Search

Background and Study Aims: No previous studies have evaluated the ability of endoscopic ultrasonography to describe the anatomic location of lymph nodes on the basis of a node-to-node comparison. The aim of this study was to assess the feasibility and safety of a new endoscopic ultrasound (EUS)-guided fine-needle technique for marking lymph nodes. Patients and Methods: Twenty-five patients with suspected or confirmed malignancies of the upper gastrointestinal tract were prospectively included. EUS-guided fine-needle marking (EUS-FNM) was performed with a silver pin with a diameter that allowed it to fit into a 19-gauge needle. The position of the pin was verified by EUS. End points were the ability to identify and isolate the marked lymph node during surgery and a comparison between the location of the pin as suggested by EUS and the actual location found in the resected specimen. Results: Twenty-three lymph nodes were marked. Nineteen intended surgical isolations were performed. The lymph nodes were isolated in the resection specimens in 18 patients (95 %). In 2 out of 20 cases the pin was not localized by laparoscopic ultrasonography. In 89 % of the cases the marked lymph node was in the same location as described by EUS. One pin (5 %) was not retrieved. In three cases, a small hematoma was observed. There was no sign of long-term complications. Conclusion: EUS-FNM with a silver pin in lymph nodes is feasible and safe. EUS-FNM seems to be a suitable tool for evaluating lymph nodes on the basis of a node-to-node comparison. [ABSTRACT FROM AUTHOR]

- Transurethral prostatotomy (TUT) in 24 patients was compared with transurethral prostatectomy (TUR) in 25 patients in a prospective randomised trial. All patients were aged 60 years or more and presented with symptomatic benign hypertrophy. One half of the patients had acute retention. Shorter operative time and less post-operative bleeding were found in the TUT group, which included 3 failures. No difference was found in post-operative duration of catheterisation or duration of hospitalisation. No significant differences were seen after 1 year's follow-up in the number of patients with positive urinary culture or urinary flow rate. One patient in the TUT group had a recurrence of symptoms, thus giving a total of 4 failures and a success rate of 82%. One patient became incontinent after TU R and 4 developed a stricture. The success rate after TU R was 78%. It was concluded that TUT and TU R produce similar functional results in cases where the gland is not too large. [ABSTRACT FROM AUTHOR]

Introduction: Minute retroperitoneal carcinoid tumor recurrences may be difficult to locate during surgery. A laparoscopic approach to re-resection is further hampered by the lack of tactile sense. Laparoscopic Ultrasonography (LUS) is a minimally invasive method which may compensate for the lack of palpation during laparoscopic surgery, and LIdS allows for an evaluation of lesions beneath the visible surfaces. LUS is used in the pretherapeutic staging of upper GI tract cancer, and LUS can identify - and if necessary also biopsy - lesions less than 10 mm in diameter. Aim(s): Use of LUS during laparoscopic resection of a carcinoid tumor recurrence. Materials and methods: Case story. Results: A 60-year-old male had endoscopic resection of a carcinoid tumor of the rectum. After 3 years follow-up a PET/CT revealed two potential lymphatic recurrrences located at the recto-sigmoideal border. The patient underwent laparoscopy with LUS. Laparoscopy alone was unable to locate any recurrences, but LUS detected two lymph node metastases located in the area suggested by PET/CT hut also an additional lymph node closer to the rectum. All three lesions were successfully resected laparoscopically, and the patient was discharged on the second postoperative day. The specimens revealed three lymph nodes harboring metastases from a carcinoid tumor with the same features as the previously resected tumor. Conclusion: We found LUS to be of great value during minimally invasive treatment of a presumed carcinoid tumor recurrence. [ABSTRACT FROM AUTHOR]

