Comparison of endoscopic ultrasound and computed tomography for detecting and staging malignant pancreatic masses

Introduction: Endoscopic ultrasound [EUS] is now established as a valuable imaging test for diagnosing and staging pancreatic cancer. But, with significant recent improvements in spiral computed tomography [CT] scanners, particularly higher resolution and ability to reconstruct 3D images, spiral CT is now increasingly accepted as being better for pancreatic cancer staging. The debate continues, however, about the best diagnostic test or combination of tests in patients with suspected pancreatic cancer. Spiral CT is more readily available than endoscopic ultrasound guided fine needle aspiration [EUS-FNA], cheaper and, therefore, more frequently used In this study, we evaluated the use of EUS-FNA in comparison with spiral CT for detection and staging of malignant pancreatic massesMethods: This prospective study was carried in El-Ebrashi unit of Gastroenterology and Hepatology, Internal Medicine department, Cairo University over 3 years from 2011 to 2014. It included 68 patient with suspected pancreatic mass lesions based on abdominal ultrasound, CT or MRI and patients with obstructive jaundice due to common bile duct [CBD] stricture as proved by endoscopic retrograde cholangiopancreatography [ERCP] or Magnetic resonance cholangiopancreatography [MRCP]. The patients were subjected to dual phase pancreatic control multi-detector computed tomography [MDCT] to be followed by EUS-FNA, then cytopathological examination of the studied patients to determine the nature of pancreatic masses, normal and benign cases are followed up after 6 months by EUS for exclusion of malignancy

Results: The final diagnosis in this study was that, 61 patients were malignant and 7 benign cases. The sensitivity of CT was 75% compared to 100% for EUS. While the specificity for CT was 14% compared to 100% for EUS. The negative predictive value for CT was 6.25% compared to 100% for EUS. With an overall accuracy of MDCT was 69% compared to 100% for EUS for diagnosing pancreatic cancer. The sensitivity of CT for detection of small lesions

Conclusion: EUS is more accurate than CT for detection of pancreatic cancer especially in small tumors. EUS is more accurate than CT in staging of pancreatic cancer in early stages

Recommendation: Early diagnosis of pancreatic cancer is the most important step in the way of decreasing its mortality rate. For screening of patients with suspected pancreatic cancer, initially CT should be performed to be followed by EUS whether to exclude masses in negative CT patients or to confirm the mass and to provide a tool for sample/or cytopathological diagnosis in patients with positive CT We recommend a future study to correlate the accuracy of staging by EUS and CT with post-operative histopathological staging

Monochromatic infrared photo energy versus low level laser therapy in patients with knee osteoarthritis

Knee osteoarthritis [KO] is the most common joint disease for which there is no optimal treatment. Monochromatic infrared photo energy [MIPE] is a relatively new light modality used to reduce pain and increase circulation. Low Level Laser Therapy [LLLT] is another light modality used to reduce pain in KO. The aim of this study was to compare the effects of the MIPE and LLLT in improving pain and function in KO. Sixty participants with KO completed the program and were randomly assigned into two groups. Group 1 [experimental, n=30] received MIPE and exercises. Group 2 [control, n=30] received LLLT and exercises. Both groups received two visits per week for six weeks. Outcome included pain intensity measured on a visual analogue scale and physical function measured with the lower extremity functional scale, before and after the 12 therapy sessions [6 weeks after the start of the intervention]. There were statistically significant improvements in pain intensity and lower extremity functional scale scores [p<0.05] in each group. However, no significant differences were recorded between the groups [p>0.05]. Therefore, MIPE and LLLT reduce pain and improve function in KO; however, there are no differences between the two modalities in reducing pain and increasing physical function in KO

Functional and structural cardiac abnormalities in cirrhotic-ascetic patients before and after paracentesis

Background: cardiovascular dysfunction in patients with liver cirrhosis has been reported by many workers. Diminished venous return due to ascites, peripheral vasodilatation, and malnutrition could interfere with myocardial performance. It has been shown that paracentesis associated with N albumin infusion is an effective and safe therapy for ascites in cirrhotic patients. It is associated with similar or lower incidence of complications than diuretic therapy and considerably shortens the duration of hospital stay. Cirrhotic cardiomyopathy is a term used to describe a constellation of features indicative of abnormal heart structure and function in patients with liver cirrhosis. Progressive cardiac dysfunction is detected in liver cirrhosis without being primary of cardiac disease

