Metodologías de Medición de Volumetría Hepática / Methodologies For Measuring Hepatic Volumetry

Lograr determinar el volumen total de un hígado (VHT), o volumetría hepática, pasa a ser de relevancia en diversas situaciones, tales como, vigilancia del progreso de una enfermedad de carácter crónico, planificación de resecciones y trasplantes hepáticos; y observación del clearance hepático de algunos fármacos hepatotropos. La VHT se puede realizar utilizando métodos de segmentación en el curso de una tomografía computarizada (TC), ya sean estos manual, automáticos, y semiautomáticos; mediante resonancia nuclear (RN), utilizando softwares de distintas generaciones (1ª a 4ª). La medición de VHT está indicada en pacientes sometidos a resecciones hepáticas mayores, en el contexto del tratamiento de neoplasias (carcinoma hepatocelular, colangiocarcinoma, metástasis hepáticas o tumores benignos de gran tamaño), abscesos (piogénicos, amebianos), y después de un traumatismo hepático complejo; así como también en la etapa preoperatoria de un trasplante hepático. El objetivo de este manuscrito fue generar un documento de estudio sobre métodos para determinar volumetría hepática.

SUMMARY: Being able to determine the total hepatic volume (THV), or THV, becomes relevant in various situations, such as monitoring the progress of a chronic disease, planning resections and liver transplants; and observation of the hepatic clearance of some hepatotropic drugs. THV can be performed using segmentation methods in the course of a computed tomography (CT), whether manual, automatic, or semi-automated; by nuclear resonance (NR), using software from different generations (1st to 4st). THV measurement is indicated in patients undergoing major liver resections, in the context of treatment of neoplasms (hepatocellular carcinoma, cholangiocarcinoma, liver metastases or large benign tumors), abscesses (pyogenic, amoebic), and after liver trauma complex, as well as in the preoperative stage of a liver transplant. The aim of this manuscript was to generate a study document regarding methods for determine hepatic volumetry.

Pancreatic ductal adenocarcinoma (PDAC) regional nodal disease at standard lymphadenectomy: is MRI accurate for identifying node-positive patients?

OBJECTIVE: To determine the accuracy of qualitative and quantitative MRI features for the diagnosis of pathologic regional lymph nodes at standard lymphadenectomy in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: All adult patients with pancreatic MRI performed from 2011 to 2021 within 3 months of a pancreaticoduodenectomy were eligible for inclusion in this single-center retrospective cohort study. Regional nodes at standard lymphadenectomy were independently reviewed by two fellowship-trained abdominal radiologists for the following qualitative features: heterogeneous T2 signal, round shape, indistinct margin, peri-nodal fat stranding, and restricted diffusion greater than the spleen. Quantitative characteristics including primary tumor size, largest node short- and long-axes length, number of regional nodes, absolute apparent diffusion coefficient (ADC) values, and ADC node-to-spleen signal index were assessed. Analysis was at the patient-level with surgical pathology as the reference standard. RESULTS: Of 75 patients, 85% (64/75) were positive for regional nodal disease on histopathology. None of the qualitative variables evaluated on MRI was associated with pathologic nodes. Median primary tumor maximum diameter was slightly larger for patients with pathologic nodes compared to those without (18 mm (10-42 mm) vs 16 mm (9-22 mm), p = 0.027). None of the other quantitative features was associated with pathologic nodes. Radiologist opinion was not associated with pathologic nodes (p = 0.520). Interobserver agreement was fair (kappa = 0.257). CONCLUSIONS: Lymph node morphologic features and radiologist opinion using MRI are of limited value for diagnosing PDAC regional nodal disease. Improved diagnostic techniques are needed given the prognostic implications of pathologic lymph nodes in these patients. KEY POINTS: • Multiple lymph node morphologic features routinely assessed on MRI for malignancies elsewhere in the body are likely not applicable when assessing for pancreatic ductal adenocarcinoma nodal disease. • Interobserver agreement for the presence or absence of pancreatic ductal adenocarcinoma lymph node morphologic features on MRI is fair (kappa = 0.257). • Many more lymph nodes are resected at PDAC standard lymphadenectomy than are detectable on MRI, median 25 vs 5 (p < 0.001), suggesting improved diagnostic techniques are needed to identify PDAC nodal disease.

Public acceptance and uptake of oesophageal adenocarcinoma screening strategies: A mixed-methods systematic review.

