Solid pancreatic lesions: The choice of fine-needle aspiration-needle to optimize the diagnosis.

INTRODUCTION: Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) have a better accuracy for the detection of pancreatic tumors compared with others images modalities. We assessed if the image criteria of elastography and contrast harmonic echo-endoscopic ultrasound could help in choosing the appropriate FNA-needle in the evaluation of focal pancreatic mass in other to maximize the diagnostic yield. This study prospectively included all new patients with focal pancreatic masses referred to be examined by EUS from October to December/2013. A total of 21 patients performed EUS with sequentially elastography and intravenous injection of a second-generation contrast agent (2.4 mL of SonoVue, Braco International, The Netherlands). The lesions which appear hipovascular were assessed with 22 gauge or 25 gauge FNA-needles. The hipervascular masses were biopsied with 19 gauge needles. RESULTS: The topography of the lesions varied on 13 at the head, 4 at the body and 1 on the tail. The finding of a hypoenhanced mass was found in 57% (12/21 patients). Hyperenhanced was detected in 28% (6/21 patients). There were 14% (three patients) which the data were not recorded. The cytological diagnosis was achieved in 81% (17/21 patients) on the first biopsy. The others four patients have reached the diagnosis on the second examination. Of those four patients, in one was used the ProCore 25 gauge (lesion on the uncinatus process), and another one was used both 22 gauge and 25 gauge in the first examination. CONCLUSION: A characterization of the pancreatic lesions with elastography and contrast agents might be useful for clinical decision of which needle is better to improve biopsy quality and minimize EUS-FNA negatives results.

Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study.

INTRODUCTION: Biliary obstruction is preferentially managed by endoscopic retrograde cholangiopancreatography (ERCP). However, after ERCP failed, alternatives include percutaneous transhepatic drainage, surgery and more recently, endoscopic ultrasonography (EUS)-guided hepaticogastrostomy. The limitation of this technique is that the drainage is restricted to the left side. The aim of this study is to describe a new method of drainage of both hepatic ductal systems by hepaticogastrostomy in patients with hilar obstruction. RESULTS: Nine prospectively patients were included, all with hilar obstruction (metastasis of a pancreatic adenocarcinoma n = 4, cholangiocarcinoma n = 1, gallbladder cancer n = 2 and metastasis from a pancreatic neuroendocrine tumor n = 2). A total of four patients had previously Whipple surgery and the others five had duodenal involvement by the tumor. The topography of the stenosis varied from Bismuth type 2 (n = 7) and hilar infiltration in the others two. All of them were submitted a three-step drainage. The first one consisted in a transgastric EUS-guided puncture of the left-side bile duct with a 19 gauge needle, insertion of a 0.0035 inch guide wire which was positioned at the right biliary tree crossing the bile bifurcation. After a dilatation with 6 Fr cystotome, a non-covered self-expandable metal stent was placed communicating the right and left biliary ducts. Finally, a second stent, partially covered, was inserted at the left biliary duct, with the distal part inside the previously stent and the proximal edge positioned at the stomach. Successful drainage was observed in seven patients, two of them presented abdominal pain during the first 72 h. One patient developed sepsis and death 7 days after the procedure and the other one had drainage failure. Jaundice was reduced significatively in seven patients and a chemotherapy was started in 6/7 patients. CONCLUSION: This pilot study shows the feasibility of this new technique to drain the right biliary duct in patients with hilar obstruction, with few major complications rates.

Predicting outcomes and complications of percutaneous endoscopic gastrostomy.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy (PEG) is the preferred route for long-term enteral feeding. Our aims were to prospectively evaluate the outcome ("PEG status") and complications of PEG and to determine whether these can be predicted by patients' baseline characteristics. PATIENTS AND METHODS: We conducted a prospective study in two tertiary hospitals between August 2003 and January 2005, enrolling all patients who were undergoing PEG placement. We completed a questionnaire with details of demographic data, diagnosis, indication for PEG, Charlson's co-morbidity index, Barthel's index, laboratory tests, complications, and date and cause of death. Patients were followed at scheduled appointments. Univariate and multivariate analyses were performed. RESULTS: 168 patients (48% male, 52% female; mean age +/- standard deviation 74 +/- 16 years) underwent PEG using the pull technique. The main indication was neurogenic dysphagia (156 patients, 92.9%). Although most indications were appropriate, in half the cases these were established too late. There were no procedure-related deaths. Major complications occurred in four patients (2.4%); minor complications occurred in 52 patients (31%). No single variable could predict complications. Fifteen patients (9%) had the PEG removed. No single variable was independently associated with PEG removal. The mortality was 6.5% at 30 days, 17.3% at 90 days and 33.9% at 1 year. The C-reactive protein was the only predictive factor of early mortality (< or = 30 days), and Charlson's co-morbidity index was the only predictive factor of late mortality (> 30 days). CONCLUSIONS: PEG placement is an easy and safe procedure, although it is often requested too late. No single variable could predict complications or PEG removal. C-reactive protein was found to be predictive of early mortality and Charlson's index was predictive of late mortality.

