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Staging algorithm for diffuse malignant pleural mesothelioma.

An algorithm of preoperative mediastinal nodal staging with endobronchial/endoesophageal ultrasonography (EBUS/EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) combined with laparoscopy/peritoneal lavage and cytology was analyzed to establish the realistic criteria for radical multimodality treatment of malignant pleural mesothelioma (MPM). The algorithm included computed tomography (CT), thoracoscopy with multiple pleural biopsies and talc pleurodesis, EBUS/EUS and one-stage TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid. Forty-two patients were diagnosed

Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy.

BACKGROUND: Real-time endobronchial ultrasound has increased the accuracy of conventional transbronchial needle aspiration biopsy in sampling mediastinal lymph nodes. Nevertheless, direct comparisons with mediastinoscopy are not available to determine the role of endobronchial ultrasound in pathologic staging. OBJECTIVES: To compare the diagnostic yield of endobronchial ultrasound against cervical mediastinoscopy in the diagnosis and staging of radiologically enlarged mediastinal lymph nodes stations accessible by both modalities in patients with suspected nonsmall cell lung cancer. METHODS:

Endoscopic Doppler optical coherence tomography in the human GI tract: initial experience.

BACKGROUND: Expanding the current endoscopic optical coherence tomography (OCT) system with Doppler capability may augment this novel high-resolution cross-sectional imaging technique with functional blood flow information. The aim of this feasibility study was to assess the clinical feasibility of an endoscopic Doppler OCT (EDOCT) system in the human GI tract. METHODS: During routine endoscopy, 22 patients were imaged by using a prototype EDOCT system, which provided color-Doppler and velocity-variance images of mucosal and submucosal blood flow at one frame per second, simultaneously with h

Three-dimensional linear endoscopic ultrasound-feasibility of a novel technique applied for the detection of vessel involvement of pancreatic masses.

BACKGROUND: Endoscopic ultrasound (EUS) can reliably diagnose and stage pancreatic cancer but is less competent for the differentiation between vascular compression (VC) and invasion (VI). AIM: Prospective comparison of linear EUS with/without three-dimensional (3D) EUS for vessel involvement in pancreatic cancer to evaluate the feasibility of linear 3D ultrasound. MATERIAL AND METHODS: Linear echoendoscopy was used to identify the pancreatic tumor, the tumor-vessel relation and for EUS-FNA to obtain tissue diagnosis. Immediately afterwards, 3D image acquisition was performed using a magneti

Diagnosis and management of ectopic pregnancy.

Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The condition is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should perform a pregnancy test. If the patient is pregnant, the physician should perform a work-up to detect possible ectopic or ruptured ectopic pregnancy. Prompt ultrasound evaluation is key in diagnosing ectopic pregnancy. Equivocal ultrasound results should be combined with quantitative beta sub

Endoscopic ultrasonography.

Endoscopic ultrasound (EUS) was introduced in the early 1980s in an attempt to improve sonographic imaging of the pancreas. Its uses have been expanded to include examination of the upper and lower gastrointestinal tracts, hepatobiliary and portal systems,and the anal sphincter; diagnosis and staging of esophageal, gastric,and pancreaticobiliary tumors; and evaluation of mediastinal nodes in lung cancer. Although EUS has its limitations and is greatly dependent on operator skill, it has wide-ranging interventional and therapeutic applications that can be expected to increase in the future with

[Preoperative diagnostic procedures in locally advanced rectal carcinoma (> or =T3 or N+). What does endoluminal ultrasound achieve at staging and restaging (after neoadjuvant radiochemotherapy) in contrast to computed tomography?].

INTRODUCTION: Neoadjuvant radiochemotherapy (neoRT/CT) in locally advanced rectal cancer requires an exact initial determination of the depth of the cancerous infiltration (T-status) and of locoregional lymph node metastasis (N-status). For staging and restaging, contrast-enhanced computed tomography (CT) is usually used. In specialised centers, the endorectal ultrasound (rES) may be preferred. METHODS: Between January 1998 and May 2001, the T- and N-status of 102 patients with adenocarcinoma of the rectum (> or =T3 or N+) was determined prospectively by rES and CT (group I: n=61 without neo-

Cerclage and cervical insufficiency: an evidence-based analysis.

Since the cervical cerclage was introduced to clinical practice 50 years ago, the efficacy of the operation has not been established by evidence-based standards for many indications. Serious flaws in the methods employed to study the safety and efficacy of cerclage have led to confusion and misuse of the operation, although some investigators maintain that current standards make randomized clinical trials of this traditional surgery unethical. At present, five randomized clinical trials have offered significant information about elective cerclages performed for historical indications, and the

Endoscopic ultrasound-guided fine needle aspiration for staging patients with carcinoma of the lung.

BACKGROUND: Endoscopic ultrasound (EUS)-guided fine needle aspiration is a safe, cost-effective procedure that can confirm the presence of mediastinal lymph node metastases and mediastinal tumor invasion. We studied the accuracy of EUS in a large population of lung cancer patients with and without enlarged mediastinal lymph nodes on computed tomographic (CT) scan. METHODS: From 1996 to 2000 all patients referred to our institution with lung tumors and no proven distant metastases were considered for EUS and surgical staging. Patients had endoscopic ultrasound with fine needle aspiration of ab

[Laparoscopic cholecystectomy in acute cholecystitis].