Oesophageal adenocarcinoma (OAC) is increasingly diagnosed and often fatal, thus representing a growing global health concern. Screening for its precursor, Barrett's oesophagus (BO), combined with endoscopic surveillance and treatment of dysplasia might prevent OAC. This review aimed to systematically explore the public's acceptance and uptake of novel screening strategies for OAC. We systematically searched three electronic databases (Ovid Medline/PubMed, Ovid EMBASE and PsycINFO) from date of inception to July 2, 2021 and hand-searched references to identify original studies published in English on acceptability and uptake of OAC screening. Two reviewers independently reviewed and appraised retrieved records and two reviewers extracted data (verified by one other reviewer). Of the 3674 unique records, 19 studies with 15 249 participants were included in the review. Thematic analysis of findings showed that acceptability of OAC screening is related to disease awareness, fear, belief in benefit, practicalities and physical discomfort. The findings were mapped on the Integrated Screening Action Model. Minimally invasive screening tests are generally well-tolerated: patient-reported outcomes were reported for sedated upper endoscopy (tolerability ++), transnasal endoscopy (tolerability +), tethered capsule endomicroscopy (tolerability +/-), and the Cytosponge-TFF3 test (acceptability ++). In discrete choice experiments, individuals mainly valued screening test accuracy. OAC screening has been performed in trials using conventional upper endoscopy (n = 231 individuals), transnasal endoscopy (n = 966), capsule endoscopy (n = 657) and the Cytosponge-TFF3 test (n = 9679), with uptake ranging from 14·5% to 48·1%. Intended participation in OAC screening in questionnaire-based studies ranged from 62·8% to 71·4%. We conclude that the general public seems to have interest in OAC screening. The findings will provide input for the design of a screening strategy that incorporates the public's values and preferences to improve informed participation. Identification of a screening strategy effective in reducing OAC mortality and morbidity remains a crucial prerequisite. Funding: This study was funded by the Netherlands Organization for Health Research and Development (ZonMw) under grant 555,004,206.

Diagnostic value of endoscopic ultrasonography for extra-hepatic bile duct dilation of unknown reasons / 中华消化内镜杂志

Objective@#To evaluate diagnostic efficacy of endoscopic ultrasonography (EUS) for extra-hepatic bile duct dilation of unknown reasons which failed to be identified by traditional radiological methods.@*Methods@#Data of consecutive 892 patients who underwent EUS from February 2016 to September 2017 were retrospectively studied. Final diagnosis was determined by endoscopic retrograde cholangiopancreatography (ERCP)-based biopsy, surgical pathology, or a follow-up of at least 10 months.@*Results@#A total of 82 patients with extra-hepatic bile duct dilation (width ≥ 7 mm) and mean age of 61.5±9.6 years were included. The width of common bile duct was 13.0±4.25 mm. Reasons for extra-hepatic bile duct dilation could be determined by EUS in most patients with abnormal liver function. No malignant causes were detected in patients with normal liver function. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 92.7%, 100.0%, 96.3%, 100.0%, and 93.2%, respectively.@*Conclusion@#For patients with dilated extra-hepatic bile duct without clear etiology, EUS may be an alternative for determining the etiology of extra-hepatic bile duct dilation. For those with extra-hepatic bile duct dilation with abnormal liver function, malignant causes should not be neglected.

[Developments in dysphagia diagnostics : Presentation of an interdisciplinary concept]. / Entwicklungen in der Dysphagiediagnostik : Vorstellung eines interdisziplinären Konzepts.

Demographic developments and medical progress will cause the already high prevalence of swallowing disorders to increase further in the future. With the same number of specialists and economic resources, it is necessary to improve the efficiency of dysphagia diagnostics and continue to offer patients a treatment concept tailored to their needs. Manifold and often co-existing causes of dysphagia require interdisciplinary cooperation in this area. Endoscopic swallowing diagnostics play a prominent role in dysphagia diagnostics and should always contain thorough endoscopy of the upper aerodigestive tract-the domain of the ENT specialist and phoniatrician. The concept of a dysphagia day clinic under phoniatric leadership presented here allows for complete and efficient evaluation of swallowing disorders, and offers the patient a comprehensive treatment concept. Technical innovations such as the use of narrow band imaging (NBI) to significantly enhance visualization of the bolus in an endoscopic swallowing examination, as well as special methods like the "dipping maneuver" to allow a close-up examination of the subglottis and trachea were able to improve endoscopic dysphagia diagnosis even further. The examination procedure and the selection of test consistencies and placebo tablets should be tailored individually to the patient, and not follow strict procedures. The task of the ENT specialist or phoniatrician should be to assess and advise each patient individually, depending on underlying illnesses, prognosis, living conditions, and their own wishes. An interdisciplinary team of physicians and therapists permits individual counseling and therapy planning.