Background . An accurate pre-therapeutic assessment of the resectability in pancreatic cancer patients is essential to reduce the number of futile surgical explorations. The aim of this study was to assess the combination of endoscopic ultrasound (EUS) and laparoscopic ultrasound (LUS) regarding the detection of patients with non-resectable tumours. Patients and methods . From 2002 to 2004, 179 consecutive patients with pancreatic cancer referred for surgical treatment were eligible. Thirty-one (17%) patients were excluded due to co-morbidity and poor performance status. Two patients (1%) were excluded due to metastasis seen on CT scans prior to referral. Thus, 146 patients entered the study. Patients were first examined with EUS followed by LUS, if EUS found no signs of non-resectability. Only patients with tumours found to be resectable or possibly resectable at EUS and LUS were offered surgical treatment. Resectability criteria were defined prior to the study. Results . In all, 108 (74%) patients had non-resectable tumours by the pre-defined criteria. EUS identified 68 (63%) patients and LUS identified an additional 26 (24%) patients. Thus, a total of 94 (87%) patients were non-resectable at either EUS or LUS. Fifty-two (36%) patients underwent surgery. Six patients had surgical exploration and three patients had palliative surgery. Forty-three patients (29%) were resected with curative intention, of whom 38 (88%) had an R0 resection and 5 (12%) had a palliative resection. Discussion . The combination of EUS and LUS is accurate in identifying the non-resectable patients and has a high predictive value for complete resection. [ABSTRACT FROM AUTHOR]

Aims: No valid markers are routinely available to follow disease progression in patients with fibrolamellar hepatocellular carcinoma (FLHCC). We report data suggesting that the vitamin B12 binding protein haptocorrin (HC) may prove a suitable marker., Methods: We monitored a 15-year-old boy diagnosed to have FLHCC by measuring the common markers alanine aminotransaminase, alkaline phosphatase, lactate dehydrogenase, and bilirubin, as well as vitamin B12 (B12), and the forms of the B12 binding proteins. Tumour biopsies were examined immunohistologically. DNA and RNA were extracted from tumour and normal tissue and examined for content of HC DNA and mRNA., Results: The only markers indicative of disease progression were HC and (B12), levels of which were markedly elevated to 84 (11) nmol/L at the time of diagnosis and returned to values within the reference interval (0.43 (0.33) nmol/L) after an apparently radical removal of the tumour. The disappearance rate of HC followed a biphasic curve, the unsaturated protein displaying a half-life of 2.8 days and B12 and saturated HC one of 13 days. Before each diagnosed relapse, an increased concentration of HC was observed. We found a strong immunoreaction against HC in tumour tissue and a high mRNA expression of HC supporting the notion that HC was tumour derived., Conclusions: Plasma HC proved to be a useful tumour marker in a patient with FLHCC, and we suggest the use of this protein as a marker of disease progression in these patients., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Extended lymphadenectomy on connection with the surgical treatment of gastric cancer is gaining access in western centres especially since Japanese centres have shown an ever increasing rate of survival over several decades, coupled with the fact that operative procedures have become more sophisticated. The latest prospective studies in the west seem to confirm the value of lymphadenectomy in some patients. Furthermore, correct staging demands extended lymphadenectomy. For patients with gastric cancer, adjuvant preoperative chemotherapy is probably an asset.

Thirty-eight patients admitted for elective cholecystectomy were preoperatively evaluated by means of liver function tests, ultrasonographic examination and intravenous cholangiography (IVC). Common bile duct stones (CBS) were found in four patients (11%, 95% confidence limits 3-25%). Due to a history of jaundice and/or elevated liver function tests, CBS were suspected in three of these patients, and unexpected in one. Totally, CBS were suspected in eight patients, either because of their history and/or elevated liver function tests. No side effects were observed during or after the IVC procedure. It can be concluded that IVC is a lenient procedure for radiological assessment of the common bile duct prior to elective laparoscopic cholecystectomy. It can be recommended as an alternative to diagnostic endoscopic retrograde cholangiography in patients in whom CBS are suspected.

The aim of this study was to analyse the frequency of permanent and transient complications following thyroid gland surgery. During a period of four years, from 1991 to 1995, 129 patients were treated operatively for thyroid disease. Sixteen patients were operated for thyrotoxicosis and 113 for nontoxic goitre. Nine patients underwent reoperation for recurrent goitre. Thyroid malignancy was found in two patients. The frequency of permanent complications was 0.7%. Transient unilateral pareses developed postoperatively in two patients. There were no permanent vocal cord paralyses. One patient developed permanent hypoparathyroidism. Five patients had transient postoperative hypocalcaemia requiring calcium supplements. Other complications were haemorrhage (3.8%), wound infection (0.7%) and other postoperative complications (1.5%). It is shown that uncomplicated thyroid surgery may be performed at a district hospital that has a special interest in patient evaluation, indications for surgery and up to date surgical technique.