PURPOSE: To determine the feasibility, operative risk and patients' benefit of laparoscopy in emergency cholecystectomy for acute calculous cholecystitis. PATIENTS AND METHODS: From January 1991 to December 1998, 234 patients with acute calculous cholecystitis were operated on by emergency laparoscopic cholecystectomy. There were 131 women and 103 men (mean age: 57 years), (Asa 2: 48%, Asa 3: 10%). In seven patients, choledocolithiasis was detected by endoscopic ultrasonography and preoperatively treated by endoscopic sphincterotomy. The mean delay between in-hospital admission and cholecyste

Keyword Index for Volume 91

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… dysplasia 1081 early discharge 651 ECarboF 1472 economic burden 77 educational attainment 923 efficacy 1434 EGFR 418, 430, 1066, 1301, 2026, 2042 EGFR family 1532 EGFR-1 470 elderly 1453 elderly NSCLC patients 489 elongation factor-1 delta 282 endocytosis 270 endometrial cancer 720, 1808 endosonography …

Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals.

BACKGROUND & AIMS: To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection. METHODS: We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs. RESU

Intraductal Tubulopapillary Neoplasm of the Pancreas and Bile Duct: A Review.

Intraductal tubulopapillary neoplasms (ITPNs) of the pancreas and bile duct are contemporary entities. It is unclear on how to best manage patients with this diagnosis because little is known about its progression to cancer. This review provides an update on the current knowledge of ITPN of the pancreas and bile duct with an overview of clinical, radiological, histopathological, and molecular features, as well as the prognosis and management. Embase and Medline databases search were performed to identify studies that evaluated ITPN of the pancreas and bile duct. The infrequent exposure to this

Macrophage inhibitory cytokine-1/growth differentiation factor-15 in premalignant and neoplastic tumours in a high-risk pancreatic cancer cohort.

BACKGROUND: Pancreatic cancer (PC) is a leading cause of cancer related mortality worldwide, with poor survival due to late diagnosis. Currently, biomarkers have limited use in early diagnosis of PC. Macrophage inhibitory cytokine-1 or growth differentiation factor-15 (MIC-1/GDF15) has been implicated as a potential serum biomarker in PC and other malignancies. AIM: To determine the role of MIC-1/GDF15 in detecting pre-malignant pancreatic lesions and neoplastic tumours in an asymptomatic high-risk cohort part of Australian Pancreatic Cancer Screening Program. METHODS: A feasibility prospect

Primary Liver Cancers: Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma.

The incidence of liver cancers has continued to increase over the past few decades and mortality related to liver cancer has increased by more than 2% annually since 2007. This article reviews the essential workup and treatment options necessary for general surgeons as they treat patients with primary liver cancers.

Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline.

Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure.Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised us

Convex Probe EBUS-guided Fiducial Placement for Malignant Central Lung Lesions.

BACKGROUND: Stereotactic body radiotherapy (SBRT) had become a therapeutic modality in patients with primary tumors, locally recurrent as well as oligometastasis involving the lung. Some modalities of SBRT require fiducial marker (FM) for dynamic tumor tracking. Previous studies have focused on evaluating bronchoscopic-guided FM placement for peripheral lung nodules. We describe the safety and feasibility of placing FM using real-time convex probe endobronchial ultrasound (CP-EBUS) for SBRT in patients with centrally located hilar/mediastinal masses or lymph nodes. METHODS: This is a retrospe

Intravascular imaging in coronary artery disease.

Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrast-filled lumen rather than imaging the diseased vessel itself. Intravascular imaging-intravascular ultrasound and more recently optical coherence tomography-provide a tomographical or cross-sectional image of the coronary arteries. These techniques are clinically useful to answer questions such

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Mediastinal Staging in a Community Medical Center.

RATIONALE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and positron emission tomography (PET)-computed tomography (CT) are valuable tools for lung cancer staging. Data from tertiary referral centers suggest that these modalities are superior to mediastinoscopy in mediastinal staging. OBJECTIVES: To validate EBUS-TBNA for lung cancer staging in a community center with operators with various levels of experience. METHODS: At an 800-bed community hospital, we reviewed all cases where EBUS-TBNA and PET-CT were performed for mediastinal staging by one of seven pri

Islet Cell Tumors of the Pancreas.

Islet cell tumors of the pancreas, also known as pancreatic neuroendocrine tumors, constitute less than 5% of pancreatic tumors, and 7% of all neuroendocrine tumors. Most are non-functional, and patients often present with metastatic disease. Functional tumors present with distinct clinical syndromes. Accurate staging is critical as surgery is both the cornerstone of treatment, and the only hope for cure. Medical management involves treating the manifestations of hormonal excess, and using somatastatin analogues when appropriate. Systemic chemotherapy, targeted molecular therapy, and peptide r