The analysis of clinical application of sedated gastrocolonoscopy / 中国基层医药

Objective To evaluate the value of clinical application of sedated gastrocolonoscopy,to release distress of patients,improve curative effect.Methods To select 148 patients with gastrointestinal diseases who received gastrocolonoscopy,148 patients were divided into two groups randomly,therapy group 74 patients,control group 74 patients.Results The patients of therapy group had less distress,higher compliance,no adverse reaction.All of patients completed diagnosis successfully.But the patients of control group appeared adverse reactions,including vomiting,restlessness equal.Furthermore 9 patients end manipulate because of this.Conclusion Sedated gastrocolonoscopy versus conventional gastrocolonoscopy had less adverse reactions,higher security,and it should be spread in clinical application.

Comparación entre las biopsias gástricas sin fijar 24 horas frente a la biopsia convencional para el diagnóstico de Helicobacter pylori en un hospital de referencia de Perú / Comparison between gastric biopsies without fixation for 24 hours and conventional biopsy for the diagnosis of Helicobacter pylori in a reference hospital in Peru

Objetivos. Comparar biopsias gástricas fijadas inmediatamente con formol al 10 por ciento frente a biopsias fijadas tras 24 horas en la detección de Helicobacter pylori (Hp) en un hospital de referencia en Perú. Materiales y métodos. Se realizó un estudio de test diagnóstico sobre las biopsias gástricas de 72 pacientes que acudieron al Servicio de Gastroenterología del Hospital Essalud Alberto Sabogal en el Callao. Las muestras de cada paciente fueron repartidas en dos frascos de vidrio, una de ellas se fijó inmediatamente con formol al 10 por ciento y a la otra se fijó luego de 24 horas. Se procesaron ambos grupos de muestras con la técnica convencional de inclusión en parafina y coloración con hematoxilina-eosina. Resultados. Se evidenció Hp en 56,9 por ciento del grupo de biopsias fijadas inmediatamente y en el 79,2 por ciento del grupo de biopsias fijadas tras 24 horas, encontrándose diferencia estadística (p<0,001). Conclusiones. Existe una mayor frecuencia de diagnóstico de Hp en las muestras que se fijaron luego de 24 horas; lo que podría sugerir que ello actuaría como un cultivo biológico para Hp que facilitaría su diagnóstico.

Objectives. To compare gastric biopsies immediately fixed with 10 percent formalin with biopsies fixed after 24 hours for the detection of Helicobacter pylori (Hp) in a reference hospital in Peru. Materials and methods. A diagnostic test study on gastric biopsies from 72 patients attending the Gastroenterology service of hospital Essalud Alberto Sabogal in Callao was performed. Samples from each patient were divided into two glass jars, one of which was fixed immediately with 10 percent formalin and the other was fixed after 24 hours. Both groups of samples were processed with the conventional technique of paraffin embedding and staining with hematoxylin-eosin. Results. Hp was found in 56.9 percent of the group of biopsies which were inmediatly fixed and in 79.2 percent of the group of biopsies fixed after 24 hours, showing statistical difference (p <0.001). Conclusions. There is an increased frequency of diagnosis of Hp in the samples that were fixed after 24 hours, which may suggest that this would act as a biological culture for Hp, which would facilitate its diagnosis.

Application of proteomics in research for gastric carcinoma / 国际肿瘤学杂志

Important developments have been obtained in research for gastric carcinoma with maturity of proteomics technology.The proteomics technology has been used to determine gastric carcinoma specimens such as cell lines,tumor tissues,serum,gastric juice,etc.Achievements have been gained in finding tumor marker and investigating biological behavior of gastric carcinoma as well as other aspects.

APPLICATION OF DEFECOGRAPHY IN THE DIAGNOSIS OF IRRITABLE BOWEL SYNDROME / 解放军医学杂志

To evaluate the clinical application of defecography in irritable bowel syndrome, 14 cases of diarrhoea predominant IBS, 12 cases of constipation predominant IBS and 10 cases of mixed patterns underwent defecography. Thirteen cases showed abnormal IBS (36 11%). The abnormal X ray features of anorectal angle and pelvic floor descent included rectocele, rectal mucosal prolapse, splanchnoptosis, perineum descent and spastic pelvic floor syndrome. Defecography is valuable in the diagnosis and treatment of irritable bowel syndrome

FOCAL NODULAR HYPERPLASIA OF THE LIVER: THE CLINICAL PATHOLOGICAL FEATURES AND TREATMENT / 解放军医学杂志

Clinical symptoms,multi screeming characters and pathological features of 15 cases of FNH were analysed retrospectively.11 cases were treated by operation.The results showed that three quarters(12/15) of the patients were male.Only one third(5/15) of the patients were diagnosed as FNH according to multi screeming of B US,CT and MRI.There were no complications for the 11 cases after operation.The results indicated it is difficult to diagnose FNH only by multi screeming methods.Operation is the best option for the treatment of FNH.