Metodologías de Medición de Volumetría Hepática / Methodologies For Measuring Hepatic Volumetry

Lograr determinar el volumen total de un hígado (VHT), o volumetría hepática, pasa a ser de relevancia en diversas situaciones, tales como, vigilancia del progreso de una enfermedad de carácter crónico, planificación de resecciones y trasplantes hepáticos; y observación del clearance hepático de algunos fármacos hepatotropos. La VHT se puede realizar utilizando métodos de segmentación en el curso de una tomografía computarizada (TC), ya sean estos manual, automáticos, y semiautomáticos; mediante resonancia nuclear (RN), utilizando softwares de distintas generaciones (1ª a 4ª). La medición de VHT está indicada en pacientes sometidos a resecciones hepáticas mayores, en el contexto del tratamiento de neoplasias (carcinoma hepatocelular, colangiocarcinoma, metástasis hepáticas o tumores benignos de gran tamaño), abscesos (piogénicos, amebianos), y después de un traumatismo hepático complejo; así como también en la etapa preoperatoria de un trasplante hepático. El objetivo de este manuscrito fue generar un documento de estudio sobre métodos para determinar volumetría hepática.

SUMMARY: Being able to determine the total hepatic volume (THV), or THV, becomes relevant in various situations, such as monitoring the progress of a chronic disease, planning resections and liver transplants; and observation of the hepatic clearance of some hepatotropic drugs. THV can be performed using segmentation methods in the course of a computed tomography (CT), whether manual, automatic, or semi-automated; by nuclear resonance (NR), using software from different generations (1st to 4st). THV measurement is indicated in patients undergoing major liver resections, in the context of treatment of neoplasms (hepatocellular carcinoma, cholangiocarcinoma, liver metastases or large benign tumors), abscesses (pyogenic, amoebic), and after liver trauma complex, as well as in the preoperative stage of a liver transplant. The aim of this manuscript was to generate a study document regarding methods for determine hepatic volumetry.

FIB-4 y Lok score como predictores de várices esofágicas en pacientes con cirrosis hepática / FIB-4 and Lok score as predictors of esophageal varices in patients with liver cirrhosis

INTRODUCCIÓN. La endoscopia digestiva es el estudio de elección para el diagnóstico de várices, es un procedimiento invasivo que en ocasiones puede no ser bien tolerado por los pacientes y tiene un alto costo, por lo que se propone el índice FIB-4 y puntaje Lok para predecir várices esofágicas en pacientes cirróticos. OBJETIVO. Determinar la utilidad de los marcadores FIB-4 y Lok Score como predictores de várices esofágicas en los pacientes cirróticos. MATERIALES Y MÉTODOS. Estudio de evaluación de pruebas diagnósticas con 639 pacientes cirróticos atendidos en el Hospital de Especialidades Carlos Andrade Marín entre enero 2010 y noviembre 2021 a quienes se les realizó endoscopia digestiva alta de tamizaje y medición de FIB-4 y puntaje Lok. Los datos se analizaron con SPSS V25. Las variables cualitativas se analizaron con frecuencias y las cuantitativas con medidas de dispersión, se calculó sensibilidad, especificidad, valor predictivo negativo, valor predictivo positivo y curva ROC. RESULTADOS. La edad media fue de 64,33 años, predominio de sexo femenino (50,2%), presencia de várices esofágicas en 80,4% de casos con complicaciones en 2,4%, siendo la más frecuente el sangrado (2,2%). Se evidenció asociación significativa entre FIB-4 y puntaje Lok con presencia de várices esofágicas (p= 0,000). Para el FIB-4 la sensibilidad fue de 79,6%, especificidad 43,2%, valor predictivo positivo 85,2% y valor predictivo negativo 33,9%. Para el puntaje Lok sensibilidad de 89,5%, especificidad de 32,8%, valor predictivo positivo 84,5% y valor predictivo negativo 50%. CONCLUSIÓN. FIB-4 y puntaje Lok son útiles como predictores de várices esofágicas en pacientes con cirrosis hepática.

