± 8.6 Years. The study included 22 ...

  6. Role of Endoscopic Ultrasound-guided Fine-needle Aspiration in Lung and Mediastinal Lesions

    Directory of Open Access Journals (Sweden)

    Lien-Fu Lin

    2010-10-01

    Conclusion: EUS-FNA can diagnose lung cancer by confirmation of mediastinal lymph node metastasis, by direct puncture of lung tumor close to the esophagus. It is useful for lymph node (N stations 5, 7, 8 and metastasis (M staging in non-small cell lung cancer, and for the diagnosis of mediastinal mass of unknown etiology.

  7. Pancreatic resection for renal cell carcinoma metastasis: An exceptionally rare coexistence

    Directory of Open Access Journals (Sweden)

    Stergios Boussios, MD, PhD candidate

    2016-01-01

    Conclusion: Recently, an increasing number of surgical resections have been performed in selected patients with limited metastatic disease to the pancreas. In addition, a rigid follow-up scheme, including endoscopic ultrasound (EUS and CT is essential give patients a chance for a prolonged life.

  8. Habitats Directive classification of Danish wetlands

    DEFF Research Database (Denmark)

    Nygaard, Bettina; Ejrnæs, Rasmus; Baattrup-Pedersen, Annette

    EUs Habitatdirektiv blev vedtaget i 1992 med det overordnede formål at sikre den biologiske mangfoldighed i Europa. Direktivet forpligter medlemsstaterne til at sikre gunstig bevaringsstatus for de naturtyper og arter, der er opført på direktivets bilagslister. NOVANAs naturtypeprogram har til fo...

  9. In vivo synthesis of europium selenide nanoparticles and related cytotoxicity evaluation of human cells.

    Science.gov (United States)

    Kim, Eun Bee; Seo, Ji Min; Kim, Gi Wook; Lee, Sang Yup; Park, Tae Jung

    2016-12-01

    Nanotechnology strives to combine new materials for development of noble nanoparticles. As the nanoparticles exhibit unique optical, electronic, and magnetic properties depending on their composition, developing safe, cost-effective and environmentally friendly technologies for the synthesis have become an important issue. In this study, in vivo synthesis of europium selenide (EuSe) nanoparticles was performed using recombinant Escherichia coli cells expressing heavy-metal binding proteins, phytochelatin synthase and metallothionein. The formation of EuSe nanoparticles was confirmed by using UV-vis spectroscopy, spectrofluorometry, X-ray diffraction, energy dispersive X-ray and transmission electron microscopy. The synthesized EuSe nanoparticles exhibited high fluorescence intensities as well as strong magnetic properties. Furthermore, anti-cancer effect of EuSe nanoparticles against cancer cell lines was investigated. This strategy for the biogenic synthesis of nanoparticles has a great potential as bioimaging tools and drug carrying agents in biomedical fields due to its simplicity and nontoxicity. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Endoscopic ultrasound, endoscopic sonoelastography, and strain ratio evaluation of lymph nodes with histology as gold standard

    DEFF Research Database (Denmark)

    Larsen, Michael Hareskov; Fristrup, Claus Wilki; Hansen, Tine Plato

    2012-01-01

    BACKGROUND AND STUDY AIMS: Accurate lymph node staging is essential for the selection of an optimal treatment in patients with upper gastrointestinal cancer. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are considered to be the most accurate method for locoregional staging. Endosc...

  11. Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis

    DEFF Research Database (Denmark)

    Puri, Rajesh; Vilmann, Peter; Saftoiu, Adrian

    2009-01-01

    ). The samples were characterized for cellularity and bloodiness, with a final cytology diagnosis established blindly. The final diagnosis was reached either by EUS-FNA if malignancy was definite, or by surgery and/or clinical follow-up of a minimum of 6 months in the cases of non-specific benign lesions...

  12. Endoscopic ultrasonographic characteristics of gastric schwannoma distinguished from gastrointestinal stromal tumor.

    Science.gov (United States)

    Park, Hyung-Chul; Son, Dong-Jun; Oh, Hyung-Hoon; Oak, Chan-Young; Kim, Mi-Young; Chung, Cho-Yun; Myung, Dae-Seong; Kim, Jong-Sun; Cho, Sung-Bum; Lee, Wan-Sik; Joo, Young-Eun

    2015-01-01

    Gastric schwannoma (GS), a rare neurogenic mesenchymal tumor, is usually benign, slow-growing, and asymptomatic. However, GS is often misdiagnosed as gastrointestinal stromal tumors (GIST) on endoscopic and radiological examinations. The purpose of this study was to evaluate EUS characteristics of GS distinguished from GIST. A total of 119 gastric subepithelial lesions, including 31 GSs and 88 GISTs, who were histologically identified and underwent EUS, were enrolled in this study. We evaluated the EUS characteristics, including location, size, gross morphology, mucosal lesion, layer of origin, border, echogenic pattern, marginal halo, and presence of an internal echoic lesion by retrospective review of the medical records. GS patients comprised nine males and 22 females, indicating female predominance. In the gross morphology according to Yamada's classification, type I was predominant in GS and type III was predominant in GIST. In location, GSs were predominantly located in the gastric body and GISTs were predominantly located in the cardia or fundus. The frequency of 4th layer origin and isoechogenicity as compared to the echogenicity of proper muscle layer was significantly more common in GS than GIST. Although not statistically significant, marginal halo was more frequent in GS than GIST. The presence of an internal echoic lesion was significantly more common in GIST than GS. The EUS characteristics, including tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion may be useful in distinguishing between GS and GIST.

  13. Challenges and Prospects

    African Journals Online (AJOL)

    Erah

    Finally, the prospective areas for biopharmaceutical innovation in Africa include research and development, marketing, workforce development and contract manufacturing. Keywords: Small .... However, in line with the EUs definition, enterprises with less than 250 employees should have turnover of less than €50 million.

  14. SENSITIVITY OF ENDOSCOPIC ULTRASOUND, MULTIDETECTOR COMPUTER TOMOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY IN THE DIAGNOSIS OF PANCREAS DIVISUM: A TERTIARY CENTER EXPERIENCE

    Science.gov (United States)

    Kushnir, Vladimir M.; Wani, Sachin B.; Fowler, Kathryn; Menias, Christine; Varma, Rakesh; Narra, Vamsi; Hovis, Christine; Murad, Faris; Mullady, Daniel; Jonnalagadda, Sreenivasa S.; Early, Dayna S.; Edmundowicz, Steven A.; Azar, Riad R.

    2014-01-01

    OBJECTIVES There are limited data comparing imaging modalities in the diagnosis of pancreas divisum. We aimed to: 1. Evaluate the sensitivity of endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and multi-detector computed tomography (MDCT) for pancreas divisum. 2. Assess interobserver agreement (IOA) among expert radiologists for detecting pancreas divisum on MDCT and MRCP. METHODS For this retrospective cohort study, we identified 45 consecutive patients with pancreaticobiliary symptoms and pancreas divisum established by endoscopic retrograde pancreatography (ERP) who underwent EUS and cross-sectional imaging. The control group was composed of patients without pancreas divisum who underwent ERP and cross-sectional imaging. RESULTS The sensitivity of EUS for pancreas divisum was 86.7%, significantly higher than sensitivity reported in the medical records for MDCT (15.5%) or MRCP (60%) [ppancreas divisum; IOA was moderate (қ=0.43). CONCLUSIONS EUS is a sensitive test for diagnosing pancreas divisum and is superior to MDCT and MRCP. Review of MDCT studies by expert radiologists substantially raises its sensitivity for pancreas divisum. PMID:23211370

  15. Refleksiv ret og virksomheders samfundsansvar

    DEFF Research Database (Denmark)

    Buhmann, Karin

    2013-01-01

    virksomheder opretholde deres samfundsmæssige ’licence to operate’. Gennem to cases - udviklingen af FNs Global Compact, og den første fase (2002-2004) af EUs Multistakeholder Forum (MSF) om CSR – forklares, hvordan den systemteori-inspirerede retsvidenskabelige teori og reguleringsstrategi refleksiv ret...

  16. Dicty_cDB: AFM161 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available eus Uni-Zap XR EST Library Sp... 46 0.003 2 ( GO147943 ) CAGA3319.fwd CAGA Alvinella pompejana Normalized ...... 40 0.005 3 ( GO097927 ) CAFZ1859.fwd CAFZ Alvinella pompejana Incyte regu... 40

  17. Enron’s Spreadsheets and Related Emails : A Dataset and Analysis

    NARCIS (Netherlands)

    Hermans, F.; Murphy-Hill, E.

    2014-01-01

    Spreadsheets are used extensively in business processes around the world and as such, a topic of research interest. Over the past few years, many spreadsheet studies have been performed on the EUSES spreadsheet corpus. While this corpus has served the spreadsheet community well, the spreadsheets it

  18. PET-CT offers accurate assessment of tumour length in oesophageal malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Rollins, K.E., E-mail: james.catton@nuh.nhs.uk [Department of Oesophago-Gastric Surgery, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); Lucas, E. [University of Nottingham, Derby Road, Nottingham (United Kingdom); Tewari, N. [Department of Oesophago-Gastric Surgery, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); James, E. [Department of Oncology, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); Hughes, S. [Department of Radiology, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); Catton, J.A. [Department of Oesophago-Gastric Surgery, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom)

    2015-02-15

    Highlights: • We examine the accuracy of staging modalities in estimating tumour length of oesophageal malignancy. • PET CT correlates most strongly with histopathological length of resected specimen. • Better measure than EUS with OGD correlating poorly. • Potential impact in radiotherapy and surgical resection planning. - Abstract: Introduction: Radiotherapy is increasingly used for both curative and palliative treatment of oesophageal malignancy. Accurate treatment depends on determining tumour location and length. This study assessed the value of PET-CT versus other staging modalities in determining tumour length. Materials and methods: Oesophageal cancer patients who underwent staging with PET/CT and endoscopic ultrasound (EUS) in addition to their diagnostic upper GI endoscopy and subsequent surgical resection were assessed. PET/CT length was obtained retrospectively by using Hermes Hybrid Viewer™ with a 1–5 Standardised Uptake Value grey scale. An SUV of 5 was used as the cut off for determining length. Direct measurement by EUS and OGD were determined. Results: 53 patients underwent PET-CT, EUS, OGD and surgical resection for oesophageal cancer. Overall the correlation between PET-CT and histopathological length was strongest (Pearson r = 0.5977, 95% CI 0.390–0.747) versus EUS (Pearson R = 0.5365, 95% CI 0.311–0.705) and OGD (Pearson r = 0.1574, 95% CI −0.118 to 0.410). After excluding tumours with a significant chemotherapy response, PET-CT length correlated significantly with histopathological length (R = 0.5651, p = 0.0005). In comparison, the correlation between histological length and EUS (R = 0.4637, p = 0.0057) measurement was less significant and this did not correlate with OGD (R = −0.1084, p = 0.5417). Conclusion: Tumour length estimated by PET-CT correlated most strongly with histopathological length of oesophageal malignancy and is the most accurate determinant of tumour length of all the staging modalities. This suggests a

  19. Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer.

    Science.gov (United States)

    Konge, L; Vilmann, P; Clementsen, P; Annema, J T; Ringsted, C

    2012-10-01

    Fine-needle aspiration (FNA) guided by endoscopic ultrasonography (EUS) is important in mediastinal staging of non-small cell lung cancer (NSCLC). Training standards and implementation strategies of this technique are currently under discussion. The aim of this study was to explore the reliability and validity of a newly developed EUS Assessment Tool (EUSAT) designed to measure competence in EUS - FNA for mediastinal staging of NSCLC. A total of 30 patients with proven or suspected NSCLC underwent EUS - FNA for mediastinal staging by three trainees and three experienced physicians. Their performances were assessed prospectively by three experts in EUS under direct observation and again 2 months later in a blinded fashion using digital video-recordings. Based on the assessments, intra-rater reliability, inter-rater reliability, and construct validity were explored. The intra-rater reliability was good (Cronbach's α = 0.80), but comparison of results based on direct observations and blinded video-recordings indicated a significant bias favoring consultants (P = 0.022). Inter-rater reliability was very good (Cronbach's α = 0.93). However, one rater assessing five procedures or two raters each assessing four procedures were necessary to secure a generalizability coefficient of 0.80. The assessment tool demonstrated construct validity by discriminating between trainees and experienced physicians (P = 0.034). Competency in mediastinal staging of NSCLC using EUS and EUS - FNA can be assessed in a reliable and valid way using the EUSAT assessment tool. Measuring and defining competency and training requirements could improve EUS quality and benefit patient care. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Projecting policy-relevant metrics for high summertime ozone pollution events over the eastern United States due to climate and emission changes during the 21st century

    Science.gov (United States)

    Rieder, Harald E.; Fiore, Arlene M.; Horowitz, Larry W.; Naik, Vaishali

    2015-01-01

    Over the eastern United States (EUS), nitrogen oxides (NOx) emission controls have led to improved air quality over the past two decades, but concerns have been raised that climate warming may offset some of these gains. Here we analyze the effect of changing emissions and climate, in isolation and combination, on EUS summertime surface ozone (O3) over the recent past and the 21st century in an ensemble of simulations performed with the Geophysical Fluid Dynamics Laboratory CM3 chemistry-climate model. The simulated summertime EUS O3 is biased high but captures the structure of observed changes in regional O3 distributions following NOx emission reductions. We introduce a statistical bias correction, which allows derivation of policy-relevant statistics by assuming a stationary mean state bias in the model, but accurate simulation of changes at each quantile of the distribution. We contrast two different 21st century scenarios: (i) representative concentration pathway (RCP) 4.5 and (ii) simulations with well-mixed greenhouse gases (WMGG) following RCP4.5 but with emissions of air pollutants and precursors held fixed at 2005 levels (RCP4.5_WMGG). We find under RCP4.5 no exceedance of maximum daily 8 hour average ozone above 75 ppb by mid-21st century, reflecting the U.S. NOx emissions reductions projected in RCP4.5, while more than half of the EUS exceeds this level by the end of the 21st century under RCP4.5_WMGG. Further, we find a simple relationship between the changes in estimated 1 year return levels and regional NOx emission changes, implying that our results can be generalized to estimate changes in the frequency of EUS pollution events under different regional NOx emission scenarios.

  1. A preliminary result of three-dimensional microarray technology to gene analysis with endoscopic ultrasound-guided fine-needle aspiration specimens and pancreatic juices

    Directory of Open Access Journals (Sweden)

    Ishigami Masatoshi

    2010-04-01

    Full Text Available Abstract Background Analysis of gene expression and gene mutation may add information to be different from ordinary pathological tissue diagnosis. Since samples obtained endoscopically are very small, it is desired that more sensitive technology is developed for gene analysis. We investigated whether gene expression and gene mutation analysis by newly developed ultra-sensitive three-dimensional (3D microarray is possible using small amount samples from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA specimens and pancreatic juices. Methods Small amount samples from 17 EUS-FNA specimens and 16 pancreatic juices were obtained. After nucleic acid extraction, the samples were amplified with labeling and analyzed by the 3D microarray. Results The analyzable rate with the microarray was 46% (6/13 in EUS-FNA specimens of RNAlater® storage, and RNA degradations were observed in all the samples of frozen storage. In pancreatic juices, the analyzable rate was 67% (4/6 in frozen storage samples and 20% (2/10 in RNAlater® storage. EUS-FNA specimens were classified into cancer and non-cancer by gene expression analysis and K-ras codon 12 mutations were also detected using the 3D microarray. Conclusions Gene analysis from small amount samples obtained endoscopically was possible by newly developed 3D microarray technology. High quality RNA from EUS-FNA samples were obtained and remained in good condition only using RNA stabilizer. In contrast, high quality RNA from pancreatic juice samples were obtained only in frozen storage without RNA stabilizer.

  2. Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study.

    Science.gov (United States)

    Consiglieri, Claudia F; Gornals, Joan B; Busquets, Juli; Peláez, Nuria; Secanella, Lluis; De-La-Hera, Meritxell; Sanzol, Resurrección; Fabregat, Joan; Castellote, José

    2018-01-01

    The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  3. In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study.

    Science.gov (United States)

    Krishna, Somashekar G; Modi, Rohan M; Kamboj, Amrit K; Swanson, Benjamin J; Hart, Phil A; Dillhoff, Mary E; Manilchuk, Andrei; Schmidt, Carl R; Conwell, Darwin L

    2017-05-14

    To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs). In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQ-Flex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.

  4. Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography.

    Science.gov (United States)

    Chen, Chien-Hua; Yang, Chi-Chieh; Yeh, Yung-Hsiang; Yang, Tsang; Chung, Tieh-Chi

    2015-09-01

    Ultrasonography (US) cannot demonstrate all the etiologies of biliary tract dilatation in patients with jaundice. Thus, we evaluated the etiologic yield of endosonography (EUS) for suspected obstructive jaundice when no definite pathology was found on US. Additionally, we sought to identify the predictors of the most common etiologies. We performed a retrospective review of 123 consecutive patients who had undergone EUS for suspected obstructive jaundice when no definite pathology was identified on US. The most common diagnoses included no pathological obstruction (n = 43), pancreatobiliary malignancy (n = 41), and choledocholithiasis (n = 28). Pancreatobiliary malignancy was associated with common bile duct (CBD) dilatation, and fever and elevated alanine aminotransferase were predictors of choledocholithiasis (p jaundice, 100% (40/40) for no pathological finding, 100% (23/23) for ampullary cancer, 100% (13/13) for pancreatic cancer, 75% (3/4) for CBD cancer, and 92.9% (26/28) for choledocholithiasis, respectively. Besides the two patients with focal chronic pancreatitis misdiagnosed as with pancreatic cancer, EUS missed the lesions in one CBD cancer patient and two patients with choledocholithiasis. The overall accuracy of EUS in ascertaining pancreatobiliary malignancy and choledocholithiasis was comparable (97.6%, 40/41 vs. 92.9%, 26/28; p > 0.05). Marked CBD dilatation (≥12 mm) should remind us of the high risk of malignancy, and the presence of CBD dilatation and fever is suggestive of choledocholithiasis. Negative EUS findings cannot assure any pathological obstruction in patients with clinically suspected obstructive jaundice. Copyright © 2013. Published by Elsevier B.V.

  5. Non-small-cell lung cancer: detection of mediastinal lymph node metastases by endoscopic ultrasound and CT

    Energy Technology Data Exchange (ETDEWEB)

    Potepan, P. [Dept. of Diagnostic Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Meroni, E. [Dept. of Endoscopy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Spagnoli, I. [Dept. of Diagnostic Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Milella, M. [Dept. of Special Radiological Procedures, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Danesini, G.M. [Dept. of Diagnostic Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Laffranchi, A. [Dept. of Diagnostic Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Civelli, E. [Dept. of Diagnostic Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Alloisio, M. [Dept. of Thoracic Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Mariani, L. [Dept. of Medical Statistics, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Spinelli, P. [Dept. of Endoscopy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy); Guzzon, A. [Dept. of Diagnostic Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan (Italy)

    1996-02-01

    In this prospective study endoscopic ultrasound (EUS) and computed tomography (CT) were evaluated to compare diagnostic accuracy of the two methods. They were performed for nodal staging in selected patients admitted to our institution for non-small-cell lung cancer (NSCLC). From February 1992 to July 1993, 45 patients were recruited for the study when N3 and N2 nodal involvement were excluded on standard chest X-ray. All the patients completed EUS and CT exams for staging before treatment. The results of sensitivity, specificity and accuracy were obtained in 30 patients who underwent surgical treatment with macroscopically radical resection of T and N, which allowed a complete surgical and histological comparison of CT and EUS findings. On a per-patient basis CT results were: Sensitivity 63.6%, specificity 78.9% and accuracy of 73.3%; on a nodal station basis sensitivity, specificity and accuracy were 70.0%, 85,1% and 81.6%, respectively. The EUS evaluation showed, on a per-patient basis, values of sensitivity 45.5%, specificity 57.9% and overall diagnostic accuracy of 53.3%. On a nodal station basis the results were 50.0%, 86.6% and 78.2%, respectively. The results obtained in the 30 patients when both techniques were taken in association regarding senstivity (90.9%), specificity (73.7%) and accuracy (80.0%) on a per-patient basis suggest that the association of EUS and CT offers the best approach for preoperative staging of NSCLC. (orig.)

  6. Diagnostic yield and safety of jumbo biopsy forceps in patients with subepithelial lesions of the upper and lower GI tract.

    Science.gov (United States)

    Buscaglia, Jonathan M; Nagula, Satish; Jayaraman, Vijay; Robbins, David H; Vadada, Deepak; Gross, Seth A; DiMaio, Christopher J; Pais, Shireen; Patel, Kal; Sejpal, Divyesh V; Kim, Michelle K

    2012-06-01

    EUS-FNA often fails to make a definitive diagnosis in the evaluation of subepithelial lesions. The addition of jumbo biopsy forceps has the potential to improve diagnostic yield, but published series are limited. To assess the likelihood of definitive diagnosis for subepithelial lesions by using jumbo biopsy forceps during EUS examination. Pooled retrospective analysis. 6 tertiary referral centers. All patients having undergone EUS examination for a subepithelial lesion in which jumbo biopsy forceps were used for tissue acquisition. Diagnostic yield of jumbo biopsy forceps use, complication rates, and comparison of diagnostic yield with that of EUS-FNA. A total of 129 patients underwent EUS with jumbo biopsy forceps; 31 patients (24%) had simultaneous EUS-FNA. The lesion locations were stomach (n = 98), esophagus (n = 14), duodenum (n = 11), colon (n = 5), and jejunum (n = 1). The average lesion size was 14.9 mm ± 9.3 mm. Overall, definitive diagnosis was obtained in 87 of 129 patients (67.4%) by using either method. A definitive diagnosis was provided by jumbo biopsy forceps use in 76 of 129 patients (58.9%) and by FNA in 14 of 31 patients (45.1%) (P = .175). The results in third-layer lesions were definitive with jumbo biopsy forceps in 56 of 86 lesions (65.1%) and with FNA in 6 of 16 lesions (37.5%) (P = .047). For fourth-layer lesions, the results with jumbo biopsy forceps were definitive in 10 of 25 (40.0%) and with FNA in 8 of 14 (57.1%) (P = .330). Forty-five of 129 patients (34.9%) experienced significant bleeding after biopsy with jumbo forceps and required some form of endoscopic hemostasis. Retrospective study. Jumbo forceps are a useful tool for the definitive diagnosis of subepithelial lesions. The greatest benefit appears to be with third-layer (submucosal) lesions. The risk of bleeding is significant. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  7. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography.

    Science.gov (United States)

    Khashab, Mouen A; Van der Merwe, Schalk; Kunda, Rastislav; El Zein, Mohamad H; Teoh, Anthony Y; Marson, Fernando P; Fabbri, Carlo; Tarantino, Ilaria; Varadarajulu, Shyam; Modayil, Rani J; Stavropoulos, Stavros N; Peñas, Irene; Ngamruengphong, Saowanee; Kumbhari, Vivek; Romagnuolo, Joseph; Shah, Raj; Kalloo, Anthony N; Perez-Miranda, Manuel; Artifon, Everson L

    2016-04-01

    Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis. A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 - 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 - 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 - 86.26 %). This study on EUS-BD demonstrates excellent efficacy

  8. [Neuroendocrine tumours of the upper gastrointestinal tract, characteristics and comparison of localization diagnostics].

    Science.gov (United States)

    Hyrdel, R; Reznák, I; Hyrdel, P; Polácek, H; Polácek, H; Hladká, M; Agouba, S M; Janík, J; Laca, L

    2011-12-01

    In daily clinical practice it's important to think of neuroendocrine tumors, since their prevalence for the past 5 years exceeded even the common occurrences of stomach, esophageal and pancreatic cancers. Patients diagnosed early and accurately with NET, have a greater chance for complete cure. The diagnostic tools over the past century were significantly inefficient in diagnosing NET i.e. (40% of tumors were not localized after USG, CT, MRI, AG investigations). Until the past 2 decades that major turnover in diagnostic methods has been achieved. In particular, the introduction of the somatostatine receptor scintigrafy (SRS) and endoscopic ultrasonography (EUS) have increased sensitivity of localization diagnostics up to 90%. Our work is to test the success of the localization diagnostics in 22 patients with surgically and histologically confirmed NET ofthe pancreas and duodenum. These patients fulfilled jointly SRS, CT and/or MRI, but also classic USG and EUS. From our comparison, clearly endoscopic USG is the most efficient tool with 90% sensitivity.

  9. Routine examination for tuberculosis is still indicated during bronchoscopy for pulmonary infiltrates

    DEFF Research Database (Denmark)

    Laub, Rasmus Rude; Sivapalan, Pradeesh; Wilcke, Torgny

    2015-01-01

    INTRODUCTION: Tuberculosis (TB) can present in numerous ways and can be radiological indistinguishable from cancer. In several guidelines for bronchoscopy (FOB) in low-incidence areas, a Mycobacterium tuberculosis test is only recommended when TB is clinically suspected. Due to the expenses...... associated with M. tuberculosis cultures, we did an analysis of tests obtained by FOB and other invasive procedures (endoscopic ultrasound (EUS)-guided needle biopsy via the oesophagus or trachea and percutaneous needle lung biopsy (PNLB)). METHODS: All patients tested positive for M. tuberculosis by culture...... and with samples obtained by FOB, EUS or PNLB in the 2008-2012 period were identified retrospectively in two centres in a low-incidence area (Copenhagen, Denmark). Patient records and radiological reports were reviewed. RESULTS: A total of 57 (1.2%) patients out of the 4,680 tested were M. tuberculosis culture...

  10. Pancreatic cystic neoplasms: Review of current knowledge, diagnostic challenges, and management options

    Science.gov (United States)

    Jana, Tanima; Shroff, Jennifer; Bhutani, Manoop S.

