Radiologic methods in the diagnosis of diseases of the spleen]

Ultrasonic and computer-aided tomographic examinations of 2457 patients with suspected diseases of the abdominal cavity organs have revealed splenic involvement in 48. The sensitivity of ultrasonic technique for the detection of splenic diseases has made up 70.8%, that of computer-aided tomography--95.8%. Invasive interventions monitored by these two methods were carried out in 26 patients; in 10 of these transcutaneous puncture drainage was carried out for cysts (2), hematoma (1), and abscesses of the spleen (7). In one patient with multiple abscesses of the spleen the drainage was found insufficient for complete cure and he had to be subjected to splenectomy, in the rest cases surgery did not have to be resorted to. Therefore, ultrasonic and computer-aided tomographic examinations of the spleen, used together with various invasive interventions, result not only in correct diagnosis and differential diagnosis of this organ's disease, but permit various therapeutic measures and help achieve cure without laparotomy.     

Ultrasonographic guidance in diagnostic and therapeutic interventions in diseases of the internal organs

A hundred fifty four invasive diagnostic and therapeutical interventions were made in patients with diseases of the abdomen and retroperitoneal space under ultrasonographic guidance. Various biopsies were performed in 139 patients; positive results were achieved in 120 (86.3%) cases. In 15 patients, diagnostic biopsies were combined with therapeutical interventions, such as aspiration of cysts in the liver (n = 3) and kidney (n = 2); drainage of abscesses in the abdomen (n = 5) and liver (n = 5). Fourteen patients with mechanical jaundice caused by extrahepatic bile duct tumors or pancreatic head cancer underwent percutaneous transhepatic cholecystocholangiography followed by external drainage. Percutaneous transhepatic drainage of the gallbladder was made in 1 patient with acute cholecystitis.     

Invasive interventions guided by computerized tomography in the diagnosis and treatment of diseases of the internal organs

Diagnostic punctures under CT guidance were made in 544 patients with diseases of the chest (n = 303), abdomen (n = 149), and retroperitoneal space (n = 92). In 87 patients, diagnostic punctures were combined with therapeutical manipulations and included aspiration and drainage of visceral organ cysts and abscesses. The proposed procedure of diagnostic biopsies under CT guidance could ascertain the morphological nature of a lesion in 90.1% of cases prior to treatment. Therapeutical aspirations and drainage of visceral cysts and abscesses under CT guidance resulted in their complete recovery in 97.8 and 85.7% of cases, respectively. Diagnostic and therapeutical interventions under CT guidance caused complications in 6.9% of cases. At diagnostic biopsy, pneumothorax is the most frequent complication *5.3%), and lung tissue hemorrhage along the puncture needle passage is the less frequent (1.3%). The use of therapeutical interventions developed complications in 1.1% of cases.     

An Experience With Ultrasonically Guided Liver Aspirates From South India

Fine needle aspiration (FNA) was performed on 102 hepatic lesions under ultrasound control. Eighty-eight lesions were solid and 14 were cystic. Ninety aspirates provided adequate material for cytodiagnosis. Aspirates from the solid lesions were assessed for the presence or absence of 20 cytological features. It was found that on a univariate statistical analysis, 11 of the features were significantly associated with hepatocellular carcinomas. Five of these 11 were considered diagnostic of the lesion on a step-wise multiple linear regression analysis. Two other features (not included among the 11) were found to be significantly associated with metastatic neoplasms. Cystic lesions were diagnosed as being either abscesses, hydatid cysts or congenital cysts. the physical appearance of the cyst fluid proved to be of diagnostic value in many cases.     

Midline (dermoid) cysts of the floor of the mouth: report of 16 cases and review of surgical techniques

