ABSTRACT
OBJECTIVES: Guidelines for testing individuals at risk (IAR) for developing pancreatic duct adenocarcinoma (PC) are being advanced from university hospital populations. We implemented a screen-in criteria and protocol for IAR for PC in our community hospital setting. METHODS: Eligibility was based on germline status and/or family history of PC. Longitudinal testing continued, alternating between endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI). The primary objective was to analyze pancreatic conditions and their associations with risk factors. The secondary objective was to evaluate the outcomes and complications resulting from testing. RESULTS: Over 93 months, 102 individuals completed baseline EUS, and 26 (25%) met defined endpoints of any abnormal findings in the pancreas. Average enrollment was 40 months, and all participants with endpoints continued standard surveillance. Two participants (1.8%) had endpoint findings requiring surgery for premalignant lesions. Increasing age predicted for endpoint findings. Analysis of longitudinal testing suggested reliability between the EUS and MRI results. CONCLUSIONS: In our community hospital population, baseline EUS was effective in identifying the majority of findings; advancing age correlated with a greater chance of abnormalities. No differences were observed between EUS and MRI findings. Screening programs for PC among IAR can be successfully performed in the community setting.
Subject(s)
Hospitals, Community , Pancreatic Neoplasms , Humans , Reproducibility of Results , Early Detection of Cancer/methods , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/epidemiology , Endosonography/methods , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy , Pancreatic NeoplasmsABSTRACT
Human infection with the sheep liver fluke Fasciola hepatica is a global zoonosis that usually parallels the prevalence of infection in sheep and other ruminants. The disease is endemic in South and Central America, Puerto Rico, the Caribbean region, many parts of Africa, Asia, the Middle East, Australia, and China. There have been a number of focal outbreaks reported from Europe, including southern France and the Mediterranean region. Since acute fascioliasis has rarely been reported in the United States, physicians in this country frequently overlook the diagnosis. Therefore, we report a case of acute human fascioliasis and review the pathogenesis, diagnosis, and treatment of this disease in a recently arrived immigrant.
