Background: The accuracy of intraductal ultrasonography (IDUS) and endoscopic ultrasonography (EUS) were compared in diagnosing biliary obstruction and in predicting surgical resectability. Methods: ...Fifty-six patients with biliary obstruction were investigated preoperatively with both conventional EUS and IDUS. The ultrasonographic miniprobe was inserted into the bile duct system through the working channel of the duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). Conventional endosonography was performed with echoendoscopes in a standard technique. Images of endoluminal ultrasonography were prospectively reviewed and compared with intraoperative findings and resection specimen analyses. Results: IDUS exceeded EUS in terms of accuracy (IDUS, 89.1%; EUS, 75.6%; P < 0.002), sensitivity (IDUS, 91.1%; EUS, 75.7%; P < 0.002), specificity (IDUS, 80%; EUS, 75%; NS), and T-staging (IDUS, 77.7%; EUS, 54.1%; P < 0.001). In bile duct carcinomas the accuracy rate for lymph node staging using IDUS (60%) is comparable with that using EUS (62.5%). In pancreatic carcinomas, however, lymph node staging using IDUS (13.3%) is significantly (P < 0.002) inferior to EUS (69.2%). Endoluminal ultrasonography may predict the potential resectability of bile duct tumors (IDUS, 81.8%; EUS, 75.6%; P < 0.002). Conclusions: IDUS proved to be accurate in preoperative diagnosing and T-staging of malignant biliary strictures, whereas it is not suitable for lymph node staging. IDUS using miniprobes during ERCP exceeds conventional EUS in terms of depiction of bile duct obstruction, diagnostic accuracy, and sensitivity and in the prediction of surgical tumor resectability. Additionally, different to EUS, IDUS can conveniently be performed during ERCP in one and the same session.
Background: It has been proposed that adenomas of the papilla of Vater are precursors of adenocarcinomas. Duodenoscopy with ERCP and forceps biopsies have substantially improved the morphologic ...exploration of the major duodenal papilla. Yet there is little and contradictory information as to the diagnostic accuracy of endoscopic biopsies in tumors of the papilla. Moreover, after endoscopic sphincterotomy data on the diagnostic impact of endoscopic biopsies from the papilla are scarce and, in most cases, retrospectively obtained. Thus, the aim of the present prospective and histopathologically controlled study was to assess the diagnostic accuracy of endoscopic biopsies taken from tumors of the papilla before and after sphincterotomy. Patients and methods: Forty patients with tumors of the papilla of Vater were included in the study. In each case, a comparison was made between endoscopic forceps biopsy diagnoses prior to and following sphincterotomy and the definitive histological diagnosis after surgical tumor resection. Results: Resected tumors were diagnosed histomorphologically as follows: 19 adenocarcinomas (47%), 6 tubular adenomas (15%), 7 villous adenomas (17%), 7 inflammatory non-neoplastic lesions (pseudotumors) (17%), and one adenomyoma (2%). Overall accuracy for preoperative histopathological diagnosis was 62% (25 of 40, 95% CI: 47%–76%) prior to sphincterotomy while it was 70% (28 of 40, 95% CI: 55%–81%) following the procedure. Regarding adenocarcinomas, sensitivity was found to be 21% (4 of 19, 95% CI: 8%–43%) prior to and 37% (7 of 19, 95% CI: 19%-58%) after sphincterotomy while specificity was 100% at both times. Conclusions: Endoscopic forceps biopsies do not allow for reliable preoperative diagnosis of tumors of the papilla of Vater.
Background: In bile duct strictures, examination of wall layers by intraductal ultrasonography (IDUS) performed during endoscopic retrograde cholangiopancreatography (ERCP) may be diagnostically ...useful. Methods: In the present study 60 patients with bile duct strictures of unknown aetiology were examined preoperatively by ERCP, including transpapillary biopsies and IDUS. Histopathological correlation was available for all patients undergoing these procedures. Results: Postoperative diagnosis revealed 30 pancreatic carcinomas, 17 bile duct cancers, three gall bladder cancers, and 10 benign bile duct strictures. Using endoscopic transpapillary forceps biopsies (ETP), a correct preoperative diagnosis was achieved in 36 of 60 patients (60% of cases). Among the 50 malignant tumours, preoperative diagnosis by ETP revealed a sensitivity of 52% and a specificity of 100%. ERCP supplemented by IDUS allowed for correct preoperative diagnosis in 83% of cases (50 of 60 patients), which was significantly higher than the accuracy of ETP (p=0.008). By combining ETP with IDUS, a correct preoperative diagnosis was made in 59 of 60 patients resulting in an accuracy rate of 98%. Conclusions: Because of its low accuracy, exclusive use of ETP is not a reliable diagnostic tool for a definitive preoperative diagnosis of bile duct strictures. By combining IDUS and ETP with ERCP however, preoperative diagnostic accuracy can be improved substantially.