    2015-01-01

    Pancreatic cystic lesions are being detected with increasing frequency, largely due to advances in cross-sectional imaging. The most common neoplasms include serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, solid pseudopapillary neoplasms, and cystic pancreatic endocrine neoplasms. Computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) are currently used as imaging modalities. EUS-guided fine needle aspiration has proved to be a useful diagnostic tool, and enables an assessment of tumor markers, cytology, chemistries, and DNA analysis. Here, we review the current literature on pancreatic cystic neoplasms, including classification, diagnosis, treatment, and recommendations for surveillance. Data for this manuscript was acquired via searching the literature from inception to December 2014 on PubMed and Ovid MEDLINE. PMID:25821410

  11. How to do pancreatic mass FNA.

    Science.gov (United States)

    Harris, Michael D; Buscaglia, Jonathan M

    2010-04-01

    FNA is an important aspect in the diagnosis and management of pancreatic masses. Studies have shown that the overall accuracy of EUS-guided FNA ranges between 71% and 90% in this setting. It is important to review all pertinent clinical data (especially cross-sectional imaging) before performing endoscopy. The choice of needle may depend on the location and size of the lesion. Once the lesion is targeted and placed in optimal position, FNA is performed under total EUS guidance while visualizing the needle tip at all times. Factors that may increase the diagnostic yield of FNA include sampling the lesion in multiple planes, targeting the margins or firmer ends of a necrotic mass, and arranging for ROSE.

  12. Clinical evaluation, imaging studies, indications for cytologic study and preprocedural requirements for duct brushing studies and pancreatic fine-needle aspiration: The Papanicolaou Society of Cytopathology Guidelines

    Directory of Open Access Journals (Sweden)

    Douglas Adler

    2014-01-01

    Full Text Available The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS and fine-needle aspiration (FNA biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing and postbiopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.

  13. Understanding the Giant Enhancement of Exchange Interaction in Bi2Se3-EuS Heterostructures

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeongwoo; Kim, Kyoung-Whan; Wang, Hui; Sinova, Jairo; Wu, Ruqian

    2017-07-01

    A recent experiment indicated that a ferromagnetic EuS film in contact with a topological insulator Bi 2 Se 3 might show a largely enhanced Curie temperature and perpendicular magnetic anisotropy [F. Katmis et al., Nature (London) 533, 513 (2016).]. Through systematic density functional calculations, we demonstrate that in addition to the factor that Bi 2 Se 3 has a strong spin orbit coupling, the topological surface states are crucial to make these unusual behaviors robust as they hybridize with EuS states and extend rather far into the magnetic layers. The magnetic moments of Eu atoms are nevertheless not much enhanced, unlike what was reported in the experiment. Our results and model analyses provide useful insights for how these quantities are linked, and pave a way for the control of properties of magnetic films via contact with topological insulators.

  14. Endoscopic ultrasonography-guided tissue acquisition: How to achieve excellence.

    Science.gov (United States)

    Bhatia, Vikram; Varadarajulu, Shyam

    2017-05-01

    Endoscopic ultrasound (EUS)-guided tissue acquisition is a basic forte of an endosonographer. The multiple skills required to accomplish successful results include not only the puncture itself, but also proper lesion identification, correct puncture sequence, collaboration with the pathologist onsite or remotely, proper handling of the specimens, choosing one or more of cytology, cell-block, and/or tissue core preparation and, last, deciding the immunohistochemistry (IHC) panels and ancillary tests which may be needed for the current case. Error in any of these decisions may lead to incomplete or inconclusive information from the procedure, even if the aspirate is 'adequate.' In the present review, we will describe the technical aspects of EUS-guided tissue acquisition, current needles available and how to choose between them, and how to appropriately handle the specimen. We will also discuss the optimal approach to common targets including lymph nodes, pancreatic masses, pancreatic cysts, and subepithelial lesions. © 2017 Japan Gastroenterological Endoscopy Society.

  15. Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy.

    Science.gov (United States)

    Zhang, Lei; Pleskow, Douglas K; Turzhitsky, Vladimir; Yee, Eric U; Berzin, Tyler M; Sawhney, Mandeep; Shinagare, Shweta; Vitkin, Edward; Zakharov, Yuri; Khan, Umar; Wang, Fen; Goldsmith, Jeffrey D; Goldberg, Saveli; Chuttani, Ram; Itzkan, Irving; Qiu, Le; Perelman, Lev T

    2017-01-01

    Pancreatic cancers are usually detected at an advanced stage and have poor prognosis. About one fifth of these arise from pancreatic cystic lesions. Yet not all lesions are precancerous, and imaging tools lack adequate accuracy for distinguishing precancerous from benign cysts. Therefore, decisions on surgical resection usually rely on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Unfortunately, cyst fluid often contains few cells, and fluid chemical analysis lacks accuracy, resulting in dire consequences, including unnecessary pancreatic surgery for benign cysts and the development of cancer. Here, we report an optical spectroscopic technique, based on a spatial gating fibre-optic probe, that predicts the malignant potential of pancreatic cystic lesions during routine diagnostic EUS-FNA procedures. In a double-blind prospective study in 25 patients, with 14 cysts measured in vivo and 13 postoperatively, the technique achieved an overall accuracy of 95%, with a 95%confidence interval of 78-99%, in cysts with definitive diagnosis.

  16. Ultrasound techniques in the evaluation of the mediastinum, part I

    DEFF Research Database (Denmark)

    Dietrich, Christoph Frank; Annema, Jouke Tabe; Clementsen, Paul

    2015-01-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable...... and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging...... endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review, in two integrative parts, is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal...

  17. Endoscopic ultrasound guided injection of iron oxide magnetic nanoparticles for liver and pancreas

    DEFF Research Database (Denmark)

    Ungureanu, Bogdan Silviu; Pirici, Daniel; Margaritescu, Claudiu

    2016-01-01

    AIMS: Pancreatic cancer and hepatocellular carcinoma are two of the most aggressive types of cancer with limited therapeutic options in stages of advanced disease. Our objective is to assess the safety and feasibility of injecting iron oxide nanoparticles (IONs) via endoscopic ultrasound (EUS......)-guidance, both systemically and locally in the liver and pancreas in order to study new potential therapies for liver and pancreatic tumors. MATERIAL AND METHODS: Six domestic pigs were used for our study design, and divided into three groups: two were injected in the portal vein, and other four were subjected...... local injection and after vascular EUS-FNI. The imaging results were confirmed by pathological examination with most of the IONs accumulated in Ito-like cells, Kupfer cells, and sinusoids. CONCLUSIONS: IONs have been widely studied for both diagnostic and therapeutic purposes. Their injection through...

  18. Monitoring the solar UV-B radiation in the North of Munich: A comparison of two sites

    Science.gov (United States)

    Albert, Andreas; Rupprecht, Werner; Mayer, Ingo; Steinmetz, Manfred; Seidlitz, Harald K.; Thiel, Stephan

    2013-05-01

    Since 2008, measurements of the downwelling solar spectral irradiance from 290 to 400 nm were compared at two field sites at Neuherberg, north of Munich, Germany, 11.6 E, 48.22 N, 490 m above sea level: (1) Research Unit Environmental Simulation (EUS) at the Helmholtz Zentrum München (former GSF National Reasearch Center for Environment and Health), (2) Federal Office for Radiation Protection (BfS). The spectral measurements of two double monochromator systems (TDM300, Bentham, Reading, UK) at 11:00 GMT were analyzed every day. Spectral comparison showed no misalignment of the wavelength calibration. The mean deviation of 1090 measurements at three different wavelengths in the UV-B range (280 - 315 nm) showed coefficients of determination better than 0.94 and a 10% higher value of spectral irradiance of the EUS system, mainly due to different entrance optics and spectral resolution.

  19. Independent verification survey report for exposure units Z2-24, Z2-31, Z2-32, AND Z2-36 in zone 2 of the East Tennessee technology park Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    King, David A. [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)

    2013-10-01

    The U.S. Department of Energy (DOE) Oak Ridge Office of Environmental Management selected Oak Ridge Associated Universities (ORAU), through the Oak Ridge Institute for Science and Education (ORISE) contract, to perform independent verification (IV) at Zone 2 of the East Tennessee Technology Park (ETTP) in Oak Ridge, Tennessee. ORAU has concluded IV surveys, per the project-specific plan (PSP) (ORAU 2013a) covering exposure units (EUs) Z2-24, -31, -32, and -36. The objective of this effort was to verify the target EUs comply with requirements in the Zone 2 Record of Decision (ROD) (DOE 2005), as implemented by using the dynamic verification strategy presented in the dynamic work plan (DWP) (BJC 2007); and confirm commitments in the DWP were adequately implemented, as verified via IV surveys and soil sampling.

  20. Endoscopic ultrasound and pancreas divisum

    DEFF Research Database (Denmark)

    Rana, Surinder S; Gonen, Can; Vilmann, Peter

    2012-01-01

    Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in minority of individuals it is presumed to cause recurrent acute pancreatitis and chronic pancreatitis. Endoscopic retrograde cholangiop......Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in minority of individuals it is presumed to cause recurrent acute pancreatitis and chronic pancreatitis. Endoscopic retrograde...... of the parenchyma also. Therefore EUS, both radial and linear, has potential for being a minimally invasive diagnostic modality for pancreas divisum. A number of EUS criteria have been suggested for the diagnosis of pancreas divisum. These criteria have varying sensitivity and specificity and hence there is a need...

  1. [Horizon 2020, new EU Framework programme for research and innovation, 2014-2020].

    Science.gov (United States)

    Kinkorová, Judita

    2014-01-01

    Horizon 2020 is a financial instrument implementing the Innovation Union, a Europe 2020 flagship initiative aimed at securing Europes global competitiveness. Running from 2014 to 2020 with a budget of just over € 80 billion, the EUs new programme for research and innovation is part of the drive to create new growth and jobs in Europe. Societal challenge Health, demographic change and wellbeing is an important part of Horizon 2020.

  2. Pancreatic involvement by metastasizing neoplasms as determined by endoscopic ultrasound-guided fine needle aspiration: A clinicopathologic characterization.

    Science.gov (United States)

    Sekulic, Miroslav; Amin, Khalid; Mettler, Tetyana; Miller, Lizette K; Mallery, Shawn; Stewart, Jimmie

    2017-05-01

    Pancreatic tumors often represent primary neoplasms, however organ involvement with metastatic disease can occur. The use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to determine the underlying pathology provides guidance of clinical management. 25 cases were identified in a retrospective review of our institution's records from 2006 to 2016. Clinical parameters and prognosis are described. Metastatic lesions to the pancreas diagnosed by EUS-FNA accounted for 4.2% of all pancreatic neoplastic diagnoses, each lesion had a median greatest dimension of 1.5 cm, were most often located in the head of the pancreas, and by EUS were typically hypoechoic masses with variably defined borders. Patients were of a median age of 64 years old at diagnosis of the metastatic lesion(s) and the mean interval from primary diagnosis to the diagnosis of metastasis to the pancreas was 58.7 months (95% confidence interval, CI, 35.4 to 82.0 months). The rates of 24-month overall survival after diagnoses of metastatic renal cell carcinoma or all other neoplasms to the pancreas were 90% and 7% respectively. The origin of the neoplasms included the kidney (n = 10), colon (n = 4), ovary (n = 3), lung (n = 2), et al. Smear-based cytomorphology, and a combination of histomorphology and immunohistochemical studies from cell block preparations showed features consistent with the neoplasm of derivation. Metastases to the pancreas can be diagnosed via EUS-FNA, with enough specimen to conduct immunohistochemical studies if necessary to delineate origin. The determination of metastatic disease to the pancreas alters management and prognosis of the patient. Diagn. Cytopathol. 2017;45:418-425. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  3. Oihartzunak-hitz sustraituak

    OpenAIRE

    Inchausti Gabilondo, Maria José

    2006-01-01

    Este artículo se puede encontrar en castellano en la revista Cuadernos de Psicomotricidad, nº 29,(2005) titulado Resonancias, y nº 30, (2005) titulado Palabras enraizadas. [EUS]Jakin badakigu ipuin bat, istorio bat entzutean emozioak bizi izaten ditugula. Hitz eta berbek mugiarazi egiten gaituzte. Eta irakurtzerakoan ere gertatzen da hori, nahiz eta prozesua konplexuagoa izan. Badira liburu teoriko batzuk intelektuala eta emozionala nahastean sortzen den eremu bitxi horretan barneratzen ga...

  4. Felleskapsmonografier Bringebærblad og Svarthyllbær

    OpenAIRE

    Sabouni, Mitra

    2012-01-01

    Bakgrunn EUs vitenskapelige komité for plantebaserte legemidler (HMPC- Herbal Medicinal Products Committee) sin hovedoppgave er å utarbeide monografier. Utarbeidelse av monografier blir utført av medlemmer av MLWP (Working Party on samfunn monografier og samfunn List) som rapportører og deres tilgjengelige eksperter. MLWP er en arbeidsgruppe under HMPC. Fellesskapsmonografiene gir en harmonisert tilnærming til vitenskapelig bedømmelse av plantebaserte legemidler i EU/EØS-området, og kan...

  5. Making EU Trade Agreements Work: The Role of Rules of Origin

    OpenAIRE

    Paul Brenton; Miriam Manchin

    2002-01-01

    A key element of the EU’s free trade and preferential trade agreements is the extent to which they deliver improved market access and so contribute to the EUs foreign policy objectives towards developing countries and neighbouring countries in Europe, including the countries of the Balkans. Previous preferential trade schemes have been ineffective in delivering improved access to the EU market. The main reason for this is probably the very restrictive rules of origin that the EU imposes, coup...

  6. Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones.

    Directory of Open Access Journals (Sweden)

    Stephen Morris

    Full Text Available Patients with suspected common bile duct (CBD stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP, an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS or Magnetic Resonance CholangioPancreatography (MRCP first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs per patient from the perspective of the UK National Health Service (NHS over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively, with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively. Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.

  7. Støtte til pleje af græsarealer

    DEFF Research Database (Denmark)

    Andersen, Erling; Kristensen, Lone Søderkvist; Busck, Anne Gravsholt

    2010-01-01

    Sverige og Danmark har vidt forskellige traditioner i forhold til registrering og viden om græsarealer, naturplejens plads i jordbrugsstøtten, de regionale myndigheders rolle mv. Så selvom landmændene i de tpolande tilbydes støtte til pleje af græsarealer indenfor de samme rammer under EU......'s landdistriktpolitik, er ordningerne i de to lande meget forskellige....

  8. SMEs, Competition and Entry - A developing country perspective

    DEFF Research Database (Denmark)

    Jensen, Camilla

    in countries with high corruption and a poor competition policy framework. Furthermore, prior to the entry into a strategic alliance the investor must carefully investigate the ethical behaviour and attitudes of the partners towards culturally embedded concepts such as what constitutes fair competition...... practise so that they conform with the expectations and formal institutions of the investor's home country and possible requirements in terms of good governance standards enshrined in the EUs free trade agreements with third countries....

  9. Fortaleza Station Report for 2012

    Science.gov (United States)

    Kaufmann, Pierre; Pereira de Lucena, A. Macilio; Sombra da Silva, Adeildo

    2013-01-01

    This is a brief report about the activities carried out at the Fortaleza geodetic VLBI station (ROEN: R´adio Observat´orio Espacial do Nordeste), located in Eus´ebio, CE, Brazil, during the period from January until December 2012. The observing activities were resumed in May after the major maintenance that comprised the azimuth bearing replacement. The total observational experiments consisted of 103 VLBI sessions and continuous GPS monitoring recordings.

  10. Critical evaluation of pancreatic masses

    Directory of Open Access Journals (Sweden)

    John DeWitt

    2012-01-01

    Full Text Available Evaluation of a patient with a pancreatic mass on a CT or MRI requires consideration of the gender and age of the patient, presenting symptoms, quality of the imaging study performed and relevant medical history. CT is generally preferred over MRI for suspected pancreatic cancer but MRI is best considered for evaluation of ductal anatomy and possible cystic neoplasms. EUS should be considered when further characterization of morphology or tissue sampling is required.

  11. Endoscopic Ultrasound Does Not Accurately Stage Early Adenocarcinoma or High-Grade Dysplasia of the Esophagus

    Science.gov (United States)

    2010-01-01

    CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:1037-1041 ORIGINAL ARTICLES- ALIMENTARY TRACT Endoscopic Ultrasound Does Not Accurately Stage Early... quality ; 8 had indi- vidual patiem-level data (n = 132). Compared with surgical or EMR pathology staging, EUS had T-stage concordance of 65%, including...currently valid OMB control number. 1. REPORT DATE 2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND SUBTITLE Endoscopic

  12. Differentiation of Pancreatic Cyst Types by Analysis of Rheological Behavior of Pancreatic Cyst Fluid

    OpenAIRE

    Khamaysi, Iyad; Abu Ammar, Aiman; Vasilyev, Gleb; Arinstein, Arkadii; Chowers, Yehuda; Zussman, Eyal

    2017-01-01

    Differentiation between mucinous and non-mucinous pancreatic cysts is exceedingly important and challenging, particularly as the former bears malignant transformation potential. Pancreatic cyst fluid (PCF)-based diagnostics, including analyses of biochemical markers, as well as cytology, has shown inadequate accuracy. Herein, a preliminary single-center study of 22 PCF samples, collected by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), assessed the rheological behavior of PCF...

  13. DIE BETREKKING TUSSEN JESUS EN JOHANNES DIE DOPER Na ...

    African Journals Online (AJOL)

    Test

    Erange/ium des /oAannes, Gött. t lte AufL 1950. 3) Vgl. HEGEStPPUS by Eus. H. E. IV. 22. Dit word tans algemeen aange- neem dat die Mandeërs nie die direkte voortsetting van die Doperdissipels was nie. In 56 n.C. het Paulus hulle nog aangetref te Efese en was hulle skynbaar ook verteenwoordig in Alexandrië.

  14. Atlantiar isurialdean landa garapena aukeran

    OpenAIRE

    Ainz Ibarrondo, María José; Zarraonandia Zabala, Nerea

    1998-01-01

    [EUS] Artikulu honetan, (UPV/EHU) Geografia Lizenziaturako ikasleek burututako Landa Garapen Aurreproiektu batzuetatik ondorioztatzen diren emaitza nagusiak plazaratzen dira. Nahiz eta lan horien hasierako helburua erabat akademikoa izan, kanpo lanaren bidez lortutako datuen interesak sintesi txiki hau bultzatzen du. [ES] En el presente artículo se presentan algunas de las conclusiones obtenidas a partir de varios Anteproyectos de Desarrollo Rural, llevados a cabo por alumnos de la Licenci...

  15. P-HPB-07: Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: An international external inter- and intra-observer study

    Science.gov (United States)

    Krishna, Somashekar; Brugge, William; Dewitt, John; Napoleon, Bertrand; Kongkam, Pradermchai; Tan, Damien; Robles-Medranda, Carol; Conwell, Darwin

    2017-01-01

    Background and Objectives: Endoscopic ultrasonography (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) although identified lacks external validation and surgical histopathology was available in a minority of subjects. We sought to externally validate EUS-nCLE images for differentiating PCLs in a larger series of subjects with a definitive diagnosis. Methods: Six expert endosonographers, blinded to clinical data, reviewed nCLE images of PCLs from 29 subjects with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. The performance characteristics of nCLE and the kappa-statistic for interobserver agreement (IOA, 95% confidence interval [CI]) and intraobserver reliability (IOR, mean, standard deviation [SD]) for the identification of nCLE image patterns were calculated. Landis and Koch interpretation of kappa values was used. Results: A total of 29 (16 mucinous PCLs, 13 nonmucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean, SD) were κ = 0.81 (almost-perfect), 95% CI 0.71–0.90 and κ = 0.86, 0.11 (almost-perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas were 99%, 98%, and 98%, respectively. The IOA and IOR (mean, SD) for recognizing characteristic image pattern of serous cystadenomas were κ = 0.83 (almost-perfect), 95% CI 0.73–0.92 and κ = 0.85, 0.11 (almost-perfect), respectively. Conclusion: EUS-nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intra-observer agreement in differentiating mucinous versus nonmucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS-nCLE.

  16. Of Asian forests and European fields: Eastern U.S. plant invasions in a global floristic context.

    Directory of Open Access Journals (Sweden)

    Jason D Fridley

    Full Text Available BACKGROUND: Biogeographic patterns of species invasions hold important clues to solving the recalcitrant 'who', 'where', and 'why' questions of invasion biology, but the few existing studies make no attempt to distinguish alien floras (all non-native occurrences from invasive floras (rapidly spreading species of significant management concern, nor have invasion biologists asked whether particular habitats are consistently invaded by species from particular regions. METHODOLOGY/PRINCIPAL FINDINGS: Here I describe the native floristic provenances of the 2629 alien plant taxa of the Eastern Deciduous Forest of the Eastern U.S. (EUS, and contrast these to the subset of 449 taxa that EUS management agencies have labeled 'invasive'. Although EUS alien plants come from all global floristic regions, nearly half (45% have native ranges that include central and northern Europe or the Mediterranean (39%. In contrast, EUS invasive species are most likely to come from East Asia (29%, a pattern that is magnified when the invasive pool is restricted to species that are native to a single floristic region (25% from East Asia, compared to only 11% from northern/central Europe and 2% from the Mediterranean. Moreover, East Asian invaders are mostly woody (56%, compared to just 23% of the total alien flora and are significantly more likely to invade intact forests and riparian areas than European species, which dominate managed or disturbed ecosystems. CONCLUSIONS/SIGNIFICANCE: These patterns suggest that the often-invoked 'imperialist dogma' view of global invasions equating invasion events with the spread of European colonialism is at best a restricted framework for invasion in disturbed ecosystems. This view must be superseded by a biogeographic invasion theory that is explicitly habitat-specific and can explain why particular world biotas tend to dominate particular environments.

  17. Product Assurance. Operational Quality Assurance. Wideband Radio Analysis

    Science.gov (United States)

    1976-05-20

    directly, or indirectly, in this CCP: Telecommunications Technology, Inc. "Taking The Mystery Out of Phase Jitter Measurement", by Elton Cookson and...N as much ~r~as a to7 Eus mayo be ineredat betwee clmae I an~d reSd~adclme.s~ n 10- r ma inan o a~~ 3~~C- a~ n aa! rne f ~ o 1~ ~FhisIs :rax Ianoma

  18. Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience.

    Science.gov (United States)

    Binmoeller, Kenneth F; Weilert, Frank; Shah, Janak N; Bhat, Yasser M; Kane, Steve

    2013-05-01

    Endosonography (EUS)-guided transmural pseudocyst drainage is a multistep procedure currently performed with different "off-the-shelf" accessories developed for other applications. Multiple device exchanges over-the-wire is time consuming and risks loss of wire access. This report describes the technical feasibility and outcomes for EUS-guided drainage of pancreatic fluid collections using a novel exchange-free device developed for translumenal therapy. Between April and November 2010, 14 patients (9 men; mean age, 49.9 years) with pancreatic fluid collection (mean size, 102 mm) underwent 16 EUS-guided drainage procedures using the exchange-free access device at a single tertiary care center. The trocar of the exchange-free device was used to gain pseudocyst access. The dual-balloon catheter then was advanced over the trocar, followed by inflation of the (first) anchor balloon. Cyst contents were sampled, and contrast was injected to define the pseudocyst anatomy. The first guidewire was inserted into the cyst cavity. The cystenterostomy tract was dilated to 10 mm with the (second) dilation balloon, followed by a second guidewire insertion. The exchange-free access device was removed, leaving the two guidewires in place for two double-pigtail stents. The procedure was technically successful for all the patients. No acute procedure-related complications occurred. Late complications included a symptomatic leak in a patient who underwent drainage of a pancreatic uncinate pseudocyst from the second duodenum, a self-limited transfusion-dependent bleed after transbulbar drainage, and symptomatic pseudocyst infection. Pseudocyst access, cystenterostomy tract dilation, and placement of two guidewires for dual stent drainage are technically feasible using an exchange-free access device. The device has the potential to standardize, simplify, and streamline EUS-guided pseudocyst drainage with a single instrument. Comparative studies with alternative tools and methods for

  19. Multidisciplinary diagnostic and therapeutic approaches to pancreatic cystic lesions

    Directory of Open Access Journals (Sweden)

    Clores MJ

    2014-02-01

    Full Text Available Michael J Clores, Amar Thosani, Jonathan M BuscagliaDivision of Gastroenterology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USAAbstract: Pancreatic cystic lesions are commonly encountered today with the routine use of cross-sectional imaging modalities such as computed tomography (CT and magnetic resonance imaging (MRI. The majority of patients discovered to have a pancreatic cyst are completely asymptomatic; yet the presence of such a finding instills fear in the minds of both patient and physician, as the concern for malignant transformation to pancreatic cancer is great despite the relatively low overall likelihood of cyst progression. Not all cysts in the pancreas represent pancreatic cystic neoplasms (PCNs, and not all PCNs have significant malignant potential. Mucinous PCNs are the most concerning, as these lesions have the greatest potential for cancerous transformation to adenocarcinoma. Within the group of mucinous PCNs, intraductal papillary mucinous neoplasms (IPMNs involving the main pancreatic duct are the most worrisome, and surgical resection should be pursued if the patient has appropriate operative risks. IPMN lesions involving the branch ducts, and mucinous cystadenomas, have a lower likelihood for malignancy, and they may be closely followed for the development of any worrisome or high-risk features. Surveillance of known PCNs is performed with a combination of CT, MRI and endoscopic ultrasound (EUS. EUS-guided fine-needle aspiration (EUS-FNA may be used to assess cyst fluid cytology, and also to detect cyst fluid amylase level, carcinoembryonic antigen level, and DNA molecular analysis in certain cases. The presence or absence of specific cyst morphological features, as well as the cyst fluid analysis, is what enables the physician to guide the patient towards continued surveillance, versus the pursuit of surgical resection.Keywords: endoscopic ultrasound, EUS-guided fine

  20. Cost-Effectiveness Analysis of Endoscopic Ultrasound versus Magnetic Resonance Cholangiopancreatography in Patients with Suspected Common Bile Duct Stones

    Science.gov (United States)

    Morris, Stephen; Gurusamy, Kurinchi S.; Sheringham, Jessica; Davidson, Brian R.

