The aim of this study was to evaluate prospectively the efficacy of different imaging methods in differentiating between chronic pancreatitis and cancer in focal pancreatic lesions and staging of adenocarcinoma. Material and Methods. Between June 2005 and October 2007, 156 consecutive patients were enrolled into the prospective clinical trial. The patients were randomized into two groups. Ultrasonoscopy and endoscopic ultrasound were performed in both the groups. Group A patients were additionally examined by computed tomography and tumor marker assay, while in the group B, intraoperative ultrasonoscopy with biopsy and urgent histological examination were done. Results of each imaging technique regarding differential diagnosis and cancer stage were compared with the fi ndings of surgical and histological examination. Results. Chronic pancreatitis and adenocarcinoma were documented in 58 (37.2%) and 78 (50%) patients, respectively. The size of the lesions and clinical presentation were similar in both the groups, but cancer patients were older than patients with pancreatitis (P<0.001). Preoperatively endosonoscopy had the highest accuracy in assessing differential diagnosis (92.1%) and adenocarcinoma (91.8%), whereas computed tomography had the highest accuracy in assessing tumor size (84.5%) and transabdominal ultrasonography in assessing lymph node involvement (78.9%) and distant metastases (88.6%). Intraoperative ultrasound was the most accurate imaging technique in the assessment of differential diagnosis (100%), adenocarcinoma (98.5%), extent of primary tumor (84.8%), lymph node involvement (87.9%), and distant metastases (100%). Conclusions. In the differential diagnosis between chronic pancreatitis and adenocarcinoma, preoperative ultrasonography and intraoperative ultrasound are the best imaging methods. When ultrasonography is nondiagnostic, computed tomography and endoscopic ultrasound are alternative techniques.
IntroductionTranscatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment.AimTo analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality.Material and methodsA retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization.ResultsThe technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01).ConclusionsIn our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.
In the present work, analytical method for the determination of trace elements in adipose tissue by means of inductively coupled plasma optical emission spectrometry (ICP-OES) was developed. Adipose tissue from two groups of the patients with obesity (with and without metabolic syndrome) was investigated. The main aim of this study was to reveal some differences and regularities in concentrations of trace elements in adipose tissue between these two groups of the individuals. Moreover, different types of adipose tissue (subcutaneous, preperitoneal, and visceral) were analyzed separately in order to investigate distribution of metals between these types in different groups of obese people. Al, Ba, Ca, Co, Cu, Cr, Fe, K, Li, Mg, Mn, Na, Ni, Sr, and Zn were selected for the quantitative determination. However, only 6 elements (Na, K, Ca, Fe, Mg, and Zn) were determined in all analyzed samples independently of the type of adipose tissue and presence of metabolic disorder of the patient. Concentrations of Ca, Fe, K, and Na were found to be strongly dependent on the type of adipose tissue. Other elements in terms of detection frequency in adipose tissue samples can be arranged in the following sequence Sr (94.7%), Cr (86.2%), Cu (24.6%), Li (18%), Ba (1.8%), Co (0.05%). The concentrations of Al, Mn, and Ni were found to be lower than limit of detection (LOD) in all analyzed samples. Comparison of metal distribution depending on the type of adipose tissue of people with and without metabolic syndrome is discussed in this work.
IntroductionThere are insufficient data regarding the changes in adipokine levels after laparoscopic adjustable gastric banding (LAGB) in diabetic and non-diabetic patients and their effects on insulin resistance and type 2 diabetes remission.AimTo assess leptin, adiponectin, and insulin resistance changes after LAGB in diabetic and non-diabetic morbidly obese patients.Material and methodsOne hundred and three patients (37 with and 66 without type 2 diabetes) underwent LAGB from January 2009 to January 2010. Glycated hemoglobin, insulin, adipokine levels and insulin resistance were evaluated preoperatively, and 1 and 4 years after LAGB.ResultsThe mean patient age was 45.9 ±11.7 years and mean preoperative body mass index was 47.5 ±7.3 kg/m2. A total of 80 of 103 patients (77.6%) completed the 4-year follow-up. After 4 years the mean excess weight loss was 38.8% and 39.5% in diabetic and non-diabetic patients respectively. Leptin levels decreased significantly in both groups at 1 year, but after 4 years this was noted only in non-diabetic patients. After 1 year adiponectin levels increased significantly only in non-diabetic patients (p = 0.003) and remained almost the same at 4 years. A significant decrease in insulin resistance was noted in both groups 1 year after LAGB and diabetes remission was observed in 23 (62.1%) patients. There was a negative correlation between preoperative insulin resistance and adiponectin levels throughout the follow-up period. Leptin levels positively correlated with BMI throughout the study period (baseline r = 0.45; p < 0.001; after 1 year r = 0.71; p < 0.001; after 4 years r = 0.68; p < 0.001). There was no significant correlation between leptin and adiponectin concentrations preoperatively or after 1 year; however, at 4 years it was significant (r = 0.27; p < 0.02).ConclusionsThe most significant metabolic changes occurred within 1 year after LAGB. The 4-year follow-up revealed stabilization in metabolic indices rather than significant improvement.
In this work the scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) elemental analysis were used for the characterization of adipose tissue samples taken from volunteer obese patients. The adipose tissue was taken from subcutaneous, preperitoneal and visceral layers of the adipose tissue. The obtained results provided information about the structural composition of adipose tissue layers in the human body, as well as the main microstructural features. It was demonstrated for the first time, to the best of our knowledge, that SEM and EDX are indispensable tools in order to investigate some special morphological features and the elemental composition of different layers of the human adipose tissue, identifying the surface microstructure and its qualitative composition. From the obtained results we concluded that such characterization of the adipose tissue is an essential step for the possible prediction of symptoms of different diseases.
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