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Sample records for aegolius funer eus

  1. Types of Funerals

    MedlinePlus

    ... In addition to the funeral home's basic services fee, costs often include embalming and dressing the body; ... funeral. Costs include the funeral home's basic services fee, as well as transportation and care of the ...

  2. Funerals against death

    PubMed Central

    Bailey, Tara; Walter, Tony

    2016-01-01

    While anthropological studies in non-Western societies show how funerals protect the community from the threat of death, sociological studies of British funerals have so far focused on meanings for the private family. The article reports on results from a Mass Observation directive – the first British study to focus specifically on the entire funeral congregation – and shows how attendees experience the contemporary life-centred funeral as a symbolic conquest of death. While the eulogy’s accuracy is important, even more so – at least for some – is its authenticity, namely that the speaker has personal knowledge of the deceased. Whereas Davies analyses the power of professionally delivered ritual words against death, our data reveals how admired is the courage exercised by non-professionals in speaking against death, however faltering their words. Further, the very presence of a congregation whose members have known the deceased in diverse ways embodies a configurational eulogy, which we term relationships against death. We thus argue that funerals symbolically conquer death not only through words delivered by ritual specialists, but also through those who knew the deceased congregating and speaking. PMID:27019605

  3. Clergy Attitudes toward Funeral Directors.

    ERIC Educational Resources Information Center

    Kalish, Richard A.; Goldberg, Helene

    1978-01-01

    On the whole, the experiences of clergy with funerals and funeral directors were positive, although a significant minority provided negative judgements. The general consensus of the clergy was that people did need more protection from inappropriate funeral practices than they were presently getting. (Author)

  4. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Required purchase of funeral goods or funeral services. 453.4 Section 453.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.4 Required purchase of funeral goods or funeral services. (a) Casket...

  5. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Required purchase of funeral goods or funeral services. 453.4 Section 453.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.4 Required purchase of funeral goods or funeral services. (a) Casket...

  6. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Required purchase of funeral goods or funeral services. 453.4 Section 453.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.4 Required purchase of funeral goods or funeral services. (a) Casket...

  7. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Required purchase of funeral goods or funeral services. 453.4 Section 453.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.4 Required purchase of funeral goods or funeral services. (a) Casket...

  8. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Required purchase of funeral goods or funeral services. 453.4 Section 453.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.4 Required purchase of funeral goods or funeral services. (a) Casket...

  9. The Good Funeral: Toward an Understanding of Funeral Participation and Satisfaction

    ERIC Educational Resources Information Center

    O'Rourke, T.; Spitzberg, Brian H.; Hannawa, Annegret F.

    2011-01-01

    This study posits a model of funeral satisfaction in which religiosity predicts general funeral attitudes, which predict levels and types of funeral participation, mediating the relationship between attitudes and satisfaction in a particular bereavement context. Over a thousand respondents rated their attitudes toward funerals in general and…

  10. Sociological Ambivalence and Funeral Consumption

    PubMed Central

    Canning, Louise

    2015-01-01

    This article builds on Hillcoat-Nallétamby and Phillips’ (2011) conceptualization of sociological ambivalence within the relational framework to examine a particular consumption practice, the funeral. We develop understanding of social, cultural and relational issues that arise from the experience associated with funeral-arranging. This is not a voluntary behaviour but one engaged with through force of circumstance and which involves commercial and relational decisions. Drawing on data from 10 interviews from a larger UK study, we focus on ambivalence surrounding choice and its impact on relations, showing how sentiments including love, obligation, regret and revenge evolve and transform past and future relationships. PMID:26236046

  11. Understanding Funeralization and Post-Funeralization Rituals: The Facilitation of Grief Work.

    ERIC Educational Resources Information Center

    Camp, Delpha; Bolton, Christopher

    Although thanatologists agree that grieving is essential in adjusting to the loss of a loved one, numerous questions about what facilitates the grieving process remain. To examine the relationship between funeral and post-funeral ritual and grief adjustment, 50 widowed persons (47 females, 3 males) were interviewed and completed two life…

  12. 48 CFR 837.7002 - List of qualified funeral directors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false List of qualified funeral... SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING Mortuary Services 837.7002 List of qualified funeral..., a list of funeral directors capable of performing the burial services specified in 837.7003....

  13. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Payment to a funeral home. 234.13 Section 234...-SUM PAYMENTS Lump-Sum Death Payment § 234.13 Payment to a funeral home. The 1937 Act LSDP is paid to a funeral home under the following conditions: (a) A person who has assumed responsibility for all or...

  14. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Payment to a funeral home. 234.13 Section 234...-SUM PAYMENTS Lump-Sum Death Payment § 234.13 Payment to a funeral home. The 1937 Act LSDP is paid to a funeral home under the following conditions: (a) A person who has assumed responsibility for all or...

  15. The Cost of Achieving Community: Pericles' Funeral Oration.

    ERIC Educational Resources Information Center

    Mackin, Jim

    Pericles' Funeral Oration, delivered at a mass funeral for a number of Athenian soldiers who had died during an attack against their rival Sparta's allies, is an example of a form of rhetoric, epideictic, that functioned as a means of developing a sense of community. In order to make the mourners at the funeral believe the soldiers had died good,…

  16. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... be of sufficient strength to support the weight of an adult human body. Cardboard or press paper or... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Funeral authorization. 837.7003 Section 837.7003 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS...

  17. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... be of sufficient strength to support the weight of an adult human body. Cardboard or press paper or... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Funeral authorization. 837.7003 Section 837.7003 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS...

  18. Large magnetocaloric effect in sintered ferromagnetic EuS

    NASA Astrophysics Data System (ADS)

    Matsumoto, Koichi; Li, Liang; Hirai, Shinji; Nakamura, Eiji; Murayama, Daiki; Ura, Yutaro; Abe, Satoshi

    2016-10-01

    We present magnetocaloric effect measurements of the ferromagnetic semiconductor EuS in the vicinity of its ordering temperature. Single phase EuS powder was synthesized by CS2 gas sulfurization of Eu2O3. A sintered compact with relative density over 95% was prepared by pulsed electric current sintering of the powder. Temperature and magnetic field dependence of the magnetization and specific heat were characteristic of a paramagnetic to ferromagnetic second order phase transition. The entropy change induced by an external magnetic field and the specific heat were both close to those of a single crystal. We obtained an entropy-temperature (S-T) diagram of the EuS sintered compact. Carnot cycle liquefaction of hydrogen using EuS was compared with several other materials, with results indicating that sintered EuS is an excellent magnetic refrigerant for hydrogen liquefaction.

  19. The Road Barely Taken: Funerals, and People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Forrester-Jones, Rachel

    2013-01-01

    Background: The topic of funerals within the life cycle approach to care in the UK remains largely absent. This small exploratory study sought to investigate how practitioners deal with this sensitive issue and to capture the views of older people with and without intellectual disabilities about funerals. Methods: A semi-structured questionnaire…

  20. 29 CFR 779.369 - Funeral home establishments may qualify as exempt 13(a)(2) establishments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Funeral home establishments may qualify as exempt 13(a)(2... Service Establishments Funeral Homes § 779.369 Funeral home establishments may qualify as exempt 13(a)(2) establishments. (a) General. A funeral home establishment may qualify as an exempt retail or...

  1. Optical Probing of metamagnetic phases in epitaxial EuSe

    SciTech Connect

    Galgano, G. D.; Henriques, A. B.; Bauer, G.; Springholz, G.

    2011-12-23

    EuSe is a wide gap magnetic semiconductors with a potential for applications in proof-of-concept spintronic devices. When the temperature is lowered, EuSe goes through sharp transitions between a variety of magnetic phases and is thus described as metamagnetic. The purpose of the present investigation is to correlate the magnetic order to the sharp dichroic doublet, discovered recently in high quality thin epitaxial layers of EuSe, grown by molecular beam epitaxy. We report detailed measurements of the doublet positions and intensities as a function of magnetic field in low temperatures, covering several magnetic phases.

  2. Haemosporidian infections in the Tengmalm's Owl (Aegolius funereus) and potential insect vectors of their transmission.

    PubMed

    Synek, Petr; Popelková, Alena; Koubínová, Darina; Šťastný, Karel; Langrová, Iva; Votýpka, Jan; Munclinger, Pavel

    2016-01-01

    Sedentary bird species are suitable model hosts for identifying potential vectors of avian blood parasites. We studied haemosporidian infections in the Tengmalm's Owl (Aegolius funereus) in the Ore Mountains of the Czech Republic using molecular detection methods. Sex of owl nestlings was scored using molecular sexing based on fragment analysis of PCR-amplified CHD1 introns. Observed infection prevalences in nestlings and adult owls were 51 and 86 %, respectively. Five parasite lineages were detected. Most of the infections comprised the Leucocytozoon AEFUN02 and STOCC06 lineages that probably refer to distinct Leucocytozoon species. Other lineages were detected only sporadically. Mixed infections were found in 49 % of samples. The main factor affecting the probability of infection was host age. No effect of individual sex on infection probability was evidenced. The youngest infected nestling was 12 days old. High parasite prevalence in the Tengmalm's Owl nestlings suggests that insect vectors must enter nest boxes to transmit parasites before fledging. Hence, we placed sticky insect traps into modified nest boxes, collected potential insect vectors, and examined them for the presence of haemosporidian parasites using molecular detection. We trapped 201 insects which were determined as biting midges from the Culicoides genus and two black fly species, Simulium (Nevermannia) vernum and Simulium (Eusimulium) angustipes. Six haemosporidian lineages were detected in the potential insect vectors, among which the Leucocytozoon lineage BT2 was common to the Tengmalm's Owl and the trapped insects. However, we have not detected the most frequently encountered Tengmalm's Owl Leucocytozoon lineages AEFUN02 and STOCC06 in insects.

  3. Sustaining the Image of Life: A Grounded Theory Study of Funeral Service Education

    ERIC Educational Resources Information Center

    Kelly, Sharen

    2012-01-01

    This grounded theory dissertation explores the educational experiences of funeral service students as they matriculate through the college of funeral service. Student interviews were utilized to explore the world of funeral service education. The analysis of the data led to the discovery of the theory, "Sustaining the Image of Life." The…

  4. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Deduction for funeral expenses. 20.2053-2 Section 20.2053-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable Estate §...

  5. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Deduction for funeral expenses. 20.2053-2 Section 20.2053-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable Estate §...

  6. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Deduction for funeral expenses. 20.2053-2 Section 20.2053-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable Estate §...

  7. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Deduction for funeral expenses. 20.2053-2 Section 20.2053-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable Estate §...

  8. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Deduction for funeral expenses. 20.2053-2 Section 20.2053-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable Estate §...

  9. Symbolism of the Sun on Mediaeval Funeral Monuments

    NASA Astrophysics Data System (ADS)

    Mijatovič, V.; Vemič, D.; Ninkovič, Slobodan

    2007-08-01

    On the territory of mediaeval Bosnian and Serbian states of the XIV and XV centuries we can find necropoles with characteristic forms of the stone funeral monuments called “steæci”. There is a great number of ornamental motifs of different content and symbolism found on these monuments. The group of astral motifs (the Sun, the Moon, the stars) is the most common one. Here, we have considered the symbol of the Sun and presented various models used in its representation.

  10. Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions

    PubMed Central

    Chapman, Christopher G.; Waxman, Irving; Siddiqui, Uzma D.

    2016-01-01

    Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD. PMID:27012290

  11. The Funeral of Froggy the Frog: The Child as Dramatist, Designer, and Realist

    ERIC Educational Resources Information Center

    Cummins, Lauren

    2004-01-01

    One sunny afternoon, six-year-old Zachary and his friend John Michael, four and a half, discovered a dead frog in a bag of clay in the garage. Zachary proposed, "Let's have a funeral for the frog." This is how the funeral drama of Froggy the Frog began. This article describes the play experiences of Zachary and John Michael as designers,…

  12. Funeral Benefits in Public Higher Education Institutions: How Do They Explain Employees' Perception of Equity?

    ERIC Educational Resources Information Center

    Komba, Aneth Anselmo

    2016-01-01

    The study examined the government and three campuses of a higher public education institution's funeral policies with a view to determining how these policies explain employees' equity perception. Three research questions guided the study: (1) what does the government's funeral policy say about the burial of government employees and their…

  13. EUS correlates of disconnected pancreatic duct syndrome in walled-off necrosis

    PubMed Central

    Bang, Ji Young; Navaneethan, Udayakumar; Hasan, Muhammad K.; Hawes, Robert H.; Varadarajulu, Shyam

    2016-01-01

    Background and study aims: Although the diagnostic features of disconnected pancreatic duct syndrome (DPDS) by computed tomography (CT) and magnetic/endoscopic retrograde cholangiopancreatography (MRCP/ERCP) have been established, no such characterization exists for endoscopic ultrasound (EUS). This study describes the imaging features of EUS that accurately define DPDS. Patients and methods: This is a prospective study comprising 21 of 42 patients who underwent EUS-guided drainage of walled-off necrosis (WON) over an 18-month period. Findings on EUS were correlated with CT and pancreatography or surgical pathology when available. DPDS by EUS was defined by the presence of a well-defined fluid collection along the course of the main pancreatic duct with the upstream pancreatic parenchyma and duct terminating into the fluid collection. The main outcome measure was to assess the accuracy of EUS in diagnosing DPDS by correlation with CT and pancreatography or surgical pathology. Results: Twenty-one patients with WON (median age 55 years; 15 males) constituted the study cohort. Median duration of pancreatitis was 12 weeks (range 5 – 20) and median WON size was 120 mm (range 40 mm to 200 mm). At EUS, the upstream pancreatic parenchyma and duct were found to terminate within the WON in all 21 patients in whom DPDS was subsequently confirmed by follow-up CT in all patients, by ERCP in 17, EUS-pancreatogram in 3 and surgical pathology in 1. There was 100 % correlation between EUS characterization of DPDS with CT and pancreatography or surgical pathology. Conclusions: We report EUS findings indicating the presence of DPDS. These findings may have significant clinical implications for the management of patients with WON. PMID:27540578

  14. Consumer's Choices to Funeral Planning. A Consumer Publication by the Chairman of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, Second Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House Select Committee on Aging.

    This Congressional consumer publication, done in conjunction with the Continental Association of Funeral and Memorial Societies, was written to help consumers have the type of funeral they want at a cost they can afford. Guidelines are provided which will educate the funeral consumer before and during funeral planning. Also included in this guide…

  15. Horizontal transmission of epizootic ulcerative syndrome (EUS)-associated virus in the snakehead Ophicephalus striatus under simulated natural conditions.

    PubMed

    Lio-Po, Gilda D; Albright, Lawrence J; Traxler, Garth S; Leaño, Eduardo M

    2003-12-29

    Natural transmission of the epizootic ulcerative syndrome (EUS) was conducted on naïve snakeheads Ophicephalus striatus (also known as Channa striata) kept (A) in aquifer water, (B) in lakewater, (C) cohabiting with EUS snakeheads in lakewater, and (D) cohabiting with apparently healthy snakeheads in lakewater during the 1994 to 1995 EUS season. The results showed that EUS-like lesions developed in 6 to 14 d among naïve snakeheads cohabiting with EUS snakeheads and with apparently healthy snakeheads in lakewater (Treatments C and D). Among naïve fish exposed to lakewater (Treatment B), similar lesions developed in 16 to 21 d, while naïve fish in aquifer water (Treatment A) did not develop EUS-like lesions. EUS signs began as Grade I (slight) lesions that gradually progressed to Grades III-IV (severe) 3 to 5 d from lesion onset, similar to the naturally affected EUS fish. The virus was recovered from some but not all naturally EUS-affected snakeheads, snakeheads with healing lesions and apparently healthy snakeheads, but not from naïve snakeheads. The results provide evidence of a waterborne horizontal transmission of the EUS-associated virus. This is the first report of a successful horizontal transmission of the EUS-associated virus from apparently healthy snakeheads to naïve fish under natural conditions and of virus recovery in tissue culture from naturally exposed experimental fish. PMID:14960033

  16. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction palliation: an article review.

    PubMed

    Artifon, Everson L A; Perez-Miranda, Manuel

    2012-04-01

    The EUS-guided biliary drainage is a new tool for the palliation of distal obstructive biliary lesions. The EUS-guided access, which creates a fistulization between the duodenal bulb and distal common biliary duct, is an effective method to relieve jaundice and has low morbidity and mortality, in patients with distal biliary obstruction (pancreatic mass or papillary câncer). This technique is called choledochoduodenostomy and is presented promptly in this article. The EUS-guided biliary drainage should be made within protocol conditions and done by very experienced endosonographers.

  17. EUS - Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review.

    PubMed

    Kalogeraki, Alexandra; Papadakis, Georgios Z; Tamiolakis, Dimitrios; Karvela-Kalogeraki, Iliana; Karvelas-Kalogerakis, Mihailos; Segredakis, John; Papadakis, Michael; Moustou, Eleni; Datseri, Galateia; Tzardi, Maria

    2016-01-01

    Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and high-frequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT) scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP) brushing, CT-guided biopsies, and transabdominal ultrasound (US) have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB) has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities such as tumors

  18. Disco funerals, a risk situation for HIV infection among youth in Kisumu, Kenya

    PubMed Central

    Njue, Carolyne; Voeten, Helene ACM; Remes, Pieter

    2009-01-01

    Objective We investigated the so called ‘disco funeral’ phenomenon in Kisumu, Kenya, whereby community members including adolescents congregate at the home of the deceased for several days, accompanied by music and dancing. We explored whether disco funerals are a risk situation for HIV/STI infection among youth. Design Cross-sectional qualitative study. Methods We conducted 44 in-depth interviews with male and female adolescents aged 15 to 20 in Kisumu municipality in Nyanza Province, Kenya. We also made observations during 6 disco funerals. Results Disco funerals were an important place for young people to hang out; they increased the opportunities to meet and engage in (risky) sexual activities. Many adolescents reported having casual sex on these occasions, sometimes with multiple partners, and mostly without condoms. Some girls were forced into sex, and there were several accounts of gang rape. Sex in exchange for money was reported frequently. Drugs and alcohol seemed to facilitate unprotected, multiple-partner, coerced, and transactional sex. Conclusions In Kisumu, a town with a generalized HIV/AIDS epidemic, the high AIDS mortality leads to frequent disco funerals. Because many adolescents are having unprotected, transactional, or coerced sex at these occasions, disco funerals might contribute to the high HIV prevalence among youth, especially among adolescent girls. HIV interventions urgently need to include outreach actions to youth who hang out at disco funerals, and link up with parents and funeral organizers to reduce risk situations. PMID:19165086

  19. Validation of a realistic, simple, and inexpensive EUS-FNA training model using isolated porcine stomach

    PubMed Central

    Hoshi, Koki; Irisawa, Atsushi; Shibukawa, Goro; Yamabe, Akane; Fujisawa, Mariko; Igarashi, Ryo; Yoshida, Yoshitsugu; Abe, Yoko; Imbe, Koh

    2016-01-01

    Background and study aims: Trainees are required to learn EUS-FNA using a model before working with a patient. The aim of the current study was to validate a new training model developed for EUS-FNA. Patients and methods: Several fresh chicken tenderloins were embedded as target lesions in the submucosal layer of an isolated porcine stomach. The stomach was fixed to a plate with nails, and was placed in a tub filled with water. The primary endpoint was feasibility of the newly developed model for EUS-FNA training, evaluated as follows: 1) visualization of the target lesion with blinding for lesion location; 2) penetrability of the needle; 3) sampling rate of macroscopic specimen; and 4) ROSE capability. Secondary endpoints were its durability and utility for multiple EUS-FNA procedures during EUS-FNA training, and the ease and cost of preparing the model. Results: Six endoscopists (1 expert, 5 trainees) attempted EUS-FNA procedures using this model. The target lesion could be identified clearly, and EUS-FNA could be performed with realistic resistance felt. In addition, rapid on-site evaluation could be easily achieved. Based on 10 needlings by each endoscopist, adequate specimens for histology could be macroscopically taken with an average 85 % success rate. Visibility and maneuverability were maintained throughout all needlings. Preparation time for this model was less than 30 minutes with a total cost of $ 22. Conclusions: An easy-to-use and inexpensive training model with a realistic feel of needling was created. This model can potentially enable beginners to practice safe and effective EUS-FNA procedures. PMID:27652292

  20. Validation of a realistic, simple, and inexpensive EUS-FNA training model using isolated porcine stomach

    PubMed Central

    Hoshi, Koki; Irisawa, Atsushi; Shibukawa, Goro; Yamabe, Akane; Fujisawa, Mariko; Igarashi, Ryo; Yoshida, Yoshitsugu; Abe, Yoko; Imbe, Koh

    2016-01-01

    Background and study aims: Trainees are required to learn EUS-FNA using a model before working with a patient. The aim of the current study was to validate a new training model developed for EUS-FNA. Patients and methods: Several fresh chicken tenderloins were embedded as target lesions in the submucosal layer of an isolated porcine stomach. The stomach was fixed to a plate with nails, and was placed in a tub filled with water. The primary endpoint was feasibility of the newly developed model for EUS-FNA training, evaluated as follows: 1) visualization of the target lesion with blinding for lesion location; 2) penetrability of the needle; 3) sampling rate of macroscopic specimen; and 4) ROSE capability. Secondary endpoints were its durability and utility for multiple EUS-FNA procedures during EUS-FNA training, and the ease and cost of preparing the model. Results: Six endoscopists (1 expert, 5 trainees) attempted EUS-FNA procedures using this model. The target lesion could be identified clearly, and EUS-FNA could be performed with realistic resistance felt. In addition, rapid on-site evaluation could be easily achieved. Based on 10 needlings by each endoscopist, adequate specimens for histology could be macroscopically taken with an average 85 % success rate. Visibility and maneuverability were maintained throughout all needlings. Preparation time for this model was less than 30 minutes with a total cost of $ 22. Conclusions: An easy-to-use and inexpensive training model with a realistic feel of needling was created. This model can potentially enable beginners to practice safe and effective EUS-FNA procedures.