    2015-01-01

    Background Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs. Aim This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones. Methods This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses. Results Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK. Conclusion From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones. PMID:25799113

  1. Development of a freehand three-dimensional radial endoscopic ultrasonography system

    OpenAIRE

    Inglis, Scott

    2009-01-01

    Oesophageal cancer is an aggressive malignancy with an overall five-year survival of 5-10% and two-thirds of patients have irresectable disease at diagnosis. Accurate staging of oesophageal cancer is important as survival closely correlates with the stage of the tumour, nodal involvement and presence of metastases (TNM staging). Endoscopic ultrasonography (EUS) is currently the most reliable modality for providing accurate T and N staging. Depending on findings of the staging, var...

  2. Targeted next generation sequencing of endoscopic ultrasound acquired cytology from ampullary and pancreatic adenocarcinoma has the potential to aid patient stratification for optimal therapy selection

    Science.gov (United States)

    Gleeson, Ferga C.; Kerr, Sarah E.; Kipp, Benjamin R.; Voss, Jesse S.; Minot, Douglas M.; Tu, Zheng Jin; Henry, Michael R.; Graham, Rondell P.; Vasmatzis, George; Cheville, John C.; Lazaridis, Konstantinos N.; Levy, Michael J.

    2016-01-01

    Background & Aims Less than 10% of registered drug intervention trials for pancreatic ductal adenocarcinoma (PDAC) include a biomarker stratification strategy. The ability to identify distinct mutation subsets via endoscopic ultrasound fine needle aspiration (EUS FNA) molecular cytology could greatly aid clinical trial patient stratification and offer predictive markers. We identified chemotherapy treatment naïve ampullary adenocarcinoma and PDAC patients who underwent EUS FNA to assess multigene mutational frequency and diversity with a surgical resection concordance assessment, where available. Methods Following strict cytology smear screening criteria, targeted next generation sequencing (NGS) using a 160 cancer gene panel was performed. Results Complete sequencing was achieved in 29 patients, whereby 83 pathogenic alterations were identified in 21 genes. Cytology genotyping revealed that the majority of mutations were identified in KRAS (93%), TP53 (72%), SMAD4 (31%), and GNAS (10%). There was 100% concordance for the following pathogenic alterations: KRAS, TP53, SMAD4, KMT2D, NOTCH2, MSH2, RB1, SMARCA4, PPP2R1A, PIK3R1, SCL7A8, ATM, and FANCD2. Absolute multigene mutational concordance was 83%. Incremental cytology smear mutations in GRIN2A, GATA3 and KDM6A were identified despite re-examination of raw sequence reads in the corresponding resection specimens. Conclusions EUS FNA cytology genotyping using a 160 cancer gene NGS panel revealed a broad spectrum of pathogenic alterations. The fidelity of cytology genotyping to that of paired surgical resection specimens suggests that EUS FNA represents a suitable surrogate and may complement the conventional stratification criteria in decision making for therapies and may guide future biomarker driven therapeutic development. PMID:27203738

  3. GenBank blastn search result: AK318517 [KOME

    Lifescience Database Archive (English)

    Full Text Available AK318517 J043004B20 EF560592.1 EF560592 Triticum turgidum subsp. durum retrotransposon... Copia WIS-1, complete sequence; transposon Caspar-1, partial sequence; transposon Hades-1, retrotransposon Veju-1, and transposon... Caspar-2, complete sequence; transposon Hades-2, partial sequence; transposon Orph...eus-1 and Pm3-3 pseudogene, complete sequence; and transposon Isaac-3, partial sequence. PLN 2e-40 1 -1 ...

  4. Optical Behavior of III-TM-N Materials and Devices

    Science.gov (United States)

    2008-09-26

    resistance (TMR). For example, EuS was used as a spin filter and showed evidence of magnetoresistance (MR) exceeding 130% at temperatures below the...injector’s inherent magnetoresistance . The origin of the splitting of resistances between 3000 Oe to -500 Oe and on the up sweep between -500 Oe to 3000 Oe is...Unfortunately, due to the limits of the PPMS, no MR measurements could be made at low temperature. Through TEM imaging, high amounts of strain were observed in

  5. Culture of human cells in experimental units for spaceflight impacts on their behavior.

    Science.gov (United States)

    Cazzaniga, Alessandra; Moscheni, Claudia; Maier, Jeanette Am; Castiglioni, Sara

    2017-05-01

    Because space missions produce pathophysiological alterations such as cardiovascular disorders and bone demineralization which are very common on Earth, biomedical research in space is a frontier that holds important promises not only to counterbalance space-associated disorders in astronauts but also to ameliorate the health of Earth-bound population. Experiments in space are complex to design. Cells must be cultured in closed cell culture systems (from now defined experimental units (EUs)), which are biocompatible, functional, safe to minimize any potential hazard to the crew, and with a high degree of automation. Therefore, to perform experiments in orbit, it is relevant to know how closely culture in the EUs reflects cellular behavior under normal growth conditions. We compared the performances in these units of three different human cell types, which were recently space flown, i.e. bone mesenchymal stem cells, micro- and macrovascular endothelial cells. Endothelial cells are only slightly and transiently affected by culture in the EUs, whereas these devices accelerate mesenchymal stem cell reprogramming toward osteogenic differentiation, in part by increasing the amounts of reactive oxygen species. We conclude that cell culture conditions in the EUs do not exactly mimic what happens in a culture dish and that more efforts are necessary to optimize these devices for biomedical experiments in space. Impact statement Cell cultures represent valuable preclinical models to decipher pathogenic circuitries. This is true also for biomedical research in space. A lot has been learnt about cell adaptation and reaction from the experiments performed on many different cell types flown to space. Obviously, cell culture in space has to meet specific requirements for the safety of the crew and to comply with the unique environmental challenges. For these reasons, specific devices for cell culture in space have been developed. It is important to clarify whether these

  6. Modelling the bioaccumulation of persistent organic pollutants in agricultural food chains for regulatory exposure assessment.

    Science.gov (United States)

    Takaki, Koki; Wade, Andrew J; Collins, Chris D

    2017-02-01

    New models for estimating bioaccumulation of persistent organic pollutants in the agricultural food chain were developed using recent improvements to plant uptake and cattle transfer models. One model named AgriSim was based on K OW regressions of bioaccumulation in plants and cattle, while the other was a steady-state mechanistic model, AgriCom. The two developed models and European Union System for the Evaluation of Substances (EUSES), as a benchmark, were applied to four reported food chain (soil/air-grass-cow-milk) scenarios to evaluate the performance of each model simulation against the observed data. The four scenarios considered were as follows: (1) polluted soil and air, (2) polluted soil, (3) highly polluted soil surface and polluted subsurface and (4) polluted soil and air at different mountain elevations. AgriCom reproduced observed milk bioaccumulation well for all four scenarios, as did AgriSim for scenarios 1 and 2, but EUSES only did this for scenario 1. The main causes of the deviation for EUSES and AgriSim were the lack of the soil-air-plant pathway and the ambient air-plant pathway, respectively. Based on the results, it is recommended that soil-air-plant and ambient air-plant pathway should be calculated separately and the K OW regression of transfer factor to milk used in EUSES be avoided. AgriCom satisfied the recommendations that led to the low residual errors between the simulated and the observed bioaccumulation in agricultural food chain for the four scenarios considered. It is therefore recommended that this model should be incorporated into regulatory exposure assessment tools. The model uncertainty of the three models should be noted since the simulated concentration in milk from 5th to 95th percentile of the uncertainty analysis often varied over two orders of magnitude. Using a measured value of soil organic carbon content was effective to reduce this uncertainty by one order of magnitude.

  7. INDEPENDENT VERIFICATION SURVEY REPORT FOR ZONE 1 OF THE EAST TENNESSEE TECHNOLOGY PARK IN OAK RIDGE, TENNESSEE

    Energy Technology Data Exchange (ETDEWEB)

    King, David A.

    2012-08-16

    Oak Ridge Associated Universities (ORAU) conducted in-process inspections and independent verification (IV) surveys in support of DOE's remedial efforts in Zone 1 of East Tennessee Technology Park (ETTP) in Oak Ridge, Tennessee. Inspections concluded that the remediation contractor's soil removal and survey objectives were satisfied and the dynamic verification strategy (DVS) was implemented as designed. Independent verification (IV) activities included gamma walkover surveys and soil sample collection/analysis over multiple exposure units (EUs).

  8. Is pancreatic exocrine insufficiency in celiac disease related to structural alterations in pancreatic parenchyma?

    OpenAIRE

    Rana, Surinder S.; Dambalkar, Arvind; Chhabra, Puneet; Sharma, Ravi; Nada, Ritambhra; Sharma, Vishal; Rana, Satyavati; Bhasin, Deepak K.

    2016-01-01

    Background Although exocrine pancreatic insufficiency (EPI) has been reported in a number of patients with celiac disease (CD), it is not clear if this is primarily a functional or a structural defect. We studied pancreatic structural abnormalities by endoscopic ultrasound (EUS) in adult CD patients with EPI. Methods Pancreatic exocrine function was prospectively assessed in 36 recently diagnosed CD patients (mean age: 29.8 years) by measuring fecal elastase. Pancreatic structural changes wer...

  9. Social Quality

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal

    2012-01-01

    Anmeldelsen af Peter Herrmanns bog om global socialpolitik omtaler både forståelsen af, hvad social kvalitet er, og hvordan dette begreb er udviklet. PÅ denne baggrund er det muligt at forholde sig kritisk til fx. EUs måde at samtænke økonomi, beskæftigelse og socialpolitik på. Alternativt kan der...

  10. Efecto del glifosato en la morfologia del tubo dogestivo y en la actividad acetilcolinesterasa de la lombriz Eisenia fetida

    OpenAIRE

    Arrojeria Arantzazistroke, Olatz

    2016-01-01

    [EUS] Gaur egun produktu kimiko ugari erabiltzen dira nekazaritzaren produktibitatea emendatzeko eta modu honetan nekazaritza-produktuen etekin eta kalitatea hobetzeko asmoz. Hala ere, produktu kimiko hauek ekosisteman izan ditzaketen hilgarriak ez diren eraginak askotan ez dira kontuan hartzen. Azken urteotan osagai aktibo gisa glifosatoa duten herbiziden erabilera emendatu da. Lan honetan, glifosatoak ingurunean sor ditzakeen eraginak ikertu nahi izan dira, lurzoruan oso ugaria den Eisenia ...

  11. Examples of Video to Communicate Scientific Findings to Non-Scientists-Bayesian Ecological Modeling

    Science.gov (United States)

    Moorman, M.; Harned, D. A.; Cuffney, T.; Qian, S.

    2011-12-01

    The U.S Geological Survey (USGS) National Water-Quality Assessment Program (NAWQA) provides information about (1) water-quality conditions and how those conditions vary locally, regionally, and nationally, (2) water-quality trends, and (3) factors that affect those conditions. As part of the NAWQA Program, the Effects of Urbanization on Stream Ecosystems (EUSE) study examined the vulnerability and resilience of streams to urbanization. Completion of the EUSE study has resulted in over 20 scientific publications. Video podcasts are being used in addition to these publications to communicate the relevance of these scientific findings to more general audiences such as resource managers, educational groups, public officials, and the general public. An example of one of the podcasts is a film about the results of modeling the effects urbanization on stream ecology. The film describes some of the results of the EUSE ecological modeling effort and the advantages of the Bayesian and multi-level statistical modeling approaches, while relating the science to fly fishing. The complex scientific discussion combined with the lighter, more popular activity of fly fishing leads to an entertaining forum while educating viewers about a complex topic. This approach is intended to represent the scientists as interesting people with diverse interests. Video can be an effective scientific communication tool for presenting scientific findings to a broad audience. The film is available for access from the EUSE website (http://water.usgs.gov/nawqa/urban/html/podcasts.html). Additional films are planned to be released in 2012 on other USGS project results and programs.

  12. Enron’s Spreadsheets and Related Emails: A Dataset and Analysis

    OpenAIRE

    Hermans, F.; Murphy-Hill, E.

    2014-01-01

    Spreadsheets are used extensively in business processes around the world and as such, a topic of research interest. Over the past few years, many spreadsheet studies have been performed on the EUSES spreadsheet corpus. While this corpus has served the spreadsheet community well, the spreadsheets it contains are mainly gathered with search engines and as such do not represent spreadsheets used in companies. This paper presents a new dataset, extracted for the Enron Email Archive, containing ov...

  13. Activation and inhibition of the micturition reflex by penile afferents in the cat

    OpenAIRE

    Woock, John P; Yoo, Paul B.; Grill, Warren M.

    2008-01-01

    Coordination of the urinary bladder and the external urethral sphincter (EUS) is controlled by descending projections from the pons, and is also subject to modulation by segmental afferents. We quantified the effects on the micturition reflex of sensory inputs from genital afferents, traveling in the penile component of the somatic pudendal nerve, by electrical stimulation of the dorsal nerve of the penis (DNP) in α-chloralose anesthetized male cats. Depending on the frequency of stimulation ...

  14. Endoscopic ultrasound in the diagnosis of pancreatic intraductal papillary mucinous neoplasms

    Science.gov (United States)

    Efthymiou, Alkiviadis; Podas, Thrasyvoulos; Zacharakis, Emmanouil

    2014-01-01

    Pancreatic cystic lesions are increasingly recognised due to the widespread use of different imaging modalities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a common, but also heterogeneous group of cystic tumors with a significant malignant potential. These neoplasms must be differentiated from other cystic tumors and properly classified into their different types, main-duct IPMNs vs branch-duct IPMNs. These types have a different malignant potential and therefore, different treatment strategies need to be implemented. Endoscopic ultrasound (EUS) offers the highest resolution of the pancreas and can aid in the differential diagnosis, classification and differentiation between benign and malignant tumors. The addition of EUS fine-needle aspiration can supply further information by obtaining fluid for cytology, measurement of tumor markers and perhaps DNA analysis. Novel techniques, such as the use of contrast and sophisticated equipment, like intraductal probes can provide information regarding malignant features and extent of these neoplasms. Thus, EUS is a valuable tool in the diagnosis and appropriate management of these tumors. PMID:24976716

  15. (REBUILDING THE EUROPEAN UNION`S INTERNATIONAL ROLE THROUGH HUMAN SECURITY STRATEGY IN THE AFTREMATHS OF THE EUROPEAN CRISIS

    Directory of Open Access Journals (Sweden)

    Andreea IANCU

    2014-10-01

    Full Text Available In a globalized world, characterized by profound shifts in the dynamics of global power and by diverse threats to peace and security, the European Union should be an active and peace-promoter actor, according to its founding principles. Thus, the European crisis left hard to heal scars within the European Union internal coherence and for its international role and image. The European crisis determined a cleavage in foreign and defence policy between the EU`s member states, creating dissonances in its internal processes. Therefore, this incongruence determined flawed reactions to international events. In order to determine the impact of the European crisis on the EU`s international role, it is briefly analysed the EU`s and its member states reactions to the conflicts from Libya and Syria. The main hypothesis of this article is that in order to overcome the effects of the economic crisis and to rebuild its international trust, the EU should reaffirm its core principles through a coherent external policy, which should be embedded in a bottom-up legitimized paradigm. This analysis demonstrates that human security strategy and the responsibility to protect principle can become the new European meta-narrative, the fact that they have the potential to overcome the current gap between rhetoric and practice in foreign and defence European policies. Therefore, this article advocates that the human security strategy and the responsibility to protect principle represent an impetus to transform the EU in an important global actor.

  16. Preoperative Imaging Overestimates the Tumor Size in Pancreatic Neuroendocrine Neoplasms Associated with Multiple Endocrine Neoplasia Type 1.

    Science.gov (United States)

    Polenta, V; Slater, E P; Kann, P H; Albers, M B; Manoharan, J; Ramaswamy, A; Mahnken, A H; Bartsch, D K

    2017-10-26

    Radiological tumor size of non-functioning pancreatic neuroendocrine neoplasms (Nf-pNENs) associated with multiple endocrine neoplasia type 1 (MEN1) is a crucial parameter to indicate surgery. The aim of this study was to compare radiological size (RS) and pathologic size (PS) of MEN1 associated with pNENs. Prospectively collected data of MEN1 patients who underwent pancreatic resections for pNENs were retrospectively analyzed. RS was defined as the largest tumor diameter measured on endoscopic ultrasound (EUS), magnetic resonance imaging (MRI) or computed tomography (CT). PS was defined as the largest tumor diameter on pathological analysis. Student's t test and linear regression analysis were used to compare the median RS and PS. p  20 mm had in reality a PS < 20 mm. MRI was the imaging technique that best correlated with PS in the total cohort (r = 0.8; p < 0.0001), whereas EUS was the best correlating imaging tool in pNENs < 20 mm (r = 0.5; p = 0.0001). Preoperative imaging, especially EUS, frequently overestimates the size of MEN1-pNENs, especially those with a PS < 20 mm. This should be considered when indicating surgery in MEN1 patients with small Nf-pNENs.

  17. A model of neural cross-talk and irritation in the pelvis: implications for the overlap of chronic pelvic pain disorders.

    Science.gov (United States)

    Pezzone, Michael A; Liang, Ruomei; Fraser, Matthew O

    2005-06-01

    Irritable bowel syndrome, interstitial cystitis, and other chronic pelvic pain (CPP) disorders often occur concomitantly. Neural cross-talk may play a role in the overlap of CPP disorders via the convergence of pelvic afferents. We investigated the hypothesis that afferent irritation of one pelvic organ may adversely influence and sensitize another via neural interactions. We measured pelvic organ smooth muscle and striated muscle reflexes during micturition and colorectal distention (CRD) in urethane-anesthetized rats. The effects of acute cystitis on distal colonic sensory thresholds to CRD and the effects of acute colonic irritation on micturition parameters were assessed. External urethral sphincter (EUS) electromyography (EMG) was typical for the rat, with phasic firing during micturition. External anal sphincter EMG also showed phasic firing during micturition in synchrony with EUS activity but, in addition, showed both tonic bursts and phasic firing independent of EUS activity. Before bladder irritation, graded CRDs to 40 cm H2O produced no notable changes in abdominal wall EMG activity. Following acute bladder irritation, dramatic increases in abdominal wall EMG activity in response to CRD were observed at much lower distention pressures, indicating colonic afferent sensitization. Analogously, following acute colonic irritation, bladder contraction frequency increased 66%, suggesting sensitization of lower urinary tract afferents. We report compelling evidence of bidirectional cross-sensitization of the colon and lower urinary tract in a novel experimental model. This cross-sensitization may account for the substantial overlap of CPP disorders; however, further studies are needed to fully characterize these pathways.

  18. Endosonogragphic features of lesions suggesting gastricectopic pancreas: experience of a single tertiary center.

    Science.gov (United States)

    Yüksel, Mahmut; Kacar, Sabite; Akpinar, Muhammet Yener; Saygili, Fatih; Akdoğan Kayhan, Meral; Dişibeyaz, Selçuk; Özin, Yasemin; Kaplan, Mustafa; Ateş, İhsan; Kayaçetin, Ertuğrul

    2017-02-27

    We aimed to present the endoscopic ultrasound (EUS) features of gastric lesions suggesting gastric ectopic pancreas during upper gastrointestinal endoscopy that were diagnosed in our gastroenterology unit, which is a tertiary center for endoscopic procedures in Turkey. The data of patients who underwent upper gastrointestinal EUS in our center between April 2012 and July 2014 were retrospectively analyzed. All of the lesions suggesting gastric ectopic pancreas were localized in the gastric antrum. Thirty-six of 44 lesions (81.1%) showed central dimpling. Lesion borders were shown to be definite in 10 (22.7%) lesions, whereas the borders of 34 lesions (77.3%) were indefinite. Thirty-nine lesions (88.6%) had heterogeneous and 5 lesions (11.4%) had homogeneous echo patterns; whereas 29 lesions (65.9%) were hypoechoic, 9 lesions (20.5%) were hyperechoic and 6 lesions (13.6%) had mixed echogenicity. Forty-two lesions (95.5%) were shown to affect only a single sonographic layer of the gastric wall. EUS features of lesions that strongly suggest gastric ectopic pancreas endoscopically, without any histopathological evidence and without either endoscopic or surgical resection, are as follows: indefinite border appearance, minimal heterogeneous hypoisoechoic echo pattern, existence of anechoic duct-like structures inside the lesion, common localization in the submucosal layer, and existence of umbilication.

  19. Counter electrojet features in the Brazilian sector: simultaneous observation by radar, digital sounder and magnetometers

    Directory of Open Access Journals (Sweden)

    C. M. Denardini

    2009-04-01

    Full Text Available In the present work we show new results regarding equatorial counter electrojet (CEJ events in the Brazilian sector, based on the RESCO radar, two set of fluxgate magnetometer systems and a digital sounder. RESCO radar is a 50 MHz backscatter coherent radar installed in 1998 at São Luís (SLZ, 2.33° S, 44.60° W, an equatorial site. The Digital sounder routinely monitors the electron density profile at the radar site. The magnetometer systems are fluxgate-type installed at SLZ and Eusébio (EUS, 03.89° S, 38.44° W. From the difference between the horizontal component of magnetic field at SLZ station and the same component at EUS (EEJ ground strength several cases of westward morning electrojet and its normal inversion to the eastward equatorial electrojet (EEJ have been observed. Also, the EEJ ground strength has shown some cases of CEJ events, which been detected with the RESCO radar too. Detection of these events were investigated with respect to their time and height of occurrence, correlation with sporadic E (Es layers at the same time, and their spectral characteristics as well as the radar echo power intensity.

  20. Proximity effect between a ferromagnetic insulator and a superconductor

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, Michael J.; Beckmann, Detlef [Karlsruher Institut fuer Technologie (KIT), Karlsruhe (Germany). Inst. fuer Nanotechnologie; Huebler, Florian [Karlsruher Institut fuer Technologie (KIT), Karlsruhe (Germany). Inst. fuer Nanotechnologie; Karlsruher Institut fuer Technologie (KIT), Karlsruhe (Germany). Inst. fuer Festkoerperphysik; Suergers, Christoph [Karlsruher Institut fuer Technologie (KIT), Karlsruhe (Germany). Physikalisches Inst.; Loehneysen, Hilbert von [Karlsruher Institut fuer Technologie (KIT), Karlsruhe (Germany). Inst. fuer Festkoerperphysik; Karlsruher Institut fuer Technologie (KIT), Karlsruhe (Germany). Physikalisches Inst.

    2012-07-01

    Electron transfer through spin-active interfaces can be modeled by the transmission amplitudes and a relative phase shift between spin-up and spin-down wavefunctions, the spin-mixing angle. Recently, Andreev bound states have been observed in F/S tunnel contacts which imply a non-zero spin-mixing angle of the ultrathin F/S barrier. In order to separate the spin-active interface from the detector tunnel contact, we have fabricated normal metal/superconductor tunnel contacts on top of a ferromagnetic insulator. We prepared EuS thin films (d{approx}20 nm) on top of Si(111) substrates by means of e-beam evaporation and created Al/Al-Oxide/Cu tunnel contacts by means of shadow evaporation. In an applied magnetic field, the tunnel spectra show an enhanced Zeeman splitting which is due to the presence of the exchange field of the EuS layer. Furthermore, we observe small peaks in the subgap region of the tunnel spectra which may be attributed to Andreev bound states due to a non-zero spin-mixing angle at the EuS/Al interface. The results suggest the use of EuS thin films for generating equal-spin triplet superconductivity.

  1. First record of epizootic ulcerative syndrome from the Upper Congo catchment: An outbreak in the Bangweulu swamps, Zambia.

    Science.gov (United States)

    Huchzermeyer, C F; Huchzermeyer, K D A; Christison, K W; Macey, B M; Colly, P A; Hang'ombe, B M; Songe, M M

    2018-01-01

    We report on the first outbreak of epizootic ulcerative syndrome (EUS) amongst wild fish populations in the Bangweulu swamps, an inland delta, in the north of Zambia during 2014. The area supports a large and diverse fish fauna related to, but distinct from, that of the Zambezi River system where EUS outbreaks have occurred since 2006. A sizeable artisanal fishery, based on extensive fish weirs, is sustained by the annual flooding of the swamps, and observations of the disease outbreak by fishermen were recorded. Signs typical of infection with Aphanomyces invadans were observed in a number of species. Clinical observations, histology and molecular diagnostic methods were used to confirm infection with A. invadans in two of the most commonly and severely affected species. Several features of the wetland may have contributed to the outbreak and the annual recurrence of the disease. Modes by which the disease may have been introduced into the swamps are discussed. The outbreak is of great significance as the Bangweulu swamps drain into the Congo River in neighbouring Democratic Republic of Congo, Africa's largest drainage system with an extensive and diverse fish fauna previously unaffected by EUS. © 2017 John Wiley & Sons Ltd.

  2. Three-dimensional growth of human endothelial cells in an automated cell culture experiment container during the SpaceX CRS-8 ISS space mission - The SPHEROIDS project.

