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41.
Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the
pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical
resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based
on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration,
i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information.
This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2)
are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic
studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic
concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging
modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should
therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since
the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic
and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically
relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be
expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies,
which may soon alter our therapeutic concepts.
相似文献
42.
43.
Pathophysiological components of irritant contact dermatitis caused by 3 chemically-different irritants were investigated. 20 healthy volunteers were patch tested with sodium lauryl sulphate, nonanoic acid and hydrochloric acid on the flexor side of the upper arm. The skin response was evaluated after 24, 48 and 96 h by visual scoring and measured by the following bioengineering methods: transepidermal water loss measurement, electrical conductance for measurement of skin hydration, laser Doppler flowmetry for measurement of cutaneous blood flow and 20 MHz ultrasound A-scan for measurement of skin thickness. In spite of homogeneous inflammatory responses, significant differences in the severity of the injury to the skin barrier function caused by the different irritants were found. Also significant differences between irritants were found in the time course of development of maximum irritant reactions. Bioengineering methods indicating inflammatory responses (measurement of blood flow and skin thickness) were helpful in quantifying the irritant response in general, while bioengineering methods indicating epidermal damage (measurement of TEWL and electrical conductance) were helpful in classifying the individual irritants. 相似文献
44.
经阴道超声诊断子宫内膜癌 总被引:1,自引:0,他引:1
目的 探讨应用经阴道超声(TVS)诊断绝经前后出血妇女子宫内膜癌的价值。方法 采用彩色多普勒超声诊断仪检测74例阴道异常出血的妇女,其中绝经前28例,绝经后46例,所有患者均取子宫内膜组织行病理对照。结果 TVS检测子宫内膜癌的敏感性、特异性、假阳性率、假阴性率、阳性预测值和阴性预测值,绝经前妇女依次为61.5%,50.0%,14.3%,23.8%,94.1%和54.5%,绝经后妇女依次为97.3%,55.6%,44.4%,2.7%,90.0%和83.0%。结论 TVS检测可作为子宫内膜癌首选的筛查方法,尤其对于绝经后妇女价值更大。 相似文献
45.
We investigated the relationship between esophageal varices and the collaterals by endoscopy and endoscopic ultrasound (20 MHz ultrasonic miniprobe; UMP). Moreover, we investigated the correlation between the collaterals around the esophagus and recurrence of esophageal varices in patients with portal hypertension who had undergone EIS. The collaterals were divided into two groups: peri‐esophageal collateral veins (peri‐ECVs) and para‐esophageal collateral veins (para‐ECVs). These were scored as mild or severe according to the stage of development. According to endoscopy, the varix form was significantly larger in severe the peri‐ECVs group than in mild the peri‐ECVs group. The prevalence of perforating veins increased according to the varix form. With regard to variceal recurrence, in patients with variceal recurrences, UMP findings included a significantly higher incidence of severe peri‐ECVs, a significantly larger diameter of perforating veins compared with patients without recurrence. In conclusion, the presence of severe peri‐ECVs and large perforating veins in the esophageal wall strongly correlates with occurrence and recurrence of esophageal varices in patients with portal hypertension. An understanding of these UMP abnormalities on the basis of hemodynamics around the esophagus is thought to be important for management of esophageal varices in patients with portal hypertension. 相似文献
46.
Endoscopic ultrasound (EUS) is sensitive for staging gastrointestinal malignancies and pancreatic lesions. EUS‐fine‐needle aspiration (EUS‐FNA) offers a diagnostic accuracy of about 60–90% for pancreatic tumors and > 90% for lymph nodes. There are several limitations of EUS‐FNA including the need for on‐site cytopathology review. In addition, accuracy of cytologic review is hampered by the presence of blood, benign epithelial cells, desmoplasia, and well‐differentiated tumors. Furthermore, the small biopsy sample and destruction of tissue architecture limits the diagnostic sensitivity for GISTs and lymphomas. Many of these problems can be overcome with use of EUS trucut biopsy (TCB) needles. These large caliber, cutting needles acquire larger tissue samples allowing preservation of tissue architecture and histologic examination. Our recently described experience with EUS‐TCB initially in swine and later humans demonstrated the safety for acquiring histologic tissue representative of the target organs sampled enabling accurate diagnosis. These studies suggested greater diagnostic accuracy of EUS‐TCB for submucosal mass lesions and lymphoma and potentially the need for fewer needle passes for solid pancreatic neoplasms. In this paper we will review the current TCB literature, device design and technique, help troubleshoot potential problems, and offer opinion as to the utility and role of this new device. 相似文献
47.