  1. How to perform EUS in the pancreaticobiliary area.

    PubMed

    Palazzo, L

    2014-10-01

    EUS remains mandatory in the management of the majority of pancreaticobiliary diseases. This article fully describes with details how to examine the pancreatico-biliary region using radial and linear EUS. Pancreaticobiliary examination with a radial instrument: 1) place the patient on left lateral decubitus position, tilted towards the examination table at an angle of 30° to 40°; 2) use a moderately inflated balloon; 3) begin the examination in the stomach 45 to 50 cm from the incisors, to examine the body and tail region; 4) after advancing through the pylorus under endoscopic control, proceed from the bulb to the second part of the duodenum by pushing the echoendoscope which is in opened position of the handle gently under ultrasound control, turning the handle clockwise if the superior duodenal angle is open, then push the echoendoscope in the long position towards the ampulla of Vater, adding up angulation. Use the ERCP withdrawal manoeuvre under endoscopic control, from the apex of the bulb if the superior duodenal angle is closed (thin patient), and allow the head of the echoendoscope to fall into the second duodenum, then push the tip over the ampulla of Vater, in the long position, and start the examination at this point. Pancreaticobiliary examination with a linear instrument: place the patient in the same position as with a radial instrument. 1) balloon slightly inflated or uninflated; 2) use the neutral position of the handle as a starting point in the stomach. Move from this position to the open position by turning the handle anti-clockwise and to the closed position by turning the handle clockwise while advancing or withdrawing the echoendoscope, adding clockwise torquing to the endoscope shaft when necessary (to examine the pancreatic tail); 3) almost the whole of the pancreatic gland, apart from the juxtaduodenal segment of the head and uncinate process and in particular the ampulla of Vater, can be examined through the stomach; 4) the examination

  2. Low-temperature solvothermal synthesis of EuS hollow microspheres

    SciTech Connect

    Peng, Yong; Wang, Hong; Li, Peng; Fu, Yao Xing, Mingming; Jiang, Tao; Luo, Xixian

    2014-09-15

    Graphical abstract: Synthesis of EuS hollow microspheres at low-temperature via solvothermal method for the first time. - Highlights: • We adopt an improved method to synthesise the (Phen)Eu(Et{sub 2}CNS{sub 2}){sub 3} in deionized water. • We have successfully synthesised the EuS hollow microsphere at 230 °C in acetonitrile. • The price of acetonitrile is more inexpensive, so the price of preparation was reduced. - Abstract: EuS crystals are synthesized by low-temperature solvothermal decomposition of the single source precursor complex (Phen)Eu(Et{sub 2}CNS{sub 2}){sub 3} in acetonitrile. X-ray powder diffraction, scanning electron microscopy, granulocyte diameter statistical analysis, surface energy-dispersive X-ray spectroscopy analysis, and UV–vis absorption spectroscopy are used to characterize the structure and properties of the obtained EuS crystals. The results show that the formed EuS crystals are uniform hollow microspheres with a typical cubic phase structure of rock salt and the average particle size of 2.01 μm. The mechanisms for the thermal decomposition of the precursor complex and the formation of the EuS hollow microspheres are postulated based on the experimental observations and previous reports.

  3. EUS-Guided Needle-Based Confocal Laser Endomicroscopy: A Novel Technique With Emerging Applications

    PubMed Central

    Koduru, Pramoda; Joshi, Virendra; Karstensen, John G.; Saftoiu, Adrian; Vilmann, Peter; Giovannini, Marc

    2015-01-01

    Endoscopic ultrasound (EUS) has emerged as an excellent tool for imaging the gastrointestinal tract, as well as surrounding structures. EUS-guided fine-needle aspiration (EUS-FNA) has become the standard of care for the tissue sampling of a variety of masses and lymph nodes within and around the gut, providing further diagnostic and staging information. Confocal laser endomicroscopy (CLE) is a novel endoscopic method that enables imaging at a subcellular level of resolution during endoscopy, allowing up to 1000-fold magnification of tissue and providing an optical biopsy. A new procedure that has been developed in the past few years is needle-based confocal laser endomicroscopy (nCLE), which involves a mini-CLE probe that can be passed through a 1 9-gauge needle during EUS-FNA. This enables the real-time visualization of tissue at a microscopic level, with the potential to further improve the diagnostic accuracy of EUS-FNA. The device has been studied in animals as well as in humans, and the results so far have been promising. Recently, this method has also been used for the visualization of regulatory proteins and receptors in the pancreas, setting a cornerstone for nCLE in molecular imaging. The aim of this article is to review the role of EUS-guided nCLE in modern endoscopy and its implications in molecular imaging. PMID:27099595

  4. An exploration of some magnetic fundamentals in EuSe using μSR

    NASA Astrophysics Data System (ADS)

    Terry, I.; Adams, P. W.; Bykovetz, N.; Giblin, S. R.; Guguchi, Z.; Khasanov, R.; Klein, J.; Lin, C. L.; Liu, T. J.

    2016-05-01

    EuSe is a simple magnetic system that appears to show many complicated features. Under applied pressure it undergoes a transition from an antiferromagnet (AF) to a ferromagnet (FM). This transition provides a means of testing certain basic fundamentals of magnetic theory and an opportunity to explore the complexities of EuSe. Using the muon-spin rotation and relaxation technique (μSR), EuSe was measured at pressures ranging from ambient to 11 kbar. In ambient-pressure EuSe, muon data reveal two local fields, but show only a single field in the FM state formed under pressure. The μSR measurements appear to show a continuous transition at Tc, contrary to previous Mössbauer results that were interpreted as being evidence of a first-order transition. Values determined for the critical exponent, β, in AF and FM EuSe, differ and therefore appear to be a clear counterexample to the Universality Hypothesis. The values of β also are indicative of EuSe's being a 2D magnet for pressures up to 11 kbar. The nature and values of the local fields seen by the muons is discussed and analyzed.

  5. EUS-Guided Needle-Based Confocal Laser Endomicroscopy: A Novel Technique With Emerging Applications.

    PubMed

    Bhutani, Manoop S; Koduru, Pramoda; Joshi, Virendra; Karstensen, John G; Saftoiu, Adrian; Vilmann, Peter; Giovannini, Marc

    2015-04-01

    Endoscopic ultrasound (EUS) has emerged as an excellent tool for imaging the gastrointestinal tract, as well as surrounding structures. EUS-guided fine-needle aspiration (EUS-FNA) has become the standard of care for the tissue sampling of a variety of masses and lymph nodes within and around the gut, providing further diagnostic and staging information. Confocal laser endomicroscopy (CLE) is a novel endoscopic method that enables imaging at a subcellular level of resolution during endoscopy, allowing up to 1000-fold magnification of tissue and providing an optical biopsy. A new procedure that has been developed in the past few years is needle-based confocal laser endomicroscopy (nCLE), which involves a mini-CLE probe that can be passed through a 1 9-gauge needle during EUS-FNA. This enables the real-time visualization of tissue at a microscopic level, with the potential to further improve the diagnostic accuracy of EUS-FNA. The device has been studied in animals as well as in humans, and the results so far have been promising. Recently, this method has also been used for the visualization of regulatory proteins and receptors in the pancreas, setting a cornerstone for nCLE in molecular imaging. The aim of this article is to review the role of EUS-guided nCLE in modern endoscopy and its implications in molecular imaging.

  6. Some Rhetorical Directions of Funeral Direction: Historical Entanglements and Contemporary Dilemmas.

    ERIC Educational Resources Information Center

    Cahill, Spencer E.

    1995-01-01

    Observation of a mortuary science program was used to construct an occupational genealogy of funeral directors and to examine rhetorical dilemmas facing them. The importance and significant consequences of the rhetoric of work and occupations were highlighted. (SK)

  7. Socio-economic transformation of Akan funeral rites in Ghana: the changing process.

    PubMed

    Boateng, Alice

    2012-01-01

    Cultural traditions at the end of life solidify societal members. As the world becomes more globalized, socio-economic factors affect how traditional practices are expressed, and the role and toll they make on modern societies. This article examines the contemporary Akan funeral practices in Ghana. Akan lineage members, from birth through puberty, marriage, maturity, old age, go through various rites of passage that bond them culturally and spiritually to others in society. One such ritual is funeral celebration. Funeral celebration, an old practice, has always been at the heart of public social events of Akan people. However, the changes in Ghanaian Akan funerals over the past 4 decades, and their impact on the people, make this an important topic. The article describes the Akan belief of life after death, the respect accorded to the dead, the prestige associated with successful funeral celebrations, and socio-economic factors that continue to shape Akan funeral practices. Socio-economic impact and the resulting challenges are discussed.

  8. Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions

    PubMed Central

    Figueiredo, Fátima A. F.; da Silva, Patricia M.; Monges, Genevieve; Bories, Erwan; Pesenti, Christian; Caillol, Fabrice; Delpero, Jean R.; Giovannini, Marc

    2012-01-01

    Objective: Although endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is the gold standard for diagnosing pancreatic lesions, its negative predictive value is suboptimal. Our aim was to evaluate the yield of contrast-enhanced EUS (CED-EUS) and of strain ratio EUS-elastography (SR-E-EUS) for differentiating pancreatic solid lesions. Methods: Forty-seven patients (27 men, 20 women, 70 ± 11 years) were consecutively involved in this single-center, prospective study. They were submitted to EUS, SR-E-EUS, CED-EUS with Sonovue®, and EUS-FNA. The final diagnosis was based on the histological assessment of EUS-FNA and/or surgical specimens when available, and on follow-up of at least 6 months. Results: From the 47 focal pancreatic lesions included, 13 (28%) were benign and 34 (72%) malignant. Patients with malignancy were older (70 ± 11 vs. 61 ± 8, P = 0.003), and had larger lesions (34 ± 12 mm vs. 22 ± 11 mm, P = 0.03). Malignant lesions had higher SR-E-EUS (31 ± 32 vs. 8 ± 9, P = 0.001) and more hypovascular pattern (93% vs. 33%, P < 0.001). Logistic regression determined that only hypovascularity (OR = 2.6, 95%CI: 1.5-130, P = 0.02) was independently predictive of malignancy. ROC analysis for SR-E-EUS yielded an optimal cutoff of 8 (AUC 0.91, 95%CI: 0.74-0.98) for the best power distinction for malignancy. There was no significant difference concerning sensitivity (79%, 90%, 93%) and specificity rates (85%, 75%, 67%) of EUS-FNA, SR-E-EUS, and CED-EUS, respectively. By analysis of the inconclusive EUS-FNA subset (9 patients, 19%), SR-E-EUS > 8 and hypovascularity showed sensitivity of 80% and 100%, and specificity of 67% and 67%, respectively. Conclusion: The clinical utility of CED-EUS and SR-E-EUS remains questionable. The accuracies of CED-EUS and SR-E-EUS are similar to EUS-FNA. Hypovascularity was independently predictive of malignancy. Patients with inconclusive EUS-FNA could benefit from CED-EUS due to the high sensitivity of

  9. Mississippi Curriculum Framework for Postsecondary Funeral Services Technology Programs (Program CIP: 12.0301--Funeral Service and Mortuary Science). Postsecondary Programs.

    ERIC Educational Resources Information Center

    Mississippi Research and Curriculum Unit for Vocational and Technical Education, State College.

    This document, which is intended for use by community and junior colleges throughout Mississippi, contains curriculum frameworks for the course sequences in the state's funeral services technology program. Presented in the introduction are a program description and suggested course sequence. Section I lists baseline competencies for the funeral…

  10. Endoscopic Closure for EUS and ERCP Related Duodenal Perforation by Endoclips

    PubMed Central

    Liu, Yaping

    2016-01-01

    Objective. To investigate the therapeutic safety, feasibility, and efficacy of endoclips for closing the endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) related duodenal perforation in a retrospective study from a single center. Methods. Patients who developed EUS and ERCP related duodenal perforation between January 2012 and January 2015 were included in the study. All the cases underwent endoscopic closure by endoclips, and the efficacy, feasibility, and safety of this technique were evaluated. Results. During the study period, a total of 17,406 patients were treated by EUS and/or ERCP. EUS and ERCP related duodenal perforation occurred in 9 cases (0.05%): 2 males and 7 females. The mean age was 69 years (range: 59–79 years). The success rate of endoscopic closure by endoclips was 100%. The mean procedure time was 45 ± 12.5 min. The mean number of endoclips placed for the closure of the duodenal perforation was 7 ± 3.2. All the patients recovered completely without any severe complications. Conclusion. The endoscopic closure by using endoclips is recommended as the first-line treatment for duodenal perforation associated with EUS and ERCP.

  11. Effect of macrophages and serum of fish susceptible or resistant to epizootic ulcerative syndrome (EUS) on the EUS pathogen, Aphanomyces invadans.

    PubMed

    Miles, D J; Kanchanakhan, S; Lilley, J H; Thompson, K D; Chinabut, S; Adams, A

    2001-10-01

    Epizootic ulcerative syndrome (EUS) is one of the most destructive diseases of fresh and brackish water farmed and wild fish in the Asia-Pacific region. The in vitro germination and growth of the propagules of the EUS pathogen, Aphanomyces invadans (= A. piscicida), were assessed in the presence of the head-kidney macrophages, serum, and serum heated to inactivate complement proteins, of three EUS-susceptible and one resistant fish species. The susceptible species were: striped snakehead (Channa striata), giant gourami (Osphronemus gouramy) and silver barb [Barbodes (= Puntius) gonionotus], and the resistant species was Nile tilapia (Oreochromis niloticus). Fish of all species were acclimatised to either low temperature (20 degrees C +/- 1.6) at which EUS is known to occur, or to high temperature (32 degrees C +/- 5.0) at which EUS does not occur, except for giant gouramis which were only studied at low temperature. The respiratory burst of the macrophages was assessed in the presence of A. invadans or the stimulant phorbol myristate acetate (PMA), and compared to that of controls. Anti-A. invadans antibody concentrations were assessed in all species except silver barbs. All assays were carried out at the same temperature, regardless of the temperature that the fish were kept at. Macrophages of all species other than snakeheads inhibited fungal germination at both temperatures, though only silver barb and gourami macrophages could inhibit germling growth. PMA increased the respiratory burst in nearly all cases. The respiratory burst in the presence of A. invadans was consistently lower than that of controls, though the difference was only significant in the case of snakeheads. The respiratory burst of all macrophage treatments was higher at a low temperature. Except in the case of PMA-stimulated macrophages, regressions between respiratory burst and inhibitory action were only found in susceptible species, suggesting that the respiratory burst is important in those

  12. The recording of demographic information on death certificates: a national survey of funeral directors.

    PubMed Central

    Hahn, Robert A.; Wetterhall, Scott F.; Gay, George A.; Harshbarger, Dorothy S.; Burnett, Carol A.; Parrish, Roy Gibson; Orend, Richard J.

    2002-01-01

    OBJECTIVE: The authors sought to ascertain the methods used by funeral directors to determine the demographic information recorded on death certificates. METHODS: Standardized questionnaires were administered to funeral directors in five urban locations in the U.S. In addition, personnel on four Indian reservations were interviewed. Study sites were selected for diverse racial/ethnic populations and variability in recording practices; funeral homes were selected by stratified random sampling. RESULTS: Fifty-two percent of responding funeral directors reported receiving no formal training in death certification. Seventy-nine percent of respondents reported finding certain demographic items difficult to complete--26% first specified race as the problematic item, and 25% first specified education. The decedent's race was "sometimes" or "often" determined through personal knowledge of the family by 58% of respondents; 43% reported "sometimes" or "often" determining race by observation. Only three respondents reported that occupation was a problematic item. CONCLUSIONS: The authors recommend that the importance of demographic data and the instructions for data collection be clarified for funeral directors, that standard data collection worksheets be developed, and that training videos be developed. PMID:12297680

  13. Staff Report to the Senior Department Official on Recognition Compliance Issues. Recommendation Page: American Board of Funeral Service Education

    ERIC Educational Resources Information Center

    US Department of Education, 2010

    2010-01-01

    The American Board of Funeral Service Education (ABFSE), Committee on Accreditation (COA), is a national specialized accrediting agency. Its current scope of recognition is the accreditation of institutions and programs awarding diplomas, associate degrees and bachelor's degrees in funeral service or mortuary science. ABFSE is, therefore, both an…

  14. Development of a device for detecting target specimens from EUS-guided FNA samples

    PubMed Central

    Matsumoto, Kazuya; Ueki, Masaru; Takeda, Yohei; Harada, Kenichi; Onoyama, Takumi; Kawata, Soichiro; Ikebuchi, Yuichiro; Imamoto, Ryu; Horie, Yasushi; Murawaki, Yoshikazu

    2015-01-01

    Background and study aims: Specimens collected by fine needle are microscopic and contain blood; therefore, the presence of a target specimen within a sample is often difficult to confirm. Although rapid on-site evaluation (ROSE) during endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) is beneficial, many health care facilities are unable to apply this technique due to a lack of cytopathologists. The aim of this study was to develop and validate a device that detects the target specimen within pancreatic tumor EUS-FNA samples. Patients and methods: Fifty-eight consecutive patients with solid pancreatic masses were studied for a preliminary case series at a tertiary-care university hospital (Tottori University Hospital, Yonago, Japan). The material collected was checked with a target sample check illuminator (TSCI) and was evaluated by one cytopathologist. Results: The agreement rate between the TSCI and histopathology was 93.7 %. Further testing procedures were not needed in 91.4 % of patients, and the mean number of needle punctures was 1.2 after a single pass using TSCI. No adverse events were encountered with the procedure. Conclusions: With the introduction of the TSCI in EUS-FNA, it became possible to both collect the minimum necessary target samples by EUS-FNA and to end further procedures, even without performing ROSE. PMID:26716133

  15. Factors affecting the duration of nestling period and fledging order in Tengmalm's owl (Aegolius funereus): effect of wing length and hatching sequence.

    PubMed

    Kouba, Marek; Bartoš, Luděk; Korpimäki, Erkki; Zárybnická, Markéta

    2015-01-01

    In altricial birds, the nestling period is an important part of the breeding phase because the juveniles may spend quite a long time in the nest, with associated high energy costs for the parents. The length of the nestling period can be variable and its duration may be influenced by both biotic and abiotic factors; however, studies of this have mostly been undertaken on passerine birds. We studied individual duration of nestling period of 98 Tengmalm's owl chicks (Aegolius funereus) at 27 nests during five breeding seasons using a camera and chip system and radio-telemetry. We found the nestlings stayed in the nest box for 27 - 38 days from hatching (mean ± SD, 32.4 ± 2.2 days). The individual duration of nestling period was negatively related to wing length, but no formally significant effect was found for body weight, sex, prey availability and/or weather conditions. The fledging sequence of individual nestlings was primarily related to hatching order; no relationship with wing length and/or other factors was found in this case. We suggest the length of wing is the most important measure of body condition and individual quality in Tengmalm's owl young determining the duration of the nestling period. Other differences from passerines (e.g., the lack of effect of weather or prey availability on nestling period) are considered likely to be due to different life-history traits, in particular different food habits and nesting sites and greater risk of nest predation among passerines.

  16. Perching of Tengmalm's owl (Aegolius funereus) nestlings at the nest box entrance: effect of time of the day, age, wing length and body weight.

    PubMed

    Kouba, Marek; Bartoš, Luděk; Zárybnická, Markéta

    2014-01-01

    The behaviour of the nestlings of nocturnal cavity-nesting species has relatively rarely been studied in detail because of problems connected with use of the technical devices required to provide long-term monitoring of individuals. However, long-term observation of nestling behaviour is crucial in order to identify different types of behaviour which may be caused by sibling competition at the end of nesting period. We studied behaviour of 43 Tengmalm's owl (Aegolius funereus) nestlings at 14 nests using a camera and a chip system. The nestlings perched at the nest box entrance from an average age of 28 days from hatching (range 24-34 days) until fledging, spending around 2 hours per day here in total, in periods ranging from a few seconds to 147 min (7.6±10.9 min, mean ± SD). We found that individual duration of perching at the nest box entrance was significantly influenced by nestlings' age and wing length and that the duration of perching at the nest box entrance significantly decreased with time of night. However, during daylight hours, time of day had no effect on either probability or duration of nestlings' perching. We suggest daylight perching at the nest box entrance results from nestlings' preparation for fledging, while individuals perching here during the night may gain an advantageous position for obtaining food from the parents; another possibility at all times of day is that nestlings can reaffirm their social dominance status by monopolizing the nest box entrance.

