AIMS: The main objective of this study was to determine the sensitivity of abdominal ultrasonography (US) in patients with isoattenuating pancreatic carcinoma and to compare the frequency of secondary signs on abdominal US and endoscopic ultrasonography (EUS) in these tumours. METHODS: Twenty-four patients with histologically or cytologically verified isoattenuating pancreatic carcinoma who underwent abdominal US, contrast-enhanced CT and EUS of the pancreas as part of the diagnostic workup were included in this retrospective study. The sensitivity of abdominal US in detecting the isoattenuating pancreatic carcinoma was investigated and the frequency of secondary signs of isoattenuating pancreatic carcinoma on abdominal US and EUS was compared. RESULTS: In 5 of 24 patients (21%) with isoattenuating pancreatic carcinoma, a hypoechogenic pancreatic lesion was directly visualised on abdominal US. Secondary signs were present on US in 21 patients (88%). These included dilatation of the common bile duct and/or intrahepatic bile ducts in 19/24 (79%), dilatation of the pancreatic duct in 3/24 (13%), abnormal contour/inhomogeneity of the pancreas in 1/24 (4%), and atrophy of the distal parenchyma in 1/24 (4%). Pancreatic duct dilatation was observed more frequently on EUS than on abdominal US (P=0.002). For other secondary signs, there was no significant difference in their detection on abdominal US and EUS (P=0.61-1.00). CONCLUSION: Abdominal US is capable of detecting secondary signs of isoattenuating pancreatic carcinoma with high sensitivity and has the potential to directly visualise these tumours.
OBJECTIVE: The aim of the study was to demonstrate that an administration of mucolytic solution with a maximum dose of simethicone and n -acetylcysteine before upper endoscopy improves mucosal visibility compared to a group without administration of mucolytic solution or water. METHODS: This study was a double-blind, randomized controlled trial. Patients were randomized into four groups, with the administration of 100 ml of water + 600 mg n -acetylcysteine + 400 mg simethicone, 100 ml of water + 400 mg n -acetylcysteine + 20 mg simethicone, 100 ml of water, and without any water or mucolytic solution. During the examination, a total of 10 images were taken in the defined areas. The overall visibility score was given by the sum of the 0-5 scores of the five areas and was assessed by the endoscopist performing the procedure and the blinded endoscopists using static images. RESULTS: A total of 129 patients were randomized. The group of patients did not differ in age, sex distribution, and indications significantly. The overall visibility score as assessed by the endoscopist performing the procedure was significantly higher in the group with the maximum dose of mucolytic solution compared to the group without solution or water (18.9 ± 2.9 vs. 16.6 ± 3.3, P = 0.023). This difference was not evident by the blinded evaluation of static photographs. CONCLUSION: Administration of mucolytic solution with a maximum dose of n -acetylcysteine and simethicone before upper endoscopy improved mucosal visibility in the upper gastrointestinal tract compared with the group without any preparation while evaluated by performing endoscopist.
- MeSH
- acetylcystein * MeSH
- dvojitá slepá metoda MeSH
- expektorancia * MeSH
- gastrointestinální endoskopie metody MeSH
- lidé MeSH
- simethikon MeSH
- voda MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Duktální adenokarcinom pankreatu (pancreatic ductal adenocarcinoma - PDAC) je obávanou malignitou s velice nízkým 5letým přežíváním i přes veškeré snahy o zdokonalení léčebných strategií. V současnosti je včasná detekce považována za nejúčinnější způsob, jak zlepšit přežití, jelikož pouze radikální resekce představuje kurativní potenciál. PDAC se dělí do čtyř kategorií podle rozsahu onemocnění: resekabilní, hraničně resekabilní, lokálně pokročilý a metastatický. Většina pacientů je bohužel diagnostikována s lokálně pokročilým nebo metastatickým onemocněním, a tím pádem není způsobilá pro kurativní resekci. To je dáno především absencí průvodních příznaků či jejich nevýrazností v době, kdy ještě onemocnění není lokálně pokročilé. Vhodná indikace a rychlá dostupnost adekvátních diagnostických nástrojů je nicméně rovněž kritickým bodem vzhledem k agresivní povaze onemocnění. Nákladově efektivní biomarker s vysokou specificitou a senzitivitou umožňující včasnou detekci PDAC bez potřeby pokročilých a invazivních metod stále chybí. Diagnostika tak zůstává závislá na radiologických metodách a endoskopické ultrasonografii. V naší přehledové práci shrnujeme nejnovější epidemiologická data, rizikové faktory, klinickou manifestaci a současné diagnostické trendy se zaměřením na sérové biomarkery a zobrazovací modality. Kromě toho popisujeme aktuální terapeutické postupy.
