No abstract available.
Gallbladder ; Gallbladder Neoplasms

Since its introduction into clinical practice in the 1980s, endoscopic ultrasound (EUS) has been described as a good imaging modality for the diagnosis of pancreatobiliary diseases. However, differential diagnosis of certain lesions based only on B-mode ultrasound images can be challenging. Clinical use of ultrasound contrast agents has expanded the utility of EUS from that of detection to characterization of pancreatobiliary lesions based on the enhancement features of contrast-enhanced EUS (CE-EUS). Current low mechanical index techniques for CE-EUS using second-generation contrast agents have a number of distinct advantages over conventional diagnostic modalities in evaluating pancreatobiliary lesions, including real-time assessment of perfusion pattern, availability, and the absence of exposure to radiation. This article describes the technical aspects of CE-EUS and reviews the expanding indications in pancreatobiliary diseases and further development of this technique.
Biliary Tract Diseases/diagnosis/*ultrasonography ; *Contrast Media ; Diagnosis, Differential ; Endosonography/*methods ; Humans ; Medical Illustration ; Pancreatic Diseases/diagnosis/*ultrasonography

No abstract available.
Adrenocorticotropic Hormone*

Endoscopic ultrasound (EUS) is a very useful modality for the diagnosis and staging of pancreatic masses. With the advent of EUS-guided fine-needle aspiration technology, this modality has made a tremendous leap from imaging modality to histologic diagnosis and therapeutic intervention. EUS offers high-resolution images of and unparalleled access to the pancreas. After locating the tip of the echoendoscope in the duodenum or stomach, several drugs or local treatment modalities can be delivered directly into the pancreas. EUS-guided ethanol lavage with/without paclitaxel injection has been tested for the treatment of cystic tumors of the pancreas, with complete resolution of cystic tumor being observed in up to 70-80% of patients. Ethanol injection is also performed for the management of solid neuroendocrine tumors of the pancreas. Various type of EUS-guided injection have also been investigated for the treatment of pancreatic cancer. An activated allogenic mixed lymphocyte culture (Cytoimplant) was injected in patients with advanced pancreatic cancer. A replication-deficient adenovirus vector carrying the tumor necrosis factor-alpha gene was also delivered intratumorally by EUS. ONYX-015 is an oncolytic attenuated adenovirus that exhibits replication preferentially in malignant cells, causing cell death, and this has also been injected into pancreatic cancers under EUS guidance. EUS-guided local ablation therapies such as radiofrequency ablation, photodynamic therapy, and brachytherapy are also under investigation. EUS-guided fine-needle injection for various solid or cystic lesions is a rapidly expanding field. This article reviews the various applications of EUS for the treatment of pancreatic tumors.
Adenoviridae ; Biopsy, Fine-Needle ; Brachytherapy ; Cell Death ; Duodenum ; Endosonography ; Ethanol ; Humans ; Immunotherapy ; Lifting ; Lymphocytes ; Neuroendocrine Tumors ; Paclitaxel ; Pancreas ; Pancreatic Neoplasms ; Photochemotherapy ; Stomach ; Therapeutic Irrigation ; Tumor Necrosis Factor-alpha ; Viral Vaccines

Pancreatic cystic lesions are becoming more and more important because of the advancement of various kinds of imaging modalities. Endoscopic ultrasonography is recognized as an indispensible tool for the differential diagnosis of pancreatic cystic tumors. High quality images enable us to identify the presence of septum, mural nodule, wall thickness and other internal details. Fine needle aspiration can give us more information about cystic fluid such as amylase, CEA, and cytology. For the treatment of benign pancreatic cystic tumors, endoscopic ultrasound guided ethanol lavage and/or paclitaxel injections are also tried and shows quite good therapeutic efficacy with minimum complications. The importance of endoscopic ultrasonography for the differential diagnosis and therapeutic decision making can not be overemphasized.
Amylases ; Biopsy, Fine-Needle ; Decision Making ; Diagnosis, Differential ; Endosonography ; Ethanol ; Paclitaxel ; Pancreatic Cyst ; Therapeutic Irrigation

