LONG‐TERM FOLLOW UP OF PATIENTS WITH SMALL GASTROINTESTINAL STROMAL TUMORS IN THE STOMACH USING ENDOSCOPIC ULTRASONOGRAPHY‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY

Background: Gastrointestinal stromal tumors (GIST) are one of the most common mesenchymal tumors of the gastrointestinal tract. GIST are defined by positive immunohistochemical staining for KIT or CD34 and thus are generally diagnosed after surgery. Because small GIST are rarely diagnosed before surgery, the clinical course of these small tumors is not clear. The aim of the present study was to follow changes in size and configuration of small GIST that were pathologically confirmed using endoscopic ultrasonography‐guided fine‐needle aspiration biopsy (EUS‐FNAB). Methods: Between July 1997 and December 2003, 16 tumors in 16 patients (10 men and 6 women) with an immunohistochemical diagnosis of GIST were regularly followed in our hospital. The median patient age when EUS‐FNAB was performed was 62 years (range 26–82 years) and the median follow‐up period was 4.9 years (range 0.5–9.6 years). Results: Fourteen tumors showed no remarkable changes in size and shape during follow up compared with the initial diagnosis. Two tumors enlarged: one tumor approximately doubled its diameter in 8 years and the other tumor increased from 1.8 cm at diagnosis to up to 10 cm after only 2 years. Doubling time of the latter tumor was calculated as 3.1 months. Conclusions: We conclude that EUS‐FNAB might be a good modality for final diagnosis of GIST without surgery, and that GIST without rapid growth on follow up can be endoscopically followed.     

A note on the synapses between vesicle containing profiles in the pontine nuclei of the cat

In the cat synapses between vesicle containing profiles were observed in ventral and dorsolateral pontine nuclei. The presynaptic elements consisted of two types of axon terminals: axon terminals characterized by a population of small (38-40 nm) round synaptic vesicles (SSV) and axon terminals containing pleomorphic synaptic vesicles (PSV). The postsynaptic pale elements (PP) had pleomorphic vesicles and some features attributed to dendrites. In the dorsolateral pontine nucleus most of PP profiles took part in serial synapses, usually as an intermediate component, they were rarely observed in triads. On the basis of their electron microscopical appearance and synaptic relations they might be considered to represent a dendritic part of putative interneurons.     

Positive sign of the stenocardia syndrome as a criterion of myocardial ischemia during the treadmill test

Diagnostic validity of the criteria of myocardial ischemia in coronary patients exposed to the treadmill test is assessed. The risk of a false diagnosis of coronary insufficiency on the basis of the pain syndrome was 5 times as high as that of diagnosis based on ischemic electrocardiographic ST depression. In subjective assessment of walking tolerance, patients with severe angina were particularly prone to mistakes. Limitations of angina classifications by severity, based on subjective sensations of coronary patients, are considered.     

Surgical tactics in clotted hemothorax in patients with combined chest injuries

Based on the experience with treatment of 26 patients the authors recommend to use mainly conservative treatment with the intrapleural administration of fibrinolytic drugs. The method was used in 20 patients. All of them recovered.     

Use of endoscopic papillosphincterotomy in the treatment of acute pancreatitis

The authors describe results of using endoscopic papillosphincterotomy in 100 patients with acute pancreatitis. Methods of endoscopic papillosphincterotomy and endoscopic papillosphincterowirsungotomy are presented. The effectiveness of the treatment was 96%. Operative procedures on emergency made up 1%, lethality-1%, complications-3% of the cases.     

Diagnosis and evaluation of the severity of arterial insufficiency of the legs using ultrasonic Doppler flowmetry in the treadmill test

A method of diagnostics and assessment of the severity of arterial insufficiency of lower extremities was developed on the basis of multistep treadmill-test and measuring time of reestablishment of continuous bloodflow in the popliteal artery by the method of ultrasonic doppler flowmetry. An examination of 40 patients with angiographically detected alterations of the vessels and 18 healthy persons was performed. It was found that the diagnostic and assessment criterion of arterial insufficiency in treadmill-test with high parameters of sensitivity and specificity is longer duration of the period of reestablishment of continuous bloodflow over 180 sec. The arterial insufficiency severity is estimated by the value of exercise by the moment of the appearance of the criterion.