Over a period of 30 months we have seen five patients with duodenal cancer (four adenocarcinomas and one carcinoid-tumour). All patients are presented with a brief history of vague and non-specific symptoms. Diagnosis was established by endoscopy and biopsies. In one case, a Whipple's procedure was performed, and the patient is without evidence of tumour recurrence eight months later. Three patients could only be offered palliative surgery, of these, one is still alive two years after the operation, one (the patient with a carcinoid tumour) died three months postoperatively, and the third has only just recently been operated. The fifth patient died ten days after the diagnosis was confirmed, without any specific treatment. The different diagnostic methods available as well as the treatment and prognosis of duodenal cancer are discussed. We conclude that: 1) despite improved diagnostic procedures, the diagnosis of duodenal cancer is still difficult and delayed due to vague and non-specific symptoms, 2) the diagnostic procedure is endoscopy and biopsy. 3) the treatment is surgery and 4) the prognosis is poor in the majority of patients.

Morphometric estimation of the antral G-cells, radioimmunoassay estimation of the antral tissue gastrin, estimation of the antral mucosal volume and gastric acid secretion have been carried out on 10 duodenal ulcer patients. The total antral tissue gastrin varied from 52.4 to 245.1 micrograms and the mean G-cell gastrin from 0.5 to 1.8 pg. No constant relationship was found between G-cell densities and antral gastrin concentration, suggesting that no constant relationship exists between G-cell numbers and G-cell function. Furthermore, no constant relationship was observed between total antral gastrin and acid secretion.

Evaluation of clinical, radiological and pathological data from 10 adult patients with xanthogranulomatous pyelonephritis has been carried out. There are no pathognomonic diagnostic features, but the majority of patients present with a previous history of recurrent urinary tract disorders. Obstruction and infection are essential pathogenetic factors, but it is suggested that immunologic factors are also play a part. The treatment is nephrectomy, as correct diagnosis cannot be established preoperatively, and as the condition is often misinterpreted as renal carcinoma. A definite diagnosis can only be obtained from pathologic examination with demonstration of the characteristic inflammatory xanthogranulomatous reaction.

Examination of the antral G-cell density, acid secretion and fasting levels of serum-gastrin were carried out on 20 patients with prepyloric ulcer (within 2 cm of the pyloric ring) and 76 patients with duodenal bulb ulcer. No difference was found in respect to the G-cell density between the group of prepyloric and that with duodenal bulb ulcer, although a lower pentagastrin stimulated acid output and consequently a smaller parietal cell mass appeared to be present in the first group as compared to the second. No relationship was found in either group between fasting levels of serum-gastrin and G-cell density, suggesting that no constant relationship exists between G-cell density and activity under basal conditions. A positive relationship, although statistically insignificant (0.05 less than P less than 0.1) between peak acid output and G-cell density in patients with duodenal bulb ulcer, indicates that in these patients the parietal cell mass and G-cell density are interrelated. The present study could not confirm the entity of antral G-cell hyperplasia in duodenal ulcer patients.

The results are reported of the treatment of eight cases of acute (traumatic) slipped capital femoral epiphysis, reduced by forceful traction on the tubercle of the tibia, followed by drilling through with Kirschner wires. No necrosis of the epiphysis developed among the eight cases. In the light of these results, this therapy is recommended in cases of acute slipping of the capital femoral epiphysis. On the other hand, as far as the late complications are concerned, such as degenerative arthritis, the late results are probably no better than those obtained with other forms of treatment.

A density study of the antral gastrin-producing cells has been performed, before and after eight weeks of treatment with a histamine H2-receptor antagonist (cimetidine 1 g per day), in a series of 38 patients suffering from chronic duodenal ulcer. The treatment produced a significant increase in numerical density and a decrease in mean cell volume. The volume density of the cells was unchanged, suggesting that the elevated serum-gastrin during treatment may be the result of gastrin-cell hyperplasia, without change in the total gastrin-cell volume. The authors suggest that G-cell hyperplasia demonstrated during cimetidine treatment may be a factor of importance with regard to the rapid recurrence of many ulcers after discontinuation of the treatment.

