Sensitivity of endoscopic retrograde cholangiopancreatography standard cytology: 10-y review of the literature

Background

Biliary strictures present a unique diagnostic challenge to clinicians as they can be caused by both benign and malignant conditions. With the high mortalities associated with hepatopancreaticobiliary malignancies, accurate and rapid tissue diagnosis is imperative and typically done before initiation of treatment. However, the exact sensitivity of standard cytology from endoscopic retrograde cholangiopancreatography (ERCP) to diagnose malignancy remains unclear because of wide distribution of reported values in the literature. Furthermore, the use of radical surgery to obtain tissue when cytology is indeterminate has led to questions about the role of ERCP in patients with biliary strictures.

Methods

A PubMed search was conducted using the terms ERCP, cytology, and brushings. Articles reviewed were published between 2002 and 2012, had patient population with biliary stricture, and had ERCP brushing results and final pathology available for review. The cytology and pathology data were abstracted from each study, and the combined overall sensitivity was calculated.

Results

Sixteen studies were identified, with sensitivities ranging from 6%–64% and 99% confidence intervals (CIs) ranging from ±6% to ±32%. A combined total of 1556 patients were included, with positive ERCP cytology results in 358 cases. On final pathology, however, 861 patients were positive for malignancy. When the data were combined, we found an overall sensitivity of 41.6% ± 3.2% (99% CI) with a negative predictive value of 58.0% ± 3.2% (99% CI).

Conclusions

ERCP brushings suffer from low sensitivity and negative predictive value. This study questions the utility of ERCP to change the surgical management of these diseases in patients with radiographic evidence of a neoplasm or high suspicion of a malignancy.     

中华按蚊对杀虫剂敏感性调查

目的分析河南省疟疾媒介中华按蚊对DDT、氟氯氰菊酯、马拉硫磷和溴氰菊酯的敏感性,为制定疟疾媒介防制对策提供依据。方法2009年6月在河南省桐柏县、淮滨县和永城市3个县(市)现场分别捕获吸血后中华按蚊成蚊417、421和433只,采用WHO推荐的成蚊滤纸接触法进行检测,计算中华按蚊分别接触4%DDT(1.428g/m2),0.15%氟氯氰菊酯(0.0 534 g/m2),5%马拉硫磷(1.78 g/m2)和0.05%溴氰菊酯(0.0 178 g/m2)的半数击倒时间(KT50)和24 h后死亡率。根据死亡率判定抗性级别,死亡率98%～100%为敏感群体(S级),80%～97%为初步抗性群体(M级),80%以下为抗性群体(R级)。结果桐柏县、淮滨县和永城市3个县(市)中华按蚊接触DDT的KT50分别为206.13、877.04和826.81 min;接触氟氯氢菊酯的KT50分别为206.43、85.39和427.60 min;接触马拉硫磷的KT50分别为19.98、48.05和97.79 min;接触溴氰菊酯的KT50分别为1122.50、89.65和960 min。接触4%DDT 24 h死亡率分别为82.52%、57.41%和65.69%,抗性级别分别为M、R和R级;接触0.15%氟氯氰菊酯24 h死亡率分别为91.89%、85.00%和72.73%,抗性级别分别为M、M和R级;接触5%马拉硫磷24h死亡率分别为95.10%、95.37%和93.16%,抗性级别均为M级;接触0.05%溴氰菊酯24h死亡率分别为92.08%、77.14%和63.46%,抗性级别分别为M、R和R级。结论河南省中华按蚊对DDT、氟氯氰菊酯和溴氰菊酯已产生较强抗性,对马拉硫磷产生初步抗性。     

胃肠超声造影对胃底静脉曲张的诊断价值

食管胃静脉曲张是肝硬化门静脉高压的常见并发症。近年来,超声造影在胃肠疾病诊断中的应用日益受到关注。目的：探讨胃肠超声造影对胃底静脉曲张的诊断价值。方法：收集2009年3月-2011年9月于河北省玉田县医院接受胃镜和口服胃肠超声造影检查的肝硬化门静脉高压患者79例,回顾性分析胃肠超声造影的声像图特征,并以胃镜检查结果为“金标准”,评价其对胃底静脉曲张的诊断价值。结果：79例肝硬化门静脉高压患者中41例经胃镜检查证实胃底静脉曲张,其中33例胃肠超声造影显示特征性声像图表现,曲张静脉内径（12．6±8．9）mm,血液流速（13．9±2．7）cm／s。胃肠超声造影诊断胃底静脉曲张的敏感性、特异性、准确率分别为80．5％（33／41）、100％（38／38）、89．9％（71／79）。结论：胃肠超声造影在胃底静脉曲张的诊断中具有较高应用价值,有望成为肝硬化门静脉高压患者胃底静脉曲张的初步筛查手段推广使用。     

血清胃蛋白酶原检测在胃癌筛查中的价值

背景:我国在亚太地区属于胃癌高危地区。亚太地区胃癌预防共识指出,低血清胃蛋白酶原(PG)Ⅰ水平和低PGⅠ/PGⅡ比值可作为筛查胃癌高危人群的标记物。目的:明确血清PG检测在胃癌筛查中的价值。方法:纳入1880例2010年3月～2011年12月南京市市级机关医院的健康体检人员以及有上腹部不适症状的门诊患者,行血清PGⅠ、PGⅡ检测,其中1028例(包括所有血清PG筛查结果阳性者和部分筛查结果阴性但有上腹部不适症状或胃癌家族史者)接受胃镜和活检组织病理检查。结果:各年龄段受检者血清PGⅠ、PGⅡ水平差异均无统计学意义,≥70岁年龄段组PGⅠ/PGⅡ比值显著低于其他各年龄段组(P<0.05)。萎缩性胃炎组、上皮内瘤变组和胃癌组血清PGⅠ水平和PGⅠ/PGⅡ比值显著低于正常/非萎缩性胃炎组(P<0.01)。以PGⅠ<70 ng/mL+PGⅠ/PGⅡ<3.0为界值,血清PG检测筛查胃癌的敏感性为74.1%,特异性为84.9%,阳性似然比为4.93,阴性似然比为0.30。结论:血清PG检测用于胃癌初筛具有敏感性高、易于接受、成本低等优势,适用于大面积人群普查,结果阳性者应进一步行胃镜筛查。     

