高频微探头内镜超声在胃皱襞粗大病变中的诊断价值

目的 评价高频微探头内镜超声（HFMPS）在胃皱襞粗大病变中的诊断价值.方法 对我院胃镜检查未能确诊的42例胃皱襞粗大病变进行HFMPS检查,将HFMPS的诊断结果与最终确诊结果比较,评价HFMPS在胃皱襞粗大病变中的诊断价值.结果 42例最终均经病理、手术和（或）反复随诊确诊,静脉曲张6例,胃癌23例,胃淋巴瘤4例,炎性病变9例.HFMPS诊断静脉曲张6例,胃癌24例（敏感性 95.7%,特异性 89.5%）,胃淋巴瘤2例,炎性病变10例（敏感性100%,特异性 96.9%）.2例胃淋巴瘤误诊为早期胃癌,1例早期胃癌误诊为炎性病变.结论 HFMPS可对胃皱襞粗大的常见病因作出较准确诊断.但胃淋巴瘤与胃癌有异病同像的现象,鉴别困难,最终需病理确诊.内镜超声检查可避免对静脉曲张病变活检的危险.     

Endosonography of groove pancreatitis.

Groove pancreatitis is a rare form of chronic pancreatitis. Distinction between pancreatitis and pancreatic carcinoma is often difficult. Two cases of groove pancreatitis diagnosed by endosonography are described. A hypoechoic pattern between the duodenal wall and pancreas was clearly imaged in both patients. Narrowing of the second part of the duodenum and evidence of bile duct obstruction were also found. The endosonographic diagnosis was confirmed either by surgery or follow-up examination.     

Endosonography versus helical computed tomography for locoregional staging of gastric cancer

BACKGROUND AND STUDY AIMS: Endosonography (EUS) has been shown to be more accurate than incremental computed tomography (CT) in the local (T) and regional (N) staging of gastric carcinoma; however, EUS has never been compared with helical CT (HCT). The fifth edition of the TNM classification changed the guidelines for N-staging of gastric carcinoma. The accuracy of imaging methods in this new system remains unknown. PATIENTS AND METHODS: Staging accuracy of EUS and HCT were compared prospectively with pathological or intraoperative findings in 88 gastric carcinoma patients. Staging was done according to the fourth and fifth editions of the TNM classification. EUS was done with a radial echo endoscope, and HCT with a scanner with two rows of detectors (two-phase contrast-enhanced scanning of a water-filled stomach). RESULTS: The T-staging accuracy of EUS (63 %, CI 52 - 73 %) was superior to the accuracy of HCT (44 %, CI 34 - 55 %; P = 0.021). N-staging accuracy of both methods was similar when the fourth edition of the TNM classification was used (EUS 47 %, CI 34 - 60 %; HCT 52 %, CI 38 - 65 %). However, HCT was more accurate than EUS when the fifth edition of the classification was applied (EUS 30 %, CI 18 - 43 %, HCT 47 %, CI 34 - 60 %; P = 0.044). The accuracy of detection of lymph node metastases was similar for both methods (EUS 67 %, CI 54 - 78 %; HCT 77 %, CI 64 - 86 %). CONCLUSIONS: EUS is more accurate than HCT in the T-staging of gastric carcinoma. Both methods are comparable for N-staging, when this is done according to the older, fourth edition of the TNM classification. If the fifth edition is used, EUS is less accurate than HCT.     

Pediatric primary gastric lymphoma.

Primary gastric lymphoma in the pediatric population is rare. We have described a case of non-Hodgkin's lymphoma (Burkitt's type) manifested as a gastric mass. Despite its rarity in children, this tumor should be treated aggressively, since long-term survival has been reported.     

Diffuse large B-cell lymphoma with concurrent gastric adenocarcinoma: case report and literature review

The simultaneous occurrence of diffuse large B-cell lymphoma (DLBCL) and gastric carcinoma is rare. The present case report describes a 61-year-old man with DLBCL at the ileocaecal junction with several metastatic lymph nodes and concurrent gastric intramucosal adenocarcinoma. Both tumours, together with the enlarged lymph nodes, were successfully removed by surgery. At 1 month postoperatively, the patient received chemotherapy consisting of rituximab, cyclophosphamide, vindesine, epirubicin hydrochloride and dexamethasone; he responded well to treatment. Reports published in the literature between January 2006 and March 2011 of other cases of DLBCL combined with concurrent non-haematological malignancies in immunocompetent patients were reviewed. The identification of common factors is important for clarification of the mechanisms of lymphomagenesis and carcinogenesis, as well as the creation of preventive and therapeutic strategies. Such cases highlight the need routinely to perform preoperative imaging studies to exclude other synchronous tumours and, if possible, to biopsy any such masses in order to offer timely and appropriate therapy.     