A retrospective review of 16 cases of midline (dermoid) cysts of the floor of the mouth is presented, evaluating the different surgical approaches. Sixteen cases of patients with a diagnosis of midline cyst of the floor of the mouth, treated at the Maxillofacial Surgery Department of the School of Medicine and Surgery of the "Federico II" University of Naples (Naples, Italy), were observed over a 10-year period, between 1988 and 1998; age, sex, localization, diagnostic technique, and type of treatment were evaluated. Male patients were more frequently affected, with a male-to-female ratio of 3:1 (12:4 cases). Patients ranged in age from 5 to 51 years (average age, 27.8 years). The preoperative assessment was made using ultrasonography in all cases but one, computed tomography in eight cases, and magnetic resonance imaging in three cases. Regarding surgical techniques used, a transcutaneous approach was adopted for median geniohyoid cysts, an extended median glossotomy technique was used for very large median genioglossal cysts, a median glossotomy technique was used for median genioglossal cysts, and a midline incision of the oral mucosa along the lingual frenulum was used for sublingual cysts. During the postoperative course, there were no complications except for modest edema in three cases. Follow-up ranged between 24 months and 12 years; no relapses or malignant changes were observed. In the authors' experience, the intraoral approach was also effective for the treatment of large lesions and led to very good cosmetic and functional results, whereas the extraoral incision was necessary only when the cysts were under the geniohyoid muscle.     

Magnetic resonance tomography in the diagnosis of nonorganic bulky masses of the retroperitoneal space. Part 1. Cysts,abscesses and flegmons

The paper considers the diagnostic capacities of magnetic resonance imaging (MRI) in detecting non-organic bulky masses of the retroperitoneal space. Based on the analysis of tomographic findings in 23 patients with non-organic cysts of the retroperitoneal space and 27 patients with its abscesses and phlegmons, the first part of the paper describes the MRI semiotics of these diseases in detail and proposes methodic approaches to their identification. Comparison of the data of MRI and pathomorphological analysis of operation materials has yielded the rates of sensitivity, specificity, and accuracy of the method, which are equal to 100, 88.5, and 94.2% for non-organic cysts and 100, 87.1, and 93.5%, respectively. The authors note the lower efficiency of MRI in recognizing hydatid cysts and foreign bodies than ultrasound study and X-ray computed tomography and show it necessary to take into account clinical information in making a radiological conclusion.     

Prevalence of Incidental Pancreatic Cysts on 3 Tesla Magnetic Resonance

Objectives

To ascertain the prevalence of pancreatic cysts detected incidentally on 3-Tesla magnetic resonance imaging (MRI) of the abdomen and correlate this prevalence with patient age and gender; assess the number, location, and size of these lesions, as well as features suspicious for malignancy; and determine the prevalence of incidentally detected dilatation of the main pancreatic duct (MPD).

Methods

Retrospective analysis of 2,678 reports of patients who underwent abdominal MRI between January 2012 and June 2013. Patients with a known history of pancreatic conditions or surgery were excluded, and the remaining 2,583 reports were examined for the presence of pancreatic cysts, which was then correlated with patient age and gender. We also assessed whether cysts were solitary or multiple, as well as their location within the pancreatic parenchyma, size, and features suspicious for malignancy. Finally, we calculated the prevalence of incidental MPD dilatation, defined as MPD diameter ≥ 2.5 mm.

Results

Pancreatic cysts were detected incidentally in 9.3% of patients (239/2,583). The prevalence of pancreatic cysts increased significantly with age (p<0.0001). There were no significant differences in prevalence between men and women (p=0.588). Most cysts were multiple (57.3%), distributed diffusely throughout the pancreas (41.8%), and 5 mm or larger (81.6%). In 12.1% of cases, cysts exhibited features suspicious for malignancy. Overall, 2.7% of subjects exhibited incidental MPD dilatation.

Conclusions

In this sample, the prevalence of pancreatic cysts detected incidentally on 3T MRI of the abdomen was 9.3%. Prevalence increased with age and was not associated with gender. The majority of cysts were multiple, diffusely distributed through the pancreatic parenchyma, and ≥ 5 mm in size; 12.1% were suspicious for malignancy. An estimated 2.7% of subjects had a dilated MPD.     

ASPIRATION OF BREAST CYSTS

In 1,364 cases of breast cyst aspiration reported in the literature, there is no note of a missed diagnosis of carcinoma.The author carried out needle aspiration in 80 patients with a definite mass in the breast as a therapeutic or diagnostic procedure.A diagnosis must be established for every definite mass in the breast and needle aspiration is a logical diagnostic procedure. If the needle encounters a solid mass, the mass must be removed for biopsy. If the needle encounters a cyst containing fluid, the fluid should be removed completely. A biopsy specimen then should be taken from the mass if (a) the fluid is bloody, (b) the mass does not entirely disappear, or (c) the mass recurs promptly. Adherence to these rules will keep the examining physician from missing a carcinoma within the cyst.Aspiration of breast cysts is a simple and safe diagnostic and therapeutic procedure that saves the patient distress and money.     

