AIM： To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels. METHODS： In 86 patients with suspected ...AIM： To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels. METHODS： In 86 patients with suspected chronic pancreatitis （age： 62± 12 years; sex： f/m 38/48）, pancreatic lesions were examined by conventional endo- scopic B-mode, power Doppler ultrasound and contrastenhanced power mode （Hitachi EUB 525, SonoVue, 2.4 mL, Bracco） using the following criteria for malignant lesions： no detectable vascularisation using conventional power Doppler scanning, irregular appearance of arterial vessels over a short distance using SonoVue contrastenhanced technique and no detectable venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable [gold standard endoscopic ultrasound （EUS）-guided fine needle aspiration cytology, operation]. The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection of SonoVue, regular appearance of vessels over a distance of at least 20 mm after injection of SonoVue and detection of arterial and venous vessels. RESULTS： The sensitivity and specifidty of conventional EUS were 73.2% and 83.3% respectively for pancreatic cancer. The sensitivity of contrast-enhanced EUS increased to 91.1% in 51 of 56 patients with malignant pancreatic lesion and the specificity increased to 93.3% in 28 of 30 patients with chronic inflammatory pancreatic disease.CONCLUSION： Contrast-enhanced endoscopic ultrasound improves the differentiation between chronic pancreatitis and pancreatic carcinoma.展开更多
In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions.Surgical pro...In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions.Surgical procedures can be avoided in many cases by using endoscopically placed,Endoscopic ultrasonography-guided techniques and drainages.Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections.The development of selfexpanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections.This review will discuss available therapeutic techniques and new developments.展开更多
Reduced cavernosal arterial inflow has been hypothesized to be the likely cause of erectile dysfunction after kidney transplants in recipients revascularized through end-to-end anastomosis to the internal lilac artery...Reduced cavernosal arterial inflow has been hypothesized to be the likely cause of erectile dysfunction after kidney transplants in recipients revascularized through end-to-end anastomosis to the internal lilac artery, suggesting that end-to-side anastomosis at the external iliac artery is preferable. The aim of this study was to prospectively evaluate the effect of the use of the external iliac artery on erectile function, hormone profiles and penile blood flow by evaluating changes in penile colour Doppler ultrasound parameters in a consecutive series of 22 recipients before and after end-to-side external lilac artery transplantation. The mean International Index of Erectile Function-Erectile Function （IIEF-EF） domain score decreased significantly 3 months after transplant （18.09±6.33 vs. 22.50±7.09, P=O.01）. The reduction in peak systolic velocity （PSV） was significant for the cavernous artery homolateral to the side of transplant （42.60±18.77 vs. 52.01±19.91, P=0.01）. The mean postoperative end diastolic velocity （EDV） did not differ significantly from the preoperative value （P=0.74）. No statistical differences were found in the serum levels of testosterone or prolactin. Kidney grafts anastomosed at the external lilac artery produced significant （P=0.01） reductions in arterial inflow at the homolateral cavernosal artery that remained above the normal threshold. Whether these haemodynamic changes can explain the worsening of postoperative erectile function remains to be proven.展开更多
The ongoing coronavirus disease-2019(COVID-19)pandemic has necessitated special considerations in the management of diseases.The way presence of pre-existing diseases or treatment for it predisposes to,alters course o...The ongoing coronavirus disease-2019(COVID-19)pandemic has necessitated special considerations in the management of diseases.The way presence of pre-existing diseases or treatment for it predisposes to,alters course of,and changes the management of COVID-19,is of relevance and is being extensively studied.Autoimmune hepatitis(AIH)is unique in that it is an autoimmune disease mandating treatment with immunosuppressive drugs,as well as a liver disease with potential for varying degrees of underlying fibrosis.The use of immunosuppressive drugs could alter the risk of acquiring COVID-19,the clinical course and severity of COVID-19 and the degree of underlying liver fibrosis could alter the clinical outcomes of patients with COVID-19.In this review,we try to summarize key areas relevant in understanding and improving the clinical care of patients with AIH in the current pandemic.Special considerations required in the management of patients with AIH in COVID-19 hotspots have been outlined based on the current evidence.展开更多
