Aim
. The present guidelines intended for primary care physicians are aimed at facilitating early diagnosis of malignant tumours of the digestive system, which can significantly improve the immediate ...and long-term results of their treatment.
General provisions
. The guidelines comprise sections devoted to esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gall bladder cancer, as well as pancreatic cancer. Each section contains information on risk factors and precancerous diseases, which allows a physician to identify whether a particular patient falls into the risk group of digestive system neoplasms. It is shown how digestive system cancers can be suspected on the basis of patients’ complaints and past medical history, as well as data obtained both from a direct examination and laboratory instrumental studies. Each section offers practical algorithms in cases of suspected esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gallbladder cancer, as well as pancreatic cancer.
Conclusion
. The knowledge of clinical manifestations and risk factors in the development of digestive system neoplasms allows a physician to suspect cancer and devise a timely and adequate diagnostic strategy, including laboratory and instrumental studies at specialised clinical centres.
Aim.
This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.
Summary.
Eosinophilic esophagitis ...(EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.
Conclusion.
Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology.
We develop a self-consistent kinetic description of a
e
+
e
–
γ
plasma, generated from vacuum in a focal spot of counterpropagating laser pulses. Our model assumes purely time-dependent external ...(laser) field, but properly takes into account the semiclassical internal (plasma) field, as well as quantum radiation. While nonperturbative kinetic description of
e
+
e
–
-pair production from vacuum and the simplest variant of backreaction problem have been previously addressed, quantum radiation is included in such a model for the first time. To achieve this goal we derived coupled kinetic equations for the electron, positron, and photon plasma species and the Maxwell equation for the internal electric field. Photon subsystem is included systematically using the BBGKY chain, which we truncate at the second order of perturbation theory by taking into account the annihilation and radiation channels. An important application of our results would be consideration of laser field depletion due to cascade production beyond the locally constant field approximation.
The article tells about the evolution in the development of endoscopic diagnostic methods for early central lung cancer, from rigid bronchoscopes to modern high-resolution video endoscopes. The ...current multimodal diagnostic methods are described, including the recent data on the use of confocal laser endomicroscopy and endocytoscopy which allow to detect lesions caused by intramucosal cancer in the tracheobronchial tree as well as to study the cellular-level morphology in vivo. Long-term clinical experience of the P.A. Herzen Moscow Oncology Research Institute in the diagnosis of central lung cancer is presented.
Stomach cancer risk factors: the modern concept V. M. Khomyakov; A. D. Yermoshina; S. S. Pirogov ...
Rossiĭskiĭ zhurnal gastroėnterologii, gepatologii, koloproktologii,
08/2018, Letnik:
27, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Aim of review. To present the systematic overview of the stomach cancer risk factors to determine prophylactic measures and to define high-risk groups of population that can be included to the ...screening programs. Summary. Stomach cancer (SC) represents one of the leading causes for morbidity and mortality among malignant neoplasms worldwide. SC is asymptomatic at early stages that causes higher rate of locally advanced and disseminated forms of the tumor at primary diagnosis. SC early detection screening programs demonstrated high efficacy only in the Asian region. The main role in early detection of this disease is played by oncological alertness of doctors at outpatient clinics and gastroenterologists, as well as the patient education. The understanding of basic etiologic and predisposing factors and mechanisms of SC development, knowledge of key risk factors allow to distinguish high-risk groups from the general population and to carry out active revealing of premalignant lesions and early forms of SC. Conclusion. Stomach cancer is a multifactorial disease which develops under effect and interaction of external and internal factors. Intestinal type SC and diffuse type SC have various pathogenesis and risk factors. Risk factor estimation provides effective prophylaxis of the disease, and also to reveal high risk groups for preventive and screening programs.
We consider contact processes on locally compact separable metric spaces with birth and death rates that are heterogeneous in space. We formulate conditions on the rates that ensure the existence of ...invariant measures of contact processes. One of the crucial conditions is the so-called critical regime condition. To prove the existence of invariant measures, we use the approach proposed in our preceding paper. We discuss in detail the multi-species contact model with a compact space of marks (species) in which both birth and death rates depend on the marks.
the aim of study was testing and introduction in clinical practice combination of EUS with sonoelastography, fine-needle biopsy and needle-based confocal laser endomicroscopy in advanced diagnostic ...of pancreatic disease.
in the period from February 2014 to December 2015, we accumulated experience of EUS-FNA in 72 patients mostly with tumor pathology of the pancreas. In 16 cases we used 19G, in 49-22G, and in 7 patients - 25G needles. In 5 patients we used COOK Echotip Procore needle. In 8 cases we performed confocal laser endomicroscopy through the 19G needle (nCLE) in 3 patients with cystic and in 5 - with solid tumors. In 20 patients, there we used.HITA-CHI-PENTAX sonoelastography was performed.
There were no complications in EUS-FNA. In all cases we received pathology verification of disease. nCLE results always confirmed by morphological examination of material. In elastography examination normal pancreatic tissue had a equable green-yellow color, in chronic pancreatitis on the same background there were areas of blue seal parenchyma, in the cases pancreatic adenocarcinoma it was marked predominance of blue color scale, in neuroendocrine tumors - diffuse distribution of green and blue areas. Using nCLE in patients with adenocarcinoma revealed the destruction of certain glands, polymorphic nuclei of epithelial cells, with their enlargement, deformation, loss of polarity. Appliance of Procore needle has its technical features, but allowed us to obtain more material with less bloody - due to fewer number of passes.
Thus, our study confirms the effectiveness of EUS-FNA with sonoelastography and nCLE. It defines objectives for improvement and expansion of the range for their clinical use.
In oncosurgery esophago-intestinal anastomotic leak as well as defects of the abdominal segment of the esophagus are serious complications associated with prolonged hospital stay and increased ...mortality rate. A choice of management tactics for each patient is individual. Treatment of esophageal anastomotic leak without separation provides the best result by reducing the time of rehabilitation, improving the quality of life and reducing mortality. Conservative treatment requires an adequate drainage when conducting enteral feeding and adequate antibiotic therapy. The indications for separation of the anastomosis include a large defect size, necrosis of the graft uncontrolled purulent-septic complications and a failure of conservative therapy. In recent decades a number of methods for endoscopic treatment of anastomotic leaks in the gastrointestinal tract have been elaborated, including the use of adhesive agents, self-expanding stents, clipping, and endoscopic vacuum system. These methods have several advantages over surgical and conservative management. Despite the accumulated experience, at present there is no single systemic approach to the use of endoscopic methods for closure of defects of anastomosis as well as defects of the abdominal segment of the esophagus. This is mainly due to a relatively small number of publications. One of the promising methods for endoscopic treatment of anastomotic leak is currently the Endoscopic Vacuum System (EndoVAC therapy). The article provides the clinical case of a patient with stomach cancer who was given transperitoneal gastrectomy with D2-lymphadenectomy which was complicated by a defect in the abdominal segment of the esophagus with peritonitis. To treat those complications relaparotomy, sanitation and drainage of the abdominal cavity was performed. In order to achieve closure of the fistula more quickly the vacuum system was used resulting in a marked decrease in fluid exudation, which in turn contributed to closure of the fistula.
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