    Science.gov (United States)

    Pietsch, Jessica; Gass, Samuel; Nebuloni, Stefano; Echegoyen, David; Riwaldt, Stefan; Baake, Christin; Bauer, Johann; Corydon, Thomas J; Egli, Marcel; Infanger, Manfred; Grimm, Daniela

    2017-04-01

    Human endothelial cells (ECs) were sent to the International Space Station (ISS) to determine the impact of microgravity on the formation of three-dimensional structures. For this project, an automatic experiment unit (EU) was designed allowing cell culture in space. In order to enable a safe cell culture, cell nourishment and fixation after a pre-programmed timeframe, the materials used for construction of the EUs were tested in regard to their biocompatibility. These tests revealed a high biocompatibility for all parts of the EUs, which were in contact with the cells or the medium used. Most importantly, we found polyether ether ketones for surrounding the incubation chamber, which kept cellular viability above 80% and allowed the cells to adhere as long as they were exposed to normal gravity. After assembling the EU the ECs were cultured therein, where they showed good cell viability at least for 14 days. In addition, the functionality of the automatic medium exchange, and fixation procedures were confirmed. Two days before launch, the ECs were cultured in the EUs, which were afterwards mounted on the SpaceX CRS-8 rocket. 5 and 12 days after launch the cells were fixed. Subsequent analyses revealed a scaffold-free formation of spheroids in space. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Excretory urography: trends in clinical use and diagnostic yield.

    Science.gov (United States)

    Pabon-Ramos, Waleska; Caoili, Elaine; Cohan, Richard; Stephens, Tausha; Francis, Isaac; Ellis, James; Korobkin, Melvyn; Schipper, Matthew

    2010-10-01

    To assess for changes in clinical usage and diagnostic yield of excretory urography (EU) following the introduction of CT urography (CTU). We retrospectively reviewed reports from 6313 EUs performed between July 1995 and February 2006. The specialty of the ordering physician and clinical indication for the study were recorded, as were any collecting system, ureter, or bladder abnormalities suspicious for urothelial malignancy identified on EU. The proportion of EUs ordered for each indication and the positivity rate for each finding were compared prior to and after 2000, when CTU was introduced. Demand for EU by all physicians has decreased threefold. Since 2000, there has been a decrease in the proportion of EUs performed for all indications: obstruction (P 0.05). The number of excretory urograms has decreased dramatically, although the proportion of these studies ordered by urologists is unchanged. The positivity rate of EU findings suggesting urothelial malignancy in the collecting system and bladder has decreased, likely because, with the advent of CTU, urologists have changed their ordering patterns for some clinical indications.

  4. Impact of diseases on fish production of baors in Jessore, Bangladesh

    Directory of Open Access Journals (Sweden)

    Bipul Kumar Dey

    2014-04-01

    Full Text Available The study was carried out to assess the impact of diseases on fish production in baors of Jessore district, Bangladesh from March 2012 to January 2013. Studied baors were selected randomly from each sub-district which covered 39.22% of total baors and 71.87% baor areas in Jessore district. All the surveyed baors were affected more or less by various diseases and in 80% baors noticeable production loss occurred almost every year. The main diseases were epizootic ulcerative syndrome (EUS, dropsy, gill rot and fin rot; out breaking time ranged from November to February each year. EUS was recorded in 85% baors whereas other diseases were found in various baors at various percentages: dropsy (75%, gill rot (45% and fin rot (55%. Conferring to the number of affected fishes, 31.25% were affected by EUS, 37.5% by dropsy, 12.5% by gill rot and 18.75% by fin rot. In the year 2012, 0.513% loss of production has occurred that designated 0.7599 million BDT. Through successful work on disease control and management, production loss may be minimized.

  5. Endoscopic ultrasound-guided hepaticogastrostomy and antegrade clearance of biliary lithiasis in patients with surgically-altered anatomy.

    Science.gov (United States)

    Hosmer, Amy; Abdelfatah, Mohamed M; Law, Ryan; Baron, Todd H

    2018-02-01

     Endoscopic retrograde cholangiography (ERC) in patients with complex surgically-altered anatomy (SAA) is technically demanding and has limitations. Developments in EUS-guided procedures allow alternative approaches for patients with altered gastrointestinal anatomy and biliary lithiasis.  Single-center, retrospective review of prospectively entered patients with SAA who underwent EUS-guided hepaticogastrostomy (HGS) followed by an interval antegrade endoscopic clearance of biliary lithiasis.  9 patients with Roux-en-Y anatomy underwent HGS to allow clearance of biliary lithiasis after a mean of 2.5 procedures. Technical success was achieved in 100 % of patients utilizing subsequent antegrade endoscopic techniques after HGS including: balloon sweep (9), transpapillary balloon dilation (8), cholangioscopy with electrohydraulic lithotripsy (4), and mechanical lithotripsy (1). HGS stents were removed in all patients. 1 adverse event (cholangitis) occurred after cholangioscopy and prolonged intraductal electrohydraulic lithotripsy.  EUS-guided antegrade therapy for the management of biliary lithiasis in patients with altered gastrointestinal anatomy appears efficacious with a low risk of adverse events. These preliminary results suggest this approach should be considered at centers with available expertise.

  6. Congenital ureteral ectopia in continent and incontinent-related Entlebucher mountain dogs: 13 cases (2006-2009).

    Science.gov (United States)

    North, C; Kruger, J M; Venta, P J; Miller, J M; Rosenstein, D S; Randall, E K; White, B; Fitzgerald, S D

    2010-01-01

    Ectopic ureters (EUs) associated with varying combinations of urinary incontinence, hydronephrosis, and urinary tract infection have been identified in related North American Entlebucher Mountain Dogs. To characterize the disease phenotype in affected dogs and evaluate possible modes of inheritance. Twenty client-owned Entlebucher Mountain Dogs. Nine dogs had clinical signs of urinary tract disease. Prospective case series in which 17 dogs were evaluated with excretory urography, ultrasonography, and urethrocystoscopy. Three additional dogs were evaluated by necropsy alone. Clinical and pedigree histories from 165 North American Entlebuchers were compiled for analysis. Eleven female and 2 male dogs were found to have EUs. Six females and 1 male were continent. Bilateral intravesicular ectopic ureters (IVEUs) were identified in 9 dogs, bilateral extravesicular ectopic ureters (EVEUs) in 3 dogs, and 1 dog had IVEU and EVEU. Hydronephrosis was identified in 5 dogs, 3 of which had bilateral IVEUs. Two necropsied dogs had bilateral hydronephrosis with presumed ureterovesical junction obstruction associated with chronic granulation tissue or lymphoplasmacytic inflammation. Twenty-six dogs with EUs were identified in the pedigree. Because of incomplete penetrance, mode of inheritance could not be determined. Ureteral ectopia is common in North American Entlebucher Mountain Dogs and clinical signs alone could not reliably predict disease phenotype. EVEUs were associated with urinary incontinence and occasionally hydronephrosis. IVEUs were clinically silent or associated with hydronephrosis. Further analyses are necessary to confirm and characterize the hereditary nature of the disorder. Copyright © 2010 by the American College of Veterinary Internal Medicine.

  7. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    Science.gov (United States)

    Yamasaki, Shuuji

    2016-01-01

    Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails. PMID:27698669

  8. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    Directory of Open Access Journals (Sweden)

    Takashi Obana

    2016-01-01

    Full Text Available Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD. A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy, followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

  9. The Role of Hemoclips Reinforcement in the Ligation-Assisted Endoscopic Enucleation for Small GISTs in Gastric Fundus

    Directory of Open Access Journals (Sweden)

    Ge Nan

    2014-01-01

    Full Text Available Background. Endoscopic ultrasonography- (EUS- assisted band ligation has been proven to be a safe and effective procedure for the treatment of small gastrointestinal stromal tumors (GISTs apart from the relatively high risk of the postligation perforation of the gastric fundus. The aim of this study is to investigate the efficacy of hemoclip reinforcement in treating small GISTs in the gastric fundus. Method. During a standard endoscopy, a transparent cap attached to the endoscopic tip was placed over the lesion to exert sustained maximal aspiration before a rubber band was released. Once a definite ligation was confirmed by EUS, the tumor was enucleated. Four to 6 hemoclips were placed on the folds around the ligation band to reduce the tension of the ligation site. Results. The small GISTs were resected completely in 192 patients. Two cases of delayed perforation were found 72 hours after the procedure and successfully treated with an ordinary conservative method. Conclusion. Hemoclip-reinforced endoscopic band ligation with systematic follow-up using EUS appears to be a simple and effective technique for the resection of small GISTs in the gastric fundus.

  10. The Efficacy and Safety of Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pain in Patients with Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Anna Wiechowska-Kozłowska

    2012-01-01

    Full Text Available Introduction. Celiac plexus neurolysis is used in pain management of patients with advanced and unresectable pancreatic cancer. We retrospectively analyzed efficacy and safety of endoscopic ultrasound- (EUS- guided celiac plexus neurolysis in patients treated in our unit. Methods. Twenty nine subjects with unresectable pancreatic cancer and severe pain despite pharmacological treatment underwent EUS-guided celiac plexus neurolysis with 98% ethanol. Patients scored their pain according to a 0–10 point scale and were interviewed 1-2 weeks and 2-3 months after the procedure. Results. Twenty five (86% patients reported improvement in their pain at 1-2 weeks following the procedure. Of these, 7 (24% reported substantial improvement (decrease in pain by more than 50% and 4 (14% complete disappearance of pain. Pain relief was still present in 76% of patients after 2-3 months. Treatment-related side effects included hypotonia in 1 patient, severe pain immediately postprocedure in 2 patients, and short episodes of diarrhea in 3 patients. Conclusion. Endoscopic ultrasound- (EUS- guided celiac plexus neurolysis is a safe and effective treatment of severe pain from advanced pancreatic cancer.

  11. Promising outcomes of screening for pancreatic cancer by genetic testing and endoscopic ultrasound.

    Science.gov (United States)

    Sud, Anchal; Wham, Deborah; Catalano, Marc; Guda, Nalini M

    2014-04-01

    This study aimed to determine if screening patients based on certain cancer syndromes or family history criteria can lead to early detection of pancreatic cancer. This was a cohort study from 2008 to 2011 at a large tertiary referral center. A total of 30 patients met high-risk criteria after genetic counseling and were referred to a gastroenterologist for possible endoscopic ultrasound (EUS). Of the 30 patients, 16 underwent EUS. Subsequently, 3 patients had fine needle aspiration. Two patients had pancreatic adenocarcinoma, and 1 patient had an intraductal papillary mucinous neoplasm with low-grade dysplasia. The 2 patients with pancreatic adenocarcinoma both had breast cancer and BRCA2 mutations. The patient with the intraductal papillary mucinous neoplasm had Peutz-Jeghers syndrome. All 3 patients underwent surgery and have remained cancer free. Genetic risk assessment with EUS +/- fine needle aspiration in high-risk patients may lead to earlier detection of pancreatic cancer and potentially improve overall morbidity and mortality. Greater emphasis should be placed on screening patients for hereditary cancer syndromes that increase the risk of pancreatic cancer.

  12. Epizootic ulcerative syndrome caused by Aphanomyces invadans in captive bullseye snakehead Channa marulius collected from south Florida, USA

    Science.gov (United States)

    Saylor, Ryan K.; Miller, Debra L.; Vandersea, Mark W.; Bevelhimer, Mark S.; Schofield, Pamela J.; Bennett, Wayne A.

    2010-01-01

    Epizootic ulcerative syndrome (EUS) caused by the oomycete Aphanomyces invadans is an invasive, opportunistic disease of both freshwater and estuarine fishes. Originally documented as the cause of mycotic granulomatosis of ornamental fishes in Japan and as the cause of EUS of fishes in southeast Asia and Australia, this pathogen is also present in estuaries and freshwater bodies of the Atlantic and gulf coasts of the USA. We describe a mass mortality event of 343 captive juvenile bullseye snakehead Channa marulius collected from freshwater canals in Miami-Dade County, Florida. Clinical signs appeared within the first 2 d of captivity and included petechiae, ulceration, erratic swimming, and inappetence. Histological examination revealed hyphae invading from the skin lesions deep into the musculature and internal organs. Species identification was confirmed using a species-specific PCR assay. Despite therapeutic attempts, 100% mortality occurred. This represents the first documented case of EUS in bullseye snakehead fish collected from waters in the USA. Future investigation of the distribution and prevalence of A. invadans within the bullseye snakehead range in south Florida may give insight into this pathogen-host system.

  13. Endosonographic Features of Gastric Schwannoma: A Single Center Experience.

    Science.gov (United States)

    Yoon, Jong Min; Kim, Gwang Ha; Park, Do Youn; Shin, Na Ri; Ahn, Sangjeong; Park, Chul Hong; Lee, Jin Sung; Lee, Key Jo; Lee, Bong Eun; Song, Geun Am

    2016-11-01

    Gastric schwannomas are rare benign mesenchymal tumors that are difficult to differentiate from other mesenchymal tumors with malignant potential, such as gastrointestinal stromal tumors. This study aimed to evaluate the characteristic findings of gastric schwannomas via endoscopic ultrasonography (EUS). We retrospectively reviewed the EUS findings of 27 gastric schwannoma cases that underwent surgical excision at Pusan National University Hospital during 2007 to 2014. Gastric schwannomas were mainly located in the middle third of the stomach with a mean tumor size of 32 mm. All lesions exhibited hypoechoic echogenicity, and 24 lesions (88.9%) exhibited heterogeneous echogenicity. Seventeen lesions (63.0%) exhibited decreased echogenicity compared to the normal proper muscle layer. Distinct borders were observed in 24 lesions (88.9%), lobulated margins were observed in six lesions (22.2%), and marginal haloes were observed in 24 lesions (88.9%). Hyperechogenic spots were observed in 21 lesions (77.8%), calcifications were observed in one lesion (3.7%), and cystic changes were observed in two lesions (7.4%). During EUS, gastric schwannomas appear as heterogeneously hypoechoic lesions with decreased echogenicity compared to the normal proper muscle layer. These features may be helpful for differentiating gastric schwannomas from other mesenchymal tumors.

  14. Sensitivity of endoscopic ultrasound, multidetector computed tomography, and magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a tertiary center experience.

    Science.gov (United States)

    Kushnir, Vladimir M; Wani, Sachin B; Fowler, Kathryn; Menias, Christine; Varma, Rakesh; Narra, Vamsi; Hovis, Christine; Murad, Faris M; Mullady, Daniel K; Jonnalagadda, Sreenivasa S; Early, Dayna S; Edmundowicz, Steven A; Azar, Riad R

    2013-04-01

    There are limited data comparing imaging modalities in the diagnosis of pancreas divisum. We aimed to: (1) evaluate the sensitivity of endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP), and multidetector computed tomography (MDCT) for pancreas divisum; and (2) assess interobserver agreement (IOA) among expert radiologists for detecting pancreas divisum on MDCT and MRCP. For this retrospective cohort study, we identified 45 consecutive patients with pancreaticobiliary symptoms and pancreas divisum established by endoscopic retrograde pancreatography who underwent EUS and cross-sectional imaging. The control group was composed of patients without pancreas divisum who underwent endoscopic retrograde pancreatography and cross-sectional imaging. The sensitivity of EUS for pancreas divisum was 86.7%, significantly higher than the sensitivity reported in the medical records for MDCT (15.5%) or MRCP (60%) (P pancreas divisum; IOA was moderate (κ = 0.43). Endoscopic ultrasound is a sensitive test for diagnosing pancreas divisum and is superior to MDCT and MRCP. Review of MDCT studies by expert radiologists substantially raises its sensitivity for pancreas divisum.

  15. Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience.

    Science.gov (United States)

    Atiq, Muslim; Bhutani, Manoop S; Ross, William A; Raju, Gottumukkala S; Gong, Yun; Tamm, Eric P; Javle, Milind; Wang, Xuemei; Lee, Jeffrey H

    2013-04-01

    Metastatic lesions to the pancreas pose diagnostic challenges with regards to their differentiation from primary pancreatic cancer. Data on the yield of endoscopic ultrasonography (EUS)-guided fine-needle aspiration in detection of these lesions are limited. This is a retrospective review of 23 patients referred to a tertiary referral center for further evaluation of suspected pancreatic metastases. Main outcome measures were diagnostic yield of endoscopic ultrasonography-guided fine-needle aspiration in evaluation of metastatic lesions to the pancreas. Of 644 patients, 23 (3.6%) undergoing EUS of the pancreas were diagnosed to have metastatic disease to the pancreas based on clinical, radiological, and cytological results. Mean (SD) age was 64.3 (11.7) years. Of the 23 patients, 18 (78.3%) were asymptomatic. Mean (SD) size of lesion on EUS was 39.1 (19.9) mm. A diagnosis of malignant lesion was made in 21 of 23 cases, with a diagnostic accuracy of 91.3%. Metastatic lesions to the pancreas present as incidental, solitary mass lesions on staging or surveillance imaging. Endoscopic ultrasonography-guided fine-needle aspiration is an important tool in the characterization and further differentiation of metastatic lesions to the pancreas from primary pancreatic cancer.

  16. Epizootic ulcerative syndrome caused by Aphanomyces invadans in captive bullseye snakehead Channa marulius collected from south Florida, USA

    Energy Technology Data Exchange (ETDEWEB)

    Saylor, Ryan [University of West Florida; Miller, Debra [University of Georgia; Vandersea, Mark [National Oceanic and Atmospheric Admin; Bevelhimer, Mark S [ORNL; Schofield, Pamela [U.S. Geological Survey; Bennett, Wayne [University of West Florida

    2010-02-01

    Epizootic ulcerative syndrome (EUS) caused by the oomycete Aphanomyces invadans is an invasive, opportunistic disease of both freshwater and estuarine fishes. Originally documented as the cause of mycotic granulomatosis of ornamental fishes in Japan and as the cause of EUS of fishes in southeast Asia and Australia, this pathogen is also present in estuaries and freshwater bodies of the Atlantic and gulf coasts of the USA. We describe a mass mortality event of 343 captive juvenile bullseye snakehead Channa marulius collected from freshwater canals in Miami-Dade County, Florida. Clinical signs appeared within the first 2 d of captivity and included petechiae, ulceration, erratic swimming, and inappetence. Histological examination revealed hyphae invading from the skin lesions deep into the musculature and internal organs. Species identification was confirmed using a species-specific PCR assay. Despite therapeutic attempts, 100% mortality occurred. This represents the first documented case of EUS in bullseye snakehead fish collected from waters in the USA. Future investigation of the distribution and prevalence of A. invadans within the bullseye snakehead range in south Florida may give insight into this pathogen-host system.

  17. Immunocytochemistry for SOX-11 and TFE3 as diagnostic markers for solid pseudopapillary neoplasms of the pancreas in FNA biopsies.

    Science.gov (United States)

    Foo, Wen-Chi; Harrison, Grant; Zhang, Xuefeng

    2017-11-01

    Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare malignant tumors that can be sampled via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Although diagnosing SPNs can be straightforward in cases with a classic morphology and a typical immunoprofile, challenges can occur with morphologic variants or limited specimens. Recently, 2 immunohistochemical stains, SRY-related high-mobility group box 11 (SOX-11) and transcription factor E3 (TFE3), have been demonstrated to be highly sensitive and specific for SPNs in pancreatic resection specimens. The current study evaluates the diagnostic utility of these stains with EUS-FNA. Thirteen EUS-FNA specimens from SPNs with sufficient material for immunocytochemistry were identified from 2000 to 2016. These cases were compared with 13 EUS-FNA specimens of non-SPN pancreatic neoplasms. Immunocytochemistry for SOX-11, TFE3, and β-catenin was performed on all cell blocks and then was scored independently by 2 pathologists in a masked manner. Nuclear reactivity for SOX-11 was detected in 13 of 13 SPNs and in 0 of 13 non-SPNs; this resulted in sensitivity and specificity values of 100%, a positive predictive value (PPV) of 1, and a negative predictive value (NPV) of 1. Nuclear reactivity for TFE3 was detected in 9 of 13 SPNs and in 0 of 13 non-SPNs; this resulted in a sensitivity of 69.2%, a specificity of 100%, a PPV of 1, and an NPV of 0.765. Nuclear reactivity for β-catenin was detected in 13 of 13 SPNs and in 1 of 13 non-SPNs; this resulted in a sensitivity of 100%, a specificity of 92.3%, a PPV of 0.929, and an NPV of 1. SOX-11 is a sensitive and specific immunocytochemical stain for SPNs in EUS-FNA specimens, and it may be useful as a diagnostic marker for distinguishing SPNs from its cytologic mimics. Cancer Cytopathol 2017;125:831-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

  18. Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis Microcolecistolitíase: papel da ecoendoscopia em pacientes com pancreatite aguda sem causa aparente

    Directory of Open Access Journals (Sweden)

    José Celso Ardengh

    2010-01-01

    Full Text Available OBJECTIVES: Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic acute pancreatitis. METHODS: Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. RESULTS: Twenty-seven patients (75% had microlithiasis confirmed by histology and nine did not (25%. EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval were 92.6% (74.2-98.7%, 55.6% (22.7-84.7%, 86.2% (67.4-95.5% and 71.4% (30.3-94.9%, respectively. Overall EUS accuracy was 83.2%. CONCLUSIONS: EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.OBJETIVOS: Cerca de 30% dos doentes com PA rotulada como sem causa aparente apresentam

  19. Identificação dos insulinomas pela ecoendoscopia Identification of insulinomas by endoscopic ultrasonography

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    José Celso Ardengh

    2004-04-01

    Full Text Available OBJETIVO: Demonstrar a sensibilidade da ecoendoscopia (EE no diagnóstico pré-operatório dos insulinomas e comparar com outros testes diagnósticos como tomografia helicoidal e ressonância magnética. MÉTODOS: Trinta pacientes foram examinados prospectivamente pela ecoendoscopia com o diagnóstico clínico de insulinoma antes de serem submetidos ao tratamento cirúrgico. O exame ecoendoscópico sempre foi precedido pelo US, TC helicoidal e em 10 pacientes pela RM. Em 12 casos foi indicada a punção aspirativa com agulha fina eco-guiada para confirmar a suspeita de insulinoma. RESULTADOS: A sensibilidade da EE na identificação dessas lesões foi de 86,6% (26/30 tumores. Vinte e seis tumores foram benignos (86,6% e quatro malignos (13,4%. Realizamos punção biópsia aspirativa em 12 pacientes (40% e o diagnóstico histológico foi feito em 10/12 pacientes (83,3%. Nessa casuística, 25 tumores foram menores que 2 cm (83,3% e cinco maiores que 2 cm (16,7%. Os tumores detectados pela EE tinham tamanho médio de 1,5 cm (0,6 a 5,4 cm. A identificação dos tumores pela EE na cabeça, corpo e cauda foi de 100%, 100% e 55,5%, respectivamente. CONCLUSÃO: A EE tem alta sensibilidade na identificação e localização dessas lesões e deve ser recomendada quando os métodos tradicionais de imagem empregados falham no diagnóstico. A PAAF é uma tentativa para evitarmos falso-positivos.BACKGROUND: The aim of this study is to compare EUS and the others diagnostics tests in the correct localization of insulinomas. METHODS: We prospectively investigated 30 patients with endoscopic ultrasound with a clinical diagnosis of insulinomas prior to surgical exploration. They were submitted to abdominal ultrasonography, spiral computed tomography and four patients were submitted to magnetic ressonance before EUS. Surgery was the gold standard for tumor localization. RESULTS: Twenty-six tumors were benign (86.6% and four were malign (13.4%. The median size

  20. PANCREATIC SPLENOSIS MIMICKING NEUROENDOCRINE TUMORS: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration

    Directory of Open Access Journals (Sweden)

    José Celso ARDENGH

    2013-03-01

    Full Text Available Context Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. Objective To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA of pancreatic nodules suspicious for pancreatic splenosis. Method From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. Results A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6% cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7, young (mean age: 42 years and asymptomatic (8. Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. Conclusion Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules. Contexto A esplenose pancreática é uma afecção benigna que pode mimetizar uma neoplasia pancreática. Objetivo Descrever o papel da ecoendoscopia associada à punção aspirativa com agulha fina ecoguiada (EE-PAAF dos nódulos de pâncreas suspeitos de esplenose pancreática. Método De 1997 a 2011, pacientes com tumores sólidos de pâncreas sugestivos de esplenose pancreática, conforme achados de exames de imagem por

  1. Fiscal Year 2007 Phased Construction Completion Report for the Zone 2 Soils, Slabs, and Subsurface Structures at East Tennessee Technology Park, Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    RSI

    2008-03-01

    The purpose of this Phased Construction Completion Report (PCCR) is to present the fiscal year (FY) 2007 results of characterization activities and recommended remedial actions (RAs) for 11 exposure units (EUs) in Zone 2 (Z2-01, Z2-03, Z2-08, Z2-23, Z2-24, Z2-28, Z2-34, Z2-37, Z2-41, Z2-43, and Z2-44) at the East Tennessee Technology Park (ETTP), which is located in the northwest corner of the U.S. Department of Energy (DOE) Oak Ridge Reservation in Oak Ridge, Tennessee (Fig. 1). ETTP encompasses a total land area of approximately 5000 acres that has been subdivided into three zones--Zone 1 ({approx}1400 acres), Zone 2 ({approx}800 acres), and the Boundary Area ({approx}2800 acres). Zone 2, which encompasses the highly industrialized portion of ETTP shown in Fig. 1, consists of all formerly secured areas of the facility, including the large processing buildings and direct support facilities; experimental laboratories and chemical and materials handling facilities; materials storage and waste disposal facilities; secure document records libraries; and shipping and receiving warehouses. The Zone 2 Record of Decision for Soil, Buried Waste, and Subsurface Structure Actions in Zone 2, East Tennessee Technology Park, Oak Ridge, Tennessee (DOE 2005) (Zone 2 ROD) specifies the future end use for Zone 2 acreage as uncontrolled industrial for the upper 10 ft of soils. Characterization activities in these areas were conducted in compliance with the Zone 2 ROD and the Dynamic Verification Strategy (DVS) and data quality objectives (DQOs) presented in the Remedial Design Report/Remedial Action Work Plan for Zone 2 Soils, Slabs, and Subsurface Structures, East Tennessee Technology Park, Oak Ridge, Tennessee (DOE 2007) (Zone 2 RDR/RAWP). The purpose of this PCCR is to address the following: (1) Document DVS characterization results for the accessible EUs in FY 2007; (2) Describe and document the risk evaluation for each EU, and determine if the EU met the Zone 2 ROD requirements