Objective: the objective of this study is to detect the changes in cardiac structure and function in response to aspiration of ascetic fluid in patients with liver cirrhosis and tense ascites

Patients and Methods: the study includes forty patients with liver cirrhosis and tense ascites. After collection of patients and exclusion of any primary cardiac or respiratory disease, paracentesis was done [2 liters daily for 5 successive days] in conjunction with IV albumin infusion [5 gm albumin for every one liter of ascetic fluid withdrawn]. They were meticulously studied by 12-leads ECG and Echocardiography before and after tapping of ascetic-fluid in the following order; [Pre-tapping: before paracentesis and Post-tapping: after paracentesis] to assess the magnitude of functional and structural changes of the heart in response to withdrawal of ascetic fluid

Results: after collection of clinical, laboratory, ECG and Echocardiographic data, comparison of the results before and after paracentesis revealed that, there's a significant lowering of heart rate [HR] in Post-tapping [post-paracentesis] with mean +/- SD [92.1 +/- 8.3 beat/min] versus [97.6 +/- 7.2 beat/min] in Pre-tapping [before paracentesis]. Significant increased systolic blood pressure after paracentesis, being [112.5 +/- 5.8 mmhg] in Pre-tapping versus [118.8 +/- 7 mmhg] in Post-tapping, with no significant change in their diastolic blood pressure. Serum Albumin level is significantly increased in Post-tapping with mean +/- SD [3.5 +/- 0.22 mg/dl] versus [2.8 +/- 0.33 mg/di] in Pre-tapping. A significant improvement of the estimated Q-Tc in Post-tapping after paraceritesis is observed with mean +/- SD [287.6 +/- 10.9 msec] in Post-tapping versus [297.5 +/- 11.1 msec] in Pre-tapping, with significant shortening of Q-Tc· after paracentesis. Echocardiographic results revealed that, there's a significant reduction of EDD in Post-tapping with mean +/- SD [46.9 +/- 2.2 mm] versus [48.4 +/- 3.0 mm] in Pre-tapping and also, reduction of ESD in Post-tapping with mean +/- SD [29.8 +/- 1.9 mm] versus [31.5 +/- 1.6 mm] in Pre-tapping. This resulted in significant elevation of both EF% and FS% with BF% of mean +/- SD [66.2 +/- 2.8 in Post-tapping versus 63.9 +/- 3.5 in Pre-tapping] and FS% [36.4 +/- 0.3 in Post-tapping versus 34.7 +/- 0.3 in Pretapping]. Right ventricular diameter is significantly reduced in Post-tapping with mean +/- SD [30.3 +/- 1.1 mm] than Pre-tapping [34.6 +/- 1.6 mm], and LA is also lesser in Post-tapping with mean +/- SD [36.9 +/- 1.4 mm] versus [39.5 +/- 1.6 mm] in Pre-tapping. In spite, no significant changes observed as regards Lv-mass, rvs and PW measures in between both groups. A significant improvement of left ventricular diastolic function after paracentesis was detected, in the form of, significant increased E-wave velocity, reduced A-wave'velocity and increased E/A ration, where, Post-tapping, Ewave was of mean +/- SD [0.93 +/- 0.13 mis] versus [0.65 +/- 0.08 mis] for Pre-tapping and A-wave was [0.62 +/- 0.07 mis] in Post-tapping versus [0.75 +/- 0.06 mis] for Pre-tapping, with resultant increased E/A ratio in Post-tapping where mean +/- SD [1.5 +/- 0.2] versus [0.86 +/- 0.11] in Pre-tapping. Also, reduction of deceleration time in Post-tapping with mean +/- SD [161.0 +/- 5.2 msec] versus [172.7 +/- 4.3 msec] in Pre-tapping. A significant lowering of pulmonary artery systolic pressure in Post-tapping is observed with mean +/- SD [40.1 +/- 3.2 mmhg] versus [45.8 +/- 4.3 mrnhg] in Pre-tapping