  17. Perching of Tengmalm's Owl (Aegolius funereus) Nestlings at the Nest Box Entrance: Effect of Time of the Day, Age, Wing Length and Body Weight

    PubMed Central

    Kouba, Marek; Bartoš, Luděk; Zárybnická, Markéta

    2014-01-01

    The behaviour of the nestlings of nocturnal cavity-nesting species has relatively rarely been studied in detail because of problems connected with use of the technical devices required to provide long-term monitoring of individuals. However, long-term observation of nestling behaviour is crucial in order to identify different types of behaviour which may be caused by sibling competition at the end of nesting period. We studied behaviour of 43 Tengmalm's owl (Aegolius funereus) nestlings at 14 nests using a camera and a chip system. The nestlings perched at the nest box entrance from an average age of 28 days from hatching (range 24–34 days) until fledging, spending around 2 hours per day here in total, in periods ranging from a few seconds to 147 min (7.6±10.9 min, mean ± SD). We found that individual duration of perching at the nest box entrance was significantly influenced by nestlings' age and wing length and that the duration of perching at the nest box entrance significantly decreased with time of night. However, during daylight hours, time of day had no effect on either probability or duration of nestlings' perching. We suggest daylight perching at the nest box entrance results from nestlings' preparation for fledging, while individuals perching here during the night may gain an advantageous position for obtaining food from the parents; another possibility at all times of day is that nestlings can reaffirm their social dominance status by monopolizing the nest box entrance. PMID:24828567

  18. Safety and Efficacy of EUS-Guided Ethanol Ablation for Treating Small Solid Pancreatic Neoplasm.

    PubMed

    Paik, Woo Hyun; Seo, Dong Wan; Dhir, Vinay; Wang, Hsiu-Po

    2016-01-01

    The strategy for treating small borderline malignant pancreatic neoplasms--such as neuroendocrine tumor (NET) and solid pseudopapillary neoplasm (SPN)--is surgical resection. However, pancreatic resection of these lesions still causes significant morbidity. We evaluated the safety and efficacy of EUS-guided ethanol ablation to treat small solid pancreatic neoplasms. A total of 8 patients with small borderline malignant pancreatic neoplasms and co-morbidities who refused surgery were included. We identified 2 cases of nonfunctioning NET, 3 cases of insulinomas, 1 case of gastrinoma, and 2 cases of SPN. EUS-guided ethanol ablation was performed, and treatment outcomes were assessed with clinical symptom, hormone assay, and imaging study. The mean tumor diameter was 15  mm (range, 7-29  mm), and the median volume of injected ethanol was 2.8  mL (range, 1.2-10.5  mL). There was 1 severe acute pancreatitis after EUS-guided ethanol ablation with 20-gauge CPN needle. During follow-up (median 16.5 months), 6 patients achieved treatment success; however, 2 patients (1 nonfunctioning NET and 1 SPN) still had persistent tumors. The patient with persistent SPN underwent surgical resection and the histopathological results showed peripancreatic infiltration with perineural invasion. Among 6 patients who achieved initial treatment success, 1 patient experienced tumor recurrence within 15 months and underwent repeated EUS-guided ethanol ablation. In conclusion, EUS-guided ethanol ablation therapy is a promising option for patients with small solid pancreatic neoplasm. Multiple sessions or surgical interventions may be required if there is a recurrent or persistent mass, and procedure-related adverse events must be carefully monitored.

  19. Critical Incident Stress among Funeral Directors: Identifying Factors Relevant for Mental Health Counseling.

    ERIC Educational Resources Information Center

    Kroshus, John; Swarthout, David; Tibbetts, Steven

    1995-01-01

    Constituting the initial phase of a longitudinal study, a questionnaire was developed and distributed to determine the prevalence of critical-incident stress and related symptoms among funeral directors (N=725). Results are related to age group and type of stressor. Implications for counseling people with work-related stress are discussed. (EMK)

  20. Environmental and climatic factors associated with epizootic ulcerative syndrome (EUS) in fish from the Zambezi floodplains, Zambia.

    PubMed

    Choongo, K; Hang'ombe, B; Samui, K L; Syachaba, M; Phiri, H; Maguswi, C; Muyangaali, K; Bwalya, G; Mataa, L

    2009-10-01

    This study was conducted to determine environmental and climatic factors associated with Epizootic Ulcerative Syndrome (EUS) in fish in the Zambezi floodplains. EUS is a fish disease that causes economic loses to the fishing industry. Streambed colour in affected water was rusty-, reddish- or yellowish- brown and pH 4.5-6.0 while pH of non affected water was 7.2. The rusty-brown precipitate on fish gills was positive for Prussian blue iron stain. Therefore, predisposing factors for EUS in the Zambezi floodplains were the acidification of ground water during drought years and eventual contamination of surface water during the floods of 2006/2007.

  1. Factors Affecting the Duration of Nestling Period and Fledging Order in Tengmalm’s Owl (Aegolius funereus): Effect of Wing Length and Hatching Sequence

    PubMed Central

    Kouba, Marek; Bartoš, Luděk; Korpimäki, Erkki; Zárybnická, Markéta

    2015-01-01

    In altricial birds, the nestling period is an important part of the breeding phase because the juveniles may spend quite a long time in the nest, with associated high energy costs for the parents. The length of the nestling period can be variable and its duration may be influenced by both biotic and abiotic factors; however, studies of this have mostly been undertaken on passerine birds. We studied individual duration of nestling period of 98 Tengmalm’s owl chicks (Aegolius funereus) at 27 nests during five breeding seasons using a camera and chip system and radio-telemetry. We found the nestlings stayed in the nest box for 27 – 38 days from hatching (mean ± SD, 32.4 ± 2.2 days). The individual duration of nestling period was negatively related to wing length, but no formally significant effect was found for body weight, sex, prey availability and/or weather conditions. The fledging sequence of individual nestlings was primarily related to hatching order; no relationship with wing length and/or other factors was found in this case. We suggest the length of wing is the most important measure of body condition and individual quality in Tengmalm’s owl young determining the duration of the nestling period. Other differences from passerines (e.g., the lack of effect of weather or prey availability on nestling period) are considered likely to be due to different life-history traits, in particular different food habits and nesting sites and greater risk of nest predation among passerines. PMID:25793880

  2. Differential Movement Patterns of Juvenile Tengmalms Owls (Aegolius funereus) during the Post-Fledging Dependence Period in Two Years with Contrasting Prey Abundance

    PubMed Central

    Kouba, Marek; Bartoš, Luděk; Štastný, Karel

    2013-01-01

    Fledgling behaviour and movement patterns throughout the post-fledging dependence period (PFDP), especially in relation to changing environmental conditions, have been rarely studied, despite the fact that this period is recognized as of crucial significance in terms of high mortality of juveniles. The PFDP can extend over quite a protracted period, particularly in birds of prey, and a knowledge of the movement patterns of individuals is fundamental for understanding mechanisms underlying survival, habitat use and dispersion. We radiotracked 39 fledglings of the Tengmalm’s owl (Aegolius funereus) in two years with different availability of prey: 2010 (n = 29) and 2011 (n = 10) and obtained 1455 daily locations. Fledglings reached independence on average in 45 days after fledging in 2010 (n = 22) and 57 days in 2011 (n = 6). Within years, the most important measures influencing the distance moved from the nest box were age of fledglings and number of surviving siblings present. Individual home range size and duration of PFDP in particular were dependent on maximal number of siblings seen outside the nest box. In the season with low prey availability fledglings were observed at greater distances from the nest box than in the year with higher prey availability (mean distance: 350 m in 2010 and 650 m in 2011) and occupied larger home ranges (mean: 30.3 ha in 2010 and 57.7 ha in 2011). The main factor causing these differences between years was probably the different availability of prey in these two years, affecting breeding success and post-fledging survivorship of the Tengmalm’s owls. PMID:23843981

  3. Differential movement patterns of juvenile Tengmalms owls (Aegolius funereus) during the post-fledging dependence period in two years with contrasting prey abundance.

    PubMed

    Kouba, Marek; Bartoš, Luděk; Štastný, Karel

    2013-01-01

    Fledgling behaviour and movement patterns throughout the post-fledging dependence period (PFDP), especially in relation to changing environmental conditions, have been rarely studied, despite the fact that this period is recognized as of crucial significance in terms of high mortality of juveniles. The PFDP can extend over quite a protracted period, particularly in birds of prey, and a knowledge of the movement patterns of individuals is fundamental for understanding mechanisms underlying survival, habitat use and dispersion. We radiotracked 39 fledglings of the Tengmalm's owl (Aegolius funereus) in two years with different availability of prey: 2010 (n = 29) and 2011 (n = 10) and obtained 1455 daily locations. Fledglings reached independence on average in 45 days after fledging in 2010 (n = 22) and 57 days in 2011 (n = 6). Within years, the most important measures influencing the distance moved from the nest box were age of fledglings and number of surviving siblings present. Individual home range size and duration of PFDP in particular were dependent on maximal number of siblings seen outside the nest box. In the season with low prey availability fledglings were observed at greater distances from the nest box than in the year with higher prey availability (mean distance: 350 m in 2010 and 650 m in 2011) and occupied larger home ranges (mean: 30.3 ha in 2010 and 57.7 ha in 2011). The main factor causing these differences between years was probably the different availability of prey in these two years, affecting breeding success and post-fledging survivorship of the Tengmalm's owls. PMID:23843981

  4. Factors affecting vocalization in Tengmalm's owl (Aegolius funereus) fledglings during post-fledging dependence period: scramble competition or honest signalling of need?

    PubMed

    Kouba, Marek; Bartoš, Luděk; Št'astný, Karel

    2014-01-01

    Begging behaviour of nestlings has been intensively studied for several decades as a key component of parent-offspring conflict. There are essentially two main theories to account for intensity of food solicitation among offspring: that intensity of begging is related to some form of scramble competition between nest mates or that it offers honest signalling of need to parents. The vast majority of studies which have addressed begging behaviour have been based on observations of, and experiments on, nestlings and have not considered begging behaviour, during the post-fledging period. Begging vocalizations in this post-fledging phase of dependence have rarely been studied, despite the importance of vocalizations as a communication method between offspring and parents, particularly for nocturnal species. We radiotracked 39 fledglings of the Tengmalm's owl (Aegolius funereus) in two years with different availability of prey: 2010 (n = 29 fledglings) and 2011 (n = 10 fledglings) and made 1320 nightly localizations in which we recorded presence or absence of begging calls. Within years, the most important measures related to the probability of vocalization were body condition at fledging, time of night, number of surviving siblings, age and weather conditions. Begging intensity increased with age in both years; however, in the year with low prey availability fledglings vocalized significantly more often. The main factor causing these differences between years was probably the different availability of prey, affecting breeding success, post-fledging behaviour, and thus also both short- and long-term needs of offspring. We believe that our results suggest honest signalling of their fledgling's need.

  5. Factors affecting vocalization in Tengmalm's owl (Aegolius funereus) fledglings during post-fledging dependence period: scramble competition or honest signalling of need?

    PubMed

    Kouba, Marek; Bartoš, Luděk; Št'astný, Karel

    2014-01-01

    Begging behaviour of nestlings has been intensively studied for several decades as a key component of parent-offspring conflict. There are essentially two main theories to account for intensity of food solicitation among offspring: that intensity of begging is related to some form of scramble competition between nest mates or that it offers honest signalling of need to parents. The vast majority of studies which have addressed begging behaviour have been based on observations of, and experiments on, nestlings and have not considered begging behaviour, during the post-fledging period. Begging vocalizations in this post-fledging phase of dependence have rarely been studied, despite the importance of vocalizations as a communication method between offspring and parents, particularly for nocturnal species. We radiotracked 39 fledglings of the Tengmalm's owl (Aegolius funereus) in two years with different availability of prey: 2010 (n = 29 fledglings) and 2011 (n = 10 fledglings) and made 1320 nightly localizations in which we recorded presence or absence of begging calls. Within years, the most important measures related to the probability of vocalization were body condition at fledging, time of night, number of surviving siblings, age and weather conditions. Begging intensity increased with age in both years; however, in the year with low prey availability fledglings vocalized significantly more often. The main factor causing these differences between years was probably the different availability of prey, affecting breeding success, post-fledging behaviour, and thus also both short- and long-term needs of offspring. We believe that our results suggest honest signalling of their fledgling's need. PMID:24760102

  6. Factors affecting the duration of nestling period and fledging order in Tengmalm's owl (Aegolius funereus): effect of wing length and hatching sequence.

    PubMed

    Kouba, Marek; Bartoš, Luděk; Korpimäki, Erkki; Zárybnická, Markéta

    2015-01-01

    In altricial birds, the nestling period is an important part of the breeding phase because the juveniles may spend quite a long time in the nest, with associated high energy costs for the parents. The length of the nestling period can be variable and its duration may be influenced by both biotic and abiotic factors; however, studies of this have mostly been undertaken on passerine birds. We studied individual duration of nestling period of 98 Tengmalm's owl chicks (Aegolius funereus) at 27 nests during five breeding seasons using a camera and chip system and radio-telemetry. We found the nestlings stayed in the nest box for 27 - 38 days from hatching (mean ± SD, 32.4 ± 2.2 days). The individual duration of nestling period was negatively related to wing length, but no formally significant effect was found for body weight, sex, prey availability and/or weather conditions. The fledging sequence of individual nestlings was primarily related to hatching order; no relationship with wing length and/or other factors was found in this case. We suggest the length of wing is the most important measure of body condition and individual quality in Tengmalm's owl young determining the duration of the nestling period. Other differences from passerines (e.g., the lack of effect of weather or prey availability on nestling period) are considered likely to be due to different life-history traits, in particular different food habits and nesting sites and greater risk of nest predation among passerines. PMID:25793880

  7. Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy

    PubMed Central

    Paik, Woo Hyun; Park, Do Hyun; Choi, Jun-Ho; Choi, Joon Hyuk; Lee, Sang Soo; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan; Lee, Jung Bok

    2014-01-01

    AIM: To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS). METHODS: Twenty-eight patients in a prospective case series who underwent EUS-HGS (phase I). Forty-six patients in a matched case-control study (phase II). The simplified technique for fistula dilation was the primary use of a 4 mm balloon catheter with a stainless steel stylet. The stent deployment was modified by deploying the metal stent inside a bile duct (half of the stent) under EUS and fluoroscopic guidance and gently pulling the echoendoscope after full deployment of the stent inside the echoendoscope channel (remaining portion of the stent) under fluoroscopic guidance. This cohort was compared with a matched historical cohort. RESULTS: In phase I, the technical and clinical success with the modified method was 96% (27/28) and 89% (24/27 as per-protocol analysis). The overall adverse event rate was 7%. In phase II, there was no difference in technical and clinical success, stent patency and overall adverse events in each group. However, the procedural time (15.3 ± 5.2 min vs 22.3 ± 6.0 min, P < 0.001) and early adverse events (0% vs 26%, P = 0.02) were statistically improved in case cohort compared with control cohort. CONCLUSION: Compared with the conventional EUS-HGS technique, the procedural time was shorter and early adverse events were less frequent with our simplified and modified technique. PMID:24803818

  8. [Pulmonary tuberculosis of occupational origin in a funeral director: a case report].

    PubMed

    Witkowska, Anna; Wiszniewska, Marta; Krakowiak, Anna; Walusiak-Skorupa, Jolanta

    2014-01-01

    In Poland the incidence rate of tuberculosis is higher than the average for countries of the European Union, Norway or Iceland. On the other hand, occupational tuberculosis is still rarely recognized in our country. In this paper we present the first in Poland--to our best knowledge--case of pulmonary manifestation of this disease acquired at work in a funeral director. The recognition of the occupational etiology of the discussed illness gave rise to an array of diagnostic problems and became feasible after a thorough analysis of the patient's history and literature data, which allowed finding the relationship between infection and performed job. We speculated that the transfer of the dead body and handling of cadavers may expel residual air from the lungs of the deceased. Although tuberculosis occurs frequently in the general population, the recognition of work-related cases of this disease is still rare, especially among funeral directors.

  9. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction.

    PubMed

    Nguyen-Tang, T; Binmoeller, K F; Sanchez-Yague, A; Shah, J N

    2010-03-01

    Endoscopic retrograde cholangiopancreatography (ERCP) with placement of self-expandable metal stents (SEMS) for palliation of malignant obstruction may not be possible in patients with an inaccessible biliary orifice. Endoscopic ultrasound (EUS)-guided drainage methods may be useful in this setting. This study aimed to determine the outcomes of EUS-guided anterograde SEMS placement across malignant strictures in patients with an inaccessible biliary orifice. Over a 2-year period, procedural and outcomes data on all patients undergoing EUS-guided anterograde SEMS drainage after failed ERCP were prospectively entered into a database and reviewed. Five patients underwent EUS-guided anterograde SEMS. Indications included: advanced pancreatic cancer (n = 3), metastatic cancer (n = 1), and anastomotic stricture (n = 1). The biliary orifice could not be reached endoscopically due to duodenal stricture (n = 4) or inaccessible hepaticojejunostomy (n = 1). EUS-guided punctures were performed transgastrically into left intrahepatic ducts (n = 4) or transbulbar into the common bile duct (n = 1). Guide wires were passed and SEMS were successfully deployed across strictures in an anterograde fashion in all patients. Jaundice resolved and serum bilirubin levels decreased in all cases. No procedure-related complications were noted during a mean follow-up of 9.2 months. EUS-guided anterograde SEMS placement appears to be a safe and efficient technique for palliation of biliary obstruction in patients with an endoscopically inaccessible biliary orifice. The procedure can be performed at the time of failed standard ERCP, and provides an alternative drainage option to percutaneous or surgical decompression and to EUS-guided creation of bilioenteric fistulae.

  10. Direct evidence for significant spin-polarization of EuS in Co/EuS multilayers at room temperature

    PubMed Central

    Pappas, S. D.; Poulopoulos, P.; Lewitz, B.; Straub, A.; Goschew, A.; Kapaklis, V.; Wilhelm, F.; Rogalev, A.; Fumagalli, P.

    2013-01-01

    The new era of spintronics promises the development of nanodevices, where the electron spin will be used to store information and charge currents will be replaced by spin currents. For this, ferromagnetic semiconductors at room temperature are needed. We report on significant room-temperature spin polarization of EuS in Co/EuS multilayers recorded by x-ray magnetic circular dichroism (XMCD). The films were found to contain a mixture of divalent and trivalent europium, but only Eu++ is responsible for the ferromagnetic behavior of EuS. The magnetic XMCD signal of Eu at room temperature could unambiguously be assigned to magnetic ordering of EuS and was found to be only one order of magnitude smaller than that at 2.5 K. The room temperature magnetic moment of EuS is as large as the one of bulk ferromagnetic Ni. Our findings pave the path for fabrication of room–temperature spintronic devices using spin polarized EuS layers. PMID:23434820

  11. Induced spin-polarization of EuS at room temperature in Ni/EuS multilayers

    SciTech Connect

    Poulopoulos, P.; Goschew, A.; Straub, A.; Fumagalli, P.; Kapaklis, V.; Wolff, M.; Delimitis, A.; Wilhelm, F.; Rogalev, A.; Pappas, S. D.

    2014-03-17

    Ni/EuS multilayers with excellent multilayer sequencing are deposited via e-beam evaporation on the native oxide of Si(100) wafers at 4 × 10{sup −9} millibars. The samples have very small surface and interface roughness and show sharp interfaces. Ni layers are nanocrystalline 4–8 nm thick and EuS layers are 2–4 nm thick and are either amorphous or nanocrystalline. Unlike for Co/EuS multilayers, all Eu ions are in divalent (ferromagnetic) state. We show a direct antiferromagnetic coupling between EuS and Ni layers. At room temperature, the EuS layers are spin-polarized due to the proximity of Ni. Therefore, Ni/EuS is a candidate for room-temperature spintronics applications.

  12. Practitioners' Perceptions of the Academic Preparation of Funeral Directors and Embalmers in the Context of Changing Death Care Preferences in the United States

    ERIC Educational Resources Information Center

    LuBrant, Michael Paul

    2013-01-01

    This study investigated practitioners' perceptions of the a) importance, b) academic preparation related to, and c) adequacy of, funeral service education at academic programs accredited by the American Board of Funeral Service Education (ABFSE) in the context of changing death care preferences in the United States. Participants in this…

  13. Synthesis and Magnetic Properties of Gd Doped EuS Nanocrystals with Enhanced Curie Temperatures

    PubMed Central

    Selinsky, Rachel S.; Han, Jae Hyo; Morales Pérez, Elvin A.; Guzei, Ilia A.; Jin, Song

    2010-01-01

    EuS nanocrystals (NCs) were doped with Gd resulting in an enhancement of their magnetic properties. New EuS and GdS single source precursors (SSPs) were synthesized, characterized, and employed to synthesize Eu1-xGdxS NCs by decomposition in oleylamine and trioctylphosphine at 290 °C. The doped NCs were characterized using X-ray diffraction, transmission electron miscroscopy and scanning transmission electron microscopy, which supports the uniform distribution of Gd dopants through electron energy loss spectroscopy (EELS) mapping. X-ray absorption spectroscopy (XAS) revealed the dopant ions in Eu1-xGdxS NCs to be predominantly Gd3+. NCs with a variety of doping ratios of Gd (0 ≤ x < 1) were systematically studied using vibrating sample magnetometry and the observed magnetic properties were correlated with the Gd doping levels (x) as quantified with ICP-AES. Enhancement of the Curie temperature (TC) was observed for samples with low Gd concentrations (x ≤ 10 %) with a maximum TC of 29.4 K observed for NCs containing 5.3 % Gd. Overall, the observed TC, Weiss temperature (θ), and hysteretic behavior correspond directly to the doping level in Eu1-xGdxS NCs and the trends qualitatively follow those previously reported for bulk and thin film samples. PMID:20964293

  14. Synthesis and Magnetic Properties of Gd Doped EuS Nanocrystals with Enhanced Curie Temperatures

    SciTech Connect

    Selinsky, Rachel S.; Han, Jae Hyo; Perez, Elvin A. Morales; Guzei, Ilia A.; Jin, Song

    2010-12-07

    EuS nanocrystals (NCs) were doped with Gd resulting in an enhancement of their magnetic properties. New EuS and GdS single source precursors (SSPs) were synthesized, characterized, and employed to synthesize Eu{sub 1-x}Gd{sub x}S NCs by decomposition in oleylamine and trioctylphosphine at 290 C. The doped NCs were characterized using X-ray diffraction, transmission electron microscopy, and scanning transmission electron microscopy, which support the uniform distribution of Gd dopants through electron energy loss spectroscopy (EELS) mapping. X-ray absorption spectroscopy (XAS) revealed the dopant ions in Eu{sub 1-x}Gd{sub x}S NCs to be predominantly Gd{sup 3+}. NCs with a variety of doping ratios of Gd (0 {le} x < 1) were systematically studied using vibrating sample magnetometry and the observed magnetic properties were correlated with the Gd doping levels (x) as quantified with ICP-AES. Enhancement of the Curie temperature (T{sub C}) was observed for samples with low Gd concentrations (x {le} 10%) with a maximum T{sub C} of 29.4 K observed for NCs containing 5.3% Gd. Overall, the observed T{sub C}, Weiss temperature ({theta}), and hysteretic behavior correspond directly to the doping level in Eu{sub 1-x}Gd{sub x}S NCs and the trends qualitatively follow those previously reported for bulk and thin film samples.