D M Reboussin D C Goff E W Lipkin D M Herrington J Summerson M Steffes R J Crouse L Jovanovic M N Feinglos J L Probstfield M A Banerji D J Pettitt J Williamson 《Diabetic medicine》2004,21(10):1082-1089
OBJECTIVE: To examine the effect of short-term improvements in glycaemic control on brachial artery endothelial function as a marker of cardiovascular health. METHODS: Persons with Type 2 diabetes who were poorly controlled on oral therapy were randomly assigned to monotherapy with repaglinide or combination therapy with repaglinide plus metformin. Brachial artery flow-mediated vasodilation was assessed by ultrasonography at randomization and following 16 weeks of therapy. The primary outcome was change in brachial artery endothelial function from baseline. Comparison of randomized groups was a secondary aim. RESULTS: Eighty-six participants were randomized, and 83 were followed to study completion. Post occlusion brachial artery vasodilation was 3.74% at baseline and 3.82% following 16 weeks of therapy (P = 0.77). The treatment effect was 0.08% (95% CI: -0.48%, 0.64%). No difference was seen between treatment groups (P = 0.69). Overall, A1C was reduced from 8.3% to 7.0%, with a greater reduction in the combination therapy group (from 8.4% to 6.7%) than in the monotherapy group (from 8.3% to 7.3%, p for difference between groups = 0.01). Statistically significant reductions were observed in fasting glucose, and plasminogen activator inhibitor-1. Statistically significant increases were observed for fasting insulin, uric acid, weight and BMI. CONCLUSIONS: Brachial artery endothelial function was not influenced by short-term improvements in glycaemic control. The CONTROL DM group was successful in lowering A1C. Future research should explore more intensive and longer-lasting improvements in glycaemic control on endothelial function. Some data previously published in abstract form (Diabetes 2001; 50 (Suppl. 2): A217). 相似文献
48.
经直肠超声引导前列腺穿刺活检203例临床分析 总被引:8,自引:1,他引:7
目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性,血清PSA〉4pg/L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果:良性前列腺增生(BPH)104例占51.24%,前列腺癌(PCa)95例占46.80%,前列腺结核及前列腺平滑肌肉瘤各2例,分别占0.98%。结论经直肠超声引导的前列腺穿刺活检其操作简单,病人痛苦小,并发症少,较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。 相似文献
49.
分析了经病理证实的40例胃占位病变的X线及超声资料,旨在探讨超声及其与X线结合在胃占位病变中的价值。结果提示,超声和X线各有优缺点,二者结合使用,可互相取长补短,对提高胃占位病变的诊断质量,帮助临床制定合理的治疗方案有肯定价值。 相似文献
50.
PL Macken FRACO FRACS CJ Pavlin FRCS R Tuli MD GE Trope PhD FRCS 《Clinical & experimental ophthalmology》1995,23(3):217-220
Background: Spherophakia is an uncommon diagnosis. This is the first case report of spherophakia evaluated by ultrasound biomicroscopy.
Methods: Ultrasound biomicroscopy is a new diagnostic technique developed by one of the authors and provides images with microscopic resolution of the anterior segment. A patient with spherophakia was evaluated by ultrasound biomicroscopy (Zeiss-Humphrey, 50MHz) before and after YAG laser iridotomy.
Results: Ultrasound biomicroscopic assessment revealed a shallow anterior chamber, a very steep anterior lens curvature, iridolenticular contact, elongated zonules, and an increased distance between the lens equator and the ciliary processes. Angle closure glaucoma was due to a pupil block mechanism. The pupil block was relieved by YAG laser iridotomy.
Conclusions: Ultrasound biomicroscopy is a useful technique to confirm the diagnosis of spherophakia. The pupil block in spherophakia is relieved by YAG laser iridotomy. 相似文献
Methods: Ultrasound biomicroscopy is a new diagnostic technique developed by one of the authors and provides images with microscopic resolution of the anterior segment. A patient with spherophakia was evaluated by ultrasound biomicroscopy (Zeiss-Humphrey, 50MHz) before and after YAG laser iridotomy.
Results: Ultrasound biomicroscopic assessment revealed a shallow anterior chamber, a very steep anterior lens curvature, iridolenticular contact, elongated zonules, and an increased distance between the lens equator and the ciliary processes. Angle closure glaucoma was due to a pupil block mechanism. The pupil block was relieved by YAG laser iridotomy.
Conclusions: Ultrasound biomicroscopy is a useful technique to confirm the diagnosis of spherophakia. The pupil block in spherophakia is relieved by YAG laser iridotomy. 相似文献