  2. American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data.

    Science.gov (United States)

    Singhi, Aatur D; Zeh, Herbert J; Brand, Randall E; Nikiforova, Marina N; Chennat, Jennifer S; Fasanella, Kenneth E; Khalid, Asif; Papachristou, Georgios I; Slivka, Adam; Hogg, Melissa; Lee, Kenneth K; Tsung, Allan; Zureikat, Amer H; McGrath, Kevin

    2016-06-01

    The American Gastroenterological Association (AGA) recently reported evidence-based guidelines for the management of asymptomatic neoplastic pancreatic cysts. These guidelines advocate a higher threshold for surgical resection than prior guidelines and imaging surveillance for a considerable number of patients with pancreatic cysts. The aims of this study were to assess the accuracy of the AGA guidelines in detecting advanced neoplasia and present an alternative approach to pancreatic cysts. The study population consisted of 225 patients who underwent EUS-guided FNA for pancreatic cysts between January 2014 and May 2015. For each patient, clinical findings, EUS features, cytopathology results, carcinoembryonic antigen analysis, and molecular testing of pancreatic cyst fluid were reviewed. Molecular testing included the assessment of hotspot mutations and deletions for KRAS, GNAS, VHL, TP53, PIK3CA, and PTEN. Diagnostic pathology results were available for 41 patients (18%), with 13 (6%) harboring advanced neoplasia. Among these cases, the AGA guidelines identified advanced neoplasia with 62% sensitivity, 79% specificity, 57% positive predictive value, and 82% negative predictive value. Moreover, the AGA guidelines missed 45% of intraductal papillary mucinous neoplasms with adenocarcinoma or high-grade dysplasia. For cases without confirmatory pathology, 27 of 184 patients (15%) with serous cystadenomas (SCAs) based on EUS findings and/or VHL alterations would continue magnetic resonance imaging (MRI) surveillance. In comparison, a novel algorithmic pathway using molecular testing of pancreatic cyst fluid detected advanced neoplasias with 100% sensitivity, 90% specificity, 79% positive predictive value, and 100% negative predictive value. The AGA guidelines were inaccurate in detecting pancreatic cysts with advanced neoplasia. Furthermore, because the AGA guidelines manage all neoplastic cysts similarly, patients with SCAs will continue to undergo unnecessary MRI

  3. Gene Expression Levels as Predictive Markers of Outcome in Pancreatic Cancer after Gemcitabine-Based Adjuvant Chemotherapy

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    Hayato Fujita

    2010-10-01

    Full Text Available BACKGROUND AND AIMS: The standard palliative chemotherapy for pancreatic ductal adenocarcinoma (PDAC is gemcitabine-based chemotherapy; however, PDAC still presents a major therapeutic challenge. The aims of this study were to investigate the expression pattern of genes involved in gemcitabine sensitivity in resected PDAC tissues and to determine correlations of gene expression with treatment outcome. MATERIALS AND METHODS: We obtained formalin-fixed paraffin-embedded (FFPE tissue samples from 70 patients with PDAC. Of the 70 patients, 40 received gemcitabine-based adjuvant chemotherapy (AC. We measured hENT1, dCK, CDA, RRM1, and RRM2 messenger RNA (mRNA levels by quantitative real-time reverse transcription-polymerase chain reaction and determined the combined score (GEM score, based on the expression levels of hENT1, dCK, RRM1, and RRM2, to investigate the association with survival time. By determining the expression levels of these genes in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA cytologic specimens, we investigated the feasibility of individualized chemotherapy. RESULTS: High dCK (P = .0067, low RRM2 (P = .003, and high GEM score (P = .0003 groups had a significantly longer disease-free survival in the gemcitabine-treated group. A low GEM score (<2 was an independent predictive marker for poor outcome to gemcitabine-based AC as shown by multivariate analysis (P = .0081. Altered expression levels of these genes were distinguishable in microdissected neoplastic cells from EUS-FNA cytologic specimens. CONCLUSIONS: Quantitative analyses of hENT1, dCK, RRM1, and RRM2 mRNA levels using FFPE tissue samples and microdissected neoplastic cells from EUS-FNA cytologic specimens may be useful in predicting the gemcitabine sensitivity of patients with PDAC.

  4. Transbronchial and transesophageal fine-needle aspiration using a single ultrasound bronchoscope in the diagnosis of locoregional recurrence of surgically-treated lung cancer.

    Science.gov (United States)

    Sanz-Santos, José; Serra, Pere; Andreo, Felipe; Torky, Mohamed; Centeno, Carmen; Morán, Teresa; Carcereny, Enric; Fernández, Esther; García-Reina, Samuel; Ruiz-Manzano, Juan

    2017-02-28

    The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.

  5. Transmission Assessment Surveys (TAS) to Define Endpoints for Lymphatic Filariasis Mass Drug Administration: A Multicenter Evaluation

    Science.gov (United States)

    Chu, Brian K.; Deming, Michael; Biritwum, Nana-Kwadwo; Bougma, Windtaré R.; Dorkenoo, Améyo M.; El-Setouhy, Maged; Fischer, Peter U.; Gass, Katherine; Gonzalez de Peña, Manuel; Mercado-Hernandez, Leda; Kyelem, Dominique; Lammie, Patrick J.; Flueckiger, Rebecca M.; Mwingira, Upendo J.; Noordin, Rahmah; Offei Owusu, Irene; Ottesen, Eric A.; Pavluck, Alexandre; Pilotte, Nils; Rao, Ramakrishna U.; Samarasekera, Dilhani; Schmaedick, Mark A.; Settinayake, Sunil; Simonsen, Paul E.; Supali, Taniawati; Taleo, Fasihah; Torres, Melissa; Weil, Gary J.; Won, Kimberly Y.

    2013-01-01

    Background Lymphatic filariasis (LF) is targeted for global elimination through treatment of entire at-risk populations with repeated annual mass drug administration (MDA). Essential for program success is defining and confirming the appropriate endpoint for MDA when transmission is presumed to have reached a level low enough that it cannot be sustained even in the absence of drug intervention. Guidelines advanced by WHO call for a transmission assessment survey (TAS) to determine if MDA can be stopped within an LF evaluation unit (EU) after at least five effective rounds of annual treatment. To test the value and practicality of these guidelines, a multicenter operational research trial was undertaken in 11 countries covering various geographic and epidemiological settings. Methodology The TAS was conducted twice in each EU with TAS-1 and TAS-2 approximately 24 months apart. Lot quality assurance sampling (LQAS) formed the basis of the TAS survey design but specific EU characteristics defined the survey site (school or community), eligible population (6–7 year olds or 1st–2nd graders), survey type (systematic or cluster-sampling), target sample size, and critical cutoff (a statistically powered threshold below which transmission is expected to be no longer sustainable). The primary diagnostic tools were the immunochromatographic (ICT) test for W. bancrofti EUs and the BmR1 test (Brugia Rapid or PanLF) for Brugia spp. EUs. Principal Findings/Conclusions In 10 of 11 EUs, the number of TAS-1 positive cases was below the critical cutoff, indicating that MDA could be stopped. The same results were found in the follow-up TAS-2, therefore, confirming the previous decision outcome. Sample sizes were highly sex and age-representative and closely matched the target value after factoring in estimates of non-participation. The TAS was determined to be a practical and effective evaluation tool for stopping MDA although its validity for longer-term post-MDA surveillance

  6. Urethral sphincter EMG-controlled dorsal penile/clitoral nerve stimulation to treat neurogenic detrusor overactivity

    Science.gov (United States)

    Opisso, E.; Borau, A.; Rijkhoff, N. J. M.

    2011-06-01

    The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH2O and for method 2 were 0.9 s and 2 cmH2O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD.

  7. Endoscopic ultrasound and endobronchial ultrasound-guided fine-needle aspiration of deep-seated lymphadenopathy: Analysis of 1338 cases

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    Amberly L Nunez

    2012-01-01

    Full Text Available Background: We retrospectively studied 1338 samples of lymph nodes obtained by endoscopic and endobronchial ultrasound-guided fine needle aspiration biopsy (EUS and EBUS-FNAB with an objective of characterizing the utility of this diagnostic modality in the assessment of deep-seated lymphadenopathy. The secondary aims were to establish the utility in the diagnosis of lymphoma and to determine the number of passes required to obtain adequate cellularity for flow cytometric analysis. Materials and Methods: On-site assessment was performed by a cytopathologist using Diff-Quik (American Scientific Products, McGraw Park, IL stain. In addition, Papanicolaou and immunohistochemical stains were performed and additional samples were sent for flow cytometric analyses (n = 145. The final cytologic diagnosis was correlated with surgical pathology diagnosis and/or clinical follow-up. In select cases, fluorescence in situ hybridization analysis with specific probes was performed on Diff-Quik smears. Results: Both morphology as well as ancillary studies (flow cytometry or immunohistochemical stain and/or fluorescence in situ hybridization show that EUS and EBUS-FNA are effective techniques to detect and stage intrathoracic and intra-abdominal tumors. Operating characteristics show that these are highly sensitive (89% and specific (100% techniques for the diagnosis of lymphoma. At least two passes provided an average of 5.66 million cells (range, 0.12-62.32 million for lymphoma cases. Conclusions: EUS and EBUS-FNA are powerful modalities to stage malignancies and at least two passes can provide adequate cells for flow cytometric analysis. We also demonstrate that fluorescence in situ hybridization analysis can be performed on Diff-Quik-stained and mounted smears.

  8. A case of mucinous cystic neoplasm of the pancreas misdiagnosed as a pancreatic pseudocyst at the initial exam and resected after a 2-year follow-up.

    Science.gov (United States)

    Ishikawa, Takuya; Haruta, Jun-Ichi; Yamaguchi, Takeo; Doisaki, Masao; Yama, Tsuyoki; Murate, Kentarou; Hattori, Shun; Hayakawa, Fumihiro; Yamada, Kenta; Yashika, Jun

    2015-04-01

    A 44-year-old woman was referred to our hospital because of a cystic lesion in the pancreatic body that was found by computed tomography (CT) as a result of a screening for impaired liver function after the patient presented with a high fever in 2011. Trans-abdominal ultrasonography (US) revealed a 33-mm unilocular cyst within the pancreatic body and a 5-mm hypoechoic mass in the pancreatic neck. Contrast-enhanced CT showed a slight enhancement around the cyst and a mild dilation of the main pancreatic duct, but neither septum nor nodule was detected inside. Contrast-enhanced endoscopic ultrasonography (CE-EUS) revealed a hyperechoic elevated lesion inside the cystic lesion without enhancement in the pancreatic body; CE-EUS also revealed a 5-mm homogeneous hypoechoic mass with a remarkable enhancement in the pancreatic neck with the use of Sonazoid(®) as a contrast medium. These lesions were diagnosed as a pancreatic pseudocyst and a neuroendocrine tumor (NET), respectively, and were followed up with periodic examinations. The cystic lesion showed contraction 6 months after the initial exam. However, US revealed an enlargement of the cystic lesion to 40 mm in diameter 2 years after the initial exam, and EUS showed irregular thickening of the wall with a cyst-in-cyst appearance. The diagnoses of a mucinous cystic neoplasm (MCN) and a concomitant small NET were made after a distal pancreatectomy. We herein report a rare case of MCN that showed various morphological changes over 2 years of observation.

  9. Endoscopic Ultrasound-Guided Direct Portal Pressure Measurement Using a Digital Pressure Wire with Real-Time Remote Display: A Survival Study.

    Science.gov (United States)

    Schulman, Allison R; Thompson, Christopher C; Ryou, Marvin

    2017-10-01

    Portal hypertension is necessary for the development of most clinical complications of cirrhosis. We recently reported a novel, endoscopic ultrasound (EUS)-guided technique for direct portal pressure measurements using a digital pressure wire. The aims of this study were to (1) evaluate safety in an animal survival model and (2) compare direct portal vein (PV) versus transhepatic access of a first-order venule. Yorkshire pigs, weighing 40-55 kg. Procedures were performed under general anesthesia. PV was identified using a linear array echoendoscope and accessed with a 22-G fine needle aspiration needle preloaded with a digital pressure wire. Access was confirmed by portal venography. Mean digital pressure measurements were recorded over 30 seconds, and again after accessing a first-order portal venule in a transhepatic manner. Procedure times and video logs were maintained throughout. Animals were survived for 2 weeks. Repeat portal pressure measurements were performed before euthanasia and necropsy. EUS-guided portal pressure measurements ranged from 3 to 11 mm Hg (mean 6.1) and were performed in a mean time of 214 seconds. There was no difference in measurement between the PV and first-order venule, or between baseline and 2-week follow-up. Five of 5 animals survived without incident. On necropsy, there was no evidence of thrombus or hemorrhage. This study represents the first survival study after EUS-guided direct portal pressure measurements using a digital pressure wire. This method appears safe, straightforward, and precise. Measurements of the PV and a first-order portal venule appear equivalent, and serial measurement seems feasible.

  10. Multidisciplinary diagnostic and therapeutic approaches to pancreatic cystic lesions.

    Science.gov (United States)

    Clores, Michael J; Thosani, Amar; Buscaglia, Jonathan M

    2014-01-01

    Pancreatic cystic lesions are commonly encountered today with the routine use of cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). The majority of patients discovered to have a pancreatic cyst are completely asymptomatic; yet the presence of such a finding instills fear in the minds of both patient and physician, as the concern for malignant transformation to pancreatic cancer is great despite the relatively low overall likelihood of cyst progression. Not all cysts in the pancreas represent pancreatic cystic neoplasms (PCNs), and not all PCNs have significant malignant potential. Mucinous PCNs are the most concerning, as these lesions have the greatest potential for cancerous transformation to adenocarcinoma. Within the group of mucinous PCNs, intraductal papillary mucinous neoplasms (IPMNs) involving the main pancreatic duct are the most worrisome, and surgical resection should be pursued if the patient has appropriate operative risks. IPMN lesions involving the branch ducts, and mucinous cystadenomas, have a lower likelihood for malignancy, and they may be closely followed for the development of any worrisome or high-risk features. Surveillance of known PCNs is performed with a combination of CT, MRI and endoscopic ultrasound (EUS). EUS-guided fine-needle aspiration (EUS-FNA) may be used to assess cyst fluid cytology, and also to detect cyst fluid amylase level, carcinoembryonic antigen level, and DNA molecular analysis in certain cases. The presence or absence of specific cyst morphological features, as well as the cyst fluid analysis, is what enables the physician to guide the patient towards continued surveillance, versus the pursuit of surgical resection.

  11. Endoscopic excavation for gastric heterotopic pancreas: an analysis of 42 cases from a tertiary center.

    Science.gov (United States)

    Zhang, Yu; Huang, Qin; Zhu, Lin-hong; Zhou, Xian-bin; Ye, Li-ping; Mao, Xin-li

    2014-09-01

    Because of the difficulty associated with making an accurate diagnosis of gastric heterotopic pancreas (HP) before surgery, surgical resection is usually performed in suspected cases. However, this is an invasive procedure and prone to certain surgical complications. This study was designed to evaluate the feasibility of endoscopic excavation for gastric HP, as well as the value of endoscopic ultrasonography (EUS) in diagnosing gastric HP. Between January 2007 and January 2013, 42 consecutive patients with gastric HP were enrolled in this retrospective study. Key steps: (1) Injection of a solution (100 ml saline + 2 ml indigo carmine + 1 ml epinephrine) into the submucosal layer after making several dots around the lesion; (2) Incision of the mucosa outside the marker dots with a needle-knife, and then circumferential excavation until complete resection of the lesion; (3) Closure of the artificial ulcer with several clips after tumor removal. In this study, 18 cases (42.9%) were suspected as gastric HP (assessed by two experienced endoscopists before endoscopic excavation), 8 (19.0%) were suspected as gastrointestinal stromal tumors, 7 (16.7%) as gastric polyp, and the remaining 9 cases (21.4%) were still unknown. The mean procedure duration was 28.6 min. En bloc resection by endoscopic excavation was achieved in 40 cases (95.2%), and no massive bleeding, delayed bleeding, perforation, or other severe complication occurred in these patients. Among the 42 lesions, a tube echo could be detected in 11 cases by EUS. Those 11 cases were diagnosed as gastric HP by histopathology. Endoscopic excavation appears to be a safe and feasible procedure for accurate histopathologic evaluation and curative treatment in gastric HP. Use of EUS has some value in the diagnosis of gastric HP before the procedure

  12. Imaging tests for accurate diagnosis of acute biliary pancreatitis

    Science.gov (United States)

    Surlin, Valeriu; Săftoiu, Adrian; Dumitrescu, Daniela

    2014-01-01

    Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end

  13. Effects of cathodal trans-spinal direct current stimulation on lower urinary tract function in normal and spinal cord injury mice with overactive bladder

    Science.gov (United States)

    Ahmed, Zaghloul

    2017-10-01

    Objective. Lower urinary tract (LUT) dysfunction is a monumental problem affecting quality of life following neurotrauma, such as spinal cord injury (SCI). Proper function of the bladder and its associated structures depends on coordinated activity of the neuronal circuitry in the spinal cord and brain. Disconnection between the spinal and brain centers controlling the LUT causes fundamental changes in the mechanisms involved in the micturition and storage reflexes. We investigated the effects of cathodal trans-spinal direct current stimulation (c-tsDCS) of the lumbosacral spine on bladder and external urinary sphincter (EUS) functions. Approach. We used cystometry and electromyography (EMG), in mice with and without SCI. Main results. c-tsDCS caused initiation of the micturition reflex in urethane-anesthetized normal mice with depressed micturition reflexes. This effect was associated with normalized EUS-EMG activity. Moreover, in urethane-anesthetized normal mice with expressed micturition reflexes, c-tsDCS increased the firing frequency, amplitude, and duration of EUS-EMG activity. These effects were associated with increased maximum intravesical pressure (P max) and intercontraction interval (ICI). In conscious normal animals, c-tsDCS caused significant increases in P max, ICI, threshold pressure (P thres), baseline pressure (P base), and number and amplitude of non-voiding contractions (NVCnumb and P im, respectively). In conscious mice with severe contusive SCI and overactive bladder, c-tsDCS increased P max, ICI, and P thres, but decreased P base, NVCnumb, and P im. c-tsDCS reduced the detrusor-overactivity/cystometry ratio, which is a measure of bladder overactivity associated with renal deterioration. Significance. These results indicate that c-tsDCS induces robust modulation of the lumbosacral spinal-cord circuitry that controls the LUT.

  14. Endoscopic therapy of rectal carcinoid: a report of 27 cases

    Directory of Open Access Journals (Sweden)

    Zhi-feng ZHAO

    2011-06-01

    Full Text Available Objective To assess the effect of treatment of rectal carcinoid tumors through endoscopy.Methods Endoscopic dissection was performed for patients during Jun.2005 to Dec.2009,in whom an elevated lesion in rectal mucosa as seen through colonoscopy,and highly suspected to be rectal carcinoid by endoscopic ultrasound(EUS,with the diameter of the lesion smaller than 1.0cm,was excised through endoscope.After being proved to be totally excised,endoscopic biopsy was performed at 4 to 6 sites along borderline of the tumor.Accurate rate of EUS was evaluated by postoperative pathology.Invasion and entirety of excised tumor were analyzed by pathological examination.Colonoscopy and liver ultrasound were carried out one time every half a year during the follow-up.Results 27 patients with elevated lesion in rectal mucosa were investigated.Rectal carcinoid was highly suspected in these patients and met the indication for endoscopic excision.The elevated lesion in rectal mucosa was excised successfully by endoscopy in all cases.Postoperative pathology confirmed that corvect diagnosis of rectal carcinoid was 92.6%(25/27.Interstitialoma was found in 1 patient,and granular cell tumor in another patient.All the 25 patients with rectal carcinoid were followed up with an average follow-up time of 33.7±12.5 months.Metastases and recurrence had not been found.Conclusions EUS has a good diagnostic specificity in the elevated lesion of rectal mucosa,and can accurately assess the indication of endoscopic excision.Endoscopic excision is a safe and effective method for rectal carcinoid which is smaller than 1.0 cm.

  15. An investigation of the effects of zaprinast, a PDE inhibitor, on the nitrergic control of the urethra in anaesthetized female rats.

    Science.gov (United States)

    Wibberley, Alexandra; Nunn, Philip A; Naylor, Alasdair M; Ramage, Andrew G

    2002-06-01

    1. The effects of L-NAME and zaprinast were investigated (i.v.) on reflex-evoked changes in bladder and urethral pressures in urethane-anaesthetized female rats. 2. L-NAME attenuated reflex-evoked urethral relaxations (65+/-10%), while zaprinast potentiated these responses (68+/-24%). L-NAME and zaprinast also increased baseline urethral pressure and urethral striated muscle (EUS-EMG) activity. These drugs had little effect on the bladder. 3. Following pre-treatment with alpha-bungarotoxin (i.v.) to block urethral striated muscle, L-NAME and zaprinast failed to increase baseline urethral pressure. Further zaprinast failed to alter the size of reflex-evoked urethral relaxations. 4. Intra-urethral zaprinast caused a significant increase while sodium nitroprusside (SNP) and isoprenaline caused decreases in urethral pressure (+14+/-3%, -25+/-5%, -29+/-7%, respectively). These changes were associated with increases in EUS-EMG activity. After chlorisondamine (i.v.), zaprinast caused a significant fall in urethral pressure, while the decrease in urethral pressure caused by SNP and isoprenaline was potentiated. No changes in EUS-EMG activity occurred. 5. These results indicate that a nitrergic pathway mediates reflex-evoked urethral smooth muscle relaxations. The data also indicates that there is a background release of NO, which reduces sphincter skeletal muscle activity. Further, the ability of zaprinast to potentiate nitrergic evoked urethral relaxations involves an increase in striated muscle tone. This appears to be an indirect result of smooth muscle relaxation and is mediated, at least in part, by a chlorisondamine-sensitive mechanism.

  16. Prospective Study for Comparison of Endoscopic Ultrasound-Guided Tissue Acquisition Using 25- and 22-Gauge Core Biopsy Needles in Solid Pancreatic Masses.

    Directory of Open Access Journals (Sweden)

    Se Woo Park

    Full Text Available Although thicker needles theoretically allow more tissue to be collected, their decreased flexibility can cause mechanical damage to the endoscope, technical failure, and sample blood contamination. The effects of needle gauge on diagnostic outcomes of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB of pancreatic mass lesions remain unknown. This study compared procurement rates of histologic cores obtained from EUS-FNB of pancreatic masses using 25- and 22-gauge core biopsy needles.From March 2014 to July 2014, 66 patients with solid pancreatic mass underwent EUS-FNB with both 25- and 22-gauge core biopsy needles. Among them, 10 patients were excluded and thus 56 patients were eligible for the analyses. Needle sequences were randomly assigned, and two passes were made with each needle, consisting of 10 uniform to-and-fro movements on each pass with 10 mL syringe suction. A pathologist blinded to needle sequence evaluated specimens for the presence of histologic core.The mean patient age was 65.8 ± 9.5 years (range, 44-89 years; 35 patients (62.5% were men. The mean pancreatic mass size was 35.3 ± 17.1 mm (range 14-122.3 mm. Twenty-eight patients (50% had tumors at the pancreas head or uncinate process. There were no significant differences in procurement rates of histologic cores between 25-gauge (49/56, 87.5% and 22-gauge (46/56, 82.1%, P = 0.581 needles or diagnostic accuracy using only histologic cores (98% and 95%. There were no technical failures or procedure-related adverse events.The 25-gauge core biopsy needle could offer acceptable and comparable outcomes regarding diagnostic performance including histologic core procurement rates compared to the 22-gauge core biopsy needle, although the differences were not statistically significant.ClinicalTrials.gov NCT01795066.

  17. Imaging tests for accurate diagnosis of acute biliary pancreatitis.

    Science.gov (United States)

    Şurlin, Valeriu; Săftoiu, Adrian; Dumitrescu, Daniela

    2014-11-28

    Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end

  18. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis.

    Science.gov (United States)

    Anderloni, Andrea; Buda, Andrea; Vieceli, Filippo; Khashab, Mouen A; Hassan, Cesare; Repici, Alessandro

    2016-12-01

    Endoscopic ultrasound-guided transmural stenting for gallbladder drainage is an emerging alternative for the treatment of acute cholecystitis in high-risk surgical patients. A variety of stents have been described, including plastic stents, self-expandable metal stents (SEMSs), and lumen-apposing metal stents (LAMSs). LAMSs represent the only specifically designed stent for transmural gallbladder drainage. A systematic review was performed to evaluate the feasibility and efficacy of EUS-guided drainage (EUS-GBD) in acute cholecystitis using different types of stents. A computer-assisted literature search up to September 2015 was performed using two electronic databases, MEDLINE and EMBASE. Search terms included MeSH and non-MeSH terms relating to acute cholecystitis, gallbladder drainage, endoscopic gallbladder drainage, endoscopic ultrasound gallbladder drainage, alone or in combination. Additional articles were retrieved by hand-searching from references of relevant studies. Pooled technical success, clinical success, and adverse event rates were calculated. Twenty-one studies met the inclusion criteria, and the eligible cases were 166. The overall technical success rate, clinical success rate, and frequency of adverse events were 95.8, 93.4, and 12.0 %, respectively. The technical success rate was 100 % using plastic stents, 98.6 % using SEMSs, and 91.5 % using LAMSs. The clinical success rate was 100, 94.4, and 90.1 % after the deployment of plastic stents, SEMSs, and LAMSs, respectively. The frequency of adverse events was 18.2 % using plastic stents, 12.3 % using SEMSs, and 9.9 % using LAMSs. Among the different drainage approaches in the non-surgical management of acute cholecystitis, EUS-guided transmural stenting for gallbladder drainage appears to be feasible, safe, and effective. LAMSs seem to have high potentials in terms of efficacy and safety, although further prospective studies are needed.