No abstract available.
Stents

BACKGROUND: The two most commonly used drugs as a stressor during wtress echocardiography are dipyridamole and dobutamine. The purpose of this study was to compare diagnostic accuracies of dipyridamole and dobutamine stress echocardiography for fixed coronary artery disease and evaluate complications related to the two agents in the same patients. METHODS: 30(M : 5=19 : 11, age=56+/-8.8yr) consecutive patients without history of previous myocardial infarction underwent coronary angiography, dipyridamole and dobutamine stress echocardiography in random order. Dipyridamole was infused up to 0.84mg/Kg for 10 minutes during clinical, ECG and echocardiographic montioring. Dobutamine was infused in dose increments from 5 to 40microg/Kg/min under the same condition. Positive criteria for myocardial ischemia by echocardiography was now regional wall mation abnormatity or worsening of regional wall motion after stress. Significant coronary disease was defined as more than 70% stenosis by coronary angiography. RESULTS: The sensitivity and specificity of both stress echocardiography were same, 82% and 92% respectively. In a single vessel disease the sensitivity of dipyridamole echocardiography was 75% and dobutamine echocardiography was 83% without statistical difference. The correlation of ischemic free time during both stress test was 0.375. During dipyridamole infusion no test was prematurely terminated because of side effects, but 3 patients(10%) developed severe hypertension and ventricular arrytricular arrythmia during dobutamine infusion and test was terminated. CONCLUSION: Thus, by this prospective direct comparison of both stress test, dipyridamole and dobutamine stress echocardiography have similar diagnostic accuracies for the detection of coronary artery disease. But during dobutamine infusion, careful monitoring for hemodynamic changes arrythmia is required for possible serious complications.
Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Sensitivity and Specificity

Pancreatic ductal adenocarcinoma is the most common malignancy occurring in the pancreas. This entity almost always shows fatal outcome and the complete cure is extremely difficult. The fatal outcome seems to be caused by the fact that this entity is usually diagnosed at its' advanced stage and the biological behavior is different from other curable types of malignancy. Endoscopic approach to the diagnosis of pancreas cancer comprises mainly of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS). Upon ERCP, pancreatic cancer usually shows stricture or complete obstruction of main pancreatic duct and distal bile duct obstruction in case of pancreas head cancer. Endoscopic brush cytology, forcep biopsy or pancreatic juice analysis can offer histologic diagnosis but the sensitivity is very low. Upon EUS, pancreatic cancer is usually observed as a hypoechoic or mixed echogenic mass and outer margin of the mass becomes more indistinct as the size of the mass increases. EUS can offer more accurate local tumor staging than helical computed tomography, in terms of nodal involvement and vascular invasion. EUS-guided fine needle aspiration can give additional histological information of the mass and therapeutic strategy can be modified according to the histology and EUS staging. EUS has limitations in the diagnosis of distant nodal involvement and hepatic metastasis. Endoscopic approach can detect pancreatic mass with high sensitivity and especially EUS can give detailed information about local tumor extent. However, physician should also understand the benefits and limitations of other imaging modalities such as computed tomography or magnetic resonance cholangiopancreatography, and try to make more accurate diagnosis of the lesion and extent.
Adenocarcinoma ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Pancreatic Ductal ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Cholestasis ; Constriction, Pathologic ; Diagnosis* ; Endoscopy ; Endosonography ; Fatal Outcome ; Head and Neck Neoplasms ; Neoplasm Metastasis ; Neoplasm Staging ; Pancreas ; Pancreatic Ducts ; Pancreatic Juice ; Pancreatic Neoplasms* ; Surgical Instruments ; Tomography, Spiral Computed

Linear array echoendoscopes were developed in the early 1990s and they have facilitated performing EUS-guided interventional procedures. The introduction of linear array echoendoscopes allows performing fine needle aspiration because the device enables tracing the path of the tip of the needle during puncture procedure. In addition to being very useful for diagnostic purpose, this device enabled us to develop various therapeutic endoscopic procedures. Therapeutic drainage procedures, including EUS-guided bile duct drainage, pancreatic pseudocyst drainage and pancreatic duct drainage, have all been more frequently performed in the last decade. In addition to the acquisition of tissue or fluid, various substances can be delivered into the target areas with EUS, with an example being an EUS-guided celiac plexus neurolysis/block. In this review, we describe the present place and role of interventional EUS in clinical practice.
Bile Ducts ; Biopsy, Fine-Needle ; Celiac Plexus ; Drainage ; Hypogonadism ; Mitochondrial Diseases ; Needles ; Ophthalmoplegia ; Pancreatic Ducts ; Pancreatic Pseudocyst ; Punctures

OBJECTIVE: This study was conducted to identify differences between people with narcolepsy and the normal control of delta and theta activity using electroencephalogram (EEG) spectrum analysis of nocturnal polysomnography (PSG). METHODS: Seven narcolepsy patients and seven age-sex matched normal controls underwent PSG and multiple sleep latency tests. Participants' non-rapid eye movement (NREM) sleep EEGs in PSG was analyzed using a Fast Fourier Transform technique. RESULTS: While NREM delta activity of people with narcolepsy declined during the first three periods of NREM, there was no change during the 4th period of NREM. The increase in NREM theta activity also lasted until the 3rd period of NREM but did not occur during the 4th period of NREM. In comparing sleep parameters, REM sleep latency in the narcolepsy group was significantly shorter than in controls. CONCLUSION: These results suggest that people with narcolepsy are likely to have a delta and theta activity-related sleep disturbance mechanism in NREM sleep.
Electroencephalography ; Eye Movements ; Fourier Analysis ; Humans ; Narcolepsy* ; Polysomnography* ; Sleep, REM ; Spectrum Analysis