Pancreatic ductal adenocarcinoma (PDAC) is a dreaded malignancy with a dismal 5-year survival rate despite maximal efforts on optimizing treatment strategies. Currently, early detection is considered to be the most effective way to improve survival as radical resection is the only potential cure. PDAC is often divided into four categories based on the extent of disease: resectable, borderline resectable, locally advanced, and metastatic. Unfortunately, the majority of patients are diagnosed with locally advanced or metastatic disease, which renders them ineligible for curative resection. This is mainly due to the lack of or vague symptoms while the disease is still localized, although appropriate utilization and prompt availability of adequate diagnostic tools is also critical given the aggressive nature of the disease. A cost-effective biomarker with high specificity and sensitivity allowing early detection of PDAC without the need for advanced or invasive methods is still not available. This leaves the diagnosis dependent on radiodiagnostic methods or endoscopic ultrasound. Here we summarize the latest epidemiological data, risk factors, clinical manifestation, and current diagnostic trends and implications of PDAC focusing on serum biomarkers and imaging modalities. Additionally, up-to-date management and therapeutic algorithms are outlined.
- MeSH
- adenokarcinom diagnóza terapie MeSH
- diagnostické zobrazování metody MeSH
- lidé MeSH
- nádorové biomarkery MeSH
- nádory slinivky břišní * diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION: Pancreatic steatosis (PS) has both metabolic consequences and local effects on the pancreas itself. Magnetic resonance imaging (MRI) is the most reliable non-invasive method for diagnosing PS. We investigated the impact of metabolic syndrome (MS) on the presence of PS, differences in individuals with and without PS, and the metabolic effects of bariatric procedures. METHODS: Changes in anthropometric and basic biochemistry values and MS occurrence were evaluated in 34 patients with obesity who underwent a bariatric procedure. After the procedure, patients underwent MRI with manual 3D segmentation mask creation to determine the pancreatic fat content (PFC). We compared the differences in the PFC and the presence of PS in individuals with and without MS and compared patients with and without PS. RESULTS: We found no significant difference in the PFC between the groups with and without MS or in the occurrence of PS. There were significant differences in patients with and without PS, especially in body mass index (BMI), fat mass, visceral adipose tissue (VAT), select adipocytokines, and lipid spectrum with no difference in glycemia levels. Significant metabolic effects of bariatric procedures were observed. CONCLUSIONS: Bariatric procedures can be considered effective in the treatment of obesity, MS, and some of its components. Measuring PFC using MRI did not show any difference in relation to MS, but patients who lost weight to BMI < 30 did not suffer from PS and had lower overall fat mass and VAT. Glycemia levels did not have an impact on the presence of PS.
