[Diagnostic value of diffusion weighted imaging in assessment of malignant focal liver lesions].

INTRODUCTION: The study was designed to determine if there was a difference between apparent diffusion coefficient (ADC) values using diffusion weighted imaging (DWI) MRI technique between different malignant focal liver lesions. PATIENTS AND METHODS: The study included 63 patients with focal hepatic lesions: fourteen patients (22.2%) with hepatocellular carcinoma (HCC), 16 patients (25.4%) with hepatic metastatic colorectal tumors, 17 patients (26.9%) with cavernous haemangioma and 16 patients (25.4%) with hepatic cysts. MRI was performed with 1.5T scanner, using EPI sequence with ADC values being determined for all lesions based on three b values. RESULTS: ADC values were statistically different among the groups (F = 70.7, p < 0.01): HCC patients 1.11 +/- 0.29 x 10(-3) s/mm2, metastatic tumours 2.18 +/- 0.15 x 10(-3) s/mm2, haemangioma 2.22 +/- 0.32 x 10(-3) s/mm, cysts 3.08 +/- 0.03 x 10(-3) s/mm2. Furthermore, there was statistically significant difference between benign lesions (haemangiom and cysts, 2.36 +/- 0.43 x 10(-3) s/mm2), and malignant diseases (HCC and secondary tumors, 1.52 +/- 0.58 x 10(-3) s/mm2), t = 5,6, p < 0.01. CONCLUSION: DWI technique could be helpful in defining the focal liver lesions.

[Magnetic resonance cholangiopancreatography: diagnostic significance in malignant diseases of bile and pancreatic ducts].

Magnetic resonance cholangiopancreatography (MR CP) is a relatively new, noninvasive method in patients with pancreaticobiliary diseases, which is comparable to invasive endoscopic retrograde cholangiopancreatography (ERCP). One of the most common indications for MRCP is malignant obstruction of the bile and pancreatic ducts. Standard imaging protocol includes routine abdominal study followed by a sequence for MRCP adapted to each of the patients and site of the malignant process. MRCP is a simple to perform, does not exposure the patients to radiation, requires no anesthesia, is less operator dependent and allows better visualization of ducts proximal to an obstruction. Thus, during one examination only, it is possible to assess not only pancreaticobiliary system but also abdominal structures, which increases diagnostic value of MR and is therefore, optimal method in evaluation of these patients.

[Treatment of gastrointestinal hemorrhage manifestation induced by nonsteroidal anti-inflammatory agents]].

INTRODUCTION: The risk of upper gastrointestinal tract bleeding in the patients taking NSAID estimates 1% per year. Bleeding stops spontaneously in approximately 80% of all cases. Persistent and repeated bleeding (expecialy during the initial hospitalization) still represent the serious clinical problem. In this group of patients, mortality rate is between 6-10%, which in the USA counts 10-20000 patients per year. AIM OF THE STUDY: The purpose of this review is to update the current knowledge of the use of different therapeutic strategies in patients with NSAID induced upper gastrointestinal bleeding. RESULTS: Proton pump inhibitors (PPI) therapy is effective as a prevention of NSAID induced acidopeptic lesions, and also represents the first and best therapeutic option for the treatment of complications, such as upper gastrointestinal bleeding. In the last three decades use of early flexibile (diagnostic and therapeutic) endoscopy, agressive acidosupression (PPIs), and surgical treatment in restrictive indications, resulted in decreasing of the mortality rates from 25-35% to 6-10%. When PPIs and flexible endoscopy are not sufficient in the control of upper gastrointestinal bleeding, use of systemic hemostatic drugs could be taken into consideration. CONCLUSION: Multidisciplinary approach, precise diagnostic and therapeutic critearia would probably result in better outcome of patients with active upper gastrointestinal bleeding.

Paraoesophageal hernia repair with and without concomitant fundoplication.

There is currently no consensus as to whether an antireflux procedure should accompany surgical repair of paraoesophageal hernia. Forty consecutive patients with paraoesophageal hernia were studied. Surgery routinely included transabdominal hernia reduction, excision of the sac and crural repair. The addition of fundoplication was based on the presence of preoperative endoscopic evidence of oesophagitis. Twenty-three patients without endoscopic oesophagitis had no antireflux procedure whereas 17 with oesophagitis underwent concomitant antireflux surgery. Thirty-six patients were followed for 1-7 years. Patients without endoscopic oesophagitis had no postoperative reflux problems. All patients with oesophagitis who underwent fundoplication were improved or cured of reflux. The selection of patients for antireflux repair can satisfactorily be based on preoperative endoscopic findings.

Venous thromboprophylaxis in oesophageal cancer surgery.

In a retrospective study of 127 patients who underwent resection for oesophageal cancer without anticoagulant thromboprophylaxis, the incidence of clinically established postoperative deep vein thrombosis (DVT) was 1.6 per cent. In a prospective study the Sue-Ling DVT risk factor index was calculated for 53 consecutive patients with oesophageal cancer; the mean (s.d.) value was -4.4(3.5). For 29 patients who underwent resection the following policy of thromboprophylaxis was applied. Patients undergoing transthoracic oesophagectomy with risk score > -4 (four patients) and those undergoing transhiatal resection with risk score > -1 (four) received both anticoagulant and mechanical thromboprophylaxis; the remaining 21 patients received only mechanical thromboprophylaxis. No patient developed DVT after operation. There were no haemorrhagic complications in the group undergoing anticoagulant thromboprophylaxis. The selective approach, based on the Sue-Ling risk factor index and type of operation, spared 72 per cent of the patients operated on from undergoing anticoagulant thromboprophylaxis and produced favourable results in this small series.