Cholangiocarcinoma is a malignancy arising from the epithelial lining of the intrahepatic or extrahepatic biliary tract. Timely diagnosis is challenging due to its silent clinical course. As reliable laboratory markers are lacking, diagnostic imaging plays a pivotal role. While cross-sectional imaging studies are usually conclusive for intrahepatic lesions, endoscopy plays an essential role in cases of extrahepatic tumors. Rational utilization of different diagnostic methods based on available evidence is needed. This article focuses on the diagnostic role of advanced biliary endoscopy, including endoscopic retrograde cholangiopancreatography, cholangioscopy, endoscopic ultrasonography, and intraductal sonography.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Until now, few cases of coincidental giardiasis and pancreatic tumors have been described. Among these cases, three described giardiasis cases coincided with confirmed pancreatic cancer. We present another case of Giardia infection coexisting with pancreatic cancer in a 67-year-old man who suffered from stenosis of the distal ductus choledochus combined with a hypoechoic mass in the head of the pancreas. The diagnostic conclusion of suspicious adenocarcinoma was based on endoscopic ultrasound fine-needle aspiration (EUS-FNA) biopsy and confirmed by a partial duodenopancreatectomy. On bloody cytology smears prepared from the EUS-FNA specimen, trophozoites of Giardia intestinalis accompanying an inflammatory background and features that fulfilled the morphological criteria of malignancy were observed. In histological sections from the duodenopancreatectomy specimens, the parasites were observed attached to the epithelium, but individual Giardia parasites were also observed beneath the epithelial lining. According to conventional genotyping, the infecting Giardia belonged to sub-assemblage AII.
- MeSH
- asymptomatické infekce * MeSH
- duodenum cytologie parazitologie MeSH
- epitelové buňky parazitologie MeSH
- Giardia lamblia genetika izolace a purifikace MeSH
- giardiáza komplikace diagnóza MeSH
- lidé MeSH
- nádory slinivky břišní komplikace parazitologie MeSH
- náhodný nález * MeSH
- senioři MeSH
- trofozoiti izolace a purifikace MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- biopsie MeSH
- cholangiopankreatografie endoskopická retrográdní * metody MeSH
- cholangitida MeSH
- lidé MeSH
- litotripse metody MeSH
- mucinózní adenokarcinom diagnóza chirurgie MeSH
- nádory slinivky břišní diagnóza chirurgie MeSH
- nemoci žlučových cest diagnóza patologie terapie MeSH
- pankreatitida MeSH
- papilární karcinom diagnóza chirurgie MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
The objective of the present study was to determine if there is correlation between signs of reflux laryngitis (RL) and reflux oesophagitis (RE) in patients with gastro-oesophageal reflux disease (GORD) symptoms. Laryngeal photography obtained from patients during oesophagogastroduodenoscopy were examined by two otolaryngologists experienced in the field of extra-oesophageal reflux regarding the presence and severity of RL. The presence of RE was evaluated by gastroenterologist. Smokers, heavy drinkers and patients with bronchial asthma were excluded from the statistical analysis. A total of 681 patients were analysed. RL was diagnosed in 367 (53.9%) cases, of whom 182 patients had mild, 118 moderate and 67 severe (Reflux Finding Score > 7) RL. RE was diagnosed in 103 (28.1%) patients with RL and in 80 (25.7%) patients without RL. Neither the difference between the overall group of patients with RL and those without (OR 1.141, 95% CI 0.811-1.605, p = 0.448), nor the differences between the respective subgroups of patients with mild, moderate and severe RL and those without RL were statistically significant. The OR and 95% CI for mild, moderate and severe RL were 1.042, 95% CI 0.712-1.526, p = 0.834, 1.182, 95% CI 0.764-1.831, p = 0.453 and 1.0, 95% CI 0.566-1.766, p = 0.999 respectively. It can be concluded that there is no correlation between RL and RE in patients with GORD symptoms.
- MeSH
- gastroezofageální reflux komplikace MeSH
- laryngitida diagnóza etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- peptická ezofagitida diagnóza etiologie MeSH
- prospektivní studie MeSH
- určení symptomu MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Plants respond locally and systemically to herbivore attack. Most of the research conducted on plant-herbivore relationships at element and molecular levels have focused on the elemental composition or/and certain molecular compounds or specific families of defence metabolites showing that herbivores tend to select plant individuals or species with higher nutrient concentrations and avoid those with higher levels of defence compounds. We performed stoichiometric and metabolomics, both local and systemic, analyses in two subspecies of Pinus sylvestris under attack from caterpillars of the pine processionary moth, an important pest in the Mediterranean Basin. Both pine subspecies responded locally to folivory mainly by increasing relative concentrations of terpenes and some phenolics. Systemic responses differed between pine subspecies, and most of the metabolites presented intermediate concentrations between those of the affected parts and unattacked trees. Our results support the hypothesis that foliar nutrient concentrations are not a key factor for plant selection by adult female processionary moths for oviposition, since folivory was not associated with any of the elements analysed. Phenolic compounds generally did not increase in the attacked trees, questioning the suggestion of induction of phenolics following folivory attack and the anti-feeding properties of phenolics. Herbivory attack produced a general systemic shift in pines, in both primary and secondary metabolism, which was less intense and chemically different from the local responses. Local pine responses were similar between pine subspecies, while systemic responses were more distant.
- MeSH
- borovice lesní metabolismus MeSH
- býložravci MeSH
- metabolom * MeSH
- metabolomika MeSH
- můry MeSH
- stromy MeSH
- terpeny metabolismus MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
AIM: Water-aided insertion as an alternative colonoscopy technique reduces patient discomfort. Warm water has been used in most published trials, but the use of cool water is easier and, if equally effective, could support the use of the water-aided technique in routine practice. METHOD: A double-blind, randomized, single-centre study was performed in which 201 patients were randomized to either cool (20-24 °C) or warm (37 °C) water immersion insertion. The primary outcome was caecal intubation time. The success rate of minimal sedation and patient discomfort were also assessed. RESULTS: The caecal intubation time for cool and warm water was similar (6.9 ± 3.5 vs 7.0 ± 3.4 min, P = 0.64). The respective success rates of minimal sedation colonoscopy (89.1% vs 90%, P = 1.00) and discomfort (P = 0.51) were no different. All other outcomes except a greater need for abdominal compression in the cool water arm (P = 0.04) were similar including the total procedure time, terminal ileum intubation rate, adenoma detection, length of the inserted scope, water volume, non-standard position rate, difficulty of the procedure and the patient's temperature sensation. CONCLUSION: The use of cool water did not modify the caecal intubation time compared with warm water. Exception for abdominal compression, all other end-points were no different. Cool water immersion is an alternative to the technically more demanding warm water immersion colonoscopy.
- MeSH
- bolesti břicha etiologie MeSH
- časové faktory MeSH
- cékum MeSH
- délka operace MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- hypnotika a sedativa aplikace a dávkování MeSH
- katetrizace * MeSH
- kolonoskopie škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- teplota * MeSH
- voda MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