Estimates of the border between antral and fundic mucosa, antral size, antral G-cell density, G-cell population, and total G-cell volume were made from multiple biopsies taken from the gastric curves during parietal cell vagotomy for duodenal ulcer in 33 patients. No relation was found between the landmarks of Latarjet's nerve and the border. The fundic mucosa was underdenervated in 20% of the patients, and the postoperative acid response to sham feeding in these was higher than in patients with an overdenervated or optimally denervated border. No relation was found between antral size, defined as antral mucosal volume containing G-cells, and preoperative acid secretion. However, an inverse relation was found between antral size, defined as antral mucosal volume containing no parietal cells, and preoperative maximum acid secretion, suggesting an inverse relation between areas with and without parietal cells. No relation was found between acid secretion and G-cell densities, G-cell population, or total G-cell volume.

Nine kidneys with typical xanthogranulomatous pyelonephritis (XP) involvement were investigated on the occurrence of bacteria, bacterial fragments and antigen, in light microscopy using Gram staining and immunohistochemistry, and by electron microscopy. The present study did not reveal any occurrence of bacteria, bacterial fragments or antigen. It is concluded that the xanthogranulomatous reaction in man represents a resorption phenomenon, and not an immunological reaction to bacteria or bacterial antigen.

The antral gastrin-producing cells (G-cells) have been identified by the indirect immunoperoxidase technique in two antrum preparations removed due to a recurrent duodenal and gastric ulcer. Morphometric principles were applied to the G-cells with determination of their volume density, numerical density, and mean cell volume. The study showed that within-observer variation, between-observer variation and within-patient variation were negligible, provided at least 200 G-cells were counted. A biopsy material can be used, as well as larger tissue blocks, when this minimum sample size is respected. A method for estimating the total G-cell population and the total G-cell volume in the antrum was developed. In the antrum removed due to a gastric ulcer the number of G-cells was 190 x 10(6) and their total volume 176 mm3.

Ultrastructural examination of the antral G cells has been carried out on 11 patients with chronic duodenal ulcer, before and after treatment with a histamine H-2 - receptor antagonist (cimetidine 1 g/day) for 8 weeks. The study demonstrated an increased area of the Golgi complex, rough endoplasmic reticulum and electron-dense granules, indicating increased G cell activity during treatment. An increased number of lysosomes was a constant feature during treatment. As an hypothesis we suggest that these lysosomes may participate in the secretory mechanism of human G cells, by destroying superfluous (Gastrin) components produced during hyperactivity.

Fifteen patients were studied 3 to 35 years after antrectomy, with a gastroduodenal (Billroth I (BI)) anastomosis in 8, and a gastrojejunal (Billroth II (BII)) anastomosis in 7. The investigations included gastric acid secretion, serum gastrin response to feeding and immunohistochemical search for gastrin-producing cells in gastric remnant mucosal biopsies. All of the patients had hypochlorhydria. The gastrin response to feeding was minimal. Apart from a significantly higher value of serum gastrin 3 hours post-prandial in BI operated as compared to BII operated patients, no greater differences were found in the gastrin production between the two groups of patients. No gastrin-producing cells could be identified in the gastric remnant, not even in areas of pseudopyloric metaplasia. It is concluded that the gastrin production following antrectomy is caused by extragastric G-cells; these cells are poorly stimulated by food, and do not respond to hypochlorhydria with hypergastrinaemia.

The antral mucosa has been examined in four duodenal ulcer patients before and during long-term, low dose treatment with cimetidine (given a total dose of between 472 g and 894 g). No convincing changes were found in the number or the volume of G cells. Signs of inactivity were demonstrated ultrastructurally, with small granules of intermediate type, a reduced amount of granular endoplasmatic reticulum and Golgi complex, mostly showing no signs of granulogenesis. The occurrence of bundles of cytoplasmic microfilaments, not observed before treatment and the reduced number of D cells may also be signs of inactivity. Hyperplasia and/or neoplasia were not seen in other antral endocrine cells.

In a consecutive material consisting of 24 stomachs resected due to adenocarcinoma, intestinal metaplasia occurred in 21. Gastrin-producing cells (G-cells) were found to be distributed in a sporadic manner in antra with intestinal metaplasia. Not a single G-cell could be demonstrated in areas with metaplasia, while in the nonmetaplastic areas the distribution of the G-cells corresponded to that of the middle part of the mucosa. This means, that an error can occur when determining the quantity of G-cells, and can explain the previous controversial results regarding the density of G-cells. Enteroglucagon containing cells (GLI-cells) on the contrary were demonstrated in areas with intestinal metaplasia in antra of 19 of the stomachs showing intestinal metaplasia but never in the nonmetaplastic mucosa. This indicated that metaplasia also includes the endocrine cells. The identification of the G-cells and the GLI-cells was carried out by means of indirect immunoperoxidase technique combined with alcian blue pH 2,6-PAS staining.

