EUS-FNA and FDG-PET are complementary procedures in the diagnosis of enlarged mediastinal lymph nodes.

BACKGROUND AND STUDY AIMS: Transoesophageal endosonography with fine needle aspiration (EUS-FNA) and 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography (FDG-PET) are now standard diagnostic procedures of the mediastinum. Our aim was to compare their value in the assessment of enlarged mediastinal lymph nodes detected by computed tomography. PATIENTS AND METHODS: Forty consecutive patients with a suspicion of cancer or a history of pulmonary, digestive, urogenital or mammary neoplasia and presenting with supracentimetric lymph nodes on computed tomography underwent whole body FDG-PET and EUS-FNA. Final diagnosis of malignancy was obtained by cytology, surgery or long-term follow-up. RESULTS: EUS-FNA showed a sensitivity, specificity and accuracy for detection of malignancy of 793, 100 and 85%, respectively. The biopsy material was adequate for cytological examination in 37 patients. Sensitivity, specificity and accuracy of PET were 100, 54.5 and 87.5%, respectively. FDG-PET correctly diagnosed the primary site in 27 patients, and showed additional unknown extrathoracic metastatic sites in 15 patients. The five false positive results observed with FDG-PET consisted in a final diagnosis of sarcoidosis, tuberculosis, anthracosilicosis and reactive lymph nodes, respectively. The association of FDG-PET and EUS-FNA avoided more invasive procedures (mediastinoscopies or staging surgery) in 34 patients. CONCLUSIONS: EUS-FNA and FDG-PET are complementary diagnostic procedures combining the high sensitivity of FDG-PET and the high specificity of EUS-FNA to accurately diagnose malignancy in enlarged mediastinal lymph nodes identified by CTscan. The combination of the two procedures in selected cases with pulmonary cancer or extra-thoracic tumours avoided more invasive diagnostic and surgical procedures.

Is pancreatoscopy of any benefit in clarifying the diagnosis of pancreatic duct lesions?

BACKGROUND AND STUDY AIMS: Modern fine-caliber endoscopes enable clinicians to directly visualize the pancreatic duct. They allow intraductal manipulation under optical control. We tried to evaluate the additional diagnostic potential of pancreatoscopy in assessing inconclusive intraductal pancreatic changes. PATIENTS AND METHODS: We prospectively performed 20 pancreatoscopies in 18 patients with inconclusive ductal abnormalities that had been previously investigated by computed tomography (CT) scan, abdominal ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). The CHF-BP 30 (Olympus Optical Co., Japan) endoscope with an outer diameter of 3.1 mm and an instrumentation channel of 1.2 mm was used. Biopsies, cytological brushing and fluid collection were carried out, and the site of ductal abnormality was visualized. Endoscopic sphincterotomy (EST) was carried out in every patient prior to insertion of the pancreatoscope. RESULTS: Seven intraductal tumors were histologically confirmed, i.e. five intraductal papillary mucinous tumors and two adenocarcinomas. Benign appearance of the intraductal lesion plus negative histopathological examinations were confirmed by a follow-up of two years in eight patients. Five had chronic pancreatitis, and a further three had pancreatitis with strictures, blood clot obstruction, and idiopathic benign stricture, respectively. There were no complications with the exception of one bleeding episode after EST; no pancreatitis occurred. CONCLUSIONS: Pancreatoscopy is of diagnostic value in addition to CT, transabdominal ultrasound and ERCP in the differential diagnosis of poorly defined pancreatic lesions, particularly when assessing alterations of the ductal caliber without parenchymatous lesions.

[Measurement of fecal elastase 1 by immunoreactivity: a new indirect test of the pancreatic function]. / Mesure de I'élastase 1 fécale par immunoréactivité: une nouvelle approche indirecte de la fonction pancréatique.

AIM: The aim of this study was to evaluate the potential and precision of the fecal elastase type 1 rest in comparison to the secretin-pancreozymin-test in the diagnosis of exocrine pancreatic insufficiency. METHODS: We studied 254 stool samples from 102 individuals without malabsorption (n = 53) and patients with pancreatic maldigestion syndromes (n = 49). Pancreatic elastase was measured immunologically, using a new enzyme immunoassay according to the sandwich technique. RESULTS: Spot stool immunoreactive elastase activity in controls ranged from 136 to 4,400 micrograms/g. Ninety five percent of all values where within 175 to 1,500 micrograms/g. The lower limit of normal was defined as 150 micrograms/g. No significant decrease of immunoreactivity was found when stool samples were stored at room temperature over five days. The assay variability calculated from 10 consecutive assays of a single fecal sample gave coefficients of variation ranging from 3.3 to 6.3% for intraassay-variability and from 4.1 to 10.2% for interassay-variability. There was a good correlation between the output of elastase compared to lipase output with correlations coefficients of 0.821 in controls and 0.905 in patients with impaired pancreatic function. In stool samples of 49 patients with exocrine pancreatic insufficiency the concentration of fecal elastase was significantly lower (P < 0.001) compared to controls and patients with Crohn or coeliac disease. Elastase immunoreactivity showed higher sensitivity and specificity as compared to fecal chymotrypsin. Furthermore, in contrast to fecal chymotrypsin, the test results were unaffected by pancreatic enzyme replacement therapy. CONCLUSION: These results indicate that fecal immunoreactive elastase may be recommended as a new, non-invasive easy-to-perform tubeless pancreatic function test with a high sensitivity and specificity in comparison with healthy controls.

Eosinophilic gastroenteritis presenting with colitis and cholangitis.

Eosinophilic gastroenteritis (EG) is a rare condition that most commonly affects the stomach and intestine. Large bowel involvement has also been described. We report a case of EG presenting with colitis and cholangitis. This is the first case of associated cholangitis demonstrated radiologically and histologically. Simultaneous biliary and gastrointestinal tract involvement suggest a common link between EG and hypereosinophilic syndrome (HES). However, HES requires high peripheral hypereosinophilia and several organs including gastrointestinal tract, lung, heart, infiltrated with eosinophils. The patient's condition improved with corticosteroids.

Biliary cystadenoma of the liver with elevated CA 19-9.

A case of intrahepatic biliary cystadenoma with mesenchymal stroma is reported. The tumor was associated with strikingly elevated serum and intracystic levels of the tumor-associated antigen CA19-9. Two months after surgical enucleation, serum CA 19-9 levels returned to normal.

[Vascular gastric anomalies, CREST syndrome and primary biliary cirrhosis: efficacy of ethinyl estradiol-norethisterone combination]. / Anomalies vasculaires gastriques, CREST syndrome et cirrhose biliaire primitive: efficacité de l'association éthinyloestradiol-noréthistérone.

Vascular gastric lesions are a rare cause of chronic gastric bleeding. We report the case of a 70-year old woman with primary biliary cirrhosis, CREST syndrome and vascular gastric lesions corresponding to watermelon stomach. Oestrogen-progesterone treatment successfully controlled recurrent blood loss.

Acute phosphine poisoning? A case report and review.

A case compatible with an acute phosphine poisoning after inhalation is presented. The observation was notably characterized by necrosis of the nasal mucosa, the delayed onset of a pulmonary edema and myocardial injury with multisystemic involvement. A review of literature, not very prolific in this field, is included in the discussion.