INTRODUCTION. Digestive endoscopy is the study of choice for the diagnosis of varicose veins, it is an invasive procedure that sometimes may not be well tolerated by patients and has a high cost, which is why the FIB-4 index and Lok Score are proposed to predict varicose veins. esophagus in cirrhotic patients. AIM. To determine the usefulness of the FIB-4 and Lok Score markers as predictors of esophageal varices in cirrhotic patients. MATERIALS AND METHODS. Diagnostic test evaluation study with 639 cirrhotic patients treated at the Carlos Andrade Marín Specialty Hospital between January 2010 and November 2021 who underwent upper digestive endoscopy for screening and measurement of Fibrosis-4 and Lok Score. The data was analyzed with SPSS V25. The qualitative variables were analyzed with frequencies and the quantitative ones with dispersion measures, sensitivity, specificity, negative predictive value, positive predictive value and ROC curve were calculated. RESULTS. The mean age was 64,33 years, female predominance (50,2%), presence of esophageal varices in 80,4% of cases with complications in 2,4%, the most frequent being bleeding (2,2%). A significant association was evidenced between FIB-4 and Lok Score with the presence of esophageal varices (p= 0,000). For the FIB-4 the sensitivity was 79,6%, specificity 43,2%, positive predictive value 85,2% and negative predictive value 33,9%. For the Lok Score sensitivity of 89,5%, specificity of 32,8%, positive predictive value 84,5% and negative predictive value 50%. CONCLUSION. FIB-4 and Lok Score are useful as predictors of esophageal varices in patients with liver cirrhosis.

Diagnostic value of endoscopic ultrasonography for extra-hepatic bile duct dilation of unknown reasons / 中华消化内镜杂志

Objective@#To evaluate diagnostic efficacy of endoscopic ultrasonography (EUS) for extra-hepatic bile duct dilation of unknown reasons which failed to be identified by traditional radiological methods.@*Methods@#Data of consecutive 892 patients who underwent EUS from February 2016 to September 2017 were retrospectively studied. Final diagnosis was determined by endoscopic retrograde cholangiopancreatography (ERCP)-based biopsy, surgical pathology, or a follow-up of at least 10 months.@*Results@#A total of 82 patients with extra-hepatic bile duct dilation (width ≥ 7 mm) and mean age of 61.5±9.6 years were included. The width of common bile duct was 13.0±4.25 mm. Reasons for extra-hepatic bile duct dilation could be determined by EUS in most patients with abnormal liver function. No malignant causes were detected in patients with normal liver function. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 92.7%, 100.0%, 96.3%, 100.0%, and 93.2%, respectively.@*Conclusion@#For patients with dilated extra-hepatic bile duct without clear etiology, EUS may be an alternative for determining the etiology of extra-hepatic bile duct dilation. For those with extra-hepatic bile duct dilation with abnormal liver function, malignant causes should not be neglected.

The analysis of clinical application of sedated gastrocolonoscopy / 中国基层医药

Objective To evaluate the value of clinical application of sedated gastrocolonoscopy,to release distress of patients,improve curative effect.Methods To select 148 patients with gastrointestinal diseases who received gastrocolonoscopy,148 patients were divided into two groups randomly,therapy group 74 patients,control group 74 patients.Results The patients of therapy group had less distress,higher compliance,no adverse reaction.All of patients completed diagnosis successfully.But the patients of control group appeared adverse reactions,including vomiting,restlessness equal.Furthermore 9 patients end manipulate because of this.Conclusion Sedated gastrocolonoscopy versus conventional gastrocolonoscopy had less adverse reactions,higher security,and it should be spread in clinical application.

