Etecp cytology and EUS-FNA cytology in the diagnosis of malignant distal biliary and pancreatic duct strictures

Endoscopic retrograde cholangio-pancreatography [ERCP] with ductal brushings and pancreatic juice cytology is widely used in suspected pancreatic cancer, despite its low sensitivity. In contrast the accuracy rates of endoscopic ultrasound [EUS]-fine needle aspiration [FNA] for diagnosis of pancreatic malignancy is high. Aim of the study: To compare diagnostic performance of ERCP cytology [ERCP-C] with EUS-FNA in suspected patients with malignant pancreatic duct stricture. Patients and A prospective study included 56 patients with pancreatic duct stricture was performed. ERCP-C and EUS-FNA were carried out for cytopathological diagnosis. The final diagnosis was pancreatic malignancy in 60.7% patients and benign pancreatic disease in 39.3% patients. The sensitivity, specificity, positive [PPV] and negative [NPV] predictive values and accuracy of EUS-FNA for malignant pancreatic ductal stricture were 87.9%, 100%, 100%, 84.6% and 92.7, respectively. The sensitivity, specificity, PPV, NP V, and accuracy of ERCP brush cytology alone [41.4%, 100%, 100%, 55.3%, 66%, respectively], and combined with pancreatic juice cytology [48.3%, 100%, 100%, 58.3%, and 70%, respectively] were inferior to EUS-FNA. Significant dfferences between post ERCP-C and post-EUS-FNA pancreatitis were detected [P<0.001]. EUS-FNA is more sensitive and safer for cytopathological diagnosis of pancreatic duct stricture than ERCP-C

Serum vascular endothelial growth factor in rheumatoid arthritis: a relationship to disease activity and pathogenesis

This study aims to determine the serum level of vascular endothelial growth factor [VEGF] in rheumatoid arthritis [RA] patients and to search for a relationship between serum VEGF level and clinical, laboratory, and radiological variables of the disease in an attempt to provide more insight regarding its role in disease activity and pathogenesis. 75 RA patients, diagnosed according to the American College of Rheumatology [ACR] criteria and 20 control subjects were included in this study. RA patients were divided into active group [38 patients] and non-active group [37 patients] as assessed clinically by using modified disease activity score [DAS-28] and laboratory by using erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. All patients included in this study were subjected to full history taking, thorough clinical examination and laboratory investigations including ESR, CRP, complete blood picture, rheumatoid factor, and serum VEGF assay using ELISA technique. Assessment of radiological severity by Larsen's score was done by using plain X-ray for both hands and wrists joints. We found that serum VEGF level was higher in RA patients group than control subjects and in the active group than non-active one. In RA patients, the serum level of VEGF was positively correlated to DAS-28, ESR and CRP. Also, the levels of serum VEGF were higher in patients with early grades of Larsen's score than those with late grades. Also, RA patients with early disease duration [<2 years] had higher serum VEGF levels than those of late disease duration [>3 years]. We suggest that VEGF may be involved in the pathogenesis of RA, and serum VEGF is a non-invasive useful method for monitoring the disease activity of RA, although this is not a specific marker for RA. Anti-VEGF strategies should largely be confined to modulating angiogenesis in RA