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

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.
Adrenocorticotropic Hormone*

No abstract available.
Stents

A clinical study was done on 42 cases of inpatients, who had been admitted for foreign body aspiration form January 1979 to June 1992. We obtained the following results by analysing the records of their treatment during that time. 1) 31(73.8%) of these cases were below the age of 3 years. 25(59.4%) were below the age of 2. The ratio of male to female was 2:1 2) In 23 cases(54.8%) onset of the symptoms and diagnosis was less than 24 hours after aspiration. 3) Most of the cases(83.3%) had a history of foreign body aspiration; 7 other cases did not. 4) The most common symptoms of bronchial foreign bodies were cough, dyspnea and fever, whereas those of laryngotracheal foreign bodies were dyspnea and cough, in that order. 5) Common complications were obstructive emphysema, pneumonia and atelectasis, in that order. These complications were observed more frequently in the cases of vegetable foreign bodies. 6) Chest X-ray at the time of admission showed obstructive emphysema (42.9%) and pneumonia(40.5%). 11 cases(26.2%) were normal. 7) The most comon site of foreign body enlodgement was the right main bronchus(38.1%), and 4 cases(9.5%) were discovered in other bronchial sites. 8) Vegetable foreign bodies occupied 54.8% of the cases, peanuts being the most common.
Arachis ; Child* ; Cough ; Diagnosis ; Dyspnea ; Emphysema ; Female ; Fever ; Foreign Bodies* ; Humans ; Infant* ; Inpatients ; Male ; Pneumonia ; Pulmonary Atelectasis ; Thorax ; Vegetables

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

A oral inotropic agent, denopamine(TA-064, (-)-alpha-(3,4-dimethoxyphenethyl aminomethyl)-4-hydroxybenzylalcohol), was shown to have strong positive inotropic effect in experimental animals. To determine effects of denopamine on the left ventricular9LV) function and clinical features in patients with severe chronic heart failure who were treated with conventional regimens, denopamine(5mg 3 times per day for 4 weeks) was administered orally to 28 patients with chronic heart failure(22 dilated cariomyopathy, 6 ischemic heart disease) and systolic time interval, 2-D and Doppler echocardiognaphy were performed to evaluate LV function. Denopamine had no effect on LV dimension, volume and fractional shortening, and produced modest increase of ejection fraction and cardiac index, and modest decrease of PEP/LVET and cardiothoracic ratio in the cheat X-ray(PA view). The stroke volume was significantly increased (32.8+/-10.0 to 36.4+/-11.1 ml, p<0.05). Systolic BP was decreased (131.3+/-32.7 to 123.2+/-20.8 mmHg, p<0.05) with little change in diastolic BP and heart rate. Subjective symptoms and NYHA functional class were improved (71.4%, 67.9%, respectively). No adverse effect and ECG abnormality were noted. In conclusion, the addition of denopamine to conventional therapy improved clinical symptoms and caused modest increase of LV contractile function in patients with severe chronic heart failure without significant untoward effects. Therefore, the addinion of denopamine to conventional therapy may be an effective and safe method for the treatment of chronic congestive heart failure.
Animals ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Stroke Volume ; Systole ; Ventricular Function, Left*

PURPOSE: Helicobacter pylori infection is probably acquired in childhood and persists as an asymptomatic infection for decades in most individuals. It is unclear why only a minority of those infected develop a clinical manifestation, even in childhood, such as peptic ulcer disease. H. pylori infection activates local immune responses and causes lymphocyte infiltration in the gastric mucosa. We have previously reported that both T and B cells in the lamina propria play important roles in the local immune response of H. pylori-infected children. The aim of this study was to investigate the association between H. pylori genotypes and gastric mucosal lymphocytes. METHODS: Twenty-five H. pylori-infected children (10 with peptic ulcer disease and 15 with gastritis) were enrolled in this study. We investigated the genotypes (cagA, cagE, vacA, and babA2) and evaluated the association with clinical manifestations, histopathology, and gastric mucosal lymphocytes. RESULTS: The prevalence of cagA, cagE, vacA s1m1, and babA2 was 80%, 60%, 84%, and 88%, respectively. The most prevalent (68%) combination of cagA, vacA, and babA2 genotypes was cagA+/ vacA s1m1+/babA2+. H. pylori genotypes were not associated with clinical manifestations, histopathology, or gastric mucosal lymphocytes. CONCLUSION: There was no association between the cagA, cagE, vacA, or babA2 status and gastric mucosal lymphocytes. The role of the host immune response in relation to H. pylori genotypes and disease potential in children needs further studies.
Asymptomatic Infections ; B-Lymphocytes ; Child ; Gastric Mucosa ; Genotype ; Helicobacter ; Helicobacter pylori ; Humans ; Lymphocytes ; Mucous Membrane ; Peptic Ulcer ; Prevalence