  15. Late Cretaceous extensional unroofing in the Funeral Mountains metamorphic core complex, California

    SciTech Connect

    Applegate, J.D.R.; Hodges, K.V. ); Walker, J.D. )

    1992-06-01

    New filed and geochronologic data document the existence of Late Cretaceous extensional structures in the Death Valley region, California-Nevada. The authors have mapped two major, low-angle, ductile shear zones that omit stratigraphy in the footwall of the Funeral Mountains metamorphic core complex. Intervening strata have been strongly attenuated. Although stratigraphic offset across the shear zones is only 1.5 km, the presence of a large metamorphic discontinuity suggests that the amount of unroofing must be much greater. The timing of shear-zone formation, attenuation, and subsequent northwest-vergent folding is constrained by U-Pb geochronology on (1) prekinematic or synkinematic and (2) postkinematic pegmatites. Deformation was taking place by 72 Ma and had ended by 70 Ma. These results support earlier petrologic and geochronologic data that suggested substantial unroofing of the Funeral Mountains in Late Cretaceous time and add to a growing body of evidence for widespread Mesozoic extension in the hinterland of the Sevier thrust belt.

  16. Enhanced Valley Zeeman Splitting in MoS2 /EuS due to interfacial exchange field

    NASA Astrophysics Data System (ADS)

    Zhao, Chuan; Scrace, Thomas; Taheri, Payam; Zhang, Peiyao; Norden, Tenzin; Blizzard, Brett; Petrou, Athos; Zeng, Hao; Zhao, Puqin; Kioseoglou, George

    A monolayer transition metal dichalcogenides such as MoS2 with broken inversion symmetry possesses two degenerate yet inequivalent valleys that can be selectively excited by circularly polarized light. The ability to manipulate valley degrees of freedom with light or external magnetic field makes them attractive for optoelectronic and spintronic applications. On the other hand, it has been demonstrated recently that a magnetic insulator such as EuS can induce magnetic exchange field (MEF) on graphene through proximity effect. Thus, construction of a magnetic insulator/TMDC heterostructure may induce large MEF on TMDC, which may lead to giant valley Zeeman splitting. In this work, we report the observation of valley Zeeman splitting in monolayer MoS2 and other TMDCs due to the MEF from EuS substrates. Using magneto-reflectivity, we measured a Zeeman splitting of valley exciton of 2 meV at 7 tesla and 4 K, for monolayer MoS2 on a SiO2 substrate. This is consistent with values reported in monolayer WSe2. However, when EuS is used as the substrate, we observed an increase of valley splitting from 2 to 10 meV. We attribute this enhanced valley splitting to the MEF from the EuS substrate. Utilizing MEF of a magnetic insulator can induce magnetic ordering and giant Zeeman splitting in 2D TMDCs, which might enable novel spintronics applications.

  17. Pulsed laser deposition of high-quality thin films of the insulating ferromagnet EuS

    SciTech Connect

    Yang, Qi I.; Zhao, Jinfeng; Risbud, Subhash H.; Zhang, Li; Dolev, Merav; Fried, Alexander D.; Marshall, Ann F.; Kapitulnik, Aharon

    2014-02-24

    High-quality thin films of the ferromagnetic insulator europium(II) sulfide (EuS) were fabricated by pulsed laser deposition on Al{sub 2}O{sub 3} (0001) and Si (100) substrates. A single orientation was obtained with the [100] planes parallel to the substrates, with atomic-scale smoothness indicates a near-ideal surface topography. The films exhibit uniform ferromagnetism below 15.9 K, with a substantial component of the magnetization perpendicular to the plane of the films. Optimization of the growth condition also yielded truly insulating films with immeasurably large resistance. This combination of magnetic and electric properties opens the gate for future devices that require a true ferromagnetic insulator.

  18. Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey

    PubMed Central

    van Riet, Priscilla A.; Cahen, Djuna L.; Poley, Jan-Werner; Bruno, Marco J.

    2016-01-01

    Background and study aims: Although Endoscopic Ultrasound (EUS)-guided tissue sampling is widely used, the optimal sampling strategy remains subject of debate. We evaluated practice patterns within the international endosonographic community. Patients and methods: An online questionnaire was sent to 400 endosonographers from the United States, Europe, and Asia. Results: A total of 186 (47 %) endosonographers participated: United States 54 (29 %), Europe 85 (46 %), and Asia 47 (25 %). European (75 %) and Asian (84 %) respondents routinely check coagulation status, whereas US respondents only check on indication (64 %, P = 0.007). While propofol sedation is standard in the United States (83 %), conscious sedation is still widely used in Europe (52 %) and Asia (84 %, P < 0.001). Overall, the 22-gauge needle is most commonly used (52 %). For fine-needle aspiration (FNA) of solid pancreatic lesions, 22-gauge (45 %) and 25-gauge (49 %) needles are used equally. For fine-needle biopsy (FNB) of solid masses, the 25-gauge device is less favored than the 22-gauge FNA device (49 % versus 21 %). The 19-gauge needle is generally used for FNB of submucosal masses (62 %). Rapid on-site pathological evaluation (ROSE) is utilized more often by US (98 %) than by European and Asian respondents (51 %, P < 0.001). Cytolyt (52 %), formalin (15 %) and alcohol (15 %) are used for FNA specimen preservation in the United States and Europe, while saline (27 %) and alcohol (38 %) are widely used in Asia (P < 0.001). Conclusions: EUS-guided tissue sampling practices vary substantially within the international endosonographic community and differ considerably from recommendations expressed in guidelines. Because the clinical relevance of these variations is largely unknown, the outcome of this survey suggests a need for further studies. PMID:27227103

  19. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline.

    PubMed

    Polkowski, M; Larghi, A; Weynand, B; Boustière, C; Giovannini, M; Pujol, B; Dumonceau, J-M

    2012-02-01

    This article is the second of a two-part publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided Trucut biopsy. The first part (the Clinical Guideline) focused on the results obtained with EUS-guided sampling, and the role of this technique in patient management, and made recommendations on circumstances that warrant its use. The current Technical Guideline discusses issues related to learning, techniques, and complications of EUS-guided sampling, and to processing of specimens. Technical issues related to maximizing the diagnostic yield (e.g., rapid on-site cytopathological evaluation, needle diameter, microcore isolation for histopathological examination, and adequate number of needle passes) are discussed and recommendations are made for various settings, including solid and cystic pancreatic lesions, submucosal tumors, and lymph nodes. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling. A two-page executive summary of evidence statements and recommendations is provided.

  20. Mesozoic burial, Mesozoic and Cenozoic exhumation of the Funeral Mountains core complex, Death Valley, Southeastern California

    NASA Astrophysics Data System (ADS)

    Beyene, Mengesha Assefa

    2011-12-01

    The Funeral Mountains of Death Valley National Park, CA, provide an opportunity to date metamorphism resulting from crustal shortening and subsequent episodic extensional events in the Sevier hinterland. It was not clear whether crustal shortening and thus peak temperature metamorphism in the hinterland of the Sevier-Laramide orogenic wedge have occurred whether in Late Jurassic, Early Cretaceous, Late Cretaceous or somewhere between. Particularly ambiguous is the timing of crustal shortening in the deep levels of the hinterland of the Sevier belt, now manifest in the metamorphic core complexes, and how and when these middle-to-lower crustal rocks were exhumed. A 6-point garnet and a whole rock Savillax isochron from middle greenschist facies pelitic schist of the southeastern Funeral Mountains core complex yields an age of 162.1 +/- 5.8 Ma (2sigma). Composite PT paths determined from growth-zoned garnets from the same samples show a nearly isothermal pressure increase of ˜2 kbar at ˜490°C, suggesting thrust burial at 162.1 +/- 5.8 Ma. A second sample of Johnnie Formation from the comparatively higher metamorphic grade area to the northwest (East of Chloride Cliff) yielded an age of 172.9 +/- 4.9 Ma (2sigma) suggesting an increase of thrust burial age towards the higher grade rocks (northwest part of the core complex), consistent with paleo-depth interpretation and metamorphic grade. 40Ar/ 39Ar muscovite ages along footwall of the Boundary Canyon detachment fault and intra-core Chloride Cliff shear zone exhibit significant 40Ar/39Ar muscovite age differences. For samples from the immediate footwall of BCD, the pattern of ages decreasing toward the northwest is consistent with differences in depth of metamorphism, and for Late Cretaceous, top-to-northwest exhumation by motion along the precursor BCD; consistent with mesoscopic and microscopic kinematic studies. Samples from the footwall of the structurally-lower Chloride Cliff shear zone yield Tertiary 40Ar/39Ar

  1. Magnetic proximity effect and spin-orbital texture at the Bi2Se3/EuS interface

    NASA Astrophysics Data System (ADS)

    Lee, Alex Taekyung; Han, Myung Joon; Park, Kyungwha

    2014-10-01

    We investigate a magnetic proximity effect on the Dirac surface states of a topological insulator (TI) induced by a Bi2Se3/EuS interface, using density-functional theory (DFT) and a low-energy effective model, motivated by a recent experimental realization of the interface. We consider a thin ferromagnetic insulator EuS film stacked on top of Bi2Se3(111) slabs of three or five quintuple layers (QLs) with the magnetization of EuS normal to the interface (z axis), which breaks time-reversal symmetry. It is found that a charge transfer and surface relaxation makes the Dirac cones electron doped. For both three and five QLs, the top-surface Dirac cone has an energy gap of 9 meV, while the bottom-surface Dirac cone remains gapless. This feature is due to the short-ranged induced magnetic moment of the EuS film. For the five QLs, an additional Dirac cone with an energy gap of 2 meV is formed right below the bottom-surface Dirac point, while for three QLs, there is no additional Dirac cone. We also examine the spin-orbital texture of the Dirac surface states with broken time-reversal symmetry, using DFT and the effective model. We find that the pz orbital is coupled to the z component of the spin moment in the opposite sign to the px and py orbitals. The pz and radial p orbitals are coupled to the in-plane spin texture in the opposite handedness to the tangential p orbital. The result obtained from the effective model agrees with our DFT calculations. The calculated spin-orbital texture may be tested from spin-polarized angle-resolved photoemission spectroscopy.

  2. Surgery or EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after ERCP failure

    PubMed Central

    Artifon, Everson L.A.; Loureiro, Jarbas F.; Baron, Todd H.; Fernandes, Kaie; Kahaleh, Michel; Marson, Fernando P.

    2015-01-01

    Background and Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage in patients with distal malignant biliary obstruction, but it fails in up to 10% of cases. Percutaneous transhepatic cholangiography (PTC) and surgical bypass are the traditional drainage alternatives. This study aimed to compare technical and clinical success, quality of life, and survival of surgical biliary bypass or hepaticojejunostomy (HJT) and endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDT) in patients with distal malignant bile duct obstruction and failed ERCP. Patients and Methods: A prospective, randomized trial was conducted. From March 2011 to September 2013, 32 patients with malignant distal biliary obstruction and failed ERCP were studied. The HJT group consisted of 15 patients and the CDT group consisted of 14 patients. Technical and clinical success, quality of life, and survival were assessed prospectively. Results: Technical success was 94% (15/16) in the HJT group and 88% (14/16) in the CDT group (P = 0.598). Clinical success occurred in 14 (93%) patients in the HJT group and in 10 (71%) patients in the CDT group (P = 0.169). During follow-up, a statistically significant difference was seen in mean functional capacity scores, physical health, pain, social functioning, and emotional and mental health aspects in both techniques (P < 0.05). The median survival time in both groups was the same (82 days). Conclusion: Data relating to technical and clinical success, quality of life, and survival were similar in patients who underwent HJT and CDT drainage after failed ERCP for malignant distal biliary obstruction. PMID:26374583

  3. Valence changes in TmSe by alloying with TmTe and EuSe

    NASA Astrophysics Data System (ADS)

    Batlogg, B.

    1981-01-01

    The valence of the Tm ions in mixed-valent TmSe has been influenced by alloying with TmTe and EuSe in order to study the interaction between intermediate-valent rare-earth ions as a function of the degree of valence mixing. Magnetic, elastic, electrical, and optical properties have been measured on TmSe1-xTex crystals for seven distinct compositions. The degree of valence mixing is increased as Se is replaced by Te up to ~ 20% and the material remains metallic. Whereas TmSe orders metamagnetically (TN=3 K), the Te-containing samples are spontaneously magnetized below 3-5 K. This increasing strength of the ferromagnetic interactions, accompanying the increase of valence mixing, is consistent with the model of a double exchange coupling of mixed-valent Tm ions. TmSe1-xTex with x>=0.5 is semiconducting, the Tm ions are divalent and the overall electronic structure is similar to the ones of the Sm, Eu, and Yb monochalcogenides. The only peculiarities are the narrow energy gaps (0.2 to 0.35 eV) which require pressures of some 20 to 30 kbar to be closed. The magnetic properties are dominated by the crystal-field-split 2F72 ground state, leading to ordering temperatures well below 1 K. As Eu replaces Tm in TmSe, it is divalent because of its highly stable 4f7 shell, whereas the Tm2+ 4f13 and Tm3+ 4f12 5d configurations are nearly degenerate: in Tm0.5Eu0.5Se they are separated by an energy gap of only 0.1 eV, which can be driven to zero with moderate external pressure (15 kbar). In the metallic Tm0.83Eu0.17Se, the Tm ions are of predominantly inhomogeneously mixed-valent character since the Eu ions, being larger in volume are thought to give rise to local deformations of the lattice.

  4. Sequence and timing of deformation in the footwall of the Funeral Mountains metamorphic core complex, California

    SciTech Connect

    Applegate, J.D.R.; Hodges, K.V. ); Walker, J.D. . Dept. of Geology)

    1992-01-01

    The metamorphic infrastructure of the Funeral Mountains has undergone a polygenetic sequence of deformation associated with Mesozoic-Tertiary burial and unroofing. The first two episodes of deformation are displayed as isoclinal, recumbent folds (F1 and F2) that have been highly attenuated by subsequent deformation, and as associated axial planar schistosities. The minimum age of D1-2 deformational features is constrained as 72 Ma by U-Pb zircon data for cross-cutting granitic pegmatites. Attenuation of older structures occurred during D3, a deformation episode that produced the dominant foliation (S3) and well-defined, WNW-ESE stretching and mineral lineations (L3). D3 deformation has been dated at 70--72 Ma. The next episode of deformation (D4) is represented by NW-vergent, tight to isoclinal folds (F4) which fold the S3 foliation. The age of this folding is bracketed between 72 Ma and 65Ma. Southwest-vergent, tight folds that involve S3 and F4 are the dominant structures of D5 deformation. These folds, which range in size from mm-scale to hundreds of meters in amplitude, are associated with a regionally developed, NW-SE crenulation lineation (L5). The age of D5 is not tightly constrained but is considered to be Tertiary. They associate D1--2 deformation with Mesozoic thrust faulting which buried the core rocks. D3 and D4 deformation are clearly Late Cretaceous and represent initial unroofing of the core. They ascribe subsequent deformational events to episodic Tertiary unroofing. D5 deformation in particular may represent an isostatic response to unroofing on the core-bounding Boundary Canyon Detachment, while D6--7 deformation may be related to late-stage doming of the core.

  5. Geologic map of the southern Funeral Mountains including nearby groundwater discharge sites in Death Valley National Park, California and Nevada

    USGS Publications Warehouse

    Fridrich, C.J.; Thompson, R.A.; Slate, J.L.; Berry, M.E.; Machette, M.N.

    2012-01-01

    This 1:50,000-scale geologic map covers the southern part of the Funeral Mountains, and adjoining parts of four structural basins—Furnace Creek, Amargosa Valley, Opera House, and central Death Valley—in California and Nevada. It extends over three full 7.5-minute quadrangles, and parts of eleven others—an area of about 1,000 square kilometers (km2). The boundaries of this map were drawn to include all of the known proximal hydrogeologic features that may affect the flow of groundwater that discharges from springs of the Furnace Creek basin, in the west-central part of the map. These springs provide the main potable water supply for Death Valley National Park. Major hydrogeologic features shown on this map include: (1) springs of the Furnace Creek basin, (2) a large Pleistocene groundwater discharge mound in the northeastern part of the map, (3) the exposed extent of limestones and dolomites that constitute the Paleozoic carbonate aquifer, and (4) the exposed extent of the alluvial conglomerates that constitute the Funeral Formation aquifer.

  6. Comparison of the PSHA results of the 1993-EUS- update and the 1998-TIP studies for waste bar

    SciTech Connect

    Savy, J; Bernreuter, D

    2001-01-09

    From 1981 to 1989, Lawrence Livermore National Laboratory (LLNL) developed for the Nuclear Regulatory Commission a method for performing Probabilistic Seismic Hazard Analysis (PSHA) in the eastern US with results documented in NUREG/CR-5250. Improvements in the handling of the uncertainties lead to updated results documented in the 1993-EUS-Update study (NUREG-1488.) These results presented substantial differences with the utilities sponsored study performed by the Electric Power Research Institute (EPRI, 1989.) In order to understand the differences between the two studies, the Nuclear Regulatory Commission (NRC), the Department Of Energy (DOE) and EPRI jointly sponsored a study led by the Senior Seismic Hazard Analysis Committee (SSHAC) the task of which was to explain the differences between the two studies and provide guidance on how to perform a state-of-the-art PSHA. The work and conclusions of the SSHAC are documented in NUREG/CR-6372, 1997. As a follow-up to the 1997 SSHAC study, the Trial Implementation Project (TIP), (UCRL-ID-133494, 1998, NUREG/CR-6607) made use of the SSHAC recommendations and developed a set of more detailed guidance for performing PSHA. The TIP project tested the more complicated issue of development of the seismic zonation and seismicity models on two sites: Watts Bar and Vogtle. It was found that the uncertainty generated by artificial disagreements among experts can be considerably reduced through interaction and discussion of the available data and by identifying the elements common to all experts' interpretation. By concentration on those elements, it was possible to develop a consensus of the group on the way to characterize them and eliminate large unnecessary differences. The present study compares the results of the 1993-EUS-Update and the 1998-TIP studies and identifies the reasons for the differences, which were found to be: (1) Differences in the ground motion (GM) attenuation models; (2) The introduction of the Eastern

  7. Initial experience with a novel EUS-guided core biopsy needle (SharkCore): results of a large North American multicenter study

    PubMed Central

    DiMaio, Christopher J.; Kolb, Jennifer M.; Benias, Petros C.; Shah, Hiral; Shah, Shashin; Haluszka, Oleh; Maranki, Jennifer; Sharzehi, Kaveh; Lam, Eric; Gordon, Stuart R.; Hyder, Sarah M.; Kaimakliotis, Pavlos Z.; Allaparthi, Satya B.; Gress, Frank G.; Sethi, Amrita; Shah, Ashish R.; Nieto, Jose; Kaul, Vivek; Kothari, Shivangi; Kothari, Truptesh H.; Ho, Sammy; Izzy, Manhal J.; Sharma, Neil R.; Watson, Rabindra R.; Muthusamy, V. Raman; Pleskow, Douglas K.; Berzin, Tyler M.; Sawhney, Mandeep; Aljahdi, Emad; Ryou, Marvin; Wong, Clarence K.; Gupta, Parantap; Yang, Dennis; Gonzalez, Susana; Adler, Douglas G.

    2016-01-01

    Background and aims: The ability to safely and effectively obtain sufficient tissue for pathologic evaluation by using endoscopic ultrasound (EUS) guidance remains a challenge. Novel designs in EUS needles may provide for improved ability to obtain such core biopsies. The aim of this study was to evaluate the diagnostic yield of core biopsy specimens obtained using a novel EUS needle specifically designed to obtain core biopsies. Patients and methods: Multicenter retrospective review of all EUS-guided fine-needle biopsies obtained using a novel biopsy needle (SharkCore FNB needle, Medtronic, Dublin, Ireland). Data regarding patient demographics, lesion type/location, technical parameters, and diagnostic yield was obtained. Results: A total of 250 lesions were biopsied in 226 patients (Median age 66 years; 113 (50 %) male). Median size of all lesions (mm): 26 (2 – 150). Overall, a cytologic diagnosis was rendered in 81 % specimens with a median number of 3 passes. When rapid onsite cytologic evaluation (ROSE) was used, cytologic diagnostic yield was 126/149 (85 %) with a median number of 3 passes; without ROSE, cytologic diagnostic yield was 31/45 (69 %, P = 0.03) with a median number of 3 passes. Overall, a pathologic diagnosis was rendered in 130/147 (88 %) specimens with a median number of 2 passes. Pathologic diagnostic yield for specific lesion types: pancreas 70/81 (86 %), subepithelial lesion 13/15 (87 %), lymph node 26/28 (93 %). Ten patients (10/226, 4 %) experienced adverse events: 4 acute pancreatitis, 5 pain, 1 fever/cholangitis. Conclusions: Initial experience with a novel EUS core biopsy needle demonstrates excellent pathologic diagnostic yield with a minimum number of passes.

  8. Initial experience with a novel EUS-guided core biopsy needle (SharkCore): results of a large North American multicenter study

    PubMed Central

    DiMaio, Christopher J.; Kolb, Jennifer M.; Benias, Petros C.; Shah, Hiral; Shah, Shashin; Haluszka, Oleh; Maranki, Jennifer; Sharzehi, Kaveh; Lam, Eric; Gordon, Stuart R.; Hyder, Sarah M.; Kaimakliotis, Pavlos Z.; Allaparthi, Satya B.; Gress, Frank G.; Sethi, Amrita; Shah, Ashish R.; Nieto, Jose; Kaul, Vivek; Kothari, Shivangi; Kothari, Truptesh H.; Ho, Sammy; Izzy, Manhal J.; Sharma, Neil R.; Watson, Rabindra R.; Muthusamy, V. Raman; Pleskow, Douglas K.; Berzin, Tyler M.; Sawhney, Mandeep; Aljahdi, Emad; Ryou, Marvin; Wong, Clarence K.; Gupta, Parantap; Yang, Dennis; Gonzalez, Susana; Adler, Douglas G.