文摘AIM： To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels. METHODS： In 86 patients with suspected chronic pancreatitis （age： 62± 12 years; sex： f/m 38/48）, pancreatic lesions were examined by conventional endo- scopic B-mode, power Doppler ultrasound and contrastenhanced power mode （Hitachi EUB 525, SonoVue, 2.4 mL, Bracco） using the following criteria for malignant lesions： no detectable vascularisation using conventional power Doppler scanning, irregular appearance of arterial vessels over a short distance using SonoVue contrastenhanced technique and no detectable venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable [gold standard endoscopic ultrasound （EUS）-guided fine needle aspiration cytology, operation]. The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection of SonoVue, regular appearance of vessels over a distance of at least 20 mm after injection of SonoVue and detection of arterial and venous vessels. RESULTS： The sensitivity and specifidty of conventional EUS were 73.2% and 83.3% respectively for pancreatic cancer. The sensitivity of contrast-enhanced EUS increased to 91.1% in 51 of 56 patients with malignant pancreatic lesion and the specificity increased to 93.3% in 28 of 30 patients with chronic inflammatory pancreatic disease.CONCLUSION： Contrast-enhanced endoscopic ultrasound improves the differentiation between chronic pancreatitis and pancreatic carcinoma.
文摘In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions.Surgical procedures can be avoided in many cases by using endoscopically placed,Endoscopic ultrasonography-guided techniques and drainages.Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections.The development of selfexpanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections.This review will discuss available therapeutic techniques and new developments.
文摘Reduced cavernosal arterial inflow has been hypothesized to be the likely cause of erectile dysfunction after kidney transplants in recipients revascularized through end-to-end anastomosis to the internal lilac artery, suggesting that end-to-side anastomosis at the external iliac artery is preferable. The aim of this study was to prospectively evaluate the effect of the use of the external iliac artery on erectile function, hormone profiles and penile blood flow by evaluating changes in penile colour Doppler ultrasound parameters in a consecutive series of 22 recipients before and after end-to-side external lilac artery transplantation. The mean International Index of Erectile Function-Erectile Function （IIEF-EF） domain score decreased significantly 3 months after transplant （18.09±6.33 vs. 22.50±7.09, P=O.01）. The reduction in peak systolic velocity （PSV） was significant for the cavernous artery homolateral to the side of transplant （42.60±18.77 vs. 52.01±19.91, P=0.01）. The mean postoperative end diastolic velocity （EDV） did not differ significantly from the preoperative value （P=0.74）. No statistical differences were found in the serum levels of testosterone or prolactin. Kidney grafts anastomosed at the external lilac artery produced significant （P=0.01） reductions in arterial inflow at the homolateral cavernosal artery that remained above the normal threshold. Whether these haemodynamic changes can explain the worsening of postoperative erectile function remains to be proven.
文摘The ongoing coronavirus disease-2019(COVID-19)pandemic has necessitated special considerations in the management of diseases.The way presence of pre-existing diseases or treatment for it predisposes to,alters course of,and changes the management of COVID-19,is of relevance and is being extensively studied.Autoimmune hepatitis(AIH)is unique in that it is an autoimmune disease mandating treatment with immunosuppressive drugs,as well as a liver disease with potential for varying degrees of underlying fibrosis.The use of immunosuppressive drugs could alter the risk of acquiring COVID-19,the clinical course and severity of COVID-19 and the degree of underlying liver fibrosis could alter the clinical outcomes of patients with COVID-19.In this review,we try to summarize key areas relevant in understanding and improving the clinical care of patients with AIH in the current pandemic.Special considerations required in the management of patients with AIH in COVID-19 hotspots have been outlined based on the current evidence.