Evaluation of the mussel Perna perna as a biomonitor of polycyclic aromatic hydrocarbon (PAH) exposure and effects.

The mussel Perna perna was used to monitor and assess areas suspected of oil contamination by transplanting animals from unimpacted to impacted sites and vice versa. The deployment lasted for three months during which total PAH were measured in seawater samples collected every 15 days. PAH concentrations were determined in mussel tissue monthly. The lysosomal neutral red assay and the condition index were used as biomarkers of the adverse biological effects. The PAH concentration in mussels at unimpacted sites, prior to deployment was ca. 100 microg kg(-1) but increased to 300 microg kg(-1) after three months at the contaminated site. Mussels transplanted to the uncontaminated site showed a decrease from 380 to 80 microg kg(-1). Significant changes in lysosomal stability occurred within one month of the beginning of the transposition; in contrast condition indexes were not correlated with the observed changes in PAH concentration.

Polycyclic aromatic hydrocarbon in inter-tidal mussel Perna perna: space-time observations, source investigation and genotoxicity.

The investigation aimed primarily at understanding the PAH record in inter-tidal mussel tissues and evaluating the bivalve performance as a bioindicator for oil contamination. The species Perna perna was used as test organism since it is abundantly distributed in coastal areas of the Americas, Africa and elsewhere. The study was carried out in Guanabara Bay and comprised two observation phases: phase one included seasonal sampling in 8 sites, whereas in phase two 4 sites were examined over 4 years. Among the 35 determined PAH (60-90 microg kg(-1) up to 4000-6000 microg kg(-1)) alkylated homologues predominated by more than 80%. The PAH profile in inter-tidal mussels is largely petrogenic with high contribution of dibenzothiophenes (DBT) and phenanthrenes (Ph). The prevailing petrogenic fingerprint, confirmed by diagnostic ratios, is linked to the properties of the inter-tidal habitat, which favors exposure to oil films. C2DBT/C2Ph and C3DBT/C3Ph ratios, however, show a wide range of values uncorrelated to specific oils. Micronucleus frequencies are significantly related to PAH concentrations, especially to those of alkylated homologues. Genotoxic expression appears at concentrations as low as 300 microg kg(-1) summation operator 35 PAH.

Evaluation of a commercially available ELISA kit as a tool to determine BTEX in groundwater.

The reliability of enzyme-linked immunosorbent assay (ELISA) tests as a screening technique to address groundwater contamination was tested in an area following leakage of gasoline from a petrol station. Immunoassay data of benzene, toluene, ethylbenzene, and o-, m- and p-xylene (BTEX) were compared with results obtained using capillary gas chromatographic analysis. Detection limits were of 20 microg l(-1) for ELISA and 0.3 microg l(-1) for gas chromatography with flame ionization and photoionization detectors (GC-FID/PID) determination. Despite an observed overestimation of BTEX concentrations as given by ELISA, the tests responded reliably to different levels of contamination.

A non-destructive assessment of the exposure of crabs to PAH using ELISA analyses of their urine and haemolymph.

Urine and haemolymph can be repeatedly sampled from crabs with no (or limited) damage to the organism. Their analysis offers a measure of the animals' exposure to biologically available contaminants. Shore crabs (Carcinus maenas) were exposed to the PAHs phenanthrene and pyrene at concentrations ranging from 20 to 200 microg l(-1). After 48 h, urine and haemolymph samples were taken and analysed using ELISA and UV-fluorescence spectrophotometry. High correlations were recorded between the two sets of results from the urine analyses (r2 = 0.83 for phenanthrene and r2 = 0.88 for pyrene). Contaminant concentrations were much lower in haemolymph than in the urine. Analyses of urine taken from crabs collected from clean and contaminated sites confirm the suitability of these analyses for environmentally exposed organisms. Again, a good correlation was recorded between the ELISA and spectrofluorimetric analysis (r2 = 0.83). In this instance, difficulties were experienced with haemolymph analyses owing to a lack of sensitivity.