    2016-01-01

    Background and aims: The ability to safely and effectively obtain sufficient tissue for pathologic evaluation by using endoscopic ultrasound (EUS) guidance remains a challenge. Novel designs in EUS needles may provide for improved ability to obtain such core biopsies. The aim of this study was to evaluate the diagnostic yield of core biopsy specimens obtained using a novel EUS needle specifically designed to obtain core biopsies. Patients and methods: Multicenter retrospective review of all EUS-guided fine-needle biopsies obtained using a novel biopsy needle (SharkCore FNB needle, Medtronic, Dublin, Ireland). Data regarding patient demographics, lesion type/location, technical parameters, and diagnostic yield was obtained. Results: A total of 250 lesions were biopsied in 226 patients (Median age 66 years; 113 (50 %) male). Median size of all lesions (mm): 26 (2 – 150). Overall, a cytologic diagnosis was rendered in 81 % specimens with a median number of 3 passes. When rapid onsite cytologic evaluation (ROSE) was used, cytologic diagnostic yield was 126/149 (85 %) with a median number of 3 passes; without ROSE, cytologic diagnostic yield was 31/45 (69 %, P = 0.03) with a median number of 3 passes. Overall, a pathologic diagnosis was rendered in 130/147 (88 %) specimens with a median number of 2 passes. Pathologic diagnostic yield for specific lesion types: pancreas 70/81 (86 %), subepithelial lesion 13/15 (87 %), lymph node 26/28 (93 %). Ten patients (10/226, 4 %) experienced adverse events: 4 acute pancreatitis, 5 pain, 1 fever/cholangitis. Conclusions: Initial experience with a novel EUS core biopsy needle demonstrates excellent pathologic diagnostic yield with a minimum number of passes. PMID:27652304

  9. Interface induced states at the boundary between a 3D topological insulator Bi2Se3 and a ferromagnetic insulator EuS

    NASA Astrophysics Data System (ADS)

    Eremeev, S. V.; Men`shov, V. N.; Tugushev, V. V.; Chulkov, E. V.

    2015-06-01

    By means of relativistic density functional theory (DFT) calculations we study electron band structure of the topological insulator (TI) Bi2Se3 thin films deposited on the ferromagnetic insulator (FMI) EuS substrate. In the Bi2Se3/EuS heterostructure, the gap opened in the spectrum of the topological state has a hybridization character and is shown to be controlled by the Bi2Se3 film thickness, while magnetic contribution to the gap is negligibly small. We also analyzed the effect of Eu doping on the magnetization of the Bi2Se3 film and demonstrated that the Eu impurity induces magnetic moments on neighboring Se and Bi atoms an order of magnitude larger than the substrate-induced moments. Recent magnetic and magneto-transport measurements in EuS/Bi2Se3 heterostructure are discussed.

  10. EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up.

    PubMed

    Yamao, K; Bhatia, V; Mizuno, N; Sawaki, A; Ishikawa, H; Tajika, M; Hoki, N; Shimizu, Y; Ashida, R; Fukami, N

    2008-04-01

    Five patients with obstructive jaundice caused by malignant periampullary biliary stenosis underwent EUS-guided choledochoduodenostomy (EUS-CDS) from the first portion of the duodenum using a convex echoendoscope and a needle knife. All the steps of the procedure including passage dilatation and the plastic stent placement were performed through the accessory channel of the echoendoscope over the guide wire. Stent insertion was technically successful in all five patients. The procedure was also clinically effective in relieving jaundice in all cases. One patient developed pneumoperitoneum, which resolved with conservative management. Stent exchange was successful in seven of eight attempts in patients with stent occlusion. One failure was due to tumor invasion to the choledochoduodenal fistula. Stent patency was maintained in the remaining patients throughout their survival period. The average stent patency was 211.8 days. EUS-CDS from the first portion of the duodenum appears to be feasible and safe in cases of obstructive jaundice caused by distal bile duct obstruction.

  11. EUS hepaticogastrostomy for bilioenteric anastomotic strictures: a permanent access for repeated ambulatory dilations? Results from a pilot study

    PubMed Central

    Miranda-García, Pablo; Gonzalez, Jean M.; Tellechea, Juan I.; Culetto, Adrian; Barthet, Marc

    2016-01-01

    Background and study aims: Postsurgical benign bilioenteric anastomotic strictures are a major adverse event of biliary surgery and endoscopic treatment, including endoscopic retrograde cholangiopancreatography (ERCP), is challenging in this setting. We present an innovative approach to treating this complication. Patients and methods: Patients underwent endoscopic ultrasound (EUS)-hepaticogastrostomy (HG) to treat nonmalignant biliary obstructions. A first endoscopy was performed to create the hepaticogastrostomy and to drain the biliary tree. The second step had a therapeutic purpose: antegrade dilation of the anastomosis. Results: Four men and three women with benign bilioenteric anastomotic strictures were included. Patients presented with jaundice or recurrent cholangitis. A fully covered HG stent was successfully deployed during the first endoscopy. During the second step, repeat antegrade dilation was performed through the HG in four cases (1 – 4 dilations) followed by double pigtail stenting in three cases. In three other patients, the stenosis was not crossable and a double pigtail stent was placed to maintain biliary drainage. All patients had symptom relief at the end of follow-up (45 weeks, range 33 – 64). Conclusions: Dilation of anastomotic stenosis through a hepaticogastrostomy is feasible and may provide permanent biliary drainage or recurrent access to the biliary tree in patients with altered anatomy. Double pigtail stents might prevent migration. PMID:27092329

  12. Ochres from rituals of prehistoric human funerals at the Toca do Enoque site, Piauí, Brazil

    NASA Astrophysics Data System (ADS)

    Cavalcante, Luis Carlos Duarte; da Luz, Maria De Fátima; Guidon, Niéde; Fabris, José Domingos; Ardisson, José Domingos

    2011-11-01

    The archaeological site known as Toca do Enoque (geographical coordinates, 09° 14' 65.3″ S 43° 55' 62.5″ W) is a rock shelter located in the Serra das Andorinhas (Serra das Confusões National Park), rural area of the city of Guaribas, state of Piauí, Brazil. Several rupestrian paintings (anthropomorphic and zoomorphic motifs along with some pure graphisms), predominantly in red, are found on the sandstone walls. Charcoals, lithic materials, necklaces with teeth, animal bones, gastropod shells, ochres and human skeletons (dated from 6,220 ± 40 to 6,610 ± 40 years before present, BP) were identified in recent excavations in this shelter. Red and yellow ochre samples were collected from prehistoric funeral structures and analyzed with powder X-ray diffractometry, Fourier-transform infrared spectroscopy and 57Fe transmission Mössbauer spectroscopy at 298 K and 80 K. Mössbauer data indicate that the red ochre do contain predominantly hematite ( α-Fe2O3) whereas goethite ( α-FeOOH) is the major mineral in the yellow ochre.

  13. The integration of single fiber reflectance (SFR) spectroscopy during endoscopic ultrasound-guided fine needle aspirations (EUS-FNA) in pancreatic masses: a feasibility study

    NASA Astrophysics Data System (ADS)

    Stegehuis, Paulien L.; Boogerd, Leonora S. F.; Inderson, Akin; Veenendaal, Roeland A.; Bonsing, Bert A.; Amelink, Arjen; Vahrmeijer, Alexander L.; Dijkstra, Jouke; Robinson, Dominic J.

    2016-03-01

    EUS-FNA can be used for pathological confirmation of a suspicious pancreatic mass. However, performance depends on an on-site cytologist and time between punction and final pathology results can be long. SFR spectroscopy is capable of extracting biologically relevant parameters (e.g. oxygenation and blood volume) in real-time from a very small tissue volume at difficult locations. In this study we determined feasibility of the integration of SFR spectroscopy during EUSFNA procedures in pancreatic masses. Patients with benign and malignant pancreatic masses who were scheduled for an EUS-FNA were included. The working guide wire inside the 19 gauge endoscopic biopsy needle was removed and the sterile single fiber (300 μm core and 700 μm outer diameter, wide-angle beam, NA 0.22) inserted through the needle. Spectroscopy measurements in the visiblenear infrared wavelength region (400-900 nm) and autofluorescence measurements (excitation at 405 nm) were taken three times, and subsequently cytology was obtained. Wavelength dependent optical properties were compared to cytology results. We took measurements in 13 patients with corresponding cytology results (including mucinous tumor, ductal adenocarcinoma, neuroendocrine tumor, and pancreatitis). In this paper we show the first analyzed results comparing normal pancreatic tissue with cancerous tissue in the same patient. We found a large difference in blood volume fraction, and blood oxygenation was higher in normal tissue. Integration of SFR spectroscopy is feasible in EUS-FNA procedures, the workflow hardly requires changes and it takes little time. The first results differentiating normal from tumor tissue are promising.

  14. Preliminary Geologic Map of the Southern Funeral Mountains and Adjacent Ground-Water Discharge Sites, Inyo County, California, and Nye County, Nevada

    USGS Publications Warehouse

    Fridrich, Christopher J.; Thompson, Ren A.; Slate, Janet L.; Berry, M.E.; Machette, Michael N.

    2008-01-01

    This map covers the southern part of the Funeral Mountains, and adjacent parts of four structural basins - Furnace Creek, Amargosa Valley, Opera House, and central Death Valley. It extends over three full 7.5-minute quadrangles, and parts of eleven others - a total area of about 950 square kilometers. The boundaries of this map were drawn to include all of the known proximal hydrogeologic features that may affect the flow of ground water that discharges from the springs of the Furnace Creek wash area, in the west-central part of the map. These springs provide the major potable water supply for Death Valley National Park.

  15. Understanding EUS (Endoscopic Ultrasonography)

    MedlinePlus

    ... Certification (MOC) Course Calendar GI Outlook (GO) Practice Management Conference Endoscopic Learning Library IT&T Hands-On Training Training and ... ASGE Endorsed Activities Ambassador Program Trainee Resources Traveling Learning ... MANAGEMENT GI Outlook (GO) Practice Management Conference Featured Courses ...

  16. Evaluation of S100A4 mRNA in EUS-FNA specimens for the assessment of chemosensitivity to gemcitabine from patients with unresectable pancreatic cancer

    PubMed Central

    Ma, Guifeng; Sun, Yan; Fu, Shiwen

    2015-01-01

    Background/Aims: Gemcitabine (GEM) is the first-line chemotherapy in patients with unresectable pancreatic cancer. However, the clinical outcomes of this regimen are still unsatisfactory in prolonging survival. Resistant to GEM is one of the reasons for poor prognosis. Therefore, looking for molecular biomarkers to predict chemosensitivity to GEM is important for treatment in unresectable pancreatic cancer patients. The aim of this study was to analyze S100A4 mRNA in tissues of unresectable pancreatic cancer obtained by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA), and to determine the relation between S100A4 mRNA level and chemosensitivity to GEM. Methods: The analysis was performed on samples from 36 patients with unresectable pancreatic cancer who were treated with gemcitabine alone. The patients were assigned to receive GEM at 1,000 mg/m2/wk for weeks 1 to 6, followed by 1 week rest, then for 4 weeks. mRNA was extracted for S100A4 mRNA assay from patients above by EUS-FNA before GEM-treatment. The 36 patients were divided into the following two groups. Patients with partial response and those with stable disease whose tumor markers decreased by 50% or more were classified as the effective group. The rest of patients were classified as the non effective group. The relationship between GEM efficacy and S100A4 mRNA expression was then examined by chi-squared test. Results: S100A4 mRNA showed a significant correlation with GEM efficacy. Patients in the effective group had low S100A4 mRNA expression, whereas patients in non-effective group had high S100A4 mRNA expressions (P = 0.0059). Conclusion: S100A4 mRNA level analyzed in EUS-FNA samples is an important molecular biomarker for prediction of chemosensitivity to GEM in unresectable pancreatic cancer. PMID:26722531

  17. Planning Your Own Funeral

    MedlinePlus

    ... Updates Blog Feed Facebook YouTube Twitter The Federal Trade Commission (FTC) is the nation’s consumer protection agency. The FTC works to prevent fraudulent, deceptive and unfair business practices in the marketplace. Privacy Policy About Us Contact Us Share Our Resources. Here's ...

  18. Shopping for Funeral Services

    MedlinePlus

    ... Updates Blog Feed Facebook YouTube Twitter The Federal Trade Commission (FTC) is the nation’s consumer protection agency. The FTC works to prevent fraudulent, deceptive and unfair business practices in the marketplace. Privacy Policy About Us Contact Us Share Our Resources. Here's ...

  19. Rise and tilt of metamorphic rocks in the lower plate of a detachment fault in the Funeral Mountains, Death Valley, California

    SciTech Connect

    Hoisch, T.D. ); Simpson, C. )

    1993-04-10

    The authors attempt to integrate new and old observations on the Funeral Mountains, in Death Valley, California, into an integrated model of the evolution of the lower plate in this region. This area consists of a detachment fault. Much effort has been directed toward explaining the development of detachment faults. Extensive petrologic, geochronologic and mapping evidence had been developed. The authors combine thermobarometric data on unsheared metamorphic rock in this region, kinematic analysis of folding in the area, and new geochronologic data from fission track measurements, K-Ar and [sup 40]Ar/[sup 39]Ar dating measurements. Their conclusion is that the data supports the feature of models for detachment faulting which claim that a fault surface dips and undergoes a rotation to a horizontal orientation, accompanied by a comparable tilt of the lower plate. 64 refs., 19 figs., 4 tabs.

  20. The role of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in non small cell lung cancer (NSCLC) patients: SEED-SEPD-AEG Joint Guideline.

    PubMed

    Vázquez-Sequeiros, Enrique; González-Panizo-Tamargo, Fernando; Barturen, Ángel; Calderón, Ángel; Esteban, José Miguel; Fernández-Esparrach, Gloria; Gimeno-García, Antonio; Ginés, Angels; Lariño, José; Pérez-Carreras, Mercedes; Romero, Rafael; Súbtil, José Carlos; Vila, Juan

    2013-04-01

    Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the "digestive tract", gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the "Sociedad Española de Endoscopia Digestiva" (SEED), "Sociedad Española de Patología Digestiva" (SEPD) and the "AsociaciónEspañola de Gastroenterología", have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations.

  1. Jurassic thrust burial in the Funeral Mountains of the Sevier retroarc: Linking P-T paths and Lu-Hf garnet geochronology

    NASA Astrophysics Data System (ADS)

    Wells, M. L.; Hoisch, T. D.; Beyene, M.; Vervoort, J. D.

    2011-12-01

    Late Jurassic to early Cenozoic eastward subduction of the Farallon plate beneath the western margin of the North American plate led to development of the classic elements of the noncollisional two-sided Cordilleran orogen of the western US. These include from west to east, the Franciscan accretionary complex, Great Valley forearc basin, Sierran magmatic arc, and the retroarc Sevier orogenic wedge, including its metamorphic hinterland. Crustal shortening and mountain building during this noncollisional orogeny are thought to have resulted from coupling at the interface between the eastward underflowing Farallon plate and the westward moving North America plate. While the timing of Sierran arc magmatism, Great Valley forearc basin sedimentation, and Franciscan trench sedimentation and subduction metamorphism are increasingly well understood, our understanding of the timing of episodic contractional deformation in the retroarc region remains incomplete, in particular for the metamorphic hinterland. This has limited our ability to link forearc, arc, and retroarc processes, and to differentiate retroarc deformation events related to noncollisional orogenesis from shortening due to older collisional events in the late Middle to early Late Jurassic. The influence of collisional events in the forearc region -- including collision of exotic and/or fringing arcs, ridge collision, or subduction termination and inception -- on deformation in the retroarc region may be under appreciated. Lu-Hf dating and P-T path determination of prograde garnet growth, from the hinterland of the Sevier orogen in the Funeral Mountains of southeastern California, document late Middle to early Late Jurassic thrust burial; importantly, this shortening predates development of the Franciscan accretionary wedge and sedimentation in the Great Valley forearc basin. Lu-Hf garnet geochronology of middle greenschist facies pelitic schist of the Johnnie Formation of the southeastern Funeral Mountains core

  2. Interbasin flow in the Great Basin with special reference to the southern Funeral Mountains and the source of Furnace Creek springs, Death Valley, California, U.S.

    USGS Publications Warehouse

    Belcher, W.R.; Bedinger, M.S.; Back, J.T.; Sweetkind, D.S.

    2009-01-01

    Interbasin flow in the Great Basin has been established by scientific studies during the past century. While not occurring uniformly between all basins, its occurrence is common and is a function of the hydraulic gradient between basins and hydraulic conductivity of the intervening rocks. The Furnace Creek springs in Death Valley, California are an example of large volume springs that are widely accepted as being the discharge points of regional interbasin flow. The flow path has been interpreted historically to be through consolidated Paleozoic carbonate rocks in the southern Funeral Mountains. This work reviews the preponderance of evidence supporting the concept of interbasin flow in the Death Valley region and the Great Basin and addresses the conceptual model of pluvial and recent recharge [Nelson, S.T., Anderson, K., Mayo, A.L., 2004. Testing the interbasin flow hypothesis at Death Valley, California. EOS 85, 349; Anderson, K., Nelson, S., Mayo, A., Tingey, D., 2006. Interbasin flow revisited: the contribution of local recharge to high-discharge springs, Death Valley, California. Journal of Hydrology 323, 276-302] as the source of the Furnace Creek springs. We find that there is insufficient modern recharge and insufficient storage potential and permeability within the basin-fill units in the Furnace Creek basin for these to serve as a local aquifer. Further, the lack of high sulfate content in the spring waters argues against significant flow through basin-fill sediments and instead suggests flow through underlying consolidated carbonate rocks. The maximum temperature of the spring discharge appears to require deep circulation through consolidated rocks; the Tertiary basin fill is of insufficient thickness to generate such temperatures as a result of local fluid circulation. Finally, the stable isotope data and chemical mass balance modeling actually support the interbasin flow conceptual model rather than the alternative presented in Nelson et al. [Nelson

  3. "We will remember them": a mixed-method study to explore which post-funeral remembrance activities are most significant and important to bereaved people living with loss, and why those particular activities are chosen.

    PubMed

    Vale-Taylor, P

    2009-09-01

    In an increasingly secular age in which society no longer offers a code of behaviour for those who are bereaved as in Victorian times, the majority of people do not seek support from church-based rituals of remembrance. Most hospices provide religious Services of Remembrance and Thanksgiving or non-faith remembrance gatherings for families and friends, and although these are usually well attended, the average number of families represented is usually less than 20% raising the question of whether alternative support should be offered to the remaining majority of families. This study explored which post-funeral remembrance activities are most significant and important to people living with death-related loss, and why those particular activities are chosen. A total of 43 participants took part in a mixed-method study using 2 different data sets: a self-report questionnaire and semi-structured interviews. To add further contextual data to support the study, a third dataset was created when six hospice bereavement counsellors met as a Focus Group. Results indicated that although formal remembrance events are valued, informal rituals created by the bereaved are more important and significant to them. Results could be divided into four different categories: rituals to maintain a 'direct link', or those undertaken 'for' the deceased, rituals that remember the deceased within the community and those viewed as an act of remembrance. The most common reason for choosing a ritual was to keep a bond with the deceased or ensure that the deceased was remembered by others. Remembrance and ritual is personal to each individual and is dynamic, altering from day to day. Remembrance appears to be a journey made up of many small daily rituals, some of which are generic to bereaved people and some of which are highly individualistic. For the majority of people, their informal rituals are far more important than the large planned events that hospices offer because the informal rituals

  4. "We will remember them": a mixed-method study to explore which post-funeral remembrance activities are most significant and important to bereaved people living with loss, and why those particular activities are chosen.

    PubMed

    Vale-Taylor, P

    2009-09-01

    In an increasingly secular age in which society no longer offers a code of behaviour for those who are bereaved as in Victorian times, the majority of people do not seek support from church-based rituals of remembrance. Most hospices provide religious Services of Remembrance and Thanksgiving or non-faith remembrance gatherings for families and friends, and although these are usually well attended, the average number of families represented is usually less than 20% raising the question of whether alternative support should be offered to the remaining majority of families. This study explored which post-funeral remembrance activities are most significant and important to people living with death-related loss, and why those particular activities are chosen. A total of 43 participants took part in a mixed-method study using 2 different data sets: a self-report questionnaire and semi-structured interviews. To add further contextual data to support the study, a third dataset was created when six hospice bereavement counsellors met as a Focus Group. Results indicated that although formal remembrance events are valued, informal rituals created by the bereaved are more important and significant to them. Results could be divided into four different categories: rituals to maintain a 'direct link', or those undertaken 'for' the deceased, rituals that remember the deceased within the community and those viewed as an act of remembrance. The most common reason for choosing a ritual was to keep a bond with the deceased or ensure that the deceased was remembered by others. Remembrance and ritual is personal to each individual and is dynamic, altering from day to day. Remembrance appears to be a journey made up of many small daily rituals, some of which are generic to bereaved people and some of which are highly individualistic. For the majority of people, their informal rituals are far more important than the large planned events that hospices offer because the informal rituals

  5. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... be of sufficient strength to support the weight of an adult human body. Cardboard or press paper or... provided. The services must consist of the following: (1) Preparation of the body, embalming. (2) Clothing...) accompanies the casket to the place of burial. (c) An additional allowance for transportation of the body...

  6. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... be of sufficient strength to support the weight of an adult human body. Cardboard or press paper or... provided. The services must consist of the following: (1) Preparation of the body, embalming. (2) Clothing...) accompanies the casket to the place of burial. (c) An additional allowance for transportation of the body...

