Helicobacter pylori in humans is associated with active, chronic gastritis, peptic ulcer disease, and most recently has been linked epidemiologically to gastric adenocarcinoma. A related organism, Helicobacter mustelae, naturally infects ferrets and also causes a persistent gastritis, a precancerous lesion, and focal glandular atrophy of the proximal antrum. In this report, we document the clinical presentation and histopathologic confirmation of H. mustelae-associated gastric adenocarcinoma in two middle-aged male ferrets. The ferret appears to be well suited to study the pathogenesis of naturally occurring Helicobacter sp.-induced gastric adenocarcinoma.
The authors' study demonstrates a significant reduction in oxygen concentration, to levels consistent with ambient air, even at points extremely close to the oxygen source, when the nasopharyngeal tube system was used.
: Anesthesiologist-delivered GA was associated with a significantly higher diagnostic yield of EUS-FNA. GA should be considered a preferred sedation method for EUS-FNA of a solid pancreatic mass.
F or patients with pancreatic cancer, early diagnosis may improve the outcome and survival. Endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA) is one of various ways to obtain tissue. It has become the preferred method because of its safety, minimal invasiveness, and good yield (71%Y100%). Although diagnostic yield may be affected by endoscopist experience, type of needle, and use of an in-room cytopathologist, the impact of sedation technique on diagnostic yield is unknown. This retrospective cohort study was undertaken to assess the yield of EUS-FNA when patients are under general anesthesia (GA) as compared with receiving conscious sedation (CS), based on the hypothesis that GA would improve diagnostic yield by improving patient cooperation and stillness during the procedure.Patients underwent CS by a registered nurse who provided intermittent administration of 0.5 to 2 mg midazolam and an opioid (either 20Y50 mg meperidine or 25Y50 Kg fentanyl) injection every 5 to 15 minutes as needed. With the GA approach, an anesthesiologist delivered GA with or without intubation. Without intubation, propofol at 1 mg/kg and alfentanil (5.0 Kg/kg) loading dose were administered followed by a propofol infusion mixed with alfentanil. If endotracheal intubation was used, propofol 1.5 to 2.0 mg/kg and fentanyl 100 Kg intravenous induction doses were given for intubation, and then the patient was maintained with sevoflurane inhalation. Clinical variables were obtained from hospital records, endoscopy reports, and anesthesiology records and included the number of needle passes, size of needle, experience level of the endosonographer, location and size of the pancreatic mass, cytologic results, and procedural complications. The cytology diagnosis was classified as either unsatisfactory specimen, negative for malignancy, atypical or indeterminate, suggestive of malignancy, and positive for malignancy. The diagnostic yield was defined as the proportion of patients who had successful EUS-FNA. General anesthesia and CS groups were compared for complications during and after the EUS-FNA procedure by the Fisher exact test.The study included 371 patients; 283 received CS, and 88 received GA (5 with planned intubation and 83 without intubation). A successful diagnosis was obtained in 73 patients (83%) in the GA group and 206 patients (73%) in the CS group. All instances of failure were the result of an inadequate specimen. The
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