Protein-losing gastropathy with hypertrophic gastric folds: endosonographic findings

We present a case of protein-losing gastropathy with hypertrophic gastric folds. A 38-year-old man was hospitalized for severe epigastric pain suggestive of hypoproteinemia. Endoscopic and radiologic examination revealed enlarged gastric folds on the greater curvature of the stomach. Endoscopic sonography revealed marked thickening of the second layer on the greater curvature of the stomach. Endoscopic mucosal resection was performed, and the diagnosis was hypertrophic gastritis. After prednisolone treatment, hypoproteinemia and the enlarged gastric folds of the stomach resolved.     

Endosonography in decision making and management of gastrointestinal endocrine tumors.

OBJECTIVE: gastroenteropancreatic (GEP) neuroendocrine tumors, suspected on clinical basis, are often difficult to localize. We report our experience with endoscopic ultrasonography (EUS) in the preoperative localization of pancreatic endocrine tumors (PETs), compared to other imaging modalities, and in staging and following up carcinoid tumors (CTs) of the gastrointestinal (GI) wall. METHODS: 50 patients (20 males; mean age 54 years), 39 with suspected PETs and 11 with GI CTs underwent EUS (Olympus GF-UM2 or GF-UM3). EUS data could be compared with resected specimens in 25 out of the 39 PETs and five out of the 11 CTs. RESULTS: in the PETs group 42 tumors (35<20 mm) were removed: 23 in the pancreas, eight in the duodenum, and 11 in the lymph nodes. EUS correctly localized 20 out of the 23 (87%) pancreatic tumors, included 11 out of the 12 (91.6%) insulinomas, three out of the eight (37.5%) duodenal gastrinomas, and ten out of the 11 (90.9%) metastatic lymph nodes. Furthermore EUS accurately evaluated the depth of parietal invasion of CTs in three out of four patients (75%) (two after and one prior to endoscopic resection). In three patients EUS was confirmed as normal on resected specimens (two pancreas and one stomach). In the PETs group, a correct localization was obtained by ultrasonography (US) only in 17.4% of cases, by computed tomography (CT) in 30.4%, by magnetic resonance imaging (MRI) in 25%, by angiography in 26.6%, and by somatostatin receptor scintigraphy in 15.4%. CONCLUSION: EUS must be considered the first-intention method in localizing PETs and is helpful in decision making and management of GEP endocrine tumors.     

Endoscopic ultrasound features of protein-losing gastropathy with hypertrophic gastric folds

BACKGROUND AND STUDY AIMS: We aim to clarify the endoscopic ultrasound (EUS) features of protein-losing gastropathy with hypertrophic gastric folds (PLGH), including Ménétrier's disease. PATIENTS AND METHODS: We analyzed the EUS and histologic findings in five patients who underwent both endoscopic ultrasonography and endoscopic resection. RESULTS: Histologically, we diagnosed one patient as having acute gastritis, three patients as having Ménétrier's disease, and the remaining patient as having hypertrophic lymphocytic gastritis (HLG). Helicobacter pylori was recognized in all but one patient. At EUS every patient was found to have giant gastric folds (13 to 20 mm in diameter), resulting from echogenic thickening of the mucosal layer with or without cystic components. Two patients who underwent eradication therapy of H. pylori showed both clinical and morphologic resolution. CONCLUSIONS: Echogenic thickening of the mucosal layer may be a characteristic EUS feature of protein-losing gastropathy with hypertrophic gastric folds, and H. pylori may be one of the causative agents.     

Endosonography of the anal sphincter in women of different ages and parity.

