ABSTRACT
BACKGROUND AND STUDY AIMS: The aim of this study was to assess the ability of transabdominal ultrasonographic morphologic features and Doppler flow parameters in differentiating benign from malignant bowel lesions. PATIENTS AND METHODS: Sixty patients with sonographically detected gastrointestinal lesions and 30 control subjects were prospectively enrolled. Bowel wall thickness; length of the affected segment; the wall layering pattern; the resistive index (RI); pulsatility index (PI); flow volume (FV) of the intramural vessels, the superior mesenteric artery (SMA), and the portal vein (PV) were recorded. The final diagnosis was histopathological. Biopsies were obtained endoscopically, ultrasound-guided, or by surgery. RESULTS: Of the patients, 48 proved to be histopathologically malignant and 12 were benign. Malignant bowel lesions were found to have a higher mean wall thickness (a cutoff value of 12.3mm), more frequent loss of wall layering pattern (88.2% vs. 38.9%), a shorter length of affected segment (11.2 vs. 49.2cm); P=0.001. The RI, PI of the intramural vessels and SMA showed no difference between the inflammatory and malignant groups. Ultrasound-guided biopsy was resorted to in 13 patients (21.7%) and it was diagnostic in all of them. CONCLUSION: Ultrasonography is helpful in the characterisation of bowel lesions suggesting their benign or malignant nature. Ultrasound-guided biopsy has certain indications. The Doppler parameters of different pathologies are overlapping and thus are of little help in this regard.
Subject(s)
Image-Guided Biopsy/methods , Intestinal Diseases/diagnostic imaging , Intestine, Small/diagnostic imaging , Regional Blood Flow , Ultrasonography, Doppler/methods , Adult , Aged , Diagnosis, Differential , Endoscopy, Gastrointestinal , Female , Humans , Intestinal Diseases/pathology , Intestine, Small/pathology , Intestine, Small/physiopathology , Male , Middle Aged , Reproducibility of ResultsABSTRACT
BACKGROUND AND STUDY AIMS: Ascites may be of undetermined origin despite comprehensive study. This study aimed to assess the accuracy and safety of conventional and interventional high-frequency peritoneal ultrasound in the diagnosis of patients with ascites of unclear origin. PATIENTS AND METHODS: A total of 62 patients were prospectively enrolled; they underwent conventional (3.5-5MHz) and high-frequency (6-8MHz) transabdominal peritoneal ultrasound to suggest the nature of ascites supplemented by fine needle aspiration cytology (FNAC) of ascites and/or core biopsy of the omentum or other extra-visceral masses for final histopathologic diagnosis. Laparoscopy or laparotomy was needed if biopsy was inconclusive. RESULTS: Ultrasound-guided procedures were diagnostic in 55 (87.7%) patients. Thirty-six (58.1%) were benign, of whom 86% had tuberculous peritonitis, 26 (41.9%) were malignant, of whom 76.9% had peritoneal metastasis. High-frequency ultrasound was able to propose ultrasonographic criteria in a trial to diagnose the nature of ascites. Our proposed ultrasonographic criteria were based on the amount and texture of ascites in addition to the omental and mesenteric features. These were able to suggest the diagnosis with 80.7% sensitivity for malignant ascites and 75% specificity for benign ascites. Moreover, histopathological examination of tissues obtained by ultrasound-guided procedures increased the sensitivity to 88.5% and the specificity to 88.9% in diagnosing malignant and benign disease, respectively, with an overall diagnostic accuracy of 88.6%. These procedures were considered to be safe as only one major (haemoperitoneum) and two minor complications (temporary ascitic fistula) were reported. CONCLUSION: High-frequency peritoneal ultrasound together with the minimally invasive ultrasound-guided FNAC/biopsy of extra-visceral lesions may be considered an effective and safe tool in the diagnosis of ascites of undetermined origin.
Subject(s)
Ascites/diagnosis , Biopsy, Fine-Needle , Peritoneum/diagnostic imaging , Ultrasonography, Interventional , Adolescent , Adult , Aged , Ascites/diagnostic imaging , Ascites/etiology , Child , Cytodiagnosis , Female , Humans , Male , Middle Aged , Peritoneal Neoplasms/complications , Peritoneal Neoplasms/diagnosis , Peritoneal Neoplasms/diagnostic imaging , Peritoneal Neoplasms/secondary , Peritoneum/pathology , Peritonitis, Tuberculous/diagnosis , Peritonitis, Tuberculous/diagnostic imaging , Sensitivity and Specificity , Young AdultABSTRACT
Egypt has possibly the highest Hepatitis C Virus (HCV) prevalence worldwide. A high proportion of HCV infections become chronic and lead to liver cirrhosis and hepatocellular carcinoma (HCC). The cellular and molecular mechanisms behind HCV infection complication are not completely understood although apoptosis has been implicated in this process. Using flowcytometry, we examined whether T lymphocyte; isolated from patients with HCV and HCV-associated HCC (HCV-HCC); are predestined in vivo to undergo spontaneous apoptosis. Also, the role of p53; a key protein in apoptotic process; in the development of HCC was examined. Our data showed that T cells were severely depleted in HCV-HCC patients and its spontaneous apoptosis was higher in patient groups as compared to normal controls. In addition, p53 expression in liver tissue (determined by ELISA) was higher in the HCC patient groups as compared to normal controls and correlated well with the HCC grade. In conclusion, HCV infection induces peripheral T cell apoptosis, depletion and subsequently immune-suppression and this may lead to persistence of infection. Also, p53 is implicated in the poor prognosis of HCV-HCC and could be used as a predictive marker to assess the prognosis of HCC patients.