  7. Factors Affecting Growth of Tengmalm's Owl (Aegolius funereus) Nestlings: Prey Abundance, Sex and Hatching Order.

    PubMed

    Zárybnická, Markéta; Riegert, Jan; Brejšková, Lucie; Šindelář, Jiří; Kouba, Marek; Hanel, Jan; Popelková, Alena; Menclová, Petra; Tomášek, Václav; Šťastný, Karel

    2015-01-01

    In altricial birds, energy supply during growth is a major predictor of the physical condition and survival prospects of fledglings. A number of experimental studies have shown that nestling body mass and wing length can vary with particular extrinsic factors, but between-year observational data on this topic are scarce. Based on a seven-year observational study in a central European Tengmalm's owl population we examine the effect of year, brood size, hatching order, and sex on nestling body mass and wing length, as well as the effect of prey abundance on parameters of growth curve. We found that nestling body mass varied among years, and parameters of growth curve, i.e. growth rate and inflection point in particular, increased with increasing abundance of the owl's main prey (Apodemus mice, Microtus voles), and pooled prey abundance (Apodemus mice, Microtus voles, and Sorex shrews). Furthermore, nestling body mass varied with hatching order and between sexes being larger for females and for the first-hatched brood mates. Brood size had no effect on nestling body mass. Simultaneously, we found no effect of year, brood size, hatching order, or sex on the wing length of nestlings. Our findings suggest that in this temperate owl population, nestling body mass is more sensitive to prey abundance than is wing length. The latter is probably more limited by the physiology of the species.

  8. Factors Affecting Growth of Tengmalm's Owl (Aegolius funereus) Nestlings: Prey Abundance, Sex and Hatching Order.

    PubMed

    Zárybnická, Markéta; Riegert, Jan; Brejšková, Lucie; Šindelář, Jiří; Kouba, Marek; Hanel, Jan; Popelková, Alena; Menclová, Petra; Tomášek, Václav; Šťastný, Karel

    2015-01-01

    In altricial birds, energy supply during growth is a major predictor of the physical condition and survival prospects of fledglings. A number of experimental studies have shown that nestling body mass and wing length can vary with particular extrinsic factors, but between-year observational data on this topic are scarce. Based on a seven-year observational study in a central European Tengmalm's owl population we examine the effect of year, brood size, hatching order, and sex on nestling body mass and wing length, as well as the effect of prey abundance on parameters of growth curve. We found that nestling body mass varied among years, and parameters of growth curve, i.e. growth rate and inflection point in particular, increased with increasing abundance of the owl's main prey (Apodemus mice, Microtus voles), and pooled prey abundance (Apodemus mice, Microtus voles, and Sorex shrews). Furthermore, nestling body mass varied with hatching order and between sexes being larger for females and for the first-hatched brood mates. Brood size had no effect on nestling body mass. Simultaneously, we found no effect of year, brood size, hatching order, or sex on the wing length of nestlings. Our findings suggest that in this temperate owl population, nestling body mass is more sensitive to prey abundance than is wing length. The latter is probably more limited by the physiology of the species. PMID:26444564

  9. Ciliated pancreatic foregut cyst: MRI, EUS, and cytologic features.

    PubMed

    Alessandrino, Francesco; Allard, Felicia D; Mortelé, Koenraad J

    2016-01-01

    Ciliated foregut cysts are extremely uncommon pancreatic cystic lesions, with-to the best of our knowledge-only five cases previously reported in the English literature. We report herein on a case of a ciliated foregut cyst of the pancreas connected with the duct of Wirsung. The magnetic resonance imaging, endoultrasonographic, and cytologic features are described and a brief review of literature is also presented. PMID:26526788

  10. T-EUS for Gastrointestinal Disorders: A Multicenter Registry

    ClinicalTrials.gov

    2015-07-31

    Cholangiocarcinoma; Pancreatic Cancer; Bile Duct Cancer; Biliary Stricture; Biliary Obstruction; Stent Obstruction; Proximal Duct Stricture; Distal Duct Stricture; Ampullary Cancer; Biliary Sphincter Stenosis; Impacted Stones; Chronic Pancreatitis; Peri-ampullary Diverticula; Altered Anatomy

  11. Factors Affecting Growth of Tengmalm’s Owl (Aegolius funereus) Nestlings: Prey Abundance, Sex and Hatching Order

    PubMed Central

    Zárybnická, Markéta; Riegert, Jan; Brejšková, Lucie; Šindelář, Jiří; Kouba, Marek; Hanel, Jan; Popelková, Alena; Menclová, Petra; Tomášek, Václav; Šťastný, Karel

    2015-01-01

    In altricial birds, energy supply during growth is a major predictor of the physical condition and survival prospects of fledglings. A number of experimental studies have shown that nestling body mass and wing length can vary with particular extrinsic factors, but between-year observational data on this topic are scarce. Based on a seven-year observational study in a central European Tengmalm’s owl population we examine the effect of year, brood size, hatching order, and sex on nestling body mass and wing length, as well as the effect of prey abundance on parameters of growth curve. We found that nestling body mass varied among years, and parameters of growth curve, i.e. growth rate and inflection point in particular, increased with increasing abundance of the owl’s main prey (Apodemus mice, Microtus voles), and pooled prey abundance (Apodemus mice, Microtus voles, and Sorex shrews). Furthermore, nestling body mass varied with hatching order and between sexes being larger for females and for the first-hatched brood mates. Brood size had no effect on nestling body mass. Simultaneously, we found no effect of year, brood size, hatching order, or sex on the wing length of nestlings. Our findings suggest that in this temperate owl population, nestling body mass is more sensitive to prey abundance than is wing length. The latter is probably more limited by the physiology of the species. PMID:26444564

  12. 2009 Mississippi Curriculum Framework: Postsecondary Funeral Service Technology. (Program CIP-12.0301 - Funeral Service and Mortuary Science)

    ERIC Educational Resources Information Center

    Anderson, Larry; Dickerson, Octavia; Harvey, Bill; Moore, Tony

    2009-01-01

    As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

  13. An Exploratory Survey of the Attitudes of Black Memphians Toward Funeral Homes, the Funeral Ritual and Preparations for Death. Findings and Analysis.

    ERIC Educational Resources Information Center

    Johnson, Gordon C., II

    Black Americans face a paradox concerning death: although their involvement with death is intense, their knowledge of death, per se, comprehension of death related behaviors, and exposure to available life extending alternatives are minimal. An interview based questionnaire was distributed to 1,010 adults in a predominantly black section of…

  14. [EUS results of malignant rectal giant condyloma acuminatum (Buschke-Loewenstein tumor)].

    PubMed

    Strock, Paul; Barrioz, Thierry; Lauroy, Johny; Babin, Philippe; Mordi, Abdel; Fort, Eric; Laurin, Christine; Sevestre, Christian; Silvain, Christine

    2004-01-01

    Giant condyloma acuminatum is a large, exophytic, cauliflower-like lesion that usually affects the anogenital region. Localisation in the rectum is uncommon and has a high rate of malignant transformation but does not lead to develop distant metastases. For the time, we report the endosonographic appearance of a malignant intrarectal giant condyloma acuminatum.

  15. Did we really #prayfornepal? Instagram posts as a massive digital funeral in Nepal earthquake aftermath

    NASA Astrophysics Data System (ADS)

    Kamil, P. I.; Pratama, A. J.; Hidayatulloh, A.

    2016-05-01

    Social media has been part of our daily life for years, and now it has become a treasure trove of data for social scientists to mine. Using our own data mining engine we downloaded 1500 Instagram posts related to the Nepal earthquake in April 2015, a disaster which caused tremendous losses counted in human lives and infrastructures. We predicted that the social media will be a place where people respond and express themselves emotionally in light of a disaster of such massive scale, a "megadeath" event. We ended up with data on 1017 posts tracked with the hashtag #prayfornepal, consisting of the post's date, time, geolocation, image, post ID, username and ID, caption, and hashtag. We categorized the posts into 7 categories and found that most of the photos (30,29%) are related to Nepal but not directly related to the disasters, which reflects death imprint, one of psychosocial responses after a megadeath event. Other analyses were done to compare each photo category, including geo-location, hashtag network and caption network which will be visualized with ArcGIS, NodeXL, Gephi, and our own word cloud engine to examine other digital reactions to Nepal Earthquake in Instagram. This study can give an overview of how community reacts to a disaster in digital world and utilize it for disaster response and awareness.

  16. The Comet Of 44 B.C. and Caesar's Funeral Games

    NASA Astrophysics Data System (ADS)

    Ramsey, John T.; Licht, A. Lewis

    1997-05-01

    Using insights from physics and classics, this book explores the social and cultural implications of the spectacular, daylight comet that was observed in 44 B.C. during the games that the future emperor Augustus gave in honor of the late Julius Caesar.

  17. "Nineteen Funerals": Ethics of Remembering Murdered Women in a Service Learning Classroom

    ERIC Educational Resources Information Center

    Parkins, Ilya

    2014-01-01

    In the winter of 2010, as the professor of an introductory Gender Studies course in a Canadian university, author Ilya Parkins was involved in a community service learning project centered on the memorialization of women murdered in her university's local community. In this article, Parkins considers what limited this project, which was so…

  18. 29 CFR 779.369 - Funeral home establishments may qualify as exempt 13(a)(2) establishments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ordinary life insurance policies. Income received from such operations is nonretail income and employees..., DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS THE... except any employees who perform any work in connection with burial insurance operations (see...

  19. Late Cretaceous to Paleocene metamorphism and magmatism in the Funeral Mountains metamorphic core complex, Death Valley, California

    USGS Publications Warehouse

    Mattinson, C.G.; Colgan, J.P.; Metcalf, J.R.; Miller, E.L.; Wooden, J.L.

    2007-01-01

    Amphibolite-facies Proterozoic metasedimentary rocks below the low-angle Ceno-zoic Boundary Canyon Detachment record deep crustal processes related to Meso-zoic crustal thickening and subsequent extension. A 91.5 ?? 1.4 Ma Th-Pb SHRIMP-RG (sensitive high-resolution ion microprobe-reverse geometry) monazite age from garnet-kyanite-staurolite schist constrains the age of prograde metamorphism in the lower plate. Between the Boundary Canyon Detachment and the structurally deeper, subparallel Monarch Spring fault, prograde metamorphic fabrics are overprinted by a pervasive greenschist-facies retrogression, high-strain subhorizontal mylonitic foliation, and a prominent WNW-ESE stretching lineation parallel to corrugations on the Boundary Canyon Detachment. Granitic pegmatite dikes are deformed, rotated into parallelism, and boudinaged within the mylonitic foliation. High-U zircons from one muscovite granite dike yield an 85.8 ?? 1.4 Ma age. Below the Monarch Spring fault, retrogression is minor, and amphibolite-facies mineral elongation lineations plunge gently north to northeast. Multiple generations of variably deformed dikes, sills, and leucosomal segregations indicate a more complex history of partial melting and intrusion compared to that above the Monarch Spring fault, but thermobarometry on garnet amphibolites above and below the Monarch Spring fault record similar peak conditions of 620-680 ??C and 7-9 kbar, indicating minor (<3-5 km) structural omission across the Monarch Spring fault. Discordant SHRIMP-RG U-Pb zircon ages and 75-88 Ma Th-Pb monazite ages from leucosomal segregations in paragneisses suggest that partial melting of Proterozoic sedimentary protoliths was a source for the structurally higher 86 Ma pegmatites. Two weakly deformed two-mica leucogranite dikes that cut the high-grademetamorphic fabrics below the Monarch Spring fault yield 62.3 ?? 2.6 and 61.7 ?? 4.7 Ma U-Pb zircon ages, and contain 1.5-1.7 Ga cores. The similarity of metamorphic, leuco-some, and pegmatite ages to the period of Sevier belt thrusting and the period of most voluminous Sierran arc magmatism suggests that both burial by thrusting and regional magmatic heating contributed to metamorphism and subsequent partial melting. ??2007 Geological Society of America. All rights reserved.

  20. Recent advances in endoscopic ultrasonography-guided biliary interventions.

    PubMed

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-08-28

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.

  1. Recent advances in endoscopic ultrasonography-guided biliary interventions

    PubMed Central

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-01-01

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives. PMID:26327757

  2. Recent advances in endoscopic ultrasonography-guided biliary interventions.

    PubMed

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-08-28

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives. PMID:26327757

  3. Bleeding Risk of Stent Removal After EUS-Guided Cystgastrostomy and Metal Stent Placement for Drainage of a Pancreatic Fluid Collection.

    PubMed

    Jalali, Farid; Samarasena, Jason; Lee, John G

    2016-07-01

    Endoscopists are keenly aware of bleeding risks during and immediately after cystgastrostomy and reduce this risk by endoscopic ultrasound guidance to avoid manipulation near major vessels. Bleeding risk associated with cystgastrostomy stent removal after resolution of a pancreatic fluid collection, however, is less evident. We present our experience with bleeding during cystgastrostomy stent removal in a patient with resolved walled-off necrosis and will discuss the significance of unexplained spontaneous upper gastrointestinal bleeding in this setting, which may serve as a warning sign for possible stent erosion into major vessels. PMID:27622199

  4. Travailleurs-Euses, Étudiant-Es : Même Combat! Association of Graduate Students Employed at McGill (AGSEM), 2012-2013 Teaching Assistants' Unit Executive

    ERIC Educational Resources Information Center

    McGill Journal of Education, 2013

    2013-01-01

    In the wake of the Québec student movement, graduate students of the 2012-2013 executive team for the Teaching Assistants' Unit of the Association of Graduate Students Employed at McGill (AGSEM) reflect on their individual backgrounds and motivations for pursuing union work. With various opportunities for employment on and off campus, what…

  5. Bleeding Risk of Stent Removal After EUS-Guided Cystgastrostomy and Metal Stent Placement for Drainage of a Pancreatic Fluid Collection

    PubMed Central

    Samarasena, Jason; Lee, John G.

    2016-01-01

    Endoscopists are keenly aware of bleeding risks during and immediately after cystgastrostomy and reduce this risk by endoscopic ultrasound guidance to avoid manipulation near major vessels. Bleeding risk associated with cystgastrostomy stent removal after resolution of a pancreatic fluid collection, however, is less evident. We present our experience with bleeding during cystgastrostomy stent removal in a patient with resolved walled-off necrosis and will discuss the significance of unexplained spontaneous upper gastrointestinal bleeding in this setting, which may serve as a warning sign for possible stent erosion into major vessels. PMID:27622199

  6. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?

    PubMed

    Hara, Kazuo; Yamao, Kenji; Mizuno, Nobumasa; Hijioka, Susumu; Imaoka, Hiroshi; Tajika, Masahiro; Tanaka, Tutomu; Ishihara, Makoto; Okuno, Nozomi; Hieda, Nobuhiro; Yoshida, Tukasa; Niwa, Yasumasa

    2016-01-21

    Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future. PMID:26811666

  7. Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications.

    PubMed

    Jenssen, Christian; Alvarez-Sánchez, Maria Victoria; Napoléon, Bertrand; Faiss, Siegbert

    2012-09-14

    Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

  8. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications

    PubMed Central

    Jenssen, Christian; Alvarez-Sánchez, Maria Victoria; Napoléon, Bertrand; Faiss, Siegbert

    2012-01-01

    Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications. PMID:23002335

  9. Endoscopic ultrasound in the diagnosis and management of carcinoma pancreas

    PubMed Central

    Puri, Rajesh; Manrai, Manish; Thandassery, Ragesh Babu; Alfadda, Abdulrahman A

    2016-01-01

    Endoscopic ultrasound (EUS) has become an important component in the diagnosis and treatment of carcinoma pancreas. With the advent of advanced imaging techniques and tissue acquisition methods the role of EUS is becoming increasingly important. Small pancreatic tumors can be reliably diagnosed with EUS. EUS guided fine needle aspiration establishes diagnosis in some cases. EUS plays an important role in staging of carcinoma pancreas and in some important therapeutic methods that include celiac plexus neurolysis, EUS guided biliary drainage and drug delivery. In this review we attempt to review the role of EUS in diagnosis and management of carcinoma pancreas. PMID:26839647

  10. The safety of endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions

    PubMed Central

    Yoon, Won Jae; Brugge, William R.

    2015-01-01

    Endoscopic ultrasound (EUS) is widely used in the evaluation of various pancreatic diseases including pancreatic cystic lesions (PCLs). EUS-guided fine-needle aspiration (EUS-FNA) of PCLs provides cyst fluid, which is used for the differentiation of PCLs. EUS-FNA of PCLs is a safe procedure with a low complication rate. Contrary to the concerns expressed by some investigators, preoperative EUS-FNA of mucinous PCLs is unlikely to increase the frequency of postoperative peritoneal seeding. PMID:26643695

  11. Applications of endoscopic ultrasound in pancreatic cancer

    PubMed Central

    Luz, Leticia Perondi; Al-Haddad, Mohammad Ali; Sey, Michael Sai Lai; DeWitt, John M

    2014-01-01

    Since the introduction of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA), EUS has assumed a growing role in the diagnosis and management of pancreatic ductal adenocarcinoma (PDAC). The objective of this review is to discuss the various applications of EUS and EUS-FNA in PDAC. Initially, its use for detection, diagnosis and staging will be described. EUS and EUS-FNA are highly accurate modalities for detection and diagnosis of PDAC, this high accuracy, however, is decreased in specific situations particularly in the presence of chronic pancreatitis. Novel techniques such as contrast-enhanced EUS, elastography and analysis of DNA markers such as k-ras mutation analysis in FNA samples are in progress and might improve the accuracy of EUS in the detection of PDAC in this setting and will be addressed. EUS and EUS-FNA have recently evolved from a diagnostic to a therapeutic technique in the management of PDAC. Significant developments in therapeutic EUS have occurred including advances in celiac plexus interventions with direct injection of ganglia and improved pain control, EUS-guided fiducial and brachytherapy seed placement, fine-needle injection of intra-tumoral agents and advances in EUS-guided biliary drainage. The future role of EUS and EUS in management of PDAC is still emerging. PMID:24976719

  12. Applications of endoscopic ultrasound in pancreatic cancer.

    PubMed

    Luz, Leticia Perondi; Al-Haddad, Mohammad Ali; Sey, Michael Sai Lai; DeWitt, John M

    2014-06-28

    Since the introduction of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA), EUS has assumed a growing role in the diagnosis and management of pancreatic ductal adenocarcinoma (PDAC). The objective of this review is to discuss the various applications of EUS and EUS-FNA in PDAC. Initially, its use for detection, diagnosis and staging will be described. EUS and EUS-FNA are highly accurate modalities for detection and diagnosis of PDAC, this high accuracy, however, is decreased in specific situations particularly in the presence of chronic pancreatitis. Novel techniques such as contrast-enhanced EUS, elastography and analysis of DNA markers such as k-ras mutation analysis in FNA samples are in progress and might improve the accuracy of EUS in the detection of PDAC in this setting and will be addressed. EUS and EUS-FNA have recently evolved from a diagnostic to a therapeutic technique in the management of PDAC. Significant developments in therapeutic EUS have occurred including advances in celiac plexus interventions with direct injection of ganglia and improved pain control, EUS-guided fiducial and brachytherapy seed placement, fine-needle injection of intra-tumoral agents and advances in EUS-guided biliary drainage. The future role of EUS and EUS in management of PDAC is still emerging.

  13. Contrast enhancement and elastography in endoscopic ultrasound: an update of clinical applications in pancreatic diseases.

    PubMed

    Serrani, Marta; Lisotti, Andrea; Caletti, Giancarlo; Fusaroli, Pietro

    2016-08-01

    It is well established that endoscopic ultrasound (EUS) is fundamental in the characterization of many diseases concerning different organs, i.e. pancreaticobiliary diseases, gastrointestinal pathologic conditions, and lymph nodes of unknown origin. It is also well known that many factors can hamper the accuracy of EUS, i.e. biliary stents, chronic pancreatitis, poor operator's expertise. These factors can also lead to suboptimal accuracy when cytological confirmation through EUS-fine needle aspiration (EUS-FNA) is indicated. In recent years, new technological tools have rapidly increased their clinical impact improving the diagnostic power of EUS and EUS-FNA. Among these new tools, the most investigated and useful ones are represented by contrast harmonic-EUS (CH-EUS) and EUS-elastography (EUS-E). The purpose of this paper is to provide, through a review of the literature, an update of the applications of CH-EUS and EUS-E in the routine clinical practice in pancreatic diseases. We discussed the first reports and applications of these techniques in our previous review published in Minerva Medica. The applications of CH-EUS and EUS-E to the study of pancreatic diseases appear feasible and safe. The use of both techniques is very simple and does not require any relevant additional workload for the endoscopic personnel. CH-EUS is now considered an important and accurate tool in the diagnosis of solid pancreatic masses and in the differential diagnosis of pancreatic cystic lesions. CH-EUS targeted FNA is an active field of research. However the available studies show that CH-EUS increases FNA accuracy by a little extent, without statistical significance; moreover, CH-EUS FNA showed a trend toward being more efficient vs. simple EUS FNA (less needle passes and more abundance in cytological material) but this trend did not reach statistical significance. On the other hand, the clinical impact of EUS-E in terms of differential diagnosis of pancreatic masses is still under

  14. Endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis: from evidence to practice.

    PubMed

    Choi, Jun-Ho; Lee, Sang Soo

    2015-01-01

    With the evolution of the linear echoendoscope and the improved ability to direct a needle within the field of interest, the therapeutic potential of endoscopic ultrasonography (EUS) has greatly expanded. Endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) may be the next frontier for therapeutic EUS. Since EUS-GBD was first described in 2007, recent reports have suggested it as an alternative to external gallbladder drainage for acute cholecystitis. EUS-GBD includes EUS-guided transmural nasogallbladder drainage, EUS-guided gallbladder aspiration, and EUS-guided transmural gallbladder stenting. Indications for the EUS-GBD technique as currently practiced, including equipment, technical details, complications, and efficacy are herein reviewed.