The computed tomographic semiotics of inflammatory diseases of the adnexa uteri

The authors sum up the results of CT and clinical investigation of 46 women with inflammatory diseases of the uterine appendages: salpingo-oophoritis, pyosalpinx, pyoovarium, and 2 types of tuboovarian abscesses. They have shown CT potentialities in differential diagnosis of inflammations of the uterine appendages with cysts and true ovarian tumors on the basis of routine investigation and an iv contrast study of intensified images. Retrospective analysis of the most typical diagnostic errors is given.     

Immunological approach in the diagnosis, therapy and prognosis of the exocrine pancreatic cancer

The aim of the paper is to outline the most important up-to-date methods regarding the immunological approach in the diagnosis, treatment and prognosis of the exocrine pancreatic cancer, keeping in mind that this localisation of neoplastic disease represents the 5th cause of cancer-related death and especially, an important cause of morbidity. This disease, diagnosed in the past in later stages, being therefore associated with poor results, has turned to be characterized by increasing survival rates due to the improvements in diagnostic and therapeutic methods. Regarding the diagnosis strategy, progress was made in imagistic sphera, aiming: 1. an early diagnosis of pancreatic cancer and, implicitly, a high resectability rate of tumor, and 2. an evaluation of the timing for palliative therapeutic methods. So that, if in the past the diagnostic algorithm meant endoscopic retrograde-cholangio-pancreatography, computed tomography and angiography, at present it means nuclear magnetic resonance and helicoidal tomography. Concerning the treatment, it has to be multidisciplinary (surgery, radiotherapy, chemotherapy, immunotherapy), complex, because, after a resection for cure (R0), the main stay of the treatment, the mean survival at 5 years is 3%-28% and the rate of recurrences is 33%-80%. Biological therapy (sometimes called immunotherapy, biotherapy or biological response modifier therapy) is a relatively new addition to the family of cancer treatments that also includes surgery, chemotherapy and radiation therapy. Biological therapies are designed to repair, stimulate or enhance the immune system responses. We shall try to point out how the exocrine pancreatic cancers, the same stages and undergoing the same approaches, have had different responses due to a different biological behavior and how the biological response modifiers (interferons, interleukins, colony-stimulating factors, monoclonal antibodies and vaccines) can improve the results in pancreatic cancer.     

Amoebiasis: diagnosis by aspiration and exfoliative cytology

The present study was undertaken to evaluate the use of fine needle aspiration and exfoliative cytology in the identification of amoebic cysts/trophozoites, and to characterize amoebiasis. The subjects consisted of 15 patients, 11 diagnosed by fine needle aspiration cytology (FNAC) as amoebic abscesses (14 liver and one pulmonary) and four women whose cervical smears contained Entamoeba histolytica cysts or trophozoites. Of 128 ultrasonographically guided FNAC of hepatic lesions over a four year period, 17 were abscesses of which 10 were diagnosed as amoebic. A single case of pulmonary amoebiasis was detected in an 18-year-old male. The case was initially diagnosed as tubercular due to deceptive symptomatology. Three cases of amoebic cysts and one trophozoite were reported on routine cervical smear screening. All four cases were unsuspected for amoebic infection. The disease may easily go undetected unless meticulous screening is exercised, and the search for cysts or trophozoites is made with clear concepts of the morphological characteristics of E. histolytica in mind.     

Fine needle aspiration of pancreatic cysts: Use of ancillary studies and difficulty in identifying surgical candidates