Supplementation of immunosuppressive therapy with mycophenolate mofetil (MMF) has been found to reduce the rate of acute rejection in renal transplantation. We report a dose-finding study for MMF ...when administered in combination with low-dose tacrolimus and corticosteroid prophylaxis in cadaveric renal transplant recipients.
Two hundred thirty-two patients at 16 centers were enrolled in this randomized, parallel-group study. The three treatment groups were tacrolimus and corticosteroids (MMF-0 group, n=82); tacrolimus, corticosteroids, and 1 g of MMF daily (MMF-1 g group, n=79); and tacrolimus, corticosteroids, and 2 g of MMF daily (MMF-2 g group, n=71). Study duration was 6 months, and patients were followed up for patient and graft survival for 12 months.
At 6 months posttransplantation, daily doses of 1 g and 2 g of MMF were associated with significantly lower rates of acute rejection compared with tacrolimus alone. The Kaplan-Meier rates were 48.5%, 24.9%, and 22.9%, respectively, for the three treatment groups when acute rejection was determined by clinical criteria (P=0.007). At month 12, patient survival rates were 100%, 97.5%, and 97.2% and graft survival rates were 90.2%, 92.4%, and 93.0% for the MMF-0 group, MMF-1 g group, and the MMF-2 g group, respectively. Gastrointestinal adverse events and leukopenia were higher in the MMF groups, especially in the MMF-2 g group (P<0.05).
Low-dose tacrolimus combined with a MMF dose of 1 g daily and corticosteroids provided an optimized efficacy and safety profile. A higher dose of MMF (2 g) was associated with greater toxicity without a significant improvement in efficacy.
SARS-CoV-2-Antikörper bei Intensiv- und Klinikpersonal Finkenzeller, T.; Faltlhauser, A.; Dietl, K.-H. ...
Medizinische Klinik, Intensivmedizin und Notfallmedizin,
12/2020, Letnik:
115, Številka:
Suppl 3
Journal Article
Odprti dostop
Zusammenfassung
Hintergrund
Klinikmitarbeiter (healthcare workers, HCW) stellen eine Risikopopulation für eine SARS-CoV-2-Infektion dar. Um die Kapazität von Gesundheitseinrichtungen und den Schutz ...von medizinischem Personal optimieren zu können, ist es wichtig, das Infektionsrisiko und den potenziellen Immunitätsstatus der Behandler von COVID-19-Patienten einzuschätzen.
Methode
Wir untersuchten die Seroprävalenz von IgM-/IgG-Antikörpern (AK) gegen SARS-CoV‑2 bei Klinikmitarbeitern der Region mit der höchsten SARS-CoV-2-Durchseuchung (1570/100.000) deutschlandweit, 4 Monate nach Ausbruch der Pandemie. Als Kontrollgruppe wurden Mitarbeiter eines nichtmedizinischen Unternehmens (MU) derselben Region untersucht und demographische Daten, medizinische Anamnese und Arbeitssituation der Teilnehmer erhoben.
Ergebnisse
Es wurden 1838 HCW und 986 MU eingeschlossen. Die Prävalenz von SARS-CoV-2-AK bei HCW war 15,1 % und im Vergleichskollektiv des Unternehmens 3,7 %. Bei den HCW waren die Pflegekräfte zu 20,0 %, das Intensivpersonal zu 20,3 %, Reinigungskräfte zu 19,3 %, das ärztliche Personal zu 12,0 %, die Funktionsdienste zu 11,3 %, die Verwaltung zu 7,1 % und der technische Dienst zu 6 % seropositiv. Bei 10,1 % der positiven HCW waren keine COVID-19 typischen Symptome aufgetreten.
Schlussfolgerung
Die Seroprävalenz von AK gegen SARS-CoV‑2 ist bei Klinikmitarbeitern einer schwer von COVID-19 betroffenen Region signifikant höher als bei einer nichtmedizinischen Kontrollgruppe. Das Infektionsrisiko der HCW ist umso höher je mehr patientennahen Tätigkeiten sie ausüben. Das Infektionsrisiko des Intensivpersonals ist im Vergleich zu anderen Tätigkeiten in einer Klinik erhöht. Das Risiko des Reinigungspersonals wird in Kliniken vermutlich unterschätzt.
