A man with abdominal pain and eosinophilia : tissue is the issue.

A 24-year-old male presented with abdominal pain, postprandial vomiting and weight loss. Lab results showed an elevated serum eosinophil count and CT-scan demonstrated a thickened antral, duodenal and jejunal wall. Repetitive endoscopic mucosal biopsies were normal. Work-up of eosinophilia-associated gastro-intestinal disorders excluded secondary causes. Bone marrow showed an elevated eosinophil count without arguments for a primary hypereosinophilic syndrome. Endoscopic ultrasound-guided fine needle biopsy detected a strongly elevated number of eosinophils in the muscularis layer of the duodenum. The diagnosis of muscularispredominant eosinophilic gastroenteritis together with a secondary hypereosinophilic syndrome was made. The patient was started on steroids and all symptoms vanished within a few days.

Anorectal staging: is EUS necessary?

A correct preoperative staging of rectal cancer is important because overall survival and disease-free survival are dependent on TN stage and treatment method. Initially endorectal ultrasound (ERUS) was the mainstay in many institutions for the local staging of all rectal carcinomas. It was more accurate than CT and magnetic resonance imaging (MRI) for the evaluation of local invasion and had a comparable diagnostic accuracy for lymph node involvement. In recent years there has been a shift away from ERUS for the staging of rectal cancer. This can be partially explained by factors linked to ERUS such as the low reported accuracy in the staging of rectal cancer in some recent studies and the operator dependency. A more important reason for the shift is caused by improvements in MRI technology. MRI has taken over the role of ERUS in a lot of centers because it is better tolerated, can be used in stenotic tumors and it can assess the circumferential resection margin. This extramural spread is the most important prognostic indicator with regard to T stage and tilts the balance towards MRI as the modality of choice for advanced rectal cancers. ERUS is still important in the pre-operative staging of early rectal cancer and can help in selecting patients eligible for local excision. ERUS can also have an added value to improve N staging by performing FNA.

A rare infectious complication after endoscopic ultrasound guided fine needle aspiration in an oncological patient and review of the literature.

An endoscopic ultrasound guided fine needle aspiration of a mediastinal lymph node was performed in a cancer patient. Shortly after this procedure, a streptococcus salivarius endocarditis was diagnosed. To our knowledge, this is the first case in the literature of endocarditis following ultrasound guided fine needle aspiration in the absence of cardiac risk factors.

Texture segmentation using Gaussian-Markov random fields and neural oscillator networks.

We propose an image segmentation method based on texture analysis. Our method is composed of two parts. The first part determines a novel set of texture features derived from a Gaussian-Markov random fields (GMRF) model. Unlike a GMRF-based approach, our method does not employ model parameters as features or require the extraction of features for a fixed set of texture types a priori. The second part is a 2D array of locally excitatory globally inhibitory oscillator networks (LEGION). After being filtered for noise suppression, features are used to determine the local couplings in the network. When LEGION runs, the oscillators corresponding to the same texture tend to synchronize, whereas different texture regions tend to correspond to distinct phases. In simulations, a large system of differential equations is solved for the first time using a recently proposed method for integrating relaxation oscillator networks. We provide results on real texture images to demonstrate the performance of our method.

Motion segmentation based on motion/brightness integration and oscillatory correlation.

A segmentation method based on the integration of motion and brightness is proposed for image sequences. The method is composed of two parallel pathways that process motion and brightness, respectively. Inspired by the visual system, the motion pathway has two stages. The first stage estimates local motion at locations with reliable information. The second stage performs segmentation based on local motion estimates. In the brightness pathway, the input scene is segmented into regions based on brightness distribution. Subsequently, segmentation results from the two pathways are integrated to refine motion estimates. The final segmentation is performed in the motion network based on refined estimates. For segmentation, locally excitatory globally inhibitory oscillator network (LEGION) architecture is employed whereby the oscillators corresponding to a region of similar motion/brightness oscillate in synchrony and different regions attain different phases. Results on synthetic and real image sequences are provided, and comparisons with other methods are made.

Gallstone recurrence after successful shock wave therapy: the magnitude of the problem and the predictive factors.

OBJECTIVE: Reports concerning long term recurrence of gallstones after successful extracorporeal shock wave lithotripsy (ESWL) show a high probability of stone recurrence. There is still discussion on the factors influencing stone recurrence. In this study we wanted to evaluate the long term recurrence of gallstones after stone clearance with ESWL and oral bile acids, and to assess possible risk and preventive factors of stone recurrence. METHODS: A total of 322 consecutive patients with stone clearance between December 1988 and December 1995 were included. All patients were contacted for ultrasonography and were interviewed for additional information on daily intake of aspirin, NSAIDs, cholesterol lowering medication, estrogen therapy, and biliary pain during follow-up. RESULTS: A total of 187 patients were still stone-free after a mean follow-up of 35 months (range: 3-89 months); 135 patients had recurrence. There was a significant association between stone recurrence and estrogen intake (p = 0.04), number of lithotripsy sessions (p = 0.0007), time until stone disappearance (p = 0.0003), and biliary pain (p < 0.0001). There was no difference in recurrence rate between solitary and multiple stones. CONCLUSIONS: Long-term recurrence of gallstones after lithotripsy is high: < or = 69% after 6 yr. We found a significant association of stone recurrence with estrogen intake, number of lithotripsy sessions, and time until stone disappearance. Intake of aspirin or NSAIDs was not associated with decreased stone recurrence. Of the patients with recurrent stones, 57% had biliary pain.

Ultrasound and CT changes of liver parenchyma in acute schistosomiasis.

Acute schistosomiasis in travellers to endemic regions often remains unrecognized. Early diagnosis is important to avoid progression to chronic disease. Diagnosis is based on clinical, epidemiological and laboratory data. The role of imaging techniques as diagnostic tools remains to be established in acute clinical schistosomiasis. We describe hypodense nodules in the liver on ultrasound and CT scanning in a patient with acute schistosomiasis (Katayama syndrome). To our knowledge this is the first description of nodular hepatic lesions in acute schistosomiasis.

Recurrent pericardial effusion as a result of chronic pancreatitis. Successful treatment with somatostatin.

We report a well-documented case of relapsing chronic calcifying pancreatitis with recurrent pleural and pericardial effusions during episodes of clinical and biochemical relapse of the pancreatitis. Pericardial effusions in association with pancreatitis have been reported only very occasionally, almost exclusively in chronic alcoholic pancreatitis with pseudocyst formation. Our successful conservative treatment consisted of parenteral nutrition and a continuous infusion of somatostatin for 6 weeks. We discuss other reported cases and proposed mechanisms of pathogenesis.