γ-干扰素释放分析T-SPOT.TB在结核性疾病中的诊断价值

目的评价γ-干扰素释放分析T-SPOT.TB检测在结核性疾病中的诊断价值。方法采用T-SPOT.TB试剂盒对疑诊或待排结核患者外周血中释放γ-干扰素的结核分枝杆菌特异性T淋巴细胞进行检测。结果γ-干扰素释放分析T-SPOT.TB检测在结核性疾病阳性检出率为83.3%(20/24),明显高于结核菌素试验(tuberculin skin test,TST)的41.7%(10/24)、涂片找抗酸杆菌的26.7%(4/15)、分枝杆菌分离培养的22.2%(2/9),差异有统计学意义(P<0.05)。γ-干扰素释放分析T-SPOT.TB检测诊断结核性疾病敏感性、特异性分别为83.3%、96.4%,显著优于结核菌素试验。结论γ-干扰素释放分析T-SPOT.TB检测是诊断结核的快速敏感方法,在结核性疾病诊断中有重要价值。     

Comparison of Cystatin C,Creatinine and Creatinine Clearance vs. GFR for Detection of Renal Failure in Renal Transplant Patients

Background: Serum cystatin C (Scyst) has been suggested as an alternative index of glomerular filtration rate (GFR) and could be useful in renal transplant patients. Methods: In a 60‐subject cohort (40 ± 12 years old), we compared the simultaneous measurements of Scyst, serum creatinine (Screat), creatinine clearance (Ccreat), Cockcroft and Gault's estimated clearance (Ccg) and GFR measured using inulin clearance (Cin). Receiver operating characteristic (ROC) analysis was performed using two Cin cut‐off (60 and 90 mL/min/1.73 m²). Results: A significant correlation was found among Cin on one hand and 1/Scyst, Ccreat, 1/Screat and Ccg on the other hand. Best fits (sensitivity/specificity) at 90 mL/min/1.73 m² were 1.18 mg/L (0.72/0.80) for Scyst, 1.32 mg/dL (0.67/0.90) for Screat, 77 mL/min (0.80/0.70) for Ccg and 104 mL/min (0.88/0.80) for Ccreat. The areas under the ROC curves were not significantly different. Conclusions: This study provides cut‐off values for Screat and Ccg for detection of renal failure in renal transplant patients. However, the results also suggest that Scyst is not a more sensitive marker than Screat or Ccg for detecting renal failure in renal transplant patients.     

Cold hypersensitivity after hand injuries. A prospective 7-year follow-up

Abstract

We studied changes in cold hypersensitivity from 3 to 7 years following severe hand injuries. Data was collected using postal questionnaires 7 years after injury in 71 patients who had participated in a 3-year follow-up from the time of injury. There was no change in cold sensitivity measured using the McCabe Cold Sensitivity Severity scale (CSS) from 3 to 7 years after injury. However, there was a trend toward decreased severity measured using a five-level scale of self-reported cold hypersensitivity. Compared to the 3-year follow-up, fewer respondents rated their condition as severe and two patients had recovered from their cold hypersensitivity at the 7-year follow-up. Furthermore, 21 (30%) of the respondents stated a decrease in cold hypersensitivity during the last 2 years. Limitations in cold associated activities and the importance of being less limited in leisure activities (NRS 0-10) did not change between the two follow-ups. In conclusion, the CSS-scores did not change from 3 to 7 years after injury. Several patients experienced improvements in cold hypersensitivity, but few recovered completely from the condition.     

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression

Background

A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide.

Aims

To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state.

Method

Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety.

Results

The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode.

Conclusions

The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.     

Discriminating value of total minor physical anomaly score on the Waldrop scale between patients with bipolar I disorder and normal controls

Minor physical anomalies (MPAs) are slight structural aberrations indicative of abnormal neurodevelopment. Most studies of MPAs in bipolar disorder have yielded limited results. We attempted to assess the potential value of MPAs as a classifying test in the status bipolar I patients vs. normal controls. Sixty one bipolar I patients and 103 controls were evaluated for MPAs using a slightly modified version of the Waldrop scale. The specificity, sensitivity and predictive value of different total MPA (MPA-T) scores were determined. The cut-off MPA-T scores that optimally discriminated patients from controls (exhibiting the most balanced sets of sensitivity, specificity, positive and negative predictive values) were MPA-T≥4 and MPA-T≥5. These values set a “border zone” in which bipolar I patients began to prevail significantly over controls. The latter presented most frequently with MPA-T ≤3 and rarely with MPA-T ≥6. Bipolar I patients prevailed among outliers (subjects with significantly higher MPA-T scores). Our data establish MPA-T score as a reliable index in distinguishing between bipolar I patients and normal controls and are consistent with the hypothesis of abnormal neurodevelopment in bipolar disorder.