Department of Gastroenterology, The First Affiliated Hospital of Zheng Zhou University, China
Background: Double-pigtail, tubular metal and novel lumen-apposing metal stents have inherent shortcomings with regard to drainage of peripancreatic fluid collection (PFC). The present study aimed to assess the feasibility and safety of the stentless drainage method endoscopic ultrasound (EUS)-guided transgastric fenestration for drainage of PFC.
Methods: We conducted a retrospective study on all consecutive patients with symptomatic PFC who underwent EUS-guided transgastric fenestration at our hospital. Technical success, procedural aspects, clinical outcomes, adverse events and follow-up observations were evaluated.
Results: The study included 15 patients (11 males; 36.5 ± 12.6 years), with nine patients defined as walled-off necrosis (WON). The mean maximum cystic diameter was 118.9 ± 56.8 mm (range, 52–220 mm). Transgastric fenestration (1.0–2.0 cm) was performed successfully in all patients (100%), and there were no procedure-related complications. The mean procedure times were 53 ± 6.8 min (range, 45–64 min) in patients with pancreatic pseudocyst (PP) and 98 min (range, 86–144 min) in patients with WON. Additional debridement was performed in 3 cases with a total number of 5 sessions. Adverse events occurred in two patients with cystic infection. The mean duration of hospitalization was 10 ± 4 days. During a follow-up period of 31.9 ± 14.6 weeks (range, 9–54 weeks), all patients achieved symptom resolution corroborated by imaging and there was no recurrence.
Conclusion: EUS-guided transgastric fenestration is effective, safe and cost-saving for drainage of PFCs. For collections attached tightly with the enteric lumen, this technique is expected to replace the placement of stents.
Biography:
De-Zhi He is a professor in the first affiliated hospital of Zheng Zhou University, China from Department of Gastroenterology. He engaged in endoscopic treatment for more than 20 years, with about 350 operations per year. His Research Fields was Endoscopic treatment of early gastrointestinal cancer (ESD), gastrointestinal stromal tumors, esophageal ach
Astghik Medical Center, Yerevan State Medical University, Armenia
Background: A hepatic hemangiomas is a common benign tumor of the liver. Hepatic hemangiomas are generally asymptomatic and incidentally diagnosed during the imaging of the abdominal cavity. Hemangiomas are composed of masses of blood vessels that are atypical or irregular in arrangement and size. The indications for surgical treatment for hepatic hemangiomas still remain disputable.
Methods: A retrospective study of 183 patients diagnosed with hepatic hemangiomas has been conducted. In 149 patients (81.4%) in Group A the size of hemangiomas was no more than 10 cm (23 of the patients in the above-mentioned group were diagnosed with multiple hemangiomas). A dynamic surveillance in the patients in Group A has been implemented twice a year. Increase in the size of hemangiomas for unidentified reasons was observed in 9 patients in this group (6%). Yet biochemical testing has not revealed any reliable statistical deviations. In Group B there were 25 patients (13.7%), in whom hepatic hemangiomas were10-20 cm. And in Group C there were 9 patients (4.9%), in whom hepatic hemangiomas were >20 cm. Patients in Group B and Group C underwent surgical treatment for hepatic hemangiomas. A comparison was then made between the groups.
Results: Expressed anemia (P<0.001), thrombocytopenia (P<0.001), prolonged prothrombin time (P<0.001) were observed in Group C patients, with IPT low and PT high on the 5-7th postoperative days. The extremely giant hemangioma group had more blood loss (P<0.001) and greater postoperative stays (P<0.001), increased hepatic enzymes (AST, ALT), increased levels of total billirubin, decreased albumin levels (P<0.001). One of the patients with a giant hemangioma had bleeding in the postoperative period, in connection with which relaparotomy was performed and bleeding was arrested. One patient had bile leakage, which stopped on its own on the 11th postoperative day. No complications occurred in Group B patients during the post-operative period, changes in hepatic enzymes were minor.
Conclusion: The giant hepatic hemangiomas are, the later liver resection is performed, the more abnormalities in the hematologic and coagulation systems occur. Moreover, the restoration of the liver function proceeds more slowly, which contributes to the prolongation of postoperative stays as well as
1The Comprehensive Cancer Center and Shanghai Key Laboratory for Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, China
2Experimental Research Center, Shanghai Jiao Tong University School of Medicine, China
3The Department of Dermatology, Duke University Medical Center, USA
Cytotoxic radiotherapy unfavorably induces tumor cells to generate various proangiogenic substances, promoting post-irradiation angiogenesis (PIA), which is one of major causes of radiotherapy failure. Though several studies have reported some mechanisms behind PIA, they have not yet described the beginning proangiogenic motivator buried in the irradiated microenvironment. In this work, we revealed that dying tumor cells induced by irradiation prompted PIA via a caspase 3 dependent mechanism. Proteolytic inactivation of caspase 3 in dying tumor cells by transducing a dominant-negative version weakened proangiogenic effects in vitro and in vivo. In addition, inhibition of caspase 3 activity suppressed tumor angiogenesis and tumorigenesis in xenograft mouse model. Importantly, we identified vascular endothelial growth factor (VEGF)-A as a downstream proangiogenic factor regulated by caspase 3 possibly through Akt signaling. Collectively, these findings indicated that besides acting as a key executioner in apoptosis, caspase 3 in dying tumor cells may play a central role in driving proangiogenic response after irradiation. Thus, radiotherapy in combination with caspase 3 inhibitors may be a novel promising therapeutic strategy to reduce tumor recurrence due to restrained PIA.