Symptoms of gastroparesis possess a heavy impact on the quality of life; delayed gastric emptying may result in poor metabolic control in diabetics. Gastric electrical stimulation (GES) has recently ...been introduced as a treatment option in patients with drug refractory gastroparesis to increase the quality of life by alleviating nausea and vomiting frequencies. However, the effect of GES on metabolic control has not been assessed yet.
We performed a prospective single center study on the long-term effect (12 months) of continuous high-frequency/low-energy GES on symptoms, gastric emptying (measured scintigraphically), and metabolic control (HbA1c) in insulin-dependent diabetic subjects suffering from drug-refractory gastroparesis for more than one year.
Seventeen (12 female, 5 male) patients entered the study; all were available for analysis at all time points. No therapy-associated adverse events occurred. Weekly vomiting and nausea frequencies decreased significantly at 6 and 12 months. Gastric retention rates improved significantly from 83 % (2 h) and 38 % (4 h) to 35 % (2 h)/14 % (4 h) and 25 % (2 h)/17 % (4 h) at 6 and 12 months, respectively. HbA1c values were lowered in all 17 subjects; initially, all HbA1c values were above 7.5 %; at 6 and 12 months, mean values had significantly decreased from 8.6 % to 6.2 % and 6.5 %, respectively.
Gastric electrical stimulation offers symptom control in diabetics with drug-refractory gastroparesis and decreases gastric retention. This study, for the first time, documents a positive effect of this therapy on metabolic control as indicated by HbA1c, a surrogate marker of the risk of diabetic complications.
The usage of stance- and swing-phase control orthoses (SSCOs) is a good option in patients with neuromuscular insufficiency of the quadriceps muscle in a broad range of musculo-skeletal disorders. ...The subjective sensation of improved mobility in daily life and walking comfort could be objectively confirmed by the ability to walk without crutches and by harmonization of the gait patterns in hip and knee. They could also be a considered mobility device after limb salvage surgery, which may even have an impact on preoperative decision making. IMPLICATIONS FOR REHABILITATION Symmetric gate in spite of femoral nerve palsy. Early gate improvements even after hours. High patient?s motivation to use the device.
The mass of the W boson is determined from the direct reconstruction of W decays in WW→qq̄qq̄ and WW→ℓνqq̄ events in e+e- collisions at LEP. The data sample corresponds to an integrated luminosity of ...683 pb-1 collected with the ALEPH detector at centre-of-mass energies up to 209 GeV. To minimise any effect from colour reconnection a new procedure is adopted in which low energy particles are not considered in the mass determination from the qq̄qq̄ channel. The combined result from all channels is \(m_{\text{W}}=80.440 \pm0.043{\text{(stat.)}} \pm0.024{\text{(syst.)}} \pm0.009{\text{(FSI)}} \pm0.009{\text{(LEP)}} \text{GeV/}c^2, \)where FSI represents the possible effects of final state interactions in the qq̄qq̄ channel and LEP indicates the uncertainty in the beam energy. From two-parameter fits to the W mass and width, the W width is found to be \(\Gamma_{\text{W}} = 2.14 \pm0.09{\text{(stat.)}} \pm0.04{\text{(syst.)}} \pm0.05{\text{(FSI)}} \pm0.01{\text{(LEP)}} \text{GeV}. \)
Intrapancreatic accessory spleen Meiler, R; Dietl, K-H; Novák, K ...
International surgery,
04/2010, Letnik:
95, Številka:
2
Journal Article
Recenzirano
Intrapancreatic accessory spleen is a rare cause of pancreatic pseudotumors and is located in the pancreatic tail in approximately 1% to 2%. Accessory spleen itself is found in approximately 7% to ...15% of the population. Our findings show a case of an intrapancreatic accessory spleen suspected for a malignancy in the pancreatic tail. A 63-year-old man admitted for cholecystitis was incidentally diagnosed with a tumor at the pancreatic tail. On hyperintense magnetic resonance imaging, a solid mass of 1.5 cm in diameter in the pancreatic tail was seen, which contrasted as hyperdense in T2-weighted imaging. Because of inhomogeneous enhancement on the early vascular phase, the diagnosis of a endocrine pancreatic tail carcinoma was suspected. Intraoperatively, an accessory spleen was found in the pancreatic tail. An oncologic left pancreatectomy was performed because of a malignant tumor. Histology showed an intrapancreatic accessory spleen in the pancreatic tail that excluded the presence of cancer. In conclusion, intrapancreatic accessory spleen is a rare cause of unnecessary laparotomy, but the absence of reliable diagnostics for this entity make histologic ascertainment of a benign tumor indispensable. Therefore, we still needed an oncologic tumor resection.
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