  19. Utility of commercial DNA analysis in detecting malignancy within pancreatic cysts.

    Science.gov (United States)

    Lee, Linda S; Wu, Bechien U; Banks, Peter A; Kadiyala, Vivek; Mehta, Shivani; Saltzman, John R; Thompson, Christopher C; Bellizzi, Andrew M

    2013-03-10

    Pancreatic cysts raise concern because of their malignant potential. Our aims were to assess accuracy of DNA analysis in detecting malignant pancreatic cysts at EUS-FNA and to determine whether DNA analysis added to imaging and cyst fluid studies enhanced International Association of Pancreatology (IAP) guidelines for resection of pancreatic cysts. This is a retrospective study including pancreatic cysts undergoing EUS-FNA and DNA analysis with k-ras and loss of heterozygosity testing. Diagnostic models of 2006 and 2012 IAP guidelines, DNA analysis alone, and DNA combined with 2012 IAP guidelines were developed, and area under receiver operator characteristic curves (AUC) compared to determine the added value of DNA for detecting malignant cysts at the time of EUS-FNA. Two-hundreds and fifty-seven patients were included with 8 (3.1%) malignant cysts. Solid component (P<0.001), main pancreatic duct dilation (P=0.012), suspicious or malignant cytology (P=0.001), and high DNA quantity (P<0.001) were associated with malignancy. Concurrent high amplitude k-ras with loss of heterozygosity mutations was highly specific (98.4%) though insensitive (12.5%) for malignancy. The 2012 IAP guideline (AUC=0.87; 95% CI: 0.82-0.91) was superior to 2006 IAP guideline (AUC=0.54; 95% CI: 0.47-0.60) and DNA analysis alone (AUC=0.60; 95% CI: 0.53-0.66) for detecting malignant cysts (P=0.004 and P=0.002, respectively). Addition of DNA did not improve performance of the 2012 IAP guideline (AUC=0.84; 95% CI: 0.79-0.88). Commercial DNA analysis does not add useful information beyond imaging and cytology for detection of malignant pancreatic cysts. The 2012 IAP guideline better predicted malignant cysts than the 2006 IAP guideline.

  20. Is pancreatic exocrine insufficiency in celiac disease related to structural alterations in pancreatic parenchyma?

    Science.gov (United States)

    Rana, Surinder S; Dambalkar, Arvind; Chhabra, Puneet; Sharma, Ravi; Nada, Ritambhra; Sharma, Vishal; Rana, Satyavati; Bhasin, Deepak K

    2016-01-01

    Although exocrine pancreatic insufficiency (EPI) has been reported in a number of patients with celiac disease (CD), it is not clear if this is primarily a functional or a structural defect. We studied pancreatic structural abnormalities by endoscopic ultrasound (EUS) in adult CD patients with EPI. Pancreatic exocrine function was prospectively assessed in 36 recently diagnosed CD patients (mean age: 29.8 years) by measuring fecal elastase. Pancreatic structural changes were assessed in CD patients with EPI by EUS and elastography. Exocrine functions were reassessed after 3 months of gluten-free diet. Of the 36 CD patients included, 30 (83%) had anemia, 21 (58%) diarrhea, and 7 (19%) hypothyroidism. Ten (28%) patients had EPI with mean elastase levels of 141.6 μg/g of stool, of whom only one had a history of recurrent acute pancreatitis while the rest 9 patients had no history of acute or chronic pancreatitis. Of these 10 patients, 8 (80%) had diarrhea, 8 (80%) anemia, and 2 (20%) hypothyroidism. EUS was done in 8 patients which showed: normal pancreas in 5 (50%), hyperechoic strands in 3 (30%), and hyperechoic foci without shadowing in 2 (20%) patients. None had lobularity or parenchymal calcification. All patients except the patient with recurrent pancreatitis had normal strain ratio. Follow-up fecal elastase was within normal range in 6 of 7 (86%) patients. EPI, assessed by fecal elastase levels in adult CD patients, possibly does not relate to structural alterations in the pancreatic parenchyma and may be reversible by following a gluten-free diet.

  1. WASKlim. Development of a transferable concept to determine the adaptability of sensitive sectors to climate change on the example of water management. Section 1: Development of methods for the evaluation of the adaptability and vulnerability; Section 2: Adaptation concepts for the water sector and dealing with conflicts of utilization; WASKlim. Entwicklung eines uebertragbaren Konzeptes zur Bestimmung der Anpassungsfaehigkeit sensibler Sektoren an den Klimawandel am Beispiel der Wasserwirtschaft. Block 1: Methodenentwicklung zur Bestimmung der Anpassungskapazitaet und Vulnerabilitaet. Block 2: Anpassungskonzepte fuer den Wassersektor und Umgang mit Nutzungskonflikten

    Energy Technology Data Exchange (ETDEWEB)

    Scherzer, Joerg; Grigoryan, Gayane; Schultze, Bernd; Stadelbacher, Veit; Niederberger, Joerg; Poehler, Hannaleena [UDATA Umweltschutz und Datenanalyse, Neustadt/Wstr. (Germany); Disse, Markus; Jacoby, Christian; Heinisch, Timo [Univ. der Bundeswehr, Muenchen (Germany). Professur fuer Wasserwirtschaft und Ressourcenschutz; Univ. der Bundeswehr, Muenchen (Germany). Bauprojektmanagement und Raumplanung

    2010-09-15

    The vulnerability of water resource management to climate change is a result of the climate change impacts and the usable potential for adaptation. A lot of scientific studies identified trends regarding the development of the water balance in the recent past. However, these trends are not or only scarcely shown in longer time series. Due to inhomogeneous scientific results (climate modelling, scenarios, methods) the trend comparison has proven to be problematic for the future development. Generally less water will be available in summer and more in winter. For the detailed analysis of the water balance sensitivity simulations were conducted for three pilot areas (Iller, Wupper, Salza) using the numerical model WaSiM-ETH and the climate data from the WETTREG and REMO regional models. The simulations were calculated for the emissions scenarios A1B, A2 and B1. To determine the usable potential for adaptation of the water resource management in consideration of the social conditions for different water uses and based on the named analyses, further literature overview and own investigations, the water demand was compared to the water availability. Based on these investigations the decision support system ''WASKlim-EUS'' was developed and tested in the three pilot areas. During the implementation process of the WASKlim-EUS the evaluation of the water demand, the water availability and the adaptation measures has proven to be challenging for stakeholders. For the first assessments of the climate change impacts in the WASKlim-EUS expert knowledge is used, which could be supplemented by stakeholder surveys. (orig.)

  2. A Novel Absorbable Radiopaque Hydrogel Spacer to Separate the Head of the Pancreas and Duodenum in Radiation Therapy for Pancreatic Cancer.

    Science.gov (United States)

    Rao, Avani D; Feng, Ziwei; Shin, Eun Ji; He, Jin; Waters, Kevin M; Coquia, Stephanie; DeJong, Robert; Rosati, Lauren M; Su, Lin; Li, Dengwang; Jackson, Juan; Clark, Stephen; Schultz, Jeffrey; Hutchings, Danielle; Kim, Seong-Hun; Hruban, Ralph H; DeWeese, Theodore L; Wong, John; Narang, Amol; Herman, Joseph M; Ding, Kai

    2017-12-01

    We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase the space between the head of the pancreas (HOP) and duodenum in a human cadaveric model. Using 3 human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum by way of open laparotomy in 1 case and endoscopic ultrasound (EUS) guidance in 2 cases. The cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement. The duodenal dose reduction and planning target volume (PTV) coverage were characterized using pre- and postspacer injection stereotactic body radiation therapy (SBRT) plans for the 2 cadavers with EUS-guided placement, the delivery method that appeared the most clinically desirable. Modeling studies were performed using 60 SBRT plans consisting of 10 previously treated patients with unresectable pancreatic cancer, each with 6 different HOP-duodenum separation distances. The duodenal volume receiving 15 Gy (V15), 20 Gy (V20), and 33 Gy (V33) was assessed for each iteration. In the 3 cadaveric studies, an average of 0.9 cm, 1.1 cm, and 0.9 cm HOP-duodenum separation was achieved. In the 2 EUS cases, the V20 decreased from 3.86 cm 3 to 0.36 cm 3 and 3.75 cm 3 to 1.08 cm 3 (treatment constraint pancreatic cancer. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  3. P-HPB-19: An unusual porta mass: Endoscopic ultrasound-guided fine needle aspiration solve the mystery

    Science.gov (United States)

    Nayak, Hemanta; Mohindra, Samir

    2017-01-01

    A 60-year-old North Indian female presented with recurrent dull-aching right upper quadrant pain of a month duration. Investigations showed the presence of anemia, raised erythrocyte sedimentation rate, and azotemia (serum creatinine 2.5 mg%). Noncontract computed tomography scan demonstrated a 5 cm × 5 cm hypodense mass lesion at porta. Endoscopic ultrasonographic (EUS) examination revealed a well-defined rounded 6 cm × 6 cm hypoechoic periportal mass without any vascular invasion, fine needle aspiration (FNA) showed sheets of atypical plasma cells and plasmablasts with eccentric nuclei, 1–2 prominent nucleoli, and abundant basophilic cytoplasm; some of the cells show the characteristic pale perinuclear “hof”. Bone marrow biopsy showed hypercellular marrow with proliferation of atypical plasma cells comprising 80% of the cellularity with reduced normal hematopoietic elements. There was a sharp M band in the gamma region of 4.7 g/dl, on serum protein electrophoresis and an elevated IgG kappa-free light chain of 1590 mg/dL. All these findings were consistent with multiple myeloma with periportal plasmacytoma. Hemato-oncology Department was consulted and she received bortezomib-based therapy. On follow-up after 4 months, M band in the gamma region decreased to 0.6 g/dl and kappa-free chain decreased to 18.7 mg/dl on serum electrophoresis. Anemia improved and serum creatinine decreased to 1.3 mg/dl. Repeat EUS revealed a decreased of porta mass to 1.5 cm × 1.5 cm. This case highlights the role of EUS FNA in solving the clinical mystery and helps in reaching the final diagnosis and providing the appropriate treatment.

  4. Retroperitoneal bronchogenic cyst resembling an adrenal tumor with high levels of serum carbohydrate antigen 19-9

    Science.gov (United States)

    Wang, Min; He, Xu; Qiu, Xia; Tian, Chuan; Li, Jian; Lv, Mingnan

    2017-01-01

    Abstract Rationale: Retroperitoneal bronchogenic cysts without specific clinical manifestations are extremely rare and difficult to diagnose preoperatively and are easily misdiagnosed as left adrenal or pancreatic tumors. Patient concerns: A 48-year-old woman with the chief complaint of obscure epigastric pain for 1 month and with no other gastrointestinal symptoms and no significant medical history. The patient had signed informed consent for publication of this case report. Diagnosis: The serum level of carbohydrate antigen 19-9 (CA 19-9) in the patient was >1200 U/mL, which far exceeded the normal level of tumor. However, endoscopic ultrasound (EUS) showed that the adrenal gland had an intact capsule and that the mass originated in the retroperitoneal space and did not involve the paranephros. Interventions: Surgical resection was performed on the patient. Outcomes: Histopathological examination demonstrated that the mass was a retroperitoneal bronchogenic cyst. At the 2-month postoperative follow-up, the level of CA 19-9 had returned to normal. Lessons: EUS appears to be superior to CT because it clearly delineated the mass from the surrounding structures of the retroperitoneal region. EUS-fine needle aspiration can be used for diagnosis or determining whether the mass is malignant or benign. To the best of our knowledge, retroperitoneal bronchogenic cysts with significantly elevated serum CA 19-9 have not been reported. Measurement of serum CA 19-9 may be helpful in the diagnosis of retroperitoneal bronchogenic cysts. However, this was a rare case, and the mechanism behind CA 19-9 elevation is not clear and needs further investigation. PMID:28767594

  5. Retroperitoneal bronchogenic cyst resembling an adrenal tumor with high levels of serum carbohydrate antigen 19-9: A case report.

    Science.gov (United States)

    Wang, Min; He, Xu; Qiu, Xia; Tian, Chuan; Li, Jian; Lv, Mingnan

    2017-08-01

    Retroperitoneal bronchogenic cysts without specific clinical manifestations are extremely rare and difficult to diagnose preoperatively and are easily misdiagnosed as left adrenal or pancreatic tumors. A 48-year-old woman with the chief complaint of obscure epigastric pain for 1 month and with no other gastrointestinal symptoms and no significant medical history. The patient had signed informed consent for publication of this case report. The serum level of carbohydrate antigen 19-9 (CA 19-9) in the patient was >1200 U/mL, which far exceeded the normal level of tumor. However, endoscopic ultrasound (EUS) showed that the adrenal gland had an intact capsule and that the mass originated in the retroperitoneal space and did not involve the paranephros. Surgical resection was performed on the patient. Histopathological examination demonstrated that the mass was a retroperitoneal bronchogenic cyst. At the 2-month postoperative follow-up, the level of CA 19-9 had returned to normal. EUS appears to be superior to CT because it clearly delineated the mass from the surrounding structures of the retroperitoneal region. EUS-fine needle aspiration can be used for diagnosis or determining whether the mass is malignant or benign. To the best of our knowledge, retroperitoneal bronchogenic cysts with significantly elevated serum CA 19-9 have not been reported. Measurement of serum CA 19-9 may be helpful in the diagnosis of retroperitoneal bronchogenic cysts. However, this was a rare case, and the mechanism behind CA 19-9 elevation is not clear and needs further investigation.

  6. Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Randomized Phase 2 Trial of Neoadjuvant Preoperative Paclitaxel/Cisplatin/Radiation Therapy (RT) or Irinotecan/Cisplatin/RT in Esophageal Adenocarcinoma: Long-Term Outcome and Implications for Trial Design

    Energy Technology Data Exchange (ETDEWEB)

    Kleinberg, Lawrence R., E-mail: kleinla@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (United States); Catalano, Paul J. [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (United States); Forastiere, Arlene A. [Department of Oncology, Johns Hopkins University, Baltimore, Maryland (United States); Keller, Steven M. [Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (United States); Mitchel, Edith P. [Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Anne, Pramila Rani [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Benson, Al B. [Department of Medicine-Hematology/Oncology, Lurie Cancer Center, Northwestern University, Chicago, Illinois (United States)

    2016-03-15

    Purpose: Toxicity, pathologic complete response, and long-term outcomes are reported for the neoadjuvant therapies assessed in a randomized phase 2 Eastern Cooperative Oncology Group and American College of Radiology Imaging Network trial for operable esophageal adenocarcinoma, staged as II-IVa by endoscopy/ultrasonography (EUS). Methods and Materials: A total of 86 eligible patients began treatment. For arm A, preoperative chemotherapy was cisplatin, 30 mg/m{sup 2}, and irinotecan, 50 mg/m{sup 2}, on day 1, 8, 22, 29 during 45 Gy radiation therapy (RT), 1.8 Gy per day over 5 weeks. Adjuvant therapy was cisplatin, 30 mg/m{sup 2}, and irinotecan, 65 mg/m{sup 2} day 1, 8 every 21 days for 3 cycles. Arm B therapy was cisplatin, 30 mg/m{sup 2}, and paclitaxel, 50 mg/m{sup 2}, day 1, 8, 15, 22, 29 with RT, followed by adjuvant cisplatin, 75 mg/m{sup 2}, and paclitaxel, 175 mg/m{sup 2}, day 1 every 21 days for 3 cycles. Stratification included EUS stage and performance status. Results: In arm A, median overall survival was 35 months, and 5-, 6-, and 7-year survival rates were 46%, 39%, and 35%, respectively, whereas for arm B, they were 21 months and 27%, 27%, and 23%, respectively. Median progression- or recurrence-free survival (PFS) was 39.8 months with a 3-year PFS of 50% for arm A and 12.4 months (P=.046) with 3-year PFS of 28% for arm B. Eighty percent of the observed incidents of progression occurred within 19 months. Survival did not differ significantly by EUS and performance status strata. Conclusions: Long-term survival was similar for both arms and did not appear superior to results achieved with other standard regimens.

  7. Afferent fibers of the pudendal nerve modulate sympathetic neurons controlling the bladder neck.

    Science.gov (United States)

    Reitz, André; Schmid, Daniel M; Curt, Armin; Knapp, Peter A; Schurch, Brigitte

    2003-01-01

    Pudendal nerve stimulation is known to have a potential modulative effect on bladder function. However, even if its efficiency has been established for various neurogenic and non-neurogenic bladder dysfunctions, the underlying neuronal mechanism, and the involved pathways in humans remain unknown. In this prospective study we focused on the effects of pudendal nerve stimulation in complete spinal cord injured patients to identify neuromodulative processes that occur on spinal level. Twenty complete spinal male presenting with upper motor neuron lesion and neurogenic incontinence underwent pudendal nerve stimulation. Bladder, bladder neck (BN), and external urethral sphincter (EUS) pressures were continuously recorded with a three channel microtip pressure transducer catheter. Fifty six pudendal stimulations using biphasic rectangular impulses (0.2 ms, 10 Hz) with intensities up to 100 mA were applied to the dorsal penile nerve. In six patients, 18 stimulations were repeated after intravenous (i.v.) administration of 7 mg phentolamine. Mean BN and EUS pressure increased during stimulation significantly (P stimulation significantly (P nerve stimulation evoked somatic responses in the EUS and autonomic responses in the smooth muscle sphincter controlling the BN. Longer latencies of the BN responses and the sensitivity to the alpha-blocking agent phentolamine suggest that sympathetic alpha-adrenergic fibers are involved. Somatic afferent fibers of the pudendal nerve are supposed to project on sympathetic thoracolumbar neurons to the BN and modulate their function. This neuromodulative effect works exclusively at the spinal level and appears to be at least partly responsible for BN competence and at least continence. Copyright 2003 Wiley-Liss, Inc.

  8. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature.

    Science.gov (United States)

    Polistina, Francesco A; Frego, Mauro; Bisello, Marco; Manzi, Emy; Vardanega, Antonella; Perin, Bortolo

    2015-04-28

    To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography (MRCP) without contrast medium and endoscopic ultrasound (EUS)/endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi. From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven (55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calculi localization/extraction at EUS/ERCP and a true negative was defined as a patient with no calculi at MRCP ad at least 6 mo of asymptomatic follow-up. Biliary tree dilatation was defined as a common bile duct diameter larger than 6 mm in a patient who had an in situ gallbladder. A third blinded radiologist who examined the MRCP and ERCP data reviewed misdiagnosed cases. Once obtained overall data on sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) we divided patients in two groups composed of those having concordant MRCP and EUS/ERCP (Group A, 72 patients) and those having discordant MRCP and EUS/ERCP (Group B, 20 patients). Dataset comparisons had been made by the Student's t-test and χ (2) when appropriate. Two-hundred patients (91 men, 109 women, mean age 67.6 years, and range 25-98 years) underwent

  9. Robotic Telesurgery Research

    Science.gov (United States)

    2009-03-01

    2006. [9] A. Fritscher-Ravens, C. A. Mosse , K. Ikeda, and P. Swain, ”Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance...C.M. Paul, K.E. Hinshaw, P. Muscarella, E.C. Ellison, and W.S. Melvin , “Natural- orifice transgastric endoscopic peritoneoscopy in humans: initial...resection: a feasibility study in pigs. Gastrointest Endosc 63:693–697 9. Fritscher-Ravens A, Mosse C, Ikeda K, Swain P (2006) Endo- scopic transgastric

  10. The Safety and Efficacy of an Alcohol-Free Pancreatic Cyst Ablation Protocol.

    Science.gov (United States)

    Moyer, Matthew T; Sharzehi, Setareh; Mathew, Abraham; Levenick, John M; Headlee, Brandy D; Blandford, Jonathan T; Heisey, Heather D; Birkholz, James H; Ancrile, Brooke B; Maranki, Jennifer L; Gusani, Niraj J; McGarrity, Thomas J; Dye, Charles E

    2017-11-01

    Endoscopic ultrasound (EUS)-guided chemoablation with ethanol lavage followed by infusion of paclitaxel is effective for the treatment of mucinous pancreatic cysts. However, complications arise in 3%-10% of patients, presumably linked to the inflammatory effects of ethanol. We aimed to determine whether alcohol is required for effective pancreatic cyst ablation, if removing alcohol from the ablation process would improve complication rates, and whether a multi-agent chemotherapeutic cocktail could increase the rate of complete cyst resolution compared with findings reported from previous trials using alcohol followed by paclitaxel alone. Between November 2011 and December 2016, we conducted a single-center, prospective, double-blind trial of 39 patients with mucinous-type pancreatic cysts. Patients were randomly assigned to 1 of 2 groups that underwent EUS-guided pancreatic cyst lavage with either 80% ethanol (control) or normal saline (alcohol-free group). Cysts in both groups were then infused with an admixture of paclitaxel and gemcitabine. Primary outcomes were the rates of complete ablation 12 months after the procedure, and rates of serious and minor adverse events within 30 days of the procedure. At 12 months, 67% of patients who underwent alcohol-free EUS-guided cyst chemoablation had complete ablation of cysts compared with 61% of patients in the control group. Serious adverse events occurred in 6% of patients in the control group vs none of the patients in the alcohol-free group. Minor adverse events occurred in 22% of patients in the control group and none of the patients in the alcohol-free group. The overall rate of complete ablation was 64%. In this prospective, randomized, controlled trial, we found that alcohol is not required for effective EUS-guided pancreatic cyst ablation, and when alcohol is removed from the ablation process, there is a significant reduction in associated adverse events. A multi-agent chemotherapeutic ablation admixture did

  11. Morphological differentiation and follow-up of pancreatic cystic neoplasms using endoscopic ultrasound

    Science.gov (United States)

    Hijioka, Susumu; Hara, Kazuo; Mizuno, Nobumasa; Imaoka, Hiroshi; Bhatia, Vikram; Yamao, Kenji

    2015-01-01

    Endoscopic ultrasound (EUS) is a key modality for the evaluation of suspected pancreatic cystic neoplasms (PCNs), as the entire pancreatic gland can be demonstrated with high spatial resolution from the stomach and duodenum. Detailed information can be acquired about the internal contents of the cyst(s) [septum, capsule, mural nodules (MNs)], its relation with the main pancreatic duct (MPD), and any parenchymal changes in the underlying gland. PCNs comprise true cysts and pseudocysts. True cysts can be neoplastic or nonneoplastic. Here, we describe serous cystic neoplasm (SCN), mucinous cystic neoplasm (MCN), and intraductal papillary mucinous neoplasm (IPMN) as prototype neoplastic cysts, along with nonneoplastic lymphoepithelial cysts (LECs). PMID:26643699

  12. Warm, Dense Plasma Characterization by X-ray Thomson Scattering

    Energy Technology Data Exchange (ETDEWEB)

    Landen, O L; Glenzer, S H; Cauble, R C; Lee, R W; Edwards, J E; Degroot, J S

    2000-07-18

    We describe how the powerful technique of spectrally resolved Thomson scattering can be extended to the x-ray regime, for direct measurements of the ionization state, density, temperature, and the microscopic behavior of dense cool plasmas. Such a direct measurement of microscopic parameters of solid density plasmas could eventually be used to properly interpret laboratory measurements of material properties such as thermal and electrical conductivity, EUS and opacity. In addition, x-ray Thomson scattering will provide new information on the characteristics of rarely and hitherto difficult to diagnose Fermi degenerate and strongly coupled plasmas.

  13. Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos).

    Science.gov (United States)

    Krishna, Somashekar G; Brugge, William R; Dewitt, John M; Kongkam, Pradermchai; Napoleon, Bertrand; Robles-Medranda, Carlos; Tan, Damien; El-Dika, Samer; McCarthy, Sean; Walker, Jon; Dillhoff, Mary E; Manilchuk, Andrei; Schmidt, Carl; Swanson, Benjamin; Shah, Zarine K; Hart, Phil A; Conwell, Darwin L

    2017-10-01

    EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis. Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used. A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively. EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS n

  14. The multimedia models for the evaluation of exposure bond to the atmospheric emissions of classified installations; Les modeles multimedia pour l'evaluation des expositions liees aux emissions atmospheriques des installations classees

    Energy Technology Data Exchange (ETDEWEB)

    Bonnard, R

    2001-12-15

    Risk assessment and environmental impacts studies are realized to preserve the public health. Today one of the most used approach is the use of an atmospheric dispersion model to assess the risks. The data are then injected in a calculation software of exposure bond to polluted soils, to evaluate the risks of non direct exposure. This report details and evaluates the models corresponding to the need: the methodology for assessing Health Risks associated with multiple pathways of exposure to combustor, human health risk assessment proto col for hazardous waste combustion facilities, EUSES, CALTOX, MEPAS, MEND-TOX, RESRAD, MMSOILS, FRAMES-HWIR, PC-GEMS and TRIM. (A.L.B.)