OBJECTIVE: To evaluate ancillary biochemical testing after pancreatic cyst fine needle aspiration (FNA) in the clinical setting. STUDY DESIGN: Findings from 110 pancreatic guided FNA were reviewed cysts evaluated by image- and correlated with histology, clinical follow-up and biochemical analysis of cyst fluid and serum. Adequate followup was available for 95. RESULTS: In terms of identifying cysts requiring surgery, FNA showed 55.3% sensitivity, 95% specificity, 92.9% positive predictive value (PPV) and 64.4% negative predictive value (NPV). FNA showed only nonspecific cyst contents in 51% of cases, but 40% of those patients proved to be surgical candidates at follow-up. Overall, patients with lesions requiring surgery were younger (p = 0.14), more often presented with pain (p = 0.006), had larger cysts (p = 0.05) and less often had a history of chronic pancreatitis (p = 0.12). Among cases in which FNA showed only nonspecific cyst contents, patients with lesions requiring surgery were more often female (p = 0.08), were younger (p = 0.10), had larger cysts (p = 0.06) and had pain at presentation (p = 0.02). Differences in fluid and serum analytes were not statistically significant. CONCLUSION: FNA of pancreatic cysts shows high specificity but poor sensitivity, even with cyst fluid and serum biochemical analysis. FNA of cysts requiring surgery often yielded nonspecific cyst cytology and causing a misinterpretation as pseudocysts. Ancillary biochemical analysis of cyst fluid remains problematic in the clinical setting.     

Impact of cytopathologist expert on diagnosis and treatment of pancreatic lesions in current clinical practice. A series of 106 endoscopic ultrasound-guided fine needle aspirations

OBJECTIVES: To evaluate the role of a cytopathologist expert in interpreting difficult pancreatic endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in terms of impact on diagnostic yield and therapy in current clinical practice. METHODS: Retrospective study of 106 EUS-FNA performed between January 2002 and September 2004. Forty-seven cases of difficult interpretation by the local cytopathologist were mailed to an expert cytopathologist. The final diagnosis was established by histology obtained by either surgery (n=30), non-equivocal FNA (n=40) or core (n=8) biopsies, or by a mean follow-up of 14 months (n=28). RESULTS: EUS-FNA involved 68 solid lesions (SL). Specimens collected were adequate in 63%. The overall sensitivity of EUS-FNA for the diagnosis of malignancy of SL was 88% versus 72% for local cytopathologist and 89% for expert. EUS-FNA with the reevaluation by expert of 39 SL gave a therapeutic impact in 47% of SL. Thirty-eight cystic lesions (CL) were evaluated. Specimens collected were adequate for cytology in 84% of cases and for biochemistry in 79%. The sensitivity of imaging+EUS-FNA+/-biochemistry for the diagnosis of a surgical CL was 58% with a therapeutic impact in 39.5%. CONCLUSION: Pancreatic EUS-FNA is an easy technique for experienced endosonographers, which can be safely performed on an outpatient basis. The possibility of mailing difficult cases to an expert cytopathologist increases the diagnostic yield. In these circumstances, EUS-FNA has a therapeutic impact in current practice in nearly one out of two pancreatic lesions.     

Endoscopic ultrasound-guided fine needle aspiration cytology of the pancreas: a morphological and multimodal approach to the diagnosis of solid and cystic mass lesions

Cytological evaluation of pancreatic masses and cysts is the preferred pre-operative diagnostic modality and is increasingly being performed by endoscopic ultrasound. This review focuses on the multimodal approach at the Massachusetts General Hospital that utilizes clinical, cytological, radiological and ancillary studies in rendering a final cytological diagnosis.     

Methodologic aspects of the x-ray endoscopic study of the pancreatobiliary system]

Methodological variants of roentgenoendoscopic investigation of the pancreatobiliary system were worked out on the basis of a combination of various methods of contrast studies of the ducts and fibroduodenoscopy. Possibilities of their use were shown with respect to a clinical situation. Investigations of 240 patients led to the conclusion that the use of the above variants of roentgenoendoscopic investigation increased diagnostic and therapeutic efficacy in diseases of the pancreatobiliary system.     

Differentiation of mucinous from non-mucinous pancreatic cyst fluid using dual-stained, 1 dimensional polyacrylamide gel electrophoresis

Background

Pancreatic cysts are being increasingly identified in patients. Mucinous cysts have malignant potential whereas non-mucinous cysts do not. Distinguishing potentially malignant cysts from harmless ones by the characterization of cyst fluid contents remains a difficult problem. This study was undertaken to determine whether cyst fluid mucin glycoprotein analysis could differentiate mucinous from non-mucinous pancreatic cysts.