Conclusion: repeated 2 liters daily paracentesis with rv albumin infusion is safe and · effective treatment for tense ascites and showed improvement at both clinical and cardiac levels with no major complications. Improved clinical feature was detected in the form of decreased HR, increased systolic blood pressure. improved cardiac function was observed in the form of shortening of Q-Tc interval, improved diastolic and systolic Lv indices and a pronounced reduction of right ventricular and pulmonary artery systolic pressure. Indeed, structural improvement was detected in the form of reduction-in intracardiac chamber dimensions for Lv, LA and Rv diameters

Doppler echocardiograhic evaluation of ventricular function in patients with bronchial asthma

Cardiac involvement in bronchial asthma [BA] has been reported previously. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been reported before. Therefore, the aim of this study was to evaluate ventricular function by measurement of myocardial performance index [MPI] and transmitral flow propagation velocity [TFPV]. Sixty patients with bronchial asthma and 20 control subjects [mean ages 6-16 and 8-14 years, respectively] participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle [LV]. LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, MPI and TFPV. Right ventricular [RV] function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. Systolic function was normal in all subjects. Among the echocardiographic indices of LV diastolic function the peak E velocity, E velocity/A velocity ratio, isovolumentric relaxation time, MPI and TFPV in the BA group were significantly different from those of the controls [P <0.05]. However, we did not observe a significant difference in RV echocardiographic indices between the two groups. Our results show that there is LV diastolic dysfunction in patients with bronchial asthma

study on heart rate variability signals in healthy children and in patients with congenital heart disease

During the last decade the interest in the field of pediatric electrophysiology was progressing and attention towards pediatric arrhythmic mortality became of extreme concern. Analyses of heart rate variability [HRV] signals are one of the sensitive tools to study the autonomic control of the heart uming to solve the arrhythmic morbidity and mortality in the pediatric age group. Few studies had reported the normal values of HRV parameters in infants and children. As autonomic disturbances and arrhythmia are common features in patients with congenital heart disease, we tried to establish ranges for HRV parameters in normal individuals and in patients with congenital cardiac defects. One hundred and fifty infants and children were the study population. 50 patients had a cyanotic congenital heart diseases; 29 males and 21 females, with a mean age + SD of 88.75 +/- 139.8 months and 50 patients had cyanotic congenital, heart disease; 18 males and 32 females, with a mean age of 5.62 +/- 3.05 months. 50 subjects with no evidence of structural heart disease were included as controls; 24 males and 26 females, with a mean age of 6.33 +/- 3.65 months. For age matching between the study groups and controls, 50 normal subjects were compared with a cyanotics while only 36 of them were compared with cyanotics patients, The normal limits [mean +/- SD] of frequency domain HRV parameters for all the 50 controls were: LF ms[2] [388.7-509.5], LF-n.u [36.8-62.08], HF ms[2] [489.1-709.6] HF-n.u. [44.3-74.3] and LF/HF ratio [0.5-0.9]. The normal limits of HRV parameters for the 36 controls age-matched to the cyanotic group were LF ms[2] [386.5-514.1], LF-n.-u [39.5-61.9], HF ms[2] [515.0-693.4], HF-n.u [50.1-70.9], and LF/HF ratio [0.54-0.86]. There was a significant negative correlation between age and both LF n.u and HF n.u. with insignificant effect on LF/HF ratio. However, there were no gender variations in the studied HRV parameters of the control groups. We observed a significantly lower HF-n.u and higher LF ms[2], LF-n.u, HF ms[2] and LF/HF ratio in both acyanotics and cyanotics when compared to controls. We also noticed that high frequency bands HF m[2] and HF-n.u. were abnormally high in a large number of acyanotics and the LF/HF ratio was relatively higher in cyanotics, although the differences were statistically insignificant. The final results provided a basis for heart rate variability signals in children. Normal ranges for the various parameters were determined. Cyanotics express more sympathetic predominance than a cyanotics which might render them more susceptible to arrhythmias