Comparación entre las biopsias gástricas sin fijar 24 horas frente a la biopsia convencional para el diagnóstico de Helicobacter pylori en un hospital de referencia de Perú / Comparison between gastric biopsies without fixation for 24 hours and conventional biopsy for the diagnosis of Helicobacter pylori in a reference hospital in Peru

Objetivos. Comparar biopsias gástricas fijadas inmediatamente con formol al 10 por ciento frente a biopsias fijadas tras 24 horas en la detección de Helicobacter pylori (Hp) en un hospital de referencia en Perú. Materiales y métodos. Se realizó un estudio de test diagnóstico sobre las biopsias gástricas de 72 pacientes que acudieron al Servicio de Gastroenterología del Hospital Essalud Alberto Sabogal en el Callao. Las muestras de cada paciente fueron repartidas en dos frascos de vidrio, una de ellas se fijó inmediatamente con formol al 10 por ciento y a la otra se fijó luego de 24 horas. Se procesaron ambos grupos de muestras con la técnica convencional de inclusión en parafina y coloración con hematoxilina-eosina. Resultados. Se evidenció Hp en 56,9 por ciento del grupo de biopsias fijadas inmediatamente y en el 79,2 por ciento del grupo de biopsias fijadas tras 24 horas, encontrándose diferencia estadística (p<0,001). Conclusiones. Existe una mayor frecuencia de diagnóstico de Hp en las muestras que se fijaron luego de 24 horas; lo que podría sugerir que ello actuaría como un cultivo biológico para Hp que facilitaría su diagnóstico.

Objectives. To compare gastric biopsies immediately fixed with 10 percent formalin with biopsies fixed after 24 hours for the detection of Helicobacter pylori (Hp) in a reference hospital in Peru. Materials and methods. A diagnostic test study on gastric biopsies from 72 patients attending the Gastroenterology service of hospital Essalud Alberto Sabogal in Callao was performed. Samples from each patient were divided into two glass jars, one of which was fixed immediately with 10 percent formalin and the other was fixed after 24 hours. Both groups of samples were processed with the conventional technique of paraffin embedding and staining with hematoxylin-eosin. Results. Hp was found in 56.9 percent of the group of biopsies which were inmediatly fixed and in 79.2 percent of the group of biopsies fixed after 24 hours, showing statistical difference (p <0.001). Conclusions. There is an increased frequency of diagnosis of Hp in the samples that were fixed after 24 hours, which may suggest that this would act as a biological culture for Hp, which would facilitate its diagnosis.

Application of proteomics in research for gastric carcinoma / 国际肿瘤学杂志

Important developments have been obtained in research for gastric carcinoma with maturity of proteomics technology.The proteomics technology has been used to determine gastric carcinoma specimens such as cell lines,tumor tissues,serum,gastric juice,etc.Achievements have been gained in finding tumor marker and investigating biological behavior of gastric carcinoma as well as other aspects.

FOCAL NODULAR HYPERPLASIA OF THE LIVER: THE CLINICAL PATHOLOGICAL FEATURES AND TREATMENT / 解放军医学杂志

Clinical symptoms,multi screeming characters and pathological features of 15 cases of FNH were analysed retrospectively.11 cases were treated by operation.The results showed that three quarters(12/15) of the patients were male.Only one third(5/15) of the patients were diagnosed as FNH according to multi screeming of B US,CT and MRI.There were no complications for the 11 cases after operation.The results indicated it is difficult to diagnose FNH only by multi screeming methods.Operation is the best option for the treatment of FNH.

APPLICATION OF DEFECOGRAPHY IN THE DIAGNOSIS OF IRRITABLE BOWEL SYNDROME / 解放军医学杂志

To evaluate the clinical application of defecography in irritable bowel syndrome, 14 cases of diarrhoea predominant IBS, 12 cases of constipation predominant IBS and 10 cases of mixed patterns underwent defecography. Thirteen cases showed abnormal IBS (36 11%). The abnormal X ray features of anorectal angle and pelvic floor descent included rectocele, rectal mucosal prolapse, splanchnoptosis, perineum descent and spastic pelvic floor syndrome. Defecography is valuable in the diagnosis and treatment of irritable bowel syndrome