  15. Endoscopic ultrasound-guided treatments: Are we getting evidence based - a systematic review

    PubMed Central

    Fabbri, Carlo; Luigiano, Carmelo; Lisotti, Andrea; Cennamo, Vincenzo; Virgilio, Clara; Caletti, Giancarlo; Fusaroli, Pietro

    2014-01-01

    The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field. PMID:25024600

  16. Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma

    PubMed Central

    Miyata, Takeshi; Kitano, Masayuki; Omoto, Shunsuke; Kadosaka, Kumpei; Kamata, Ken; Imai, Hajime; Sakamoto, Hiroki; Nisida, Naoshi; Harwani, Yogesh; Murakami, Takamichi; Takeyama, Yoshifumi; Chiba, Yasutaka; Kudo, Masatoshi

    2016-01-01

    AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma. METHODS: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled. In the primary analysis, patients with successful EUS-fine needle aspiration (FNA) were included. The lymph nodes were assessed by several standard EUS variables (short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel (CIV) presence] and CH-EUS variable (heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUS-FNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical resection. RESULTS: One hundred and nine patients (143 lymph nodes) fulfilled the criteria. The short axis cut-off ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by CH-EUS. CONCLUSION: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases. PMID:27022220

  17. Endoscopic ultrasonography-guided hepaticogastrostomy.

    PubMed

    Park, Do Hyun

    2012-04-01

    To date, percutaneous transhepatic biliary drainage (PTBD) has been considered as the usual biliary access after failed endoscopic retrograde cholangiopancreatography (ERCP). Since endoscopic ultrasonography (EUS)-guided bile duct puncture was first described in 1996, sporadic case reports of EUS-guided biliary drainage (EUS-BD) have suggested it as an alternative to PTBD after failed ERCP. The potential benefits of EUS-BD include internal drainage, thus avoiding long-term external drainage in cases where external PTBD drainage catheters cannot be internalized. EUS-guided hepaticogastrostomy (EUS-HG) is one form of EUS-BD. This article describes the indications, techniques, and outcomes of published data on EUS-HG. PMID:22632949

  18. Application of the NEAREST Tsunami Detection Algorithm to tide gauge data of Arena Cove, CA and Cordova, AK. An example of a synergy in the field of tsunami Early Warning within CoopEUS framework.

    NASA Astrophysics Data System (ADS)

    Chierici, Francesco; Beranzoli, Laura; Best, Mairi; Embriaco, Davide; Favali, Paolo; Galbraith, Nan; Heeseman, Martin; Kelly, Deborah; Pignagnoli, Luca; Pirenne, Benoit; Scofield, Oscar; Weller, Robert; Zitellini, Nevio

    2015-04-01

    The development of Tsunami modeling and Tsunami Early Warning Systems able to operate in near-source areas is a common need for many coastal regions like Mediterranean, Juan de Fuca/NE Pacific Coast of North America, Indian Ocean archipelagos and Japan. These regions with the important exception of Mediterranean and North East Atlantic are presently covered by Tsunami Warning Systems and Ocean Bottom Observatories, in the frame of EMSO, OOI and ONC ocean networks equipped with a varieties of sensors, using different technologies, data formats and detection procedures. A significant improvement in efficiency, cost saving and detection reliability can be achieved by exchanging technologies and data and by harmonizing sensors metadata and instrument settings. To undertake a step in this direction we propose to apply the Tsunami Detection Algorithm, which was developed in the framework of NEAREST EU project for open ocean data in near source areas and is presently used by NEMO-SN1 EMSO abyssal observatory, to the tide gauge data of Arena Cove, CA and Cordova, AK. We show the first results of the application of the algorithm.

  19. Twins and politics: political careers and political attitudes / twin research reviews: pair-bonding; facial expressivity in reared apart twins; educating multiples / stories that move and amaze us: a military funeral; a twins' reunion; Egyptian septuplets; rare occupations.

    PubMed

    Segal, Nancy L

    2008-12-01

    Twins and twin research are providing fresh insights into the roots of political behavior. This topic is approached from dual perspectives: why some individuals choose to become politicians, and why individuals vary in their political attitudes and interests. Reviews of timely twin studies in the areas of pair-bonding, facial expressivity and education follow. Finally, some extraordinary events in the lives of twins and their families are revealed.

  20. Funeral Processions, Street Urchins, Education, and Surveillance--The Relationship between Education, State Building, Vagrancy, and Cultural Change in Stockholm, Sweden in the Latter Half of the Seventeenth Century

    ERIC Educational Resources Information Center

    Sandin, Bengt

    2003-01-01

    A modernization of the educational system was an important priority for the government. Sweden emerged as a dominant military power during the 17th century. The new schools were then established in the midst of a social, political, and cultural transformation with fundamental effects on the school system. The new schools had difficulties freeing…

  1. A bill to amend title XVI of the Social Security Act to clarify that the value of certain funeral and burial arrangements are not to be considered available resources under the supplemental security income program.

    THOMAS, 112th Congress

    Sen. Snowe, Olympia J. [R-ME

    2012-03-01

    03/01/2012 Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S1201) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  2. Echoendoscopes.

    PubMed

    Murad, Faris M; Komanduri, Sri; Abu Dayyeh, Barham K; Chauhan, Shailendra S; Enestvedt, Brintha K; Fujii-Lau, Larissa L; Konda, Vani; Maple, John T; Pannala, Rahul; Thosani, Nirav C; Banerjee, Subhas

    2015-08-01

    Advances in echoendoscopes and their processors have significantly expanded the role of EUS and its clinical applications.The diagnostic and therapeutic capabilities of EUS continue to evolve and improve. EUS has made a large impact on patient care but comes with significant startup and maintenance costs. As improved technology continues to enhance image resolution while decreasing the size of EUS processors, use of endosonography will become more widespread. EUS will continue to be a vital part of patient care and complement currently available cross-sectional imaging. PMID:26077457

  3. [Endoscopic ultrasonic diagnosis of esophageal cancer].

    PubMed

    Kouzu, T; Ogino, Y; Isono, K

    1986-08-01

    Endoscopic Ultrasonography (EUS) has been developed rapidly and is becoming a new routine examination of the digestive diseases. In this thesis, the usefulness of EUS with reference to the diagnosis of the depth and the margins of the cancer invasion and the metastatic lymph nodes is described. Furthermore, the judgment of the efficacy of the combined therapy including radiotherapy, chemotherapy and immunotherapy will be possible with EUS. The information from EUS is useful to determine the treatment plan of esophageal cancer. Therefore, EUS is expected to become a preoperative necessary examination of cases with esophageal cancer. PMID:3537360

  4. New endoscopic ultrasound techniques for digestive tract diseases: A comprehensive review

    PubMed Central

    Meng, Fan-Sheng; Zhang, Zhao-Hong; Ji, Feng

    2015-01-01

    Endoscopic ultrasound (EUS) is one of the most important modalities for the diagnosis of digestive tract diseases. EUS has been evolving ever since it was introduced. New techniques such as elastography and contrast enhancement have emerged, increasing the accuracy, sensitivity and specificity of EUS for the diagnosis of digestive tract diseases including pancreatic masses and lymphadenopathy. EUS-elastography evaluates tissue elasticity and therefore, can be used to differentiate various lesions. Contrast-enhanced EUS can distinguish benign from malignant pancreatic lesions and lymphadenopathy using the intravenous injection of contrast agents. This review discusses the principles and types of these new techniques, as well as their clinical applications and limitations. PMID:25944994

  5. Therapeutic aspects of endoscopic ultrasound

    NASA Astrophysics Data System (ADS)

    Woodward, Timothy A.

    1999-06-01

    Endoscopic ultrasound (EUS) is a technology that had been used primarily as a passive imaging modality. Recent advances have enabled us to move beyond the use of EUS solely as a staging tool to an interventional device. Current studies suggest that interventional applications of EUS will allow for minimally invasive assessment and therapies in a cost-effective manner. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has been demonstrated to be a technically feasible, relatively safe method of obtaining cytologic specimens. The clinical utility of EUS- FNA appears to be greatest in the diagnosis and staging of pancreatic cancer and in the nodal staging of gastrointestinal and pulmonary malignancies. In addition, EUS-FNA has demonstrated utility in the sampling pleural and ascitic fluid not generally appreciated or assessable to standard interventions. Interventional applications of EUS include EUS-guided pseudocyst drainage, EUS-guided injection of botulinum toxin in the treatment of achalasia, and EUS- guided celiac plexus neurolysis in the treatment of pancreatic cancer pain. Finally, EUS-guided fine-needle installation is being evaluated, in conjunction with recent bimolecular treatment modalities, as a delivery system in the treatment of certain gastrointestinal tumors.

  6. Endoscopic Ultrasound in Gastroenteropancreatic Neuroendocrine Tumors

    PubMed Central

    2012-01-01

    Endoscopic ultrasound (EUS) is an advanced endoscopic technique currently used in the staging and diagnosis of many gastrointestinal neoplasms. The proximity of the echoendoscope to the gastrointestinal tract lends itself to a detailed view of the luminal pathology and the pancreas. This unique ability enables endoscopists to use EUS in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Diagnostic EUS allows previously unidentified NETs to be localized. EUS also determines tumor management by staging the GEP-NETS, enabling the clinicians to choose the appropriate endoscopic or surgical management. The ability to obtain a tissue diagnosis with EUS guidance enables disease confirmation. Finally, recent developments suggest that EUS may be used to deliver therapeutic agents for the treatment of NETs. This review will highlight the advances in our knowledge of EUS in the clinical management of these tumors. PMID:23170141

  7. Learning models for endoscopic ultrasonography in gastrointestinal endoscopy

    PubMed Central

    Kim, Gwang Ha; Bang, Sung Jo; Hwang, Joo Ha

    2015-01-01

    Endoscopic ultrasonography (EUS) has become a useful diagnostic and therapeutic modality in gastrointestinal endoscopy. However, EUS requires additional training since it requires simultaneous endoscopic manipulation and ultrasonographic interpretation. Obtaining adequate EUS training can be challenging since EUS is highly operator-dependent and training on actual patients can be associated with an increased risk of complications including inaccurate diagnosis. Therefore, several models have been developed to help facilitate training of EUS. The models currently available for EUS training include computer-based simulators, phantoms, ex vivo models, and live animal models. Although each model has its own merits and limitations, the value of these different models is rather complementary than competitive. However, there is a lack of objective data regarding the efficacy of each model with recommendations on the use of various training models based on expert opinion only. Therefore, objective studies evaluating the efficacy of various EUS training models on technical and clinical outcomes are still needed. PMID:25954091

  8. Endoscopic ultrasound guided vascular access and therapy (with videos)

    PubMed Central

    Saxena, Payal; Lakhtakia, Sundeep

    2015-01-01

    The continued need to develop minimally invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. EUS has now stepped into the therapeutic arena. EUS provides the unique advantage of both real-time imaging and access to structures within and adjacent to the gastrointestinal (GI) tract. Hence, EUS-guided therapeutic techniques continue to evolve in several directions enabling a variety of minimally invasive therapies for pancreatic and biliary pathologies. Furthermore, the close proximity of the GI tract to vascular structures in the mediastinum and abdomen permits EUS-guided vascular access and therapy. Studies have demonstrated several EUS-guided vascular interventions by using standard endoscopic accessories and available tools from the interventional radiology armamentarium. This article provides an overview of the literature including clinical and nonclinical studies for the management of nonvariceal and variceal GI bleeding, formation of intrahepatic portosystemic shunts (IPSS), and EUS-guided cardiac access and therapy. PMID:26374574

  9. Endoscopic ultrasonography: Transition towards the future of gastro-intestinal diseases

    PubMed Central

    De Lisi, Stefania; Giovannini, Marc

    2016-01-01

    Endoscopic ultrasonography (EUS) is a technique with an established role in the diagnosis and staging of gastro-intestinal tumors. In recent years, the spread of new devices dedicated to tissue sampling has improved the diagnostic accuracy of EUS fine-needle aspiration. The development of EUS-guided drainage of the bilio-pancreatic region and abdominal fluid collections has allowed EUS to evolve into an interventional tool that can replace more invasive procedures. Emerging techniques applying EUS in pancreatic cancer treatment and in celiac neurolysis have been described. Recently, confocal laser endomicroscopy has been applied to EUS as a promising technique for the in vivo histological diagnosis of gastro-intestinal, bilio-pancreatic and lymph node lesions. In this state-of-the-art review, we report the most recent data from the literature regarding EUS devices, interventional EUS, EUS-guided confocal laser endomicroscopy and EUS pancreatic cancer treatment, and we also provide an overview of their principles, clinical applications and limitations. PMID:26855537

  10. What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth?

    PubMed Central

    Watari, Jiro; Ueyama, Shigemitsu; Tomita, Toshihiko; Ikehara, Hisatomo; Hori, Kazutoshi; Hara, Ken; Yamasaki, Takahisa; Okugawa, Takuya; Kondo, Takashi; Kono, Tomoaki; Tozawa, Katsuyuki; Oshima, Tadayuki; Fukui, Hirokazu; Miwa, Hiroto

    2016-01-01

    AIM To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography (EUS) and the characteristics of early gastric cancers (EGCs) that are indications for EUS-based assessment of cancer invasion depth. METHODS We retrospectively investigated the cases of 153 EGC patients who underwent conventional endoscopy (CE) and EUS (20 MHz) before treatment. RESULTS We found that 13.7% were “inconclusive” cases with low-quality EUS images, including all nine of the cases with protruded (0-I)-type EGCs. There was no significant difference in the diagnostic accuracy between CE and EUS. Two significant independent risk factors for misdiagnosis by EUS were identified-ulcer scarring [UL(+); odds ratio (OR) = 4.49, P = 0.003] and non-indication criteria for endoscopic resection (ER) (OR = 3.02, P = 0.03). In the subgroup analysis, 23.1% of the differentiated-type cancers exhibiting SM massive invasion (SM2) invasion (submucosal invasion ≥ 500 μm) by CE were correctly diagnosed by EUS, and 23.1% of the undifferentiated-type EGCs meeting the expanded-indication criteria for ER were correctly diagnosed by EUS. CONCLUSION There is no need to perform EUS for UL(+) EGCs or 0-I-type EGCs, but EUS may enhance the pretreatment staging of differentiated-type EGCs with SM2 invasion without UL or undifferentiated-type EGCs revealed by CE as meeting the expanded-indication criteria for ER. PMID:27621768

  11. Endoscopic ultrasound comes of age: Mature, established, creative and here to stay!

    PubMed

    Bhutani, Manoop S

    2014-07-01

    Research in endoscopic ultrasound (EUS) is alive and kicking! This paper will present recent interesting developments in EUS based on research presented at the Digestive Disease Week (DDW) held in Chicago in 2014. Endosonographers are looking at various techniques to improve yield of fine needle aspiration and core biopsies, assess circulating tumor cells, apply EUS for personalized medicine and develop devices to ensure the adequacy of sampling. EUS may open new vistas in understanding of neurogastroenterology and gastrointestinal motility disorders as discussed in this paper. EUS guided drainage of pancreatic fluid collections, bile duct and gallbladder is feasible, and many randomized trials are being done to compare different techniques. EUS guided delivery of fiducials, drugs, coils or chemo loaded beads in possible. EUS has come off age, has matured and is here to stay! The DDW in 2014 in Chicago was a very active year for EUS. There were numerous papers on different aspects of EUS, some perfecting and improving old techniques, others dealing with randomized trials and many with novel concepts. In this paper, I will highlight some of the papers that were presented. It is not possible to discuss all the abstracts in detail. I have, therefore, chosen selected papers in different aspects of EUS to give the readers a flavor of the kind of research that was presented at DDW. PMID:25184120

  12. Contrast-enhanced harmonic endoscopic ultrasound imaging: basic principles, present situation and future perspectives.

    PubMed

    Alvarez-Sánchez, María-Victoria; Napoléon, Bertrand

    2014-11-14

    Over the last decade, the development of stabilised microbubble contrast agents and improvements in available ultrasonic equipment, such as harmonic imaging, have enabled us to display microbubble enhancements on a greyscale with optimal contrast and spatial resolution. Recent technological advances made contrast harmonic technology available for endoscopic ultrasound (EUS) for the first time in 2008. Thus, the evaluation of microcirculation is now feasible with EUS, prompting the evolution of contrast-enhanced EUS from vascular imaging to images of the perfused tissue. Although the relevant experience is still preliminary, several reports have highlighted contrast-enhanced harmonic EUS (CH-EUS) as a promising noninvasive method to visualise and characterise lesions and to differentiate benign from malignant focal lesions. Even if histology remains the gold standard, the combination of CH-EUS and EUS fine needle aspiration (EUS-FNA) can not only render EUS more accurate but may also assist physicians in making decisions when EUS-FNA is inconclusive, increasing the yield of EUS-FNA by guiding the puncture with simultaneous imaging of the vascularity. The development of CH-EUS has also opened up exciting possibilities in other research areas, including monitoring responses to anticancer chemotherapy or to ethanol-induced pancreatic tissue ablation, anticancer therapies based on ultrasound-triggered drug and gene delivery, and therapeutic adjuvants by contrast ultrasound-induced apoptosis. Contrast harmonic imaging is gaining popularity because of its efficacy, simplicity and non-invasive nature, and many expectations are currently resting on this technique. If its potential is confirmed in the near future, contrast harmonic imaging will become a standard practice in EUS.

  13. Contrast-enhanced harmonic endoscopic ultrasound imaging: Basic principles, present situation and future perspectives

    PubMed Central

    Alvarez-Sánchez, María-Victoria; Napoléon, Bertrand

    2014-01-01

    Over the last decade, the development of stabilised microbubble contrast agents and improvements in available ultrasonic equipment, such as harmonic imaging, have enabled us to display microbubble enhancements on a greyscale with optimal contrast and spatial resolution. Recent technological advances made contrast harmonic technology available for endoscopic ultrasound (EUS) for the first time in 2008. Thus, the evaluation of microcirculation is now feasible with EUS, prompting the evolution of contrast-enhanced EUS from vascular imaging to images of the perfused tissue. Although the relevant experience is still preliminary, several reports have highlighted contrast-enhanced harmonic EUS (CH-EUS) as a promising noninvasive method to visualise and characterise lesions and to differentiate benign from malignant focal lesions. Even if histology remains the gold standard, the combination of CH-EUS and EUS fine needle aspiration (EUS-FNA) can not only render EUS more accurate but may also assist physicians in making decisions when EUS-FNA is inconclusive, increasing the yield of EUS-FNA by guiding the puncture with simultaneous imaging of the vascularity. The development of CH-EUS has also opened up exciting possibilities in other research areas, including monitoring responses to anticancer chemotherapy or to ethanol-induced pancreatic tissue ablation, anticancer therapies based on ultrasound-triggered drug and gene delivery, and therapeutic adjuvants by contrast ultrasound-induced apoptosis. Contrast harmonic imaging is gaining popularity because of its efficacy, simplicity and non-invasive nature, and many expectations are currently resting on this technique. If its potential is confirmed in the near future, contrast harmonic imaging will become a standard practice in EUS. PMID:25400439

  14. Therapeutic role of endoscopic ultrasound in pancreaticobiliary disease: A comprehensive review

    PubMed Central

    Meng, Fan-Sheng; Zhang, Zhao-Hong; Ji, Feng

    2015-01-01

    With the development of technology and accessories, the role of endoscopic ultrasound (EUS) has evolved from diagnostics to therapeutics. In order to characterise the therapeutic role of EUS, we searched Web of Knowledge database and reviewed articles associated with therapeutic EUS. There are two modalities for the therapeutic purpose: drainage and fine-needle injection. EUS-guided drainage is a promising procedure for the treatment of peripancreatic fluid collection and biliary obstruction; EUS-guided fine-needle injections such as celiac plexus neurolysis, for the purpose of pain relief for pancreatic cancer and chronic pancreatitis, has emerged as a promising procedure. The aim of the study was to perform a comprehensive and conscientious review on the techniques, complications and clinical outcomes of those EUS-based procedures. PMID:26675538

  15. Role of endoscopic ultrasound in diagnosis and management of hepatocellular carcinoma

    PubMed Central

    Koduru, Pramoda; Suzuki, Rei; Lakhtakia, Sundeep; Ramchandani, Mohan; Makmun, Dadang; Bhutani, Manoop S

    2015-01-01

    Hepatocellular carcinoma (HCC) is an aggressive tumor and a leading cause of cancer-related deaths globally. The mortality rate remains high despite many advances in treatment. HCC is frequently diagnosed late in its course due to lack of classical symptoms at earlier stages. Endoscopic ultrasound (EUS) has emerged as an important diagnostic tool for the diagnostic evaluation, staging, and treatment of gastrointestinal tract disorders. EUS-guided fine needle aspiration has been a valuable addition to EUS by being able to obtain tissue under direct visualization. Here, we review the potential role of EUS in the diagnosis and management of HCC. EUS seems to be a safe and reliable alternative method for obtaining tissue for diagnosis of liver cancer, especially for lesions that are inaccessible by traditional methods. EUS could play an important role in the diagnosis and management of HCC. PMID:27508203

  16. Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions.

    PubMed

    Hammoud, Ghassan M; Almashhrawi, Ashraf; Ibdah, Jamal A

    2014-11-15

    Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of the liver is a safe procedure in the diagnosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for liver lesions poorly accessible to other imaging modalities of the liver. EUS-guided FNA of biliary neoplasia and malignant biliary stricture is superior to the conventional endoscopic brushing and biopsy. PMID:25400873

  17. Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions

    PubMed Central

    Hammoud, Ghassan M; Almashhrawi, Ashraf; Ibdah, Jamal A

    2014-01-01

    Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of the liver is a safe procedure in the diagnosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for liver lesions poorly accessible to other imaging modalities of the liver. EUS-guided FNA of biliary neoplasia and malignant biliary stricture is superior to the conventional endoscopic brushing and biopsy. PMID:25400873

  18. Techniques of imaging of the aorta and its first order branches by endoscopic ultrasound (with videos)

    PubMed Central

    Sharma, Malay; Rai, Praveer; Mehta, Varun; Rameshbabu, C. S.