Biography:
Xiao Feng has acquired the Doctorʼs Degree in Oncology from Shanghai Jiao Tong University in july 2017. Xiao Feng has been focusing on unrevealing the mechanisms of how dying tumor cells promote tumor repopulation after radiotherapy from the perspective of neovascularization. Similarly, not only in colorectal cancer, we have also discovered important role of caspase 3 in post-irradiation angiogenesis in glioma cells. Therefore, we may hypothesized that it might be a biologically conservative signaling pathway in the process of tumor recurrence after radiotherapy. We hope this interesting phenomenon could be known by more researchers.
1Department of Radiology, E-Da Hospital, I-Shou University, Taiwan
2Department of Radiology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung
3Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taiwan
Objective: To investigate the familial risk of appendicitis in the general population.
Study design: A nationwide, cross-sectional study consisting of 24 349 599 Taiwan National Health Insurance beneficiaries in 2015 was conducted. Among them, 788 042 individuals had at least 1 first-degree relative with appendicitis. The familial relative risks (RRs) of appendicitis and familial transmission were estimated.
Results: The overall RR (95% CI) of appendicitis in individuals with any affected first-degree relatives was 1.67 (1.64-1.71) compared with the general population. The RRs for individuals with an affected twin, sibling, offspring and parent were 3.40 (2.66-4.35), 1.98 (1.92-2.04), 1.55 (1.51-1.59) and 1.54 (1.50-1.58), respectively. The RRs for individuals with 1, 2, 3 or more affected first-degree relatives were 1.65 (1.62-1.68), 2.63 (2.37-2.91) and 6.70 (4.22-10.63), respectively. Furthermore, there was an age-dependent trend of the RRs, with the greatest RR in the youngest group. The estimated familial transmission (genetic plus shared environmental contribution to the total phenotypic variance of appendicitis) was 23.2%.
Conclusion: Individuals with a family history of appendicitis have an increased risk of appendicitis. This risk is age-dependent and related to the genetic distance and numbers of affected relatives.
References:
1. Bhangu A, Søreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis and management. Lancet 2015; 386:1278-87.
2. Sanda RB. Epidemiologic features of appendicitis, appendicitis—a collection of essays from around the world. In Tech; 2012. https://doi.org/10.5772/26110. Accessed August 11, 2018.
3. Carr NJ. The pathology of acute appendicitis. Ann Diagn Pathol 2000; 4:46-58.
4. Ergul E, Ucar AE, Ozgun YM, et al. Family history of acute appendicitis. J Pak Med Assoc 2008; 58:635-7.
5. Basta M, Morton N, Mulvihill J, et al. Inheritance of acute appendicitis: familial aggregation and evidence of polygenic transmission. Am J Hum Genet 1990; 46:377.
Rzeszów University, Poland
Magnetic Resonance Elastography (MRE) is a non-invasive technique based on MRI used to quantify the mechanical properties of tissues in vivo. MRE is performed using a source of vibrations to generate low-frequency mechanical waves (20 - 200 Hz).
In the above-mentioned technique, we can specify three steps:
- generation of transverse waves in the tissue,
- obtaining images showing the propagation of induced transverse waves,
- transverse waves images processing to get quantitative tissue stiffness maps (elastograms).
MRE is used for clinical evaluation of patients with chronic liver diseases, which allows assessing the degree of liver fibrosis. Pathological changes are characterized by increased stiffness.
This technique is considered as a non-invasive and safe alternative to liver biopsy.
Liver fibrosis is the proliferation of the connective tissue of the organ that occurs during excessive accumulation of extracellular matrix proteins (the basis of connective tissue). This process is observed in most types of chronic liver disease.
In our research work, we have examined 100 volunteers in the age of 18-25 years.
We have measured the liver stiffness of each patient and analyzed results.
On the basis of the results we received, volunteers were classified into groups according to the degree of liver stiffness.
Biography:
Vitaliy Atamaniuk is a student of University of Rzeszów, Poland. He was studying Diagnostic Systems in medicine. He participated in a research project that specializes in Magnetic Resonance Elastography. For 3 years, he has been conducting research related to liver disorders such as liver fibrosis, nonalcoholic fatty liver disease or cirrhosis. Luckily, none of his young volunteers had serious problems with the liver. However, he cooperated with Government Hospital and he has the opportunity to examine patients
Rzeszów University, Poland
Magnetic Resonance Elastography (MRE) is a non-invasive technique based on MRI used to quantify the mechanical properties of tissues in vivo. MRE is performed using a source of vibrations to generate low-frequency mechanical waves (20 - 200 Hz).
In the above-mentioned technique, we can specify three steps:
- generation of transverse waves in the tissue,
- obtaining images showing the propagation of induced transverse waves,
- transverse waves images processing to get quantitative tissue stiffness maps (elastograms).
MRE is used for clinical evaluation of patients with chronic liver diseases, which allows assessing the degree of liver fibrosis. Pathological changes are characterized by increased stiffness.
This technique is considered as a non-invasive and safe alternative to liver biopsy.
Liver fibrosis is the proliferation of the connective tissue of the organ that occurs during excessive accumulation of extracellular matrix proteins (the basis of connective tissue). This process is observed in most types of chronic liver disease.
In our research work, we have examined 100 volunteers in the age of 18-25 years.
We have measured the liver stiffness of each patient and analyzed results.
On the basis of the results we received, volunteers were classified into groups according to the degree of liver stiffness.
Biography:
Łukasz Hańczyk is a student of University of Rzeszów, Poland. He was studying Diagnostic Systems in medicine. He participated in a research project that specializes in Magnetic Resonance Elastography. For 3 years, he has been conducting research related to liver disorders such as liver fibrosis, nonalcoholic fatty liver disease or cirrhosis. Luckily, none of his young volunteers had serious problems with the liver. However, he cooperated with Government Hospital and he has the opportunity to examine patients, which have different liver diseases.
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