  15. Cálculo, prestígio e interesses: o amor em outra perspectiva na ficção de Camilo Castelo Branco e Manuel Antônio de Almeida

    OpenAIRE

    Tatiana de Fatima Alves Moyses

    2015-01-01

    O século XIX, período marcado pelo processo de ascensão da burguesia em Portugal, caracterizou-se também pelos arranjos matrimoniais, que passaram a priorizar as questões financeiras em detrimento dos valores de sangue. Camilo Castelo Branco, assim como muitos escritores do período, não prescindiu de discorrer criticamente acerca desse tema em sua obra. Nos romances Aventuras de Basílio Fernandes Enxertado, Eusébio Macário e A corja, o autor engendra personagens que empregam estratégias arriv...

  16. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature

    Science.gov (United States)

    Polistina, Francesco A; Frego, Mauro; Bisello, Marco; Manzi, Emy; Vardanega, Antonella; Perin, Bortolo

    2015-01-01

    AIM: To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography (MRCP) without contrast medium and endoscopic ultrasound (EUS)/endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi. METHODS: From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven (55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calculi localization/extraction at EUS/ERCP and a true negative was defined as a patient with no calculi at MRCP ad at least 6 mo of asymptomatic follow-up. Biliary tree dilatation was defined as a common bile duct diameter larger than 6 mm in a patient who had an in situ gallbladder. A third blinded radiologist who examined the MRCP and ERCP data reviewed misdiagnosed cases. Once obtained overall data on sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) we divided patients in two groups composed of those having concordant MRCP and EUS/ERCP (Group A, 72 patients) and those having discordant MRCP and EUS/ERCP (Group B, 20 patients). Dataset comparisons had been made by the Student’s t-test and χ2 when appropriate. RESULTS: Two-hundred patients (91 men, 109 women, mean age 67.6 years, and range 25

  17. Actitudes frente al peso corporal de estudiantes de la Universidad del País Vasco

    OpenAIRE

    Rocandio Pablo, Ana María; Arroyo Izaga, Marta; Ansotegui Alday, Laura; Herrera, Héctor; Salces Beti, Itziar; Rebato Ochoa, Esther Matilde

    2005-01-01

    [ES] La presión que la sociedad ejerce sobre sus miembros hace que , exista un tendencia generalizada a la excesiva preocupación por el peso y la apariencia física. Se estudiaron las actitudes frente al peso de 526 estudiantes, 158 hombres y 368 mujeres. Muestran un deseo de ser más delgados de lo que son aunque consideran su peso menor al saludable. [EUS] Gizarteak bere kideen gainean egiten duen presioak dakar pisu eta itxura fisikoagatik gaur egun orokorra den gehiegi arduratzeko joera ...

  18. Multimodality Imaging Evaluation of an Uncommon Entity: Esophageal Heterotopic Pancreas

    Directory of Open Access Journals (Sweden)

    Takman Mack

    2014-01-01

    Full Text Available A 25-year-old male was referred to the Radiology Department with new onset of right upper quadrant and epigastric abdominal pain. He had no past medical or surgical history. Physical exam was unremarkable. The patient underwent computed tomography (CT, fluoroscopic upper gastrointestinal (GI evaluation, endoscopic ultrasound (EUS, and positron emission tomography (PET evaluation, revealing the presence of a heterogeneous esophageal mass. In light of imaging findings and clinical workup, the patient was ultimately referred for thorascopic surgery. Surgical findings and histology confirmed the diagnosis of esophageal heterotopic pancreas.

  19. Advanced fuels for plutonium management in pressurized water reactors

    Science.gov (United States)

    Vasile, A.; Dufour, Ph; Golfier, H.; Grouiller, J. P.; Guillet, J. L.; Poinot, Ch; Youinou, G.; Zaetta, A.

    2003-06-01

    Several fuel concepts are under investigation at CEA with the aim of manage plutonium inventories in pressurized water reactors. This options range from the use of mature technologies like MOX adapted in the case of MOX-EUS (enriched uranium support) and COmbustible Recyclage A ILot (CORAIL) assemblies to more innovative technologies using IMF like DUPLEX and advanced plutonium assembly (APA). The plutonium burning performances reported to the electrical production go from 7 to 60 kg (TW h) -1. More detailed analysis covering economic, sustainability, reliability and safety aspects and their integration in the whole fuel cycle would allow identifying the best candidate.

  20. Endoscopic assessment of inflammatory bowel disease: colonoscopy/esophagogastroduodenoscopy.

    LENUS (Irish Health Repository)

    Chan, Grace

    2012-06-01

    Endoscopy plays an important role in the initial diagnosis of IBD, including the evaluation of disease severity, activity, and extent. The implications of complete mucosal healing further confirm the function of endoscopy in the follow-up of IBD patients. The use of therapeutic endoscopy, for example stricture dilatation, can avoid the need for bowel resection. Modalities such as capsule endoscopy, EUS, NBI, CE, and other emerging techniques are likely to have an increasing role in the management of IBD, particularly in the area of dysplasia surveillance and treatment.

  1. High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Hornslet, Pernille; Konge, Lars

    2016-01-01

    data from patients sedated with intermittent deep NAPS for ERCP, EUS or double balloon enteroscopy (DBE, since the method was implemented in May 2007 through December 2012 were included for evaluation in a retrospective case-control design. RESULTS: Data from 1899 patients undergoing 1899 procedures...... was requested eight times (0.4 %). One patient was intubated due to suspected aspiration. CONCLUSIONS: Intermittent deep NAPS for advanced endoscopies in selected patients provided an almost 100 % success rate. However, the rate of hypoxia, hypotension and respiratory support was high compared with previously...

  2. Pyrometric fuel particle measurements in pressurised reactors

    Energy Technology Data Exchange (ETDEWEB)

    Hernberg, R.; Joutsenoja, T. [Tampere Univ. of Technology (Finland)

    1996-12-01

    A fiberoptic two-colour pyrometric technique for fuel particle temperature and size measurement is modified and applied to three pressurized reactors of different type in Finland, Germany and France. A modification of the pyrometric method for simultaneous in situ measurement of the temperature and size of individual pulverized coal particles at the pressurized entrained flow reactor in Jyvaeskylae was developed and several series of measurements were made. In Orleans a fiberoptic pyrometric device was installed to a pressurised thermogravimetric reactor and the two-colour temperatures of fuel samples were measured. Some results of these measurements are presented. The project belongs to EU`s Joule 2 extension research programme. (author)

  3. Primary malignant esophageal melanoma arising from localized benign melanocytosis.

    Science.gov (United States)

    Maroy, Bernard; Baylac, Francois

    2013-04-01

    A heavy drinker and smoker had a normal UGI-endoscopy in 1996. In 1999, a repeat examination disclosed distal esophageal benign melanocytosis, typical, macro- and microscopically. Endoscopic and microscopic features were stable in 2002 and 2004. In 2007, dysphagia prompted an endoscopy, which disclosed a poorly differentiated epidermoid carcinoma at 19 cm and black nodules of the cardia with a microscopy typical of malignant melanoma, uT3N1 at EUS. Radiochemotherapy led to an 8-month improvement, which did not prevent death one year after diagnosis. Copyright © 2012. Published by Elsevier Masson SAS.

  4. Endoscopic diagnosis and treatment of neuroendocrine tumors of the digestive system

    Directory of Open Access Journals (Sweden)

    Sivero Luigi

    2016-01-01

    Full Text Available The authors evaluated the role of endoscopic techniques in the diagnosis and in the potential treatment of neuroendocrine tumors (NET localized in the gastro-entero-pancreatic system, on the basis of their experience and of the international literature. NET are rare tumors that arise from neuroendocrine cells of the gastrointestinal tract and pancreas. It is a possibility that both the digestive endoscopy and EUS play an important role in the diagnosis, staging and surveillance of this disease. In some cases, especially in the early stages, surgical endoscopy allows the treatment of such tumors.

  5. Civil-Defense Needs of High-Risk Areas of the United States. Revision A

    Science.gov (United States)

    1979-03-01

    aistrict offices. * A hotue study course entitled "Civil Defense USA " is available upon request for all ira. estc:d citizens. The course outlines the...22000 o~,0 nae~e .s4 M 23.4W S" w"L oa~ ALBt~c. At., tS4.3i0 FIGURE -12. NE MEXIC ,INTAPOUAIN(eusBruEtmaefr196 4890 217"o4,0 1f30 I I I LIST OF TABLES

  6. Prescreening Military Officer Candidates for High Level Security Clearances

    Science.gov (United States)

    1989-06-01

    a Commission in the United States Air Force (AF Form 56) which asks questions about criminal history, sexual deviancy, etc. Applicants who admit to...0 6 76 Homo-xuality 22 63 92 3 180 77 Sexual Perversion 0 5 16 1 22 78 Good of the Service 7 0 2 0 9 79 Failure of Selection for Promotion 2153 1196...Inan ilra far-y acoso ) ase as cesc be &Dove. FROM TWi DATE FORWARD, ec-ce-s -e Drug~ &me alco’soi aoi~sby mit-ibenrof *,*,eU.S Air orce woiates A.r

  7. ORF Alignment: NC_002951 [GENIUS II[Archive

    Lifescience Database Archive (English)

    Full Text Available eus] ... sp|Q5HCN2|ICAR_STAAC Biofilm operon icaABCD HTH-type ... negative transcriptional reg...ulator icaR (Intercellular ... adhesion protein R) sp|Q9RQQ0|ICAR_STAAU Biofilm...dhesion protein R) sp|Q7A352|ICAR_STAAN ... Biofilm operon icaABCD HTH-type negative transcriptional ... ... regulator icaR (Intercellular adhesion protein R) ... sp|Q7A2K5|ICAR_STAAM Biofilm operon ...r ... adhesion protein R) sp|Q79ZV4|ICAR_STAAW Biofilm operon ... icaABCD HTH-type negative tr

  8. ORF Alignment: NC_002745 [GENIUS II[Archive

    Lifescience Database Archive (English)

    Full Text Available eus] ... sp|Q5HCN2|ICAR_STAAC Biofilm operon icaABCD HTH-type ... negative transcriptional reg...ulator icaR (Intercellular ... adhesion protein R) sp|Q9RQQ0|ICAR_STAAU Biofilm...dhesion protein R) sp|Q7A352|ICAR_STAAN ... Biofilm operon icaABCD HTH-type negative transcriptional ... ... regulator icaR (Intercellular adhesion protein R) ... sp|Q7A2K5|ICAR_STAAM Biofilm operon ...r ... adhesion protein R) sp|Q79ZV4|ICAR_STAAW Biofilm operon ... icaABCD HTH-type negative tr

  9. ORF Alignment: NC_002953 [GENIUS II[Archive

    Lifescience Database Archive (English)

    Full Text Available eus] ... sp|Q5HCN2|ICAR_STAAC Biofilm operon icaABCD HTH-type ... negative transcriptional reg...ulator icaR (Intercellular ... adhesion protein R) sp|Q9RQQ0|ICAR_STAAU Biofilm...dhesion protein R) sp|Q7A352|ICAR_STAAN ... Biofilm operon icaABCD HTH-type negative transcriptional ... ... regulator icaR (Intercellular adhesion protein R) ... sp|Q7A2K5|ICAR_STAAM Biofilm operon ...r ... adhesion protein R) sp|Q79ZV4|ICAR_STAAW Biofilm operon ... icaABCD HTH-type negative tr

  10. ORF Alignment: NC_002952 [GENIUS II[Archive

    Lifescience Database Archive (English)

    Full Text Available eus] ... sp|Q5HCN2|ICAR_STAAC Biofilm operon icaABCD HTH-type ... negative transcriptional reg...ulator icaR (Intercellular ... adhesion protein R) sp|Q9RQQ0|ICAR_STAAU Biofilm...dhesion protein R) sp|Q7A352|ICAR_STAAN ... Biofilm operon icaABCD HTH-type negative transcriptional ... ... regulator icaR (Intercellular adhesion protein R) ... sp|Q7A2K5|ICAR_STAAM Biofilm operon ...r ... adhesion protein R) sp|Q79ZV4|ICAR_STAAW Biofilm operon ... icaABCD HTH-type negative tr

  11. ORF Alignment: NC_002758 [GENIUS II[Archive

    Lifescience Database Archive (English)

    Full Text Available eus] ... sp|Q5HCN2|ICAR_STAAC Biofilm operon icaABCD HTH-type ... negative transcriptional reg...ulator icaR (Intercellular ... adhesion protein R) sp|Q9RQQ0|ICAR_STAAU Biofilm...dhesion protein R) sp|Q7A352|ICAR_STAAN ... Biofilm operon icaABCD HTH-type negative transcriptional ... ... regulator icaR (Intercellular adhesion protein R) ... sp|Q7A2K5|ICAR_STAAM Biofilm operon ...r ... adhesion protein R) sp|Q79ZV4|ICAR_STAAW Biofilm operon ... icaABCD HTH-type negative tr

  12. ORF Alignment: NC_003923 [GENIUS II[Archive

    Lifescience Database Archive (English)

    Full Text Available eus] ... sp|Q5HCN2|ICAR_STAAC Biofilm operon icaABCD HTH-type ... negative transcriptional reg...ulator icaR (Intercellular ... adhesion protein R) sp|Q9RQQ0|ICAR_STAAU Biofilm...dhesion protein R) sp|Q7A352|ICAR_STAAN ... Biofilm operon icaABCD HTH-type negative transcriptional ... ... regulator icaR (Intercellular adhesion protein R) ... sp|Q7A2K5|ICAR_STAAM Biofilm operon ...r ... adhesion protein R) sp|Q79ZV4|ICAR_STAAW Biofilm operon ... icaABCD HTH-type negative tr

  13. Frequency-dependent seismic attenuation in the eastern United States as observed from the 2011 central Virginia earthquake and aftershock sequence

    Science.gov (United States)

    McNamara, Daniel E.; Gee, Lind; Benz, Harley M.; Chapman, Martin

    2014-01-01

    Ground shaking due to earthquakes in the eastern United States (EUS) is felt at significantly greater distances than in the western United States (WUS) and for some earthquakes it has been shown to display a strong preferential direction. Shaking intensity variation can be due to propagation path effects, source directivity, and/or site amplification. In this paper, we use S and Lg waves recorded from the 2011 central Virginia earthquake and aftershock sequence, in the Central Virginia Seismic Zone, to quantify attenuation as frequency‐dependent Q(f). In support of observations based on shaking intensity, we observe high Q values in the EUS relative to previous studies in the WUS with especially efficient propagation along the structural trend of the Appalachian mountains. Our analysis of Q(f) quantifies the path effects of the northeast‐trending felt distribution previously inferred from the U.S. Geological Survey (USGS) “Did You Feel It” data, historic intensity data, and the asymmetrical distribution of rockfalls and landslides.

  14. Successful mucosal incision-assisted biopsy for the histological diagnosis of duodenal lymphoma: A case report

    Science.gov (United States)

    MORISHITA, ASAHIRO; MORI, HIROHITO; KOBARA, HIDEKI; NISHIYAMA, NORIKO; FUJIHARA, SHINTARO; YACHIDA, TATSUO; AYAKI, MAKI; MATSUNAGA, TAE; SAKAMOTO, TEPPEI; MAEDA, EMIKO; NOMURA, TAKAKO; TANI, JOJI; MIYOSHI, HISAAKI; YONEYAMA, HIROHITO; HIMOTO, TAKASHI; KAGAWA, SEIKO; HABA, REIJI; MASAKI, TSUTOMU

    2016-01-01

    Tissue sampling of primary duodenal lymphoma is essential for its histological diagnosis. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), which is frequently used for submucosal tumor (SMT)-like duodenal tumors, is adequate for cytological diagnosis, but not for histological diagnosis. Therefore, in the present study, a mucosal incision-assisted biopsy (MIAB) was performed in an 81-year-old woman for the diagnosis of an SMT-like duodenal mass, as tissue sampling for histological analysis using a regular endoscopic biopsy had failed to establish a definite diagnosis of malignant lymphoma. EUS-FNA had also led to poor tissue sampling due to the difficult location of the duodenal tumor. The pathological examination of biopsy samples using MIAB revealed the presence of a diffuse proliferation of atypical lymphocytes, and the expression of cluster of differentiation (CD)20 and CD79a, but no expression of CD3 in the tumor specimens. The patient was diagnosed with diffuse large B-cell lymphoma. To the best of knowledge, this is first report of a case using MIAB as a sampling method for the histological diagnosis of SMT-like primary duodenal lymphoma. This case suggests that MIAB may be an essential method for obtaining tissue samples from SMT-like duodenal tumors. PMID:26870243

  15. Review of biological factors relevant to import risk assessments for epizootic ulcerative syndrome (Aphanomyces invadans).

    Science.gov (United States)

    Oidtmann, B

    2012-02-01

    Epizootic ulcerative syndrome (EUS) is a disease affecting both wild and farmed fish in freshwater and estuarine environments. After it was first described in Japan in 1971, the disease has spread widely across Asia and to some regions of Australia, North America and Africa. In Asia and Africa, the spread of the disease has substantially affected livelihoods of fish farmers and fishermen. No reports are yet published showing the presence of the disease in Europe or South America. Given its epizootic nature and its broad susceptible fish species range, it would appear that the disease has the potential for further spread. This study provides a review of the scientific literature on several biological factors of the pathogen, Aphanomyces invadans, associated with the disease EUS and aspects of the disease that are relevant to undertaking import risk assessments (IRA) covering (i) Life cycle and routes of transmission; (ii) Minimum infectious dose; (iii) Tissue localization and pathogen load; (iv) Predisposing factors for infection and factors influencing expression of disease; (v) Carrier state in fish; (vi) Diagnostic methods; (vii) Survival in the environment; (viii) Permissive temperature range; (ix) Stability of the agent in aquatic animal products; (x) Prevalence of infection; and (xi) Affected life stages. Much of the biological information presented is relevant to a broad range of risk questions. Areas where data are lacking were identified, and the information provided is put into context with other aspects that need to be addressed in an IRA. © 2011 Crown copyright.

  16. Differentiation of Pancreatic Cyst Types by Analysis of Rheological Behavior of Pancreatic Cyst Fluid

    Science.gov (United States)

    Khamaysi, Iyad; Abu Ammar, Aiman; Vasilyev, Gleb; Arinstein, Arkadii; Chowers, Yehuda; Zussman, Eyal

    2017-01-01

    Differentiation between mucinous and non-mucinous pancreatic cysts is exceedingly important and challenging, particularly as the former bears malignant transformation potential. Pancreatic cyst fluid (PCF)-based diagnostics, including analyses of biochemical markers, as well as cytology, has shown inadequate accuracy. Herein, a preliminary single-center study of 22 PCF samples, collected by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), assessed the rheological behavior of PCF and its correlation with lesion type. The dependence of PCF shear viscosity on shear rate was found to follow a power law and could be fitted using Ostwald–de Waele model. Three types of flow curves were identified, where two types correlated with non-mucinous cysts, differing by their power law exponent, and the third type corresponding to mucinous cysts. Viscosity measured at a high shear rate was shown to serve as an accurate and independent marker distinguishing between mucinous and non-mucinous cysts, with an optimal cutoff value of ηc = 1.3 cP The accuracy of this novel technique proved superior to string-sign, cytology, carcinoembryonic antigen, and amylase assessments. Moreover, the combined predictive value of ηc and patient age provided for sensitivity and specificity of 100% and 95.5%, respectively. This simple and rapid diagnostic tool can be immediately implemented after EUS-FNA sampling. PMID:28358122

  17. Endoscopic Management of Pancreatic Fluid Collections in Children.

    Science.gov (United States)

    Nabi, Zaheer; Talukdar, Rupjyoti; Reddy, D Nageshwar

    2017-07-15

    The incidence of acute pancreatitis in children has increased over the last few decades. The development of pancreatic fluid collection is not uncommon after severe acute pancreatitis, although its natural course in children and adolescents is poorly understood. Asymptomatic fluid collections can be safely observed without any intervention. However, the presence of clinically significant symptoms warrants the drainage of these fluid collections. Endoscopic management of pancreatic fluid collection is safe and effective in adults. The use of endoscopic ultrasound (EUS)-guided procedure has improved the efficacy and safety of drainage of pancreatic fluid collections, which have not been well studied in pediatric populations, barring a scant volume of small case series. Excellent results of EUS-guided drainage in adult patients also need to be verified in children and adolescents. Endoprostheses used to drain pancreatic fluid collections include plastic and metal stents. Metal stents have wider lumens and become clogged less often than plastic stents. Fully covered metal stents specifically designed for pancreatic fluid collection are available, and initial studies have shown encouraging results in adult patients. The future of endoscopic management of pancreatic fluid collection in children appears promising. Prospective studies with larger sample sizes are required to establish their definitive role in the pediatric age group.

  18. Morphology and dynamics of the male pelvic floor before and after retrourethral transobturator sling placement: first insight using MRI.

    Science.gov (United States)

    Soljanik, Irina; Bauer, Ricarda M; Becker, Armin J; Stief, Christian G; Gozzi, Christian; Soljanik, Olga; Kirchhoff, Sonja M

    2013-06-01

    We prospectively evaluated changes in morphology and dynamics of the male pelvic floor on magnetic resonance imaging (MRI) associated with retrourethral transobturator sling (RTS) placement. Twenty-six men with post-prostatectomy incontinence consecutively underwent functional cine-MRI before and 12 months after RTS. The membranous urethra length (MUL) and severity of periurethral/urethral fibrosis were assessed on static MRI. A lowering of the posterior bladder wall (BPW), the bladder neck (BN), the external urinary sphincter (EUS) and symphysial rotation of these structures were analysed on dynamic MR images. The success rate was defined as cure (0-1 dry 'security' pad) or improvement (pad reduction ≥ 50 %). The success rate was 77 % (20/26 patients). The mean follow-up was 20.4 months. The MUL significantly increased post-operatively (p elevation of the BPW (p elevation of the BN, BPW and EUS. De novo development of periurethral or urethral fibrosis seems not to be confirmed. The RTS failure was related to the severity of pre- and post-operative periurethral fibrosis. The impact of MRI on pre-operative diagnostics of RTS failure needs further evaluation.

  19. Photoswitchable Faraday effect in EuS-Au nanosystems

    Energy Technology Data Exchange (ETDEWEB)

    Kawashima, Akira; Nakanishi, Takayuki; Kitagawa, Yuichi; Fushimi, Koji; Hasegawa, Yasuchika [Division of Applied Chemistry, Faculty of Engineering, Hokkaido University, North-13 West-8, Kita-ku, 060-8628, Sapporo (Japan)

    2016-01-15

    Effective photoswitchable europium sulfide nanocrystals with gold nanoparticles using dithiol (DDT: 1,10-decanedithiol) joint molecules, EuS-Au nanosystems, are demonstrated. The TEM image indicates the formation of EuS-Au nanosystems composed of cube-shaped EuS nanocrystals and spherical Au nanoparticles. Under visible-light irradiation, a drastic change of absorption band of EuS-Au nanosystems at around 600 nm was observed. The Faraday effects of EuS-Au nanosystems were estimated using magnetic circular dichroism (MCD) measurements. The effective change of the MCD spectra of EuS-Au nanosystems under visible-light irradiation was successfully observed at around 670 nm for the first time. The effective reversible changes in MCD spectra with the alternative irradiation cycles of visible light (>440 nm) and dark are also presented. The decrease rate of rotation angle at 670 nm of EuS-Au nanosystems is larger than that of absorbance. These results indicate that the effective change of MCD spectra of EuS-Au nanosystems would be dominated not only by a drastic change of absorption band related to enhanced LSPR of Au nanoparticles but also by specific interaction between EuS and Au in nanosystem under irradiation. Illustration of photoswitch and TEM image of EuS-Au nanosystems. (copyright 2015 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  20. Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments.

    Science.gov (United States)

    Koulouris, Andreas I; Banim, Paul; Hart, Andrew R

    2017-04-01

    Pain affects approximately 80% of patients with pancreatic cancer, with half requiring strong opioid analgesia, namely: morphine-based drugs on step three of the WHO analgesic ladder (as opposed to the weak opioids: codeine and tramadol). The presence of pain is associated with reduced survival. This article reviews the literature regarding pain: prevalence, mechanisms, pharmacological, and endoscopic treatments and identifies areas for research to develop individualized patient pain management pathways. The online literature review was conducted through: PubMed, Clinical Key, Uptodate, and NICE Evidence. There are two principal mechanisms for pain: pancreatic duct obstruction and pancreatic neuropathy which, respectively, activate mechanical and chemical nociceptors. In pancreatic neuropathy, several histological, molecular, and immunological changes occur which correlate with pain including: transient receptor potential cation channel activation and mast cell infiltration. Current pain management is empirical rather etiology-based and is informed by the WHO analgesic ladder for first-line therapies, and then endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with resistant pain. For EUS-CPN, there is only one clinical trial reporting a benefit, which has limited generalizability. Case series report pancreatic duct stenting gives effective analgesia, but there are no clinical trials. Progress in understanding the mechanisms for pain and when this occurs in the natural history, together with assessing new therapies both pharmacological and endoscopic, will enable individualized care and may improve patients' quality of life and survival.

  1. Primary peripancreatic lymph node tuberculosis as a differential diagnosis of pancreatic neoplasia.

    Science.gov (United States)

    García Del Olmo, Nuria; Boscà Robledo, Andrea; Penalba Palmí, Rafael; Añón Iranzo, Elena; Aguiló Lucía, Javier

    2017-07-01

    Primary peripancreatic lymph node tuberculosis is an exceptional entity in immunocompetent patients, but its incidence is increasing in developed countries in recent years due to increasing immigration. It usually presents as a pancreatic mass and is misdiagnosed as pancreatic neoplasia in most cases, with the diagnosis of tuberculosis occurring after surgery. We report the case of a 38 year old Pakistani man with abdominal pain of several months duration, who was initially diagnosed with a pancreatic neoplasm after detecting a mass in the pancreatic isthmus by computed tomography (CT) and abdominal magnetic resonance imaging (MRI). However, after performing an endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB), the patient was diagnosed with peripancreatic lymph node tuberculosis. After receiving anti-tuberculous treatment, the patient presented clinical improvement, despite a small reduction in the lesion size. In conclusion, peripancreatic lymph node tuberculosis is part of the differential diagnosis of pancreatic neoplasia. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) represents a valuable and useful diagnostic tool for detecting this pathology, avoiding surgeries with a high morbidity and mortality.