OBJECTIVES: To obtain reference data representative of normal findings at anal endosonography in pregnant and non-pregnant women. To determine intraobserver and interobserver agreement in the detection of endosonographic anal sphincter defects in asymptomatic women. METHODS: Twenty-five non-pregnant nulliparous women and 25 non-pregnant parous women (age range, 20-67 years) and 47 pregnant women (age range, 21-39 years) underwent anal manometry and anal endosonography. The endosonographic internal and external sphincter thickness and sphincter length were measured online. Endosonographic sphincter defects were measured and classified offline from videotapes by two independent examiners using an endosonographic defect score ranging from 0 (no defect) to 16 (maximal defect), the score taking into account the location and the longitudinal and circumferential extension of the defect. RESULTS: Endosonographic sphincter thickness and length did not differ between non-pregnant nulliparous and parous women and did not change substantially with age. The anal sphincter was thicker and the anal resting pressure area and manometric sphincter length were greater in pregnant than in non-pregnant women of the same age (20-39 years). There was good intra- and interobserver agreement with regard to detection of endosonographic anal sphincter defects (kappa > or = 0.70). Eighteen (19%) women had endosonographic sphincter defects but in only four (4%; 4/97) cases were they moderate or large (defect score, 7-10). Ten (20%) of the non-pregnant women reported minor gas incontinence and one reported minor incontinence for both gas and liquid stool. The frequency of incontinence did not differ between women with and without sphincter defects. CONCLUSIONS: Reference data representative of normal findings at anal endosonography have been established for non-pregnant women and for nulliparous women in the third trimester of pregnancy. Small endosonographic sphincter defects and minor gas incontinence are common in women without known sphincter trauma. They seem to be unrelated to each other and may be regarded as normal variants.     

Primary mediastinal large B-cell lymphoma

Primary mediastinal large B-cell lymphoma (PMLBCL) is a distinct disease entity that has a relatively short history. The prognosis and therapy of patients with PMLBCL is still controversial. We summarize our experience with PMLBCL at the Medical University of South Carolina between 1997 and 2000.     

Prevention and treatment of intertrigo in large skin folds of adults: a systematic review

Background  

Intertrigo in the large skin folds is a common problem. There is a plethora of treatments, but a lack of evidence about their efficacy. A nursing guideline on this matter had to be updated and broadened in scope to other health care professionals.     

Primary gastric lymphoma versus gastric cancer. An endoscopic and radiographic study of differential diagnostic possibilities

Eighteen patients with primary gastric malignant lymphoma were compared retrospectively with an age- and sex-matched group of patients with gastric cancer. It was found that a correct preoperative diagnosis was established in 8 out of 18 lymphoma patients (44%). Of the remaining patients eight were preoperatively diagnosed as cancers and two as benign ulcers. Malignancy was not suggested by biopsy or cytology in a total of six lymphoma patients. There was no difference as regards the size of the gastric lesion between the groups. A diffuse involvement of the stomach was found only in lymphoma patients. Furthermore, lymphoma patients often showed superficial stellate ulcers and a sharp margin between the lesion and the normal mucosa. It is suggested that these findings should make the investigator aware of the possibility of a gastric lymphoma. When this diagnosis is considered, great importance should be attached to obtaining large biopsies which possibly allow a correct preoperative diagnosis more often.     

Brentuximab vedotin in anaplastic large cell lymphoma

Objective: We aimed to investigate the influence of natalizumab (NTZ) treatment on multiple sclerosis course in patients with and without spinal involvement.

Methods: Annualized relapse rate (ARR), disability progression and occurrence of new brain and spinal T2 lesions (N2TL) in 68 spinal (S-P) versus 68 non-spinal matched patients (NS-P) were retrospectively collected and compared between before (2 years) and after NTZ treatment using multivariate regression models.

Results: Mean duration of NTZ treatment was 31.3 ± 16.3 months in S-P and 32.1 ± 15.1 months in N-SP (p = 0.56). The mean ARR after NTZ treatment was similarly reduced in both S-P (0.07 ± 0.19) and N-SP (0.07 ± 0.16) (p < 0.001 for both). Disability progression after NTZ start was similarly low in S-P and NS-P. However, when compared to before NTZ start, disability progression was significantly reduced in S-P (p = 0.017), but not in NS-P (p = 0.68). This was largely mediated by a higher disability progression before NTZ start in S-P than N-SP. The risk of developing N2TL during NTZ was not different between S-P and NS-P (p = 0.10).

Conclusions: NTZ similarly reduced the occurrence of relapses and NT2L in S-P and NS-P, whereas the effect on disability progression was particularly evident in the presence of spinal involvement. NTZ appears to be a treatment of high efficacy in both S-P and NS-P.