- MeSH
- bariatrická chirurgie * MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- metabolický syndrom * diagnostické zobrazování metabolismus MeSH
- morbidní obezita * chirurgie MeSH
- nitrobřišní tuk metabolismus MeSH
- obezita metabolismus MeSH
- pankreas diagnostické zobrazování metabolismus MeSH
- retrospektivní studie MeSH
- ztučnělá játra * patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Endosonography-guided fine needle aspiration biopsy (EUS-FNA)-associated metachronous gastric seeding metastases (GSM) of pancreatic ductal adenocarcinoma (PDAC) represent a serious condition with insufficient evidence. METHODS: Retrospective analysis of PDAC resections with a curative-intent, proven pathological diagnosis of PDAC, preoperative EUS-FNA and post-resection follow-up of at least 60 months. The systematic literature search of published data was used for the GSM growth evaluation using Pearson correlation and the linear regression analyses. RESULTS: The inclusion criteria met 59/134 cases, 16 (27%) had retained needle tract (15 following distal pancreatectomy, 1 following pylorus-sparing head resection). In total, 3/16 cases (19%) developed identical solitary GSM (10-26th month following primary surgery) and were radically resected. A total of 30 published cases of PDAC GSM following EUS-FNA were identified. Lesion was resected in 20 distal pancreatectomy cases with complete information in 14 cases. A correlation between the metastasis size and time (r = 0.612) was proven. The regression coefficient b = 0.72 expresses the growth of 0.72 mm per month. CONCLUSIONS: The GSM represent a preventable and curable condition. A remarkably high number of GSM following EUS-FNA was identified, leading to follow-up recommendation of EUS-FNA sampled patients. Multimodal management (gastric resection, adjuvant chemotherapy) may prolong survival.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
(1) Background. The aim was to define typical features of isoattenuating pancreatic carcinomas on computed tomography (CT) and endosonography and determine the yield of fine-needle aspiration endosonography (EUS-FNA) in their diagnosis. (2) Methods. One hundred and seventy-three patients with pancreatic carcinomas underwent multiphase contrast-enhanced CT followed by EUS-FNA at the time of diagnosis. Secondary signs on CT, size and location on EUS, and the yield of EUS-FNA in isoattenuating and hypoattenuating pancreatic cancer, were evaluated. (3) Results. Isoattenuating pancreatic carcinomas occurred in 12.1% of patients. Secondary signs of isoattenuating pancreatic carcinomas on CT were present in 95.2% cases and included dilatation of the pancreatic duct and/or the common bile duct (85.7%), interruption of the pancreatic duct (76.2%), abnormal pancreatic contour (33.3%), and atrophy of the distal parenchyma (9.5%) Compared to hypoattenuating pancreatic carcinomas, isoattenuating carcinomas were more often localized in the pancreatic head (100% vs. 59.2%; p < 0.001). In ROC (receiver operating characteristic) analysis, the optimal cut-off value for the size of isoattenuating carcinomas on EUS was ≤ 25 mm (AUC = 0.898). The sensitivity of EUS-FNA in confirmation of isoattenuating and hypoattenuating pancreatic cancer were 90.5% and 92.8% (p = 0.886). (4) Conclusions. Isoattenuating pancreatic head carcinoma can be revealed by indirect signs on CT and confirmed with high sensitivity by EUS-FNA.
- Publikační typ
- časopisecké články MeSH
Neuroendokrinní nádory jsou pomalu rostoucí neoplazie, histologicky vycházející z enteroendokrinních buněk. Jedná se o nádory s různým stupněm diferenciace, nejisté biologické povahy a se schopností metastazovat. Nejčastější lokalizací je gastrointestinální trakt, přičemž zvláštní skupinou jsou neuroendokrinní nádory appendixu, na které se přichází náhodně po appendektomii. V kazuistice prezentujeme případ pacienta s neuroendokrinním nádorem appendixu diagnostikovaným koloskopií.
Neuroendocrine tumors are slow-growing neoplasms, histologically based on enteroendocrine cells. They are tumors with different degrees of differentiation, uncertain biological nature and metastatic ability. Their most common localization is the gastrointestinal tract, with a special group of the neuroendocrine tumors of appendix, which are incidentally found after appendectomy. In case report, we would like to present a case of a patient with neuroendocrine tumors of appendix diagnosed by colonoscopy.
- MeSH
- kolonoskopie metody MeSH
- lidé MeSH
- nádory apendixu * chirurgie diagnóza MeSH
- neuroendokrinní nádory * chirurgie diagnóza MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
V článku prezentujeme kazuištiku 61letého pacienta sledovaného pro posttraumatickou akutní pankreatitidu s disrupcí pankreatíckého vývodu a následnou tvorbou pseudocysty v oblasti kaudy pankreatu. Pro postupnou progresi velikosti pseudocysty byl pacient indikován k endosonograficky navigované pseudocystogastrostomii. V dalším období byl pacient několikrát hospitalizován na gastro-enterologickém oddělení za účelem drenáže pankreatíckého duktu pomocí ERCP (5krát), kdy se zavedl pankreatický stent, který byl po dobu 1 roku opakovaně vyměňován. Pacient rovněž pravidelně absolvoval klinické kontroly spojené s ultrazvukem a CT břicha (CT 6krát za 2 roky) a 2krát absolvoval endosonografii pankreatu včetně tenkojehlové aspirace. Dva roky od úrazu byla na CT nečekaně nově nalezena mnohočetná metastatická ložiska jater, primární tumor detekován nebyl. Při kontrolní endosonografii bylo nalezeno hypoechogenní ložisko vtěle pankreatu, dle odebrané cytologie s průkazem maligních buněk. Zanedlouho od stanovení diagnózy adenokarcinomu pankreatu pacient umírá na generalizaci onemocnění.
We present a case report of a 61 years old male monitored for post-traumatic acute pancreatitis, with pancreatic duct disruption and subsequent pseudocyst formation in the pancreatic tail. Because of gradual progression of this pseudocyst´s size, the patient was indicated for endoscopic ultrasound-guided pseudocystogastrostomy with 3 double pig-tail stents. In the meantime, the patient´s condition was complicated by an infection of the pseudocyst, which was managed using antibiotic therapy. During the next year, the patient had to be repeatedly admitted at the gastroenterology department for pancreatic duct drainage using ERCP (5x). During this time, a pancreatic stent was introduced and repeatedly had to be replaced. Repeated check-ups were performed using abdominal ultrasound and CT (computed tomography - 6x) and endosonography of the pancreas, including fine-needle aspiration (EUS-FNA - 2x). Less than two years after the injury, multiple liver metastases were found using CT, the primary tumour was not detected. In a follow-up endosonography, a hypoechogenie mass was found in the pancreatic body, with evidence of malignant cells according to the collected cytology. After the final diagnosis of pancreatic adenocarcinoma, the patient has died, with cause of death being the spreading of the disease.
Nádory pankreatu jsou čtvrtou nejčastější příčinou úmrtí souvisejících s rakovinou na světě. Česká republika patří dlouhodobě mezi státy s nejvyšší incidencí karcinomu pankreatu. Mortalita těsně kopíruje incidenci i proto, že ani v současnosti častokrát nedokážeme toto onemocnění včasně a správně diagnostikovat. Jeden z hlavních diagnostických problémů představují izodenzní tumory pankreatu, které nejsme schopni vizualizovat pomocí CT. Kromě CT sehrávají zásadní roli v diagnostice karcinomu pankreatu i ostatní zobrazovací metody, a to břišní ultrasonografie, magnetická rezonance, endoskopická ultrasonografie a pozitronová emisní tomografie. Článek shrnuje zásadní informace o zobrazování adenokarcinomu pankreatu a jeho odlišení od ostatních solidních tumorózních mas. Mezi nejčastější neoplazie, které se uvádějí v diferenciální diagnostice adenokarcinomu, zařazujeme neuroendokrinní tumory, solidní pseudopapilární tumor, lymfom a pankreatické metastázy jiných primárních tumorů. Ačkoliv adenokarcinom pankreatu tvoří majoritní podíl z hlediska počtu solidních pankreatických mas, je důležité myslet i na další raritnější léze, které mohou napodobovat toto maligní onemocnění. Patří k nim některé vrozené stavy, lipomatóza pankreatu, peripankreatické léze, jiné méně časté tumory nebo sarkoidóza pankreatu. Samostatnou kapitolu zasluhuje i odlišení adenokarcinomu pankreatu od tumoriformní chronické pankreatitidy.
Pancreatic tumours are the fourth most common cause of cancer-related deaths in the world. Czech Republic has long been amongst countries with the highest incidence of pancreatic carcinoma. Mortality closely reflects incidence, because even at present time, we often fail to diagnose this disease in a timely and correct manner. Isoattenuating tumours that cannot be visualised on CT is one of the major diagnostic problems. In addition to CT, other imaging methods, such as abdomi nal ultrasonography, magnetic resonance imaging, endoscopic ultrasonography and positron emission tomography, play a crucial role in the diagnosis of pancreatic cancer. The article summarises essential information about pancreatic adenocarcinoma imaging and its distinction from other tumours. Among the most common neoplasms mentioned in its differential diagnosis are neuroendocrine tumours, solid pseudopapillary tumour, lymphoma and metastases into the pancreas. Although pancreatic adenocarcinoma forms the majority share of the number of solid pancreatic masses, it is important to think of other more rare lesions that can imitate this malignant disease. These include, for example, some congenital conditions, fatty infiltration-replacement, peripancreatic lesions, other uncommon tumours or pancreatic sarcoidosis. The distinction of pancreatic adenocarcinoma from tumour-like chronic pancreatitis also deserves a separate chapter.