  2. Primary peripancreatic lymph node tuberculosis as a differential diagnosis of pancreatic neoplasia

    Directory of Open Access Journals (Sweden)

    Nuria García-del-Olmo

    Full Text Available Primary peripancreatic lymph node tuberculosis is an exceptional entity in immunocompetent patients, but its incidence is increasing in developed countries in recent years due to increasing immigration. It usually presents as a pancreatic mass and is misdiagnosed as pancreatic neoplasia in most cases, with the diagnosis of tuberculosis occurring after surgery. We report the case of a 38 year old Pakistani man with abdominal pain of several months duration, who was initially diagnosed with a pancreatic neoplasm after detecting a mass in the pancreatic isthmus by computed tomography (CT and abdominal magnetic resonance imaging (MRI. However, after performing an endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB, the patient was diagnosed with peripancreatic lymph node tuberculosis. After receiving anti-tuberculous treatment, the patient presented clinical improvement, despite a small reduction in the lesion size. In conclusion, peripancreatic lymph node tuberculosis is part of the differential diagnosis of pancreatic neoplasia. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB represents a valuable and useful diagnostic tool for detecting this pathology, avoiding surgeries with a high morbidity and mortality.

  3. Endoscopic prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.

    Science.gov (United States)

    Lee, Tae Hoon; Park, Do Hyun

    2014-11-28

    Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is not an uncommon adverse event but may be an avoidable complication. Although pancreatitis of severe grade is reported in 0.1%-0.5% of ERCP patients, a serious clinical course may be lethal. For prevention of severe PEP, patient risk stratification, appropriate selection of patients using noninvasive diagnostic imaging methods such as magnetic resonance cholangiopancreatography or endoscopic ultrasonography (EUS), and avoidance of unnecessary invasive procedures, are important measures to be taken before any procedure. Pharmacological prevention is also commonly attempted but is usually ineffective. No ideal agent has not yet been found and the available data conflict. Currently, rectal non-steroidal anti-inflammatory drugs are used to prevent PEP in high-risk patients, but additional studies using larger numbers of subjects are necessary to confirm any prophylactic effect. In this review, we focus on endoscopic procedures seeking to prevent or decrease the severity of PEP. Among various cannulation methods, wire-guided cannulation, precut fistulotomy, and transpancreatic septostomy are reviewed. Prophylactic pancreatic stent placement, which is the best-known prophylactic method, is reviewed with reference to the ideal stent type, adequate duration of stent placement, and stent-related complications. Finally, we comment on other treatment alternatives, and make the point that further advances in EUS-guided techniques may afford useful PEP prophylaxis.

  4. Splenic Artery Pseudoaneurysm Presenting as Massive Hematemesis: A Diagnostic Dilemma

    Directory of Open Access Journals (Sweden)

    Peeyush Varshney

    2014-01-01

    Full Text Available Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0 gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.

  5. [Latest advances in chronic pancreatitis].

    Science.gov (United States)

    Domínguez-Muñoz, J Enrique

    2014-09-01

    This article summarizes some of the recent and clinically relevant advances in chronic pancreatitis. These advances mainly concern the early diagnosis of the disease, the prediction of the fibrosis degree of the gland, the evaluation of patients with asymptomatic hyperenzimemia, the medical and surgical treatment of abdominal pain and the knowledge of the natural history of the autoimmune pancreatitis. In patients with indetermined EUS findings of chronic pancreatitis, a new endoscopic ultrasound examination in the follow-up is of help to confirm or to exclude the disease. Smoking, number of relapses, results of pancreatic function tests and EUS findings allow predicting the degree of pancreatic fibrosis in patients with chronic pancreatitis. Antioxidant therapy has shown to be effective in reducing pain secondary to chronic pancreatitis, although the type and optimal dose of antioxidants remains to be elucidated. Development of intestinal bacterial overgrowth is frequent in patients with chronic pancreatitis, but its impact on symptoms is unknown and deserves further investigations. Finally, autoimmune pancreatitis relapses in about half of the patients with either type 1 or type 2 disease; relapses frequently occur within the first two years of follow-up. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. Laparoscopic and Percutaneous Core Needle Biopsy Plays a Central Role for the Diagnosis of Autoimmune Pancreatitis in a Single-Center Study from Denmark

    DEFF Research Database (Denmark)

    Detlefsen, Sönke; Mortensen, Michael Bau; Kjærulf Pless, Torsten

    2015-01-01

    organ involvement was observed in 40% of type 1 and 13% of type 2, but inflammatory bowel disease only in type 2 (P = 0.001). One patient had IgG4-related chronic perisplenitis as a hitherto undescribed manifestation of IgG4-related disease. Nineteen (91%) of 21 biopsied patients had diagnostic CNB...... Hospital from 2007 to 2013 were included (n = 30; mean follow-up, 26.2 months). Data from laparoscopic or percutaneous ultrasound-guided core needle biopsy (CNB), resection specimens, endoscopic ultrasound (EUS), EUS-guided CNB, computed tomography, serum immunoglobulin G4 (IgG4), and pancreatography were...... retrospectively analyzed according to ICDC. RESULTS: Twenty patients were diagnosed with type 1, 8 with type 2, and 2 with not otherwise specified AIP. Twenty-eight patients (93%) could correctly be classified when ICDC were retrospectively applied. Serum IgG4 was elevated in 44% of type 1 and 0% of type 2. Other...

  7. A Case of Pancreatic Cancer in the Setting of Autoimmune Pancreatitis with Nondiagnostic Serum Markers

    Directory of Open Access Journals (Sweden)

    Manju D. Chandrasegaram

    2013-01-01

    Full Text Available Background. Autoimmune pancreatitis (AIP often mimics pancreatic cancer. The diagnosis of both conditions is difficult preoperatively let alone when they coexist. Several reports have been published describing pancreatic cancer in the setting of AIP. Case Report. The case of a 53-year-old man who presented with abdominal pain, jaundice, and radiological features of autoimmune pancreatitis, with a “sausage-shaped” pancreas and bulky pancreatic head with portal vein impingement, is presented. He had a normal serum IgG4 and only mildly elevated Ca-19.9. Initial endoscopic ultrasound-(EUS- guided fine-needle aspiration (FNA of the pancreas revealed an inflammatory sclerosing process only. A repeat EUS guided biopsy following biliary decompression demonstrated both malignancy and features of autoimmune pancreatitis. At laparotomy, a uniformly hard, bulky pancreas was found with no sonographically definable mass. A total pancreatectomy with portal vein resection and reconstruction was performed. Histology revealed adenosquamous carcinoma of the pancreatic head and autoimmune pancreatitis and squamous metaplasia in the remaining pancreas. Conclusion. This case highlights the diagnostic and management difficulties in a patient with pancreatic cancer in the setting of serum IgG4-negative, Type 2 AIP.

  8. Composites for Exploration Upper Stage

    Science.gov (United States)

    Fikes, J. C.; Jackson, J. R.; Richardson, S. W.; Thomas, A. D.; Mann, T. O.; Miller, S. G.

    2016-01-01

    The Composites for Exploration Upper Stage (CEUS) was a 3-year, level III project within the Technology Demonstration Missions program of the NASA Space Technology Mission Directorate. Studies have shown that composites provide important programmatic enhancements, including reduced weight to increase capability and accelerated expansion of exploration and science mission objectives. The CEUS project was focused on technologies that best advanced innovation, infusion, and broad applications for the inclusion of composites on future large human-rated launch vehicles and spacecraft. The benefits included near- and far-term opportunities for infusion (NASA, industry/commercial, Department of Defense), demonstrated critical technologies and technically implementable evolvable innovations, and sustained Agency experience. The initial scope of the project was to advance technologies for large composite structures applicable to the Space Launch System (SLS) Exploration Upper Stage (EUS) by focusing on the affordability and technical performance of the EUS forward and aft skirts. The project was tasked to develop and demonstrate critical composite technologies with a focus on full-scale materials, design, manufacturing, and test using NASA in-house capabilities. This would have demonstrated a major advancement in confidence and matured the large-scale composite technology to a Technology Readiness Level 6. This project would, therefore, have bridged the gap for providing composite application to SLS upgrades, enabling future exploration missions.

  9. [Selection of patients with rectal tumors for local excision based on preoperative diagnosis. Results of a consecutive evaluation study of 552 patients].

    Science.gov (United States)

    Kneist, W; Terzic, A; Burghardt, J; Heintz, A; Junginger, T

    2004-02-01

    The aim of our study was to evaluate the accuracy of clinical staging (CS), biopsies, and endoluminal ultrasonic examination (EUS) in preoperative staging of rectal tumors treated with transanal local excision. This local excision is an adequate procedure for benign rectal polyps and low-risk T1 carcinoma. The study included 552 patients with rectal adenocarcinoma, villous adenoma, or tumors with other histologic characteristics who underwent a transanal excision (transanal endoscopic microsurgery n=513 or transanal excision n=39). We compared the results of CS, biopsies, and EUS with postoperative pathology findings. Preoperative histological diagnosis of the rectal carcinoma depended on tumor size (52% in cancers 3 cm; p=0.001) and was correct in 56% of cases. Transanal ultrasonography (uT0/1) had superior sensitivity (95% vs 78%) and a higher positive predictive value (93% vs 85%) than clinical staging (CS I) in detecting adenoma or T1 rectal carcinoma, whereas specificity was similar in both (62% vs 58%). In patients in whom preoperative histological analysis revealed adenomas, transanal ultrasonography was accurate (uT0/1) for the postoperatively assessed adenoma pT1 in 97%, whereas diagnosis (uT0/1) was correct in only 71% of cases in which preoperative histological analyses showed rectal carcinomas. In patients with rectal tumors, preoperative staging with transanal ultrasonography and biopsy is essential for the indication and allows selection of patients for transanal local excision.

  10. Chronic spinal cord injury causes upregulation of serotonin (5-HT)2A and 5-HT2C receptors in lumbosacral cord motoneurons.

    Science.gov (United States)

    Cao, Nailong; Ni, Jianshu; Wang, Xiaohu; Tu, Hongjian; Gu, Baojun; Si, Jiemin; Wu, Gang; Andersson, Karl-Erik

    2018-01-01

    To investigate whether the voiding dysfunction caused by spinal cord injury (SCI) in rats can be improved by i.v. administration of the serotonin (5-HT)2A/2C receptor agonist 2,5-dimethoxy-4-iodophenyl-2-aminopropanehydrochloride (DOI), and to discuss whether the mechanism can be ascribed to 5-HT2A and 5-HT 2C receptor upregulation in lumbosacral cord motoneurons. Female Sprague-Dawley rats were divided into two groups (SCI group vs normal control [NC] group). Under urethane anaesthesia, cystometry was performed to examine the variation in urodynamic variables before and after successive intrathecal (i.t.) administration of various doses of DOI into the lumbosacral cord. Changes in 5-HT2A and -2C receptors in the lumbosacral cord were also investigated using immunohistochemical staining and Western blot analysis. Compared with NC rats, the SCI rats had higher bladder capacity and post-void residual urine volume, and lower voiding efficiency. After SCI, DOI improved voiding efficiency, probably via external urethral sphincter (EUS) activity. Immunohistochemical staining and Western blot analysis showed that 5-HT2A and -2C receptors were upregulated in lumbosacral cord motoneurons. In rats with SCI, DOI can improve voiding efficiency; this may be attributable to 5-HT2A and -2C receptor upregulation in lumbosacral cord motoneurons controlling EUS activity. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  11. Epizootic ulcerative syndrome: exotic fish disease threatens Africa's aquatic ecosystems.

    Science.gov (United States)

    Huchzermeyer, Karl D A; van der Waal, Benjamin C W

    2012-09-25

    In late 2006 an unusual ulcerative condition in wild fish was reported for the first time in Africa from the Chobe and upper Zambezi Rivers in Botswana and Namibia. Concern increased with subsistence fishermen reporting large numbers of ulcerated fish in their catches. In April 2007 the condition was confirmed as an outbreak of epizootic ulcerative syndrome (EUS). The causative agent, Aphanomyces invadans, is a pathogenic water mould of fish that shows little host specificity. Ulcers follow infection of tissues by oomycete zoospores, resulting in a granulomatous inflammation associated with invading oomycete hyphae. Granulomatous tracts surrounding oomycete hyphae within the necrotic tissues characterise the diagnostic histological picture. The upper Zambezi floodplain at the confluence with the Chobe River spans the four countries of Botswana, Namibia, Zambia and Zimbabwe, making disease control a challenge. The floodplain ecosystem supports a high fish diversity of around 80 species, and is an important breeding and nursery ground. The annual cycle of flooding brings about changes in water quality that are thought to favour the infectivity of A. invadans, with diseased fish appearing soon after the plains become flooded. Since 2006 the disease has spread rapidly upstream along the upper Zambezi and its tributaries. By 2010 the disease was reported from the Okavango Delta in Botswana and in 2011 from the Western Cape Province of South Africa. EUS has the potential to disrupt floodplain ecosystems elsewhere in Africa where high fish diversity forms the basis of subsistence fisheries and local economies, and is a direct threat to freshwater fish culture.

  12. Endoscopic ultrasound features of gastric schwannomas with radiological correlation: a case series report.

    Science.gov (United States)

    Zhong, Dan-Dan; Wang, Cai-Hua; Xu, Jing-Hong; Chen, Miao-Yan; Cai, Jian-Ting

    2012-12-28

    Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract. They are usually misdiagnosed as other submucosal tumors preoperatively. Experience of the imaging features of gastric schwannomas is extremely limited. In this report, we summarize the features of a series of endoscopic ultrasound (EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate. We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results. Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity, and a well-demarcated margin. The tumors originated from the fourth layer. Cystic changes and calcification were uncommon. Marginal hypoechoic haloes were observed in two patients. The results described here were different from those of previous studies. In the EUS evaluation, the internal echogenicity of gastric schwannomas was heterogeneous and low, but slightly higher than that of muscularis propria. These features might help us differentiate gastric schwannomas from other submucosal tumors. Further investigation is needed to differentiate these mesenchymal tumors.

  13. Gastric Schwannoma with Enlargement of the Regional Lymph Nodes Resected Using Laparoscopic Distal Gastrectomy: Report of a Patient.

    Science.gov (United States)

    Shimizu, Shota; Saito, Hiroaki; Kono, Yusuke; Murakami, Yuki; Kuroda, Hirohiko; Matsunaga, Tomoyuki; Fukumoto, Yoji; Osaki, Tomohiro; Fujiwara, Yoshiyuki

    2017-03-01

    Preoperative differential diagnosis of gastric submucosal tumors has generally been difficult because they are covered with normal mucosa. However, recent advances in endoscopic ultrasound (EUS)-guided sampling of submucosal gastrointestinal lesions have made it possible to achieve preoperative differential diagnosis of gastric submucosal tumors. A 76-year-old woman was referred to our hospital with a gastric submucosal tumor. The tumor was observed in the antrum of the stomach. It was preoperatively diagnosed as a schwannoma after immunohistochemical evaluation of a biopsy specimen, obtained using endoscopic ultrasound-guided fine needle aspiration. A computed tomography scan of the abdomen revealed lymphadenopathies near the tumor indicating the possibility of lymph node metastasis from the gastric tumor. The patient underwent laparoscopic distal gastrectomy with D1 + lymph node dissection. The resected tumor was a submucosal tumor measuring 65 × 45 × 35 mm; it was histopathologically diagnosed as a schwannoma. Resected lymph nodes were enlarged in the absence of lymph node metastasis as a result of reactive lymphadenopathy. A definitive preoperative diagnosis of gastric schwannoma is possible using immunohistochemical staining techniques and EUS-guided sampling techniques. After definitive preoperative diagnosis of gastric schwannoma, minimal surgery is recommended to achieve R0 resection.

  14. Endoscopic Management of a Primary Duodenal Carcinoid Tumor

    Directory of Open Access Journals (Sweden)

    Albin Abraham

    2012-03-01

    Full Text Available Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer.

  15. Endoscopic diagnosis of extrahepatic bile duct carcinoma: Advances and current limitations

    Science.gov (United States)

    Tamada, Kiichi; Ushio, Jun; Sugano, Kentaro

    2011-01-01

    The accurate diagnosis of extrahepatic bile duct carcinoma is difficult, even now. When ultrasonography (US) shows dilatation of the bile duct, magnetic resonance cholangiopancreatography followed by endoscopic US (EUS) is the next step. When US or EUS shows localized bile duct wall thickening, endoscopic retrograde cholangiopancreatography should be conducted with intraductal US (IDUS) and forceps biopsy. Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity. In patients with papillary type bile duct carcinoma, three biopsies are sufficient. In patients with nodular or infiltrating-type bile duct carcinoma, multiple biopsies are warranted, and IDUS can compensate for the limitations of biopsies. In preoperative staging, the combination of dynamic multi-detector low computed tomography (MDCT) and IDUS is useful for evaluating vascular invasion and cancer depth infiltration. However, assessment of lymph nodes metastases is difficult. In resectable cases, assessment of longitudinal cancer spread is important. The combination of IDUS and MDCT is useful for revealing submucosal cancer extension, which is common in hilar cholangiocarcinoma. To estimate the mucosal extension, which is common in extrahepatic bile duct carcinoma, the combination of IDUS and cholangioscopy is required. The utility of current peroral cholangioscopy is limited by the maneuverability of the “baby scope”. A new baby scope (10 Fr), called “SpyGlass” has potential, if the image quality can be improved. Since extrahepatic bile duct carcinoma is common in the Far East, many researchers in Japan and Korea contributed these studies, especially, in the evaluation of longitudinal cancer extension. PMID:21611097

  16. Endoscopic staging of low-grade gastric malt lymphoma Estadificación por ecoendoscopia en el linfoma gástrico tipo malt de bajo grado

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    M. J. Varas

    2006-03-01

    Full Text Available Introduction: endoscopic ultrasonography (EUS has already proven useful in the assessment of submucosal lesions, and the staging of gastrointestinal cancer, particularly gastric MALT-type lymphoma. The goal of this paper was EUS staging. Patients and method: 24 patients (10 females, 14 males with a median age of 56 years and possibly gastric MALT lymphoma (25 cases were studied using videoendoscopy, biopsies, and echoendoscopy with 7.5- and 20-MHz radial EUS, and also with 12- and 20-MHz miniprobes (MPs. Nineteen patients were definitely evaluated (7 females, 12 males as having 20 MALT-type lymphomas, as five patients were post-hoc disregarded when an invasive, high-grade gastric lymphoma (3c or plasmocytoma (2c was subsequently demonstrated. Of these 19 patients, all had T1 lesions except for two with T2 lesions; one patient had a gastroduodenal T1 lymphoma. Echographic findings with MPs were compared to EUS (gold standard and histology both before and after eradication. Then, patients were followed up every 1-3-6 months using videoendoscopy and MPs. Results: echoendoscopy correctly identified T stages in 90% of cases. MPs identified T stages in 88% of cases, and N stages in 33% of cases, with results being slightly inferior to those obtained with conventional EUS (91 vs. 45%; they were consequently used for follow-up. After eradication, all but two patients are in complete remission and have been followed every 1-3-6 months using MPs without echographic abnormalities, except for a patient who relapsed.Introducción: la ultrasonografía endoscópica (USE ha demostrado ya su utilidad en la evaluación de las lesiones submucosas, en la estadificación del cáncer digestivo en general, y del linfoma gástrico tipo MALT en particular. El objetivo de este trabajo fue la estadificación por USE. Pacientes y método: veinticuatro enfermos (10 mujeres y 14 varones con edad media de 56 años y con posible linfoma gástrico tipo MALT (25 casos fueron

  17. Prospective comparison of MR with diffusion-weighted imaging, endoscopic ultrasound, MDCT and positron emission tomography-CT in the pre-operative staging of oesophageal cancer: results from a pilot study.

    Science.gov (United States)

    Giganti, Francesco; Ambrosi, Alessandro; Petrone, Maria C; Canevari, Carla; Chiari, Damiano; Salerno, Annalaura; Arcidiacono, Paolo G; Nicoletti, Roberto; Albarello, Luca; Mazza, Elena; Gallivanone, Francesca; Gianolli, Luigi; Orsenigo, Elena; Esposito, Antonio; Staudacher, Carlo; Del Maschio, Alessandro; De Cobelli, Francesco

    2016-12-01

    To compare the diagnostic performance of MR and diffusion-weighted imaging (DWI), multidetector CT, endoscopic ultrasonography (EUS) and 18 F-FDG (fluorine-18 fludeoxyglucose) positron emission tomography CT (PET-CT) in the pre-operative locoregional staging of oesophageal cancer. 18 patients with oesophageal or Siewert I tumour (9 directly treated with surgery and 9 addressed to chemo-/radiotherapy before) underwent 1.5-T MR and DWI, 64-channel multidetector CT, EUS and PET-CT before (n = 18) and also after neoadjuvant treatment (n = 9). All images were analysed and staged blindly by dedicated operators (seventh TNM edition). Two radiologists calculated independently the apparent diffusion coefficient from the first scan. Results were compared with histopathological findings. After the population had been divided according to local invasion (T1-T2 vs T3-T4) and nodal involvement (N0 vs N+), sensitivity, specificity, accuracy, positive- and negative-predictive values were calculated and compared. Quantitative measurements from DWI and PET-CT were also analysed. For T staging, EUS showed the best sensitivity (100%), whereas MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%), but none of the techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage, although this was not significantly different to the other modalities. The apparent diffusion coefficient was different between surgery-only and chemo-/radiotherapy groups (1.90 vs 1.30 × 10 -3  mm 2  s -1 , respectively; p = 0.005)-optimal cut off for local invasion: 1.33 × 10 -3  mm 2  s -1 (p = 0.05). Difference in standardized uptake value was also very close to conventional levels of statistical significance (8.81 vs 13.97 g cm -3 , respectively; p = 0.05)-optimal cut off: 7.97 g cm -3 (p = 0.44). In this pilot study, we have shown that MR with

  18. Fiscal Year 2009 Phased Construction Completion Report for EU Z2-36 in Zone 2, East Tennessee Technology Park, Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Bechtel Jacobs

    2009-02-10

    evaluation results. The Zone 2 ROD divided the area into 7 geographic areas and 44 EUs. To facilitate DQOs of the DVS process, the Zone 2 RDR/RAWP regrouped the 44 EUs into 12 DQO scoping EU groups. These groups facilitated the DqO process by placing similar facilities and their support facilities together and allowing identification of data gaps. The EU groups were no longer pertinent after DQO planning was completed, and characterization was conducted as EUs became accessible. As the opportunity to complete characterization became available, the planned DVS program was completed in FY 2009 for EU Z2-36.

  19. GROWTH AND CHARACTERIZATION OF Eu DOPED GaSe SINGLE CRYSTALS BY X-RAY DIFFRACTION AND RAMAN SPECTROSCOPY

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    Dumitru UNTILA

    2017-08-01

    Full Text Available GaSe single crystals doped with Eu (0.025, 0.05, 0.5, 1.0 and 3.0 at% were grown by Bridgman method using Ga, Se and Eu elementary components. The crystalline structure and vibration modes of the GaSe: Eu crystals lattice were studied by X-ray diffraction and Raman spectroscopy. Eu atoms arranged in the van der Waals space of GaSe: Eu crystals form Eu-Se valence bonds and restructure hexagonal lattice of GaSe leading to EuGa2Se4 crystallites formation. Defects generated by EuGa2Se4 crystallites lead to broadening and shifting of single phonon peaks present in Raman spectra towards shorter wavenumbers, and at the same time, activate the longitudinal optical vibrations of EuSe sublattice.Keywords: GaSe, doping, Eu, XRD, Raman. CREȘTEREA ȘI CARACTERIZAREA MONOCRISTALELOR DE GaSe: Eu PRIN DIFRACȚIA RAZELOR X ȘI SPECTROSCOPIA RAMANMonocristalele de GaSe nedopate și dopate cu Eu în cantități de 0.025, 0.05, 0.5, 1.0 și 3.0% at. au fost crescute prin metoda Bridgman din componente elementare Ga, Se și Eu. Structura cristalină și modelele de vibrație a rețelei crista­lelor de GaSe:Eu au fost studiate prin difracția razelor X și spectroscopia Raman. Atomii de Eu localizați în spaţiul van der Waals al cristalelor de GaSe:Eu creează legături de valență Eu-Se și restructurează rețeaua hexagonală a compusului GaSe, conducând la formarea cristalitelor de EuGa2Se4. Defectele generate de cristalitele de EuGa2Se4 duc la lărgirea și deplasarea benzilor monofononice de difuzie Raman spre numere de undă mici și, totodată, activează vibraţiile optice longitudinale ale subreţelei EuSe.Cuvinte-cheie: GaSe, dopare, Eu, XRD, Raman.

  20. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

    Science.gov (United States)

    Costi, Renato; Gnocchi, Alessandro; Di Mario, Francesco; Sarli, Leopoldo

    2014-01-01

    Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones (CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and cost-effectiveness of imaging techniques used to identify CBDS increase together in a parallel way, the concept of “risk of carrying CBDS” has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of “under-studying” by poor diagnostic work up or “over-studying” by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. “Low risk” patients do not require further examination before laparoscopic cholecystectomy. Two main “philosophical approaches” face each other for patients with an “intermediate to high risk” of carrying CBDS: on one hand, the “laparoscopy-first” approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the “endoscopy-first” attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent