Preoperative biliary decompression increases the risk for postoperative wound infections after pancreaticoduodenectomy. However, there was no increase in the risk of major postoperative complications or death associated with preoperative stent placement. Patients with extrahepatic biliary obstruction do not necessarily require immediate laparotomy to undergo pancreaticoduodenectomy with acceptable morbidity and mortality rates; such patients can be treated by endoscopic biliary drainage without concern for increased major complications and death associated with subsequent pancreaticoduodenectomy.

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A subset of H. pylori-positive gastric MALT lymphomas, including infiltrative tumors, may respond to antibiotics. The likelihood of early complete remission seems to be greatest for superficial and distal tumors.

BACKGROUND Recently, endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) has emerged as a diagnostic adjunct for small pancreatic lesions and abdominal and mediastinal lymph node diseases. DESIGN. During a 21‐month period, we performed 179 EUS‐FNAs in 166 consecutive patients; these data are the subject of this study. An average of 2.6 needle passes were obtained and aspiration was performed most commonly in the pancreas (162 cases, 91%). The FNA smears were reviewed using six diagnostic categories (negative for malignancy/nondiagnostic [NND], atypia, suspicious for malignancy, benign tumor/cyst, neuroendocrine neoplasm [NEN], and carcinoma). The review diagnosis was correlated with the histologic diagnosis made on resection or surgical biopsy specimens in 70 cases. Up to 17 months of clinical follow‐up were sought for the cases with a negative or inconclusive FNA diagnosis and no diagnostic tissue confirmation (81 cases). RESULTS The review FNA diagnoses were as follows: NND (49 cases), atypia (17 cases), suspicious for malignancy (12 cases), benign tumor/cyst excluding NEN (10 cases), NEN (6 cases), carcinoma (85 cases). Follow‐up methods included resection (49 cases), surgical biopsy (21 cases), repeat FNA or brushing cytology (28 cases), and clinical follow‐up only (81 cases). Of the 49 NND cases, 23 (47%) had positive follow‐up results (i.e., false‐negative diagnosis) that were confirmed by tissue diagnosis (resection/surgical biopsy in 11 cases [48%] and repeat FNA/brushing in 12 cases [52%]). These included pancreatic/ampullary adenocarcinoma in 20 cases, esophageal squamous carcinoma in 1 case, and NEN in 2 cases. Follow‐up also revealed carcinoma in all 12 suspicious cases and 13 pancreatic adenocarcinomas and 1 microcystic adenoma in 14 of the 17 atypical cases. Overall, repeat computed tomography (CT)‐guided FNA samples yielded a definite diagnosis in four atypical and seven NND cases, whereas EUS‐FNA results provided a definite diagnosis in three cases in which CT‐guided FNA failed and in two cases in which ampullary biopsy failed. No false‐positive cases were identified. The false‐negative rate due to inadequate sampling was 13.2%. Sensitivity (including cases with inadequate cellularity and nondiagnsotic aspirates) was 81.7% and specificity was 100%. None of the factors evaluated (lesion characteristics, aspiration site, and tumor type) significantly influenced diagnostic results. CONCLUSION EUS‐FNA is a valuable diagnostic and staging tool with high specificity and sensitivity. Negative or nondiagnostic cases on EUS‐FNA require further diagnostic work for a definitive diagnosis when clinical or radiographic findings do not correlate with the FNA results. Cancer (Cancer Cytopathol) 2002. © 2002 American Cancer Society.

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To investigate the role of interferon (IFN)-gamma in human cryptosporidiosis, jejunal biopsies from experimentally infected volunteers and chronically infected AIDS patients were examined for IFN-gamma expression by in situ hybridization. IFN-gamma expression was compared with oocyst excretion, baseline serum anti-Cryptosporidium antibody, and symptoms. IFN-gamma mRNA was detected in biopsies from 13 of 26 volunteers after experimental infection but not in biopsies taken before C. parvum exposure or in biopsies from patients with AIDS-associated cryptosporidiosis. After challenge, 9 of 10 volunteers with baseline C. parvum antibody produced IFN-gamma, compared with 4 of 16 volunteers without baseline antibody (P<.01). Furthermore, IFN-gamma mRNA was detected in 9 of 13 volunteers who did not excrete oocysts, compared with 4 of 13 with organisms (P<.05). Thus, expression of IFN-gamma in the jejunum was associated with prior sensitization and absence of oocyst shedding. IFN-gamma production may explain the resistance to infection noted in sensitized persons but may not be involved in control of human primary infection.