The influence of sham feeding (PAOSh) preceding pentagastrin-stimulated gastric acid secretion (PAOPg) was investigated in 28 patients with duodenal ulcer (DU) before vagotomy and in 36 after parietal cell vagotomy (PCV). Sham feeding had little influence on PAOPg, and it is concluded that the two secretion tests may be combined. The ratio PAOSh/PAOPg was significantly reduced by PCV. Fourty-four patients with DU were studied for 1 year after PCV, and their PAOPg was measured preoperatively and their PAOPg and PAOSh postoperatively. Seven of the 44 patients had recurrent ulcer within 1 year. PAOPg had no predictive value pre- and post-operatively, but postoperative PAOSh and PAOSh/PAOPg were both significantly higher in patients with recurrent ulcer. It is concluded that PAOSh and PAOSh/PAOPg after PCV may assess completeness of vagotomy, but the relationship between PAOSh and risk of recurrent ulcer may be stronger than that between PAOSh/PAOPg and recurrence.

The case history of a patient with arterial hypertension and increased plasma renin activity is reported. The causative pathology was found to be a renal carcinoma. After nephrectomy both blood pressure and plasma renin activity returned to normal.

Twenty patients with clinical signs of deep vein thrombosis of a duration not exceeding 72 hours, and with the condition confirmed phlebographically, were randomly allocated to one of two groups in a double-blind study. In group 1 the patients received urokinase in a low-dose regimen of 200 000 Ploug units during the first 24 hours, followed by infusion of heparin, 40 000 units daily during the next 5 days. Patients in group 2 received heparin only, 40 000 units daily for 6 days. The clinical course was assessed daily. When the infusion period was completed, the phlebography was repeated, and the results of the two examinations were compared with respect to extent of filling defects and the degree of non-filling of the deep veins. We found no superiority in the regimen consisting of urokinase preceding heparin infusion, compared with that of heparin infusion alone. Most of the patients improved clinically during the 6-day infusion period, but the degree of thrombosis, evaluated phlebographically, was unaltered or even deteriorated during the period in all patients except two. Overt bleeding was noted in 6 patients.

Twenty-five patients with chronic duodenal ulcer and subjected to parietal cell vagotomy were evaluated as either underdenervated or optimally denervated, depending on whether parietal cells were present distal to the last branch of Latarjet's nerve. A 5-year follow-up study demonstrated recurrent ulcer in three of five judged as underdenervated. In addition to the possible technical error of distal and proximal dissection, the importance of the inborn error of incomplete distal denervation is confirmed.

The liquid antacid Novaluzid (10 ml seven times daily) was compared with ranitidine (150 mg twice daily) and with placebo in 57 patients with symptoms and endoscopic signs of oesophagitis and gastro-oesophageal reflux. A randomized three-period change-over design with the double-dummy technique was used. Each treatment period lasted 6 weeks. Only 37 patients (64.9%) completed the entire trial. In retrospect, five patients receiving placebo were withdrawn because of insufficient effect, six patients because of side effects while taking Novaluzid and two while taking ranitidine. The remaining seven dropouts/withdrawals were for reasons without evident relationship to the treatment given. Statistical analyses based both on the 37 completers and on the 43 patients who had at least two treatment periods showed that ranitidine and Novaluzid were superior to placebo with regard to pain score (p less than 0.005) but not with regard to regurgitation, dysphagia, histology, and appearance on endoscopy (p greater than 0.05). It was impossible to distinguish statistically between ranitidine and Novaluzid. In conclusion, ranitidine and high-dose antacids are of equal effectiveness in the short-term treatment of reflux oesophagitis, and both are superior to placebo with regard to symptomatic relief.

Intestinal metaplasia in the non-tumour bearing parts of the gastric mucosa was demonstrated in 24 cases in a material consisting of 27 consecutive patients operated for carcinoma of the stomach. Two mucin histochemical types of intestinal metaplasia could be identified. 1) "Small intestinal type" which was present in all 24 cases, and which was by far the most dominating type. 2) "Colonic type" which occurred in small foci in the gastric mucosa of 11 cases, and which was significantly more frequent in stomachs bearing tumours of presumed intestinal histogenesis, than in those bearing tumours of presumed non-intestinal histogenesis.