ABSTRACT
Endosonography is a distinct method in evaluating gastrointestinal [GI] structural lesions, particularly in the pancreatobiliary system. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesions through fine needle aspiration [FNA]. This study aims to evaluate the results and efficacy of endosonographic fine needle aspiration [EUS-FNA] in patients presenting with solid pancreatic masses. This was a descriptive, prospective, case series study of patients who presented with solid pancreatic masses to Imam Khomeini Hospital, Tehran, Iran over a one year period [from November 2009-2010] In order to determine false negative cases, patients were followed for 6 to 12 months. A total of 53 patients underwent EUS-FNA with no complications. The results were diagnostic in 46 [87%] cases. The majority of patients were male [68%] and 81% had a mass in the pancreatic head. Cytopathology results revealed 36 [68%] adenocarcinomas, 7 [13%] other malignancies, 3 [6%] benign lesions and 7 [13%] nondiagnostic cases. The frequency of nondiagnostic results was significantly more in masses smaller than 3 cm [6 vs. 1, p < 0.002]. Patients with nondiagnostic results were younger than those with malignant cytopathologies [52 +/- 7.5 vs. 66 +/- 7.5 years, p < 0.001]. Sensitivity, specificity, PPV, NPV and accuracy of EUS-FNA in adenocarcinoma cases were 88%, 100%, 100%, 70% and 90%, respectively. EUS-FNA is an effective and safe procedure in the histopathologic diagnosis of pancreatic tumors
ABSTRACT
Hepatitis B is still a major health problem in many parts of the world. In some developing countries the most common cause of chronic hepatitis and liver cirrhosis is hepatitis B virus [HBV]. The progression of chronic hepatitis B to cirrhosis and hepatocellular carcinoma [HCC] include such viral factors as genotype C and high levels of serum HBV DNA in addition to host factors such as older age, male gender, obesity and diabetes. Other factors that influence progression to cirrhosis and HCC are simultaneous alcohol use, and co-infections with HIV, HDV and HCV. The present study aims to determine the correlations between serum HBV DNA viral load and related factors. In this study, new HBV DNA and ALT levels that enable better separation between different stages of this disease are presented. Materials and Chronic hepatitis B patients who presented to the Liver Clinic at Imam Khomeini Hospital in 1388 who were HBsAg positive for more than six months were enrolled in this study. Patients who had previously been treated or those with concurrent HIV, HCV and HDV infections as well as those with autoimmune hepatitis and fatty liver were excluded. Patients' data, HbeAg state, demographics, liver enzymes, HBV DNA level, smoking history, cirrhosis and disease stage were recorded. In order to better differentiation between non-replicative and reactive chronic hepatitis B patients, statistical analysis was done to distinguish between their HBV DNA levels. Evaluation of the relationships between HBV DNA level and the above mentioned variables was performed. High Levels of HBV DNA correlated with HBeAg positive state, smoking [p=0.005] and elevated liver enzymes [p=0.002]. The cut-off value for ALT level that separated HbeAg-positive group [immunoclearance and immunotolerance phases] was set at 42 U/l on the roc curve[r=0.889 area under curve] with 100% sensitivity and 67.7% specificity. The cut-off value for serum HBV DNA levels that differentiated between the Hbe Ag-negative group [non-replicative and reactive phases] was set at 3000 IU/ml on the roc curve [r=0.987 area under curve] with 97% sensitivity and 92% specificity. The present study determined that serum HBV DNA at a level of 3000 IU/ml was a better level for classification of HBeAg-negative patients into the non-replicative and reactive groups