    2015-01-01

    Endoscopic ultrasonography (EUS) is a useful modality for imaging of the blood vessels of the mediastinum and abdomen. The aorta acts as an important home base during EUS imaging. The aorta and its branches are accessible by standard angiographic methods, but endosonography also provides a unique opportunity to evaluate the aorta and its branches. This article describes the techniques of imaging of different part of the aorta by EUS. PMID:26020043

  19. The efficacy of contrast-enhanced harmonic endoscopic ultrasonography in diagnosing gallbladder cancer.

    PubMed

    Sugimoto, Mitsuru; Takagi, Tadayuki; Konno, Naoki; Suzuki, Rei; Asama, Hiroyuki; Hikichi, Takuto; Watanabe, Ko; Waragai, Yuichi; Kikuchi, Hitomi; Takasumi, Mika; Ohira, Hiromasa

    2016-01-01

    The aim of this study was to review the efficacy of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in diagnosing gallbladder (GB)-protruded lesions. Thirty-eight patients underwent CH-EUS for the diagnosis of GB-protruded lesions. Twenty-four patients whose major axes of their largest lesions were longer than 10 mm were recruited. The ability of CH-EUS to diagnose malignant or benign lesions was reviewed. We treated lesions with brindled enhanced patterns as malignant and those with uniformly enhanced or unenhanced patterns as benign. Furthermore, three gastroenterologists who were not familiar with pancreaticobiliary EUS compared the diagnostic abilities of CH-EUS and conventional EUS using photographs. The sensitivity, specificity, and malignant accuracy of CH-EUS were 100, 94.4, and 95.8%, respectively. The number of lesions that presented with enhanced patterns was significantly different between the malignant lesions and the benign lesions (P < 0.001). In the comparison of diagnostic abilities between CH-EUS and conventional EUS by the three gastroenterologists, CH-EUS was significantly superior to conventional EUS in terms of sensitivity, specificity, and accuracy (76.1 vs. 42.9%, P = 0.029; 66.7 vs. 39.2%, P = 0.005; and 69.4 vs. 40.3%, P < 0.001; respectively). In conclusion, CH-EUS was useful for diagnosing malignant and benign GB-protruded lesions.

  20. The efficacy of contrast-enhanced harmonic endoscopic ultrasonography in diagnosing gallbladder cancer

    PubMed Central

    Sugimoto, Mitsuru; Takagi, Tadayuki; Konno, Naoki; Suzuki, Rei; Asama, Hiroyuki; Hikichi, Takuto; Watanabe, Ko; Waragai, Yuichi; Kikuchi, Hitomi; Takasumi, Mika; Ohira, Hiromasa

    2016-01-01

    The aim of this study was to review the efficacy of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in diagnosing gallbladder (GB)-protruded lesions. Thirty-eight patients underwent CH-EUS for the diagnosis of GB-protruded lesions. Twenty-four patients whose major axes of their largest lesions were longer than 10 mm were recruited. The ability of CH-EUS to diagnose malignant or benign lesions was reviewed. We treated lesions with brindled enhanced patterns as malignant and those with uniformly enhanced or unenhanced patterns as benign. Furthermore, three gastroenterologists who were not familiar with pancreaticobiliary EUS compared the diagnostic abilities of CH-EUS and conventional EUS using photographs. The sensitivity, specificity, and malignant accuracy of CH-EUS were 100, 94.4, and 95.8%, respectively. The number of lesions that presented with enhanced patterns was significantly different between the malignant lesions and the benign lesions (P < 0.001). In the comparison of diagnostic abilities between CH-EUS and conventional EUS by the three gastroenterologists, CH-EUS was significantly superior to conventional EUS in terms of sensitivity, specificity, and accuracy (76.1 vs. 42.9%, P = 0.029; 66.7 vs. 39.2%, P = 0.005; and 69.4 vs. 40.3%, P < 0.001; respectively). In conclusion, CH-EUS was useful for diagnosing malignant and benign GB-protruded lesions. PMID:27162097

  1. Accuracy of endoscopic ultrasonography for diagnosing ulcerative early gastric cancers.

    PubMed

    Park, Jin-Seok; Kim, Hyungkil; Bang, Byongwook; Kwon, Kyesook; Shin, Youngwoon

    2016-07-01

    Although endoscopic ultrasonography (EUS) is the first-choice imaging modality for predicting the invasion depth of early gastric cancer (EGC), the prediction accuracy of EUS is significantly decreased when EGC is combined with ulceration.The aim of present study was to compare the accuracy of EUS and conventional endoscopy (CE) for determining the depth of EGC. In addition, the various clinic-pathologic factors affecting the diagnostic accuracy of EUS, with a particular focus on endoscopic ulcer shapes, were evaluated.We retrospectively reviewed data from 236 consecutive patients with ulcerative EGC. All patients underwent EUS for estimating tumor invasion depth, followed by either curative surgery or endoscopic treatment. The diagnostic accuracy of EUS and CE was evaluated by comparing the final histologic result of resected specimen. The correlation between accuracy of EUS and characteristics of EGC (tumor size, histology, location in stomach, tumor invasion depth, and endoscopic ulcer shapes) was analyzed. Endoscopic ulcer shapes were classified into 3 groups: definite ulcer, superficial ulcer, and ill-defined ulcer.The overall accuracy of EUS and CE for predicting the invasion depth in ulcerative EGC was 68.6% and 55.5%, respectively. Of the 236 patients, 36 patients were classified as definite ulcers, 98 were superficial ulcers, and 102 were ill-defined ulcers, In univariate analysis, EUS accuracy was associated with invasion depth (P = 0.023), tumor size (P = 0.034), and endoscopic ulcer shapes (P = 0.001). In multivariate analysis, there is a significant association between superficial ulcer in CE and EUS accuracy (odds ratio: 2.977; 95% confidence interval: 1.255-7.064; P = 0.013).The accuracy of EUS for determining tumor invasion depth in ulcerative EGC was superior to that of CE. In addition, ulcer shape was an important factor that affected EUS accuracy. PMID:27472672

  2. Utility of endoscopic ultrasound in patients with portal hypertension.

    PubMed

    Hammoud, Ghassan M; Ibdah, Jamal A

    2014-10-21

    Endoscopic ultrasound (EUS) has revolutionized the diagnostic and therapeutic approach to patients with gastrointestinal disorders. Its application in patients with liver disease and portal hypertension is increasing. Patients with chronic liver disease are at risk for development of portal hypertension sequale such as ascites, spontaneous bacterial peritonitis and gastroesophageal varices. Bleeding esophageal and gastric varices are among the most common causes of mortality in patients with cirrhosis. Thus, early detection and treatment improve the outcome in this population. EUS can improve the detection and diagnosis of gastroesophageal varices and collateral veins and can provide endoscopic therapy of gastroesophageal varices such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided cynoacrylate (Glue) injection of gastric varices. EUS can also provide knowledge on the efficacy of pharmacotherapy of portal hypertension. Furthermore, EUS can provide assessment and prediction of variceal recurrence after endoscopic therapy and assessment of portal hemodynamics such as E-Flow and Doppler study of the azygous and portal veins. Moreover, EUS-guided fine needle aspiration may provide cytologic diagnosis of focal hepatic tumors and analysis of free abdominal fluid. Using specialized EUS-guided needle biopsy, a sample of liver tissue can be obtained to diagnose and evaluate for chronic liver disease. EUS-guided fine needle injection can be used to study portal vein pressure and hemodynamics, and potentially could be used to assist in exact measurement of portal vein pressure and placement of intrahepatic portosystemic shunt. PMID:25339809

  3. Utility of endoscopic ultrasound in patients with portal hypertension

    PubMed Central

    Hammoud, Ghassan M; Ibdah, Jamal A

    2014-01-01

    Endoscopic ultrasound (EUS) has revolutionized the diagnostic and therapeutic approach to patients with gastrointestinal disorders. Its application in patients with liver disease and portal hypertension is increasing. Patients with chronic liver disease are at risk for development of portal hypertension sequale such as ascites, spontaneous bacterial peritonitis and gastroesophageal varices. Bleeding esophageal and gastric varices are among the most common causes of mortality in patients with cirrhosis. Thus, early detection and treatment improve the outcome in this population. EUS can improve the detection and diagnosis of gastroesophageal varices and collateral veins and can provide endoscopic therapy of gastroesophageal varices such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided cynoacrylate (Glue) injection of gastric varices. EUS can also provide knowledge on the efficacy of pharmacotherapy of portal hypertension. Furthermore, EUS can provide assessment and prediction of variceal recurrence after endoscopic therapy and assessment of portal hemodynamics such as E-Flow and Doppler study of the azygous and portal veins. Moreover, EUS-guided fine needle aspiration may provide cytologic diagnosis of focal hepatic tumors and analysis of free abdominal fluid. Using specialized EUS-guided needle biopsy, a sample of liver tissue can be obtained to diagnose and evaluate for chronic liver disease. EUS-guided fine needle injection can be used to study portal vein pressure and hemodynamics, and potentially could be used to assist in exact measurement of portal vein pressure and placement of intrahepatic portosystemic shunt. PMID:25339809

  4. A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy*

    PubMed Central

    Aadam, A. Aziz; Wani, Sachin; Amick, Ashley; Shah, Janak N.; Bhat, Yasser M.; Hamerski, Christopher M.; Klapman, Jason B.; Muthusamy, V. Raman; Watson, Rabindra R.; Rademaker, Alfred W.; Keswani, Rajesh N.; Keefer, Laurie; Das, Ananya; Komanduri, Srinadh

    2016-01-01

    Background and study aims: Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic and non-pancreatic masses. Patients and methods: Consecutive patients referred for EUS-TA underwent randomization to EUS-FNA or EUS-FNB at four tertiary-care medical centers. A maximum of three passes were allowed for the initial method of EUS-TA and patients were crossed over to the other arm based on on-site specimen adequacy. Results: A total of 140 patients were enrolled. The overall DY was significantly higher with specimens obtained by EUS-FNB compared to EUS-FNA (90.0 % vs. 67.1 %, P = 0.002). While there was no difference in the DY between the two groups for pancreatic masses (FNB: 91.7 % vs. FNA: 78.4 %, P = 0.19), the DY of EUS-FNB was higher than the EUS-FNA for non-pancreatic lesions (88.2 % vs. 54.5 %, P = 0.006). Specimen adequacy was higher for EUS-FNB compared to EUS-FNA for all lesions (P = 0.006). There was a significant rescue effect of crossover from failed FNA to FNB in 27 out of 28 cases (96.5 %, P = 0.0003). Decision analysis showed that the strategy of EUS-FNB was cost saving compared to EUS-FNA over a wide range of cost and outcome probabilities. Conclusions: Results of this RCT and decision analysis demonstrate superior DY and specimen adequacy for solid mass lesions sampled by EUS-FNB. PMID:27227104

  5. Utility of endoscopic ultrasound in the diagnosis and management of esophagogastric varices

    PubMed Central

    Wang, An-Jiang; Li, Bi-Min; Zheng, Xue-Lian; Shu, Xu; Zhu, Xuan

    2016-01-01

    Endoscopic ultrasound (EUS) has significantly improved our understanding of the complex vascular structural changes in patients with portal hypertension. At present, EUS is a useful diagnostic tool for the evaluation of esophagogastric varices (EGVs) and guidance of endoscopic therapy. Several studies have employed this new technique for the diagnosis and management of esophageal and gastric varices, respectively. In the present review, we have summarized the current status of EUS for the diagnosis and management of EGVs and clarified the clinical feasibility of this procedure. New indications for EUS can be developed in the future after adequate validation. PMID:27503152

  6. Comparing cost-effectiveness between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in diagnosis of common bile duct stone in patients with predefined risks: A study from a developing country

    PubMed Central

    Netinatsunton, Nisa; Attasaranya, Siriboon; Sottisuporn, Jaksin; Witeerungrot, Teepawit; Jongboonyanuparp, Theeratus; Piratvisuth, Teerha; Ovartlarnporn, Bancha

    2016-01-01

    Background and Objectives: Endoscopic ultrasound (EUS) achieves results comparable to endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of common bile duct (CBD) stone, but studies from the western have shown EUS to be less expensive in patients with intermediate risk for CBD stones. The aim of this study was to compare the costs of EUS and ERCP in the diagnosis of CBD stones in a developing country. Materials and Methods: A prospective study was done with 141 patients with suspected CBD stones, categorized as having high or intermediate risk for CBD stone. All underwent EUS, and the high-risk patients had ERCP after the EUS. For intermediate-risk patients, an ERCP was done at the discretion of the attending physician. The CBD stone was confirmed by ERCP in patients who underwent both EUS and ERCP. Patients who received EUS only were followed up every 3 months for 1 year. The false negative rate in patients with EUS and ERCP was estimated in the clinical follow-up. Result: One hundred and forty-one patients (141: 83 females, 58 males) with a mean age ± standard deviation (SD) of 55.71 ±18.68 years were recruited. Ninety-four (94) patients underwent both EUS and ERCP. ERCP confirmed the diagnosis in 83 of 85 patients (97.6%) with CBD stone detected by EUS. Forty-seven (47) patients with a negative EUS and no ERCP done were symptom-free during the follow-up. The overall sensitivity, specificity, positive predictive value, and negative predictive value of EUS were 97.6%, 80%, 97.6%, and 80% respectively. An EUS-based strategy for high-risk patients was 15% more expensive than an ERCP-based strategy, but the EUS-based strategy reduced the cost to 37.78% less than the ERCP-based strategy in intermediate-risk patients. The EUS-based strategy was cost-saving when the CBD stone prevalence was less than 52.5%. Conclusion: EUS is safer and less costly than ERCP for CBD stone diagnosis in patients with intermediate risk. PMID:27386473

  7. Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care.

    PubMed

    Mitchell, Robert A; Stanger, Dylan; Shuster, Constantin; Telford, Jennifer; Lam, Eric; Enns, Robert

    2016-01-01

    Background. There is a high incidence of inconclusive cytopathology at initial EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for suspected malignant pancreatic lesions. To obtain appropriate preoperative or palliative chemotherapy for pancreatic cancer, definitive cytopathology is often required. The utility of repeat EUS-FNA is not well established. Methods. A retrospective cohort study was conducted evaluating the yield of repeat EUS-FNA in determining a cytological diagnosis in patients who had undergone a prior EUS-FNA for diagnosis of suspected malignant pancreatic lesions with inconclusive cytopathology. The wait times to the second procedure and to decisions regarding therapy were calculated. Results. Overall, 45 repeat EUS-FNA procedures were performed over seven years for suspected malignant pancreatic lesions. Cytopathological class (I to IV) changed between first and second EUS-FNA in 32 patients (71%). Of 34 patients with an initially nonconclusive diagnosis, 20 had a conclusive diagnosis (59%) on repeat EUS-FNA. The cumulative yield after repeat EUS-FNA for definite pancreatic adenocarcinoma was 7 (16%). The median time interval between first and second EUS-FNA was 31 (7-175) days. Conclusions. A substantial number of patients had a definitive diagnosis of adenocarcinoma on repeat FNA and were, therefore, subsequently able to access appropriate care. PMID:27648440

  8. Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

    PubMed Central

    Gonzalo-Marin, Juana; Vila, Juan Jose; Perez-Miranda, Manuel

    2014-01-01

    Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography (CT) and transabdominal ultrasound for recognising early pancreatic tumors. As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer. The complication rate of EUS is as low as 1.1%-3.0%. New technical developments such as elastography and the use of contrast agents have recently been applied to EUS, improving its diagnostic capability. EUS has been found to be superior to the recent multidetector CT for T staging with less risk of overstaying in comparison to both CT and magnetic resonance imaging, so that patients are not being ruled out of a potentially beneficial resection. The accuracy for N staging with EUS is 64%-82%. In unresectable cancers, EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block, biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy. PMID:25232461

  9. Endoscopic Ultrasound-Guided Therapies in Pancreatic Neoplasms

    PubMed Central

    Yang, Dennis; DiMaio, Christopher J.

    2015-01-01

    Endoscopic ultrasound (EUS) has evolved from being primarily a diagnostic modality into an interventional endoscopic tool for the management of both benign and malignant gastrointestinal illnesses. EUS-guided therapy has garnered particular interest as a minimally invasive approach for the treatment of pancreatic cancer, a disease often complicated by its aggressive course and poor survival. The potential advantage of an EUS-guided approach revolves around real-time imaging for targeted therapy of a difficult to reach organ. In this review, we focus on EUS-guided therapies for pancreatic neoplasms. PMID:25802863

  10. Efficacy of Contrast-enhanced Harmonic Endoscopic Ultrasonography in the Diagnosis of Pancreatic Ductal Carcinoma

    PubMed Central

    Uekitani, Toshiyuki; Kaino, Seiji; Harima, Hirofumi; Suenaga, Shigeyuki; Sen-yo, Manabu; Sakaida, Isao

    2016-01-01

    Background/Aims: Distinguishing pancreatic ductal carcinoma (DC) from other pancreatic masses remains challenging. This study aims at evaluating the efficacy of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) in the diagnosis of DC. Patients and Methods: Forty-nine patients with solid pancreatic mass lesions underwent CEH-EUS. EUS (B-mode) was used to evaluate the inner echoes, distributions, and borders of the masses. The vascular patterns of the masses were evaluated with CEH-EUS at 30–50 s (early phase) and 70–90 s (late phase) after the administration of Sonazoid®. Results: The final diagnoses included DCs (37), mass-forming pancreatitis (6), endocrine neoplasms (3), a solid pseudopapillary neoplasm (1), a metastatic carcinoma (1), and an acinar cell carcinoma (1). The sensitivity, specificity, and accuracy of the diagnoses of DC in hypoechoic masses using EUS (B-mode) were 89.2%, 16.7%, and 71.4%, respectively. The sensitivity, specificity, and accuracy for the diagnosis of DC in hypovascular masses using CEH-EUS were 73.0%, 91.7%, and 77.6% in the early phase and 83.8%, 91.7%, and 85.7% in the late phase, respectively. Conclusions: CEH-EUS for the diagnosis of DC is superior to EUS. CEH-EUS in the late phase was particularly efficacious in the diagnosis of DC. PMID:27184637

  11. Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care

    PubMed Central

    Stanger, Dylan; Shuster, Constantin; Telford, Jennifer; Lam, Eric

    2016-01-01

    Background. There is a high incidence of inconclusive cytopathology at initial EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for suspected malignant pancreatic lesions. To obtain appropriate preoperative or palliative chemotherapy for pancreatic cancer, definitive cytopathology is often required. The utility of repeat EUS-FNA is not well established. Methods. A retrospective cohort study was conducted evaluating the yield of repeat EUS-FNA in determining a cytological diagnosis in patients who had undergone a prior EUS-FNA for diagnosis of suspected malignant pancreatic lesions with inconclusive cytopathology. The wait times to the second procedure and to decisions regarding therapy were calculated. Results. Overall, 45 repeat EUS-FNA procedures were performed over seven years for suspected malignant pancreatic lesions. Cytopathological class (I to IV) changed between first and second EUS-FNA in 32 patients (71%). Of 34 patients with an initially nonconclusive diagnosis, 20 had a conclusive diagnosis (59%) on repeat EUS-FNA. The cumulative yield after repeat EUS-FNA for definite pancreatic adenocarcinoma was 7 (16%). The median time interval between first and second EUS-FNA was 31 (7–175) days. Conclusions. A substantial number of patients had a definitive diagnosis of adenocarcinoma on repeat FNA and were, therefore, subsequently able to access appropriate care. PMID:27648440

  12. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy

    PubMed Central

    Ogura, Takeshi; Higuchi, Kazuhide

    2016-01-01

    Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUS-guided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUS-guided hepaticogastrostomy (EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82% (221/270), the clinical success rate was 97% (218/225), and the overall adverse event rate for EUS-HGS was 23% (62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUS-HGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur. PMID:27099437

  13. Is endoscopic ultrasonography useful for endoscopic submucosal dissection?

    PubMed Central

    Han, Ye; Sun, Siyu; Guo, Jintao; Ge, Nan; Wang, Sheng; Liu, Xiang; Wang, Guoxin; Hu, Jinlong; Wang, Shupeng

    2016-01-01

    Endoscopic submucosal dissection (ESD) is an innovative advance in the treatment of early gastrointestinal (GI) cancer without lymph node metastases and precancerous lesions as it is an effective and safe therapeutic method. ESD has also been a promising therapeutic option for removal of submucosal tumors (SMTs) for improving the completeness of resection of a large lesion. Endoscopic ultrasonography (EUS) can be used to detect the depth of invasion during the preoperative evaluation because of its close proximity to the lesion. EUS-guided fine-needle aspiration can be used to increase the diagnostic accuracy of EUS in determining the malignant lymph node. EUS is considered to be a useful imaging procedure to characterize early GI cancer, which is suspicious for submucosal invasion, and the most accurate procedure for detecting and diagnosing SMTs for further treatment. In the process of ESD, EUS can also be used to detect surrounding blood vessels and the degree of fibrosis; this may be helpful for predicting procedure time and decreasing the risk of bleeding and perforation. EUS-guided injection before ESD renders the endoscopic resection safe and accurate. Therefore, EUS plays an important role in the use of ESD. However, compared to conventional endoscopic staging, EUS sometimes can under or overstage the lesion, and the diagnostic accuracy is controversial. In this review, we summarize the latest research findings regarding the role of EUS in ESD. PMID:27803900

  14. 75 FR 63862 - Division of Longshore and Harbor Workers' Compensation; Proposed Extension of Existing Collection...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-18

    ...: Certification of Funeral Expenses (LS-265). A copy of the proposed information collection request can be... shall be paid in all compensable death cases. The LS-265 has been provided for use in submitting the.... Title: Certification of Funeral Expenses. OMB Number: 1240-0040. Agency Number: LS-265. Affected...

  15. 78 FR 77169 - Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-20

    ... collection: Certification of Funeral Expenses (LS-265). A copy of the proposed information collection request... to exceed $3,000 shall be paid in all compensable death cases. The LS-265 has been provided for use...: Extension. Title: Certification of Funeral Expenses. OMB Number: 1240-0040. Agency Number: LS-265....

  16. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Price disclosures. 453.2 Section 453.2 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.2 Price disclosures. (a) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods...

  17. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Price disclosures. 453.2 Section 453.2 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.2 Price disclosures. (a) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods...

  18. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Price disclosures. 453.2 Section 453.2 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.2 Price disclosures. (a) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods...

  19. 16 CFR 453.6 - Retention of documents.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Retention of documents. 453.6 Section 453.6 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.6... of this rule, funeral