Methods

Cyst fluid from 28 patients who underwent resection of a pancreatic cyst was used for the study. In each case the type of cyst was histologically identified. One dimensional SDS polyacrylamide gel electrophoresis (1D-SDS PAGE) was performed on cyst fluid samples. For the detection of the separated proteins, we employed a novel dual staining technique. The gel was first stained with periodic acid Schiff (PAS), a mucin histochemical stain followed by a secondary protein staining with Simply Blue Safestain (Invitrogen).

Results

Visual scoring (based on the presence of mucins) gave a sensitivity of 95%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 88% for prediction of mucinous histology.

Conclusions

One dimensional SDS polyacrylamide gel electrophoresis of pancreatic cyst fluid, followed by mucin (PAS) and protein (Simply Blue Safestain) staining, provides a means of concentrating and visualizing mucins, which allows the accurate differentiation of mucinous from non-mucinous histology in pancreatic cysts.     

Role of proteomics to differentiate between benign and potentially malignant pancreatic cysts

Pancreatic cystic neoplasms represent 10-15% of primary cystic masses of the pancreas. While pancreatic cysts are detected with an increasing frequency due to the use of advanced imaging modalities in clinical practice, the diagnosis of pancreatic cystic neoplasms remains unsatisfactory because available diagnostic techniques proved not sensitive enough so far. This study was designed to characterize the proteomic pattern of pancreatic cyst fluids obtained from various cystic lesions. Cyst fluids were collected by direct puncture during open surgery to avoid any possible contamination from other tissues. CEA, CA-19-9, and amylase concentrations were measured using specific immunoassays. After immunodepletion and fractionation by SDS-PAGE, proteins were digested and analyzed by LC-MS/MS. Specific histological lesions were found to be associated with distinct protein patterns. Interestingly, some of these proteins have been proposed as biomarkers of pancreatic cancer. Immunoblots allowed for verifying the differential expression in specific cyst fluids of two selected proteins, olfactomedin-4 and mucin-18. Finally, immunohistochemistry was performed to correlate these data with the expression pattern of olfactomedin-4 and mucin-18 in pancreatic cyst tissues. Results from this study indicate that proteomic analysis of cyst fluid could provide reliable candidates for developing new biomarkers for the preoperative management of malignant and premalignant pancreatic cysts.     

CT characteristics of solitary long bone cysts before and after treatment

Computed tomography was used to study the X-ray morphological characteristics of femoral and humoral bone cysts and the course of a reparative process after surgery in 23 patients with varying activity of solitary bone cysts. Treatment using transosseous osteosynthesis, intraosseous armoring, and therapeutic and diagnostic punctures in patients with solitary bone cysts could yield the most active osteoproductive effect and cause a considerable increase in the density of cyst contents in active and activity-losing stages, which was most evident around the intraosseous wires. Patients with late-stage cysts were found to have an osteogenic effect, mainly in an area of osteotomy.     

Effets secondaires pancréatiques de la substitution hormonale après thyroïdectomie chez un patient obèse

An obese patient, treated by thyroid hormone substitution after total thyroidectomy in 2001, with a differentiated papillary carcinoma (pT2mN0M0G0), complained about daily vomiting and abdominal pain from 2001 to 2007. Repeated diagnostic set-ups showed a substantial increase of pancreatic enzymes. Symptomatic pharmacological treatments were without effect. Two pharmacological interventions designed as modulated posologies of thyroid hormone substitution were undertaken. Clinical symptoms disappeared instantaneously and definitively. A therapeutic test demonstrated the iatrogenic relation between the pancreatic changes and modalities of thyroid hormone substitution.     

A method of reproduction in mice of chronic sacculated staphylococciasis the deeply tissues]

The intranasal method of infeciton of mice proved to be of no avail in search of a model of prolonged staphylococciasis in animals. Intraorbital infection by Badenski's method - by high staphylococcus doses - produced a severe septico-pyemic process with a high percentage of animal death during the first days of the disease. Intraorbital administration to mice of the pathogenic staphylococci in a dose of 300,000-500,000 microbial cells led to formation (in 60 to 80% cases of the sacculated purulent foci with a preponderant localization of the abscesses in the area of the chest, their prolonged persistance and progressive development. The suggested modification of Badenski's method consisting in the use of a 200 times lower infective dose served as a convenient model for studying the pathogenesis of chronic staphylococcus infection and for testing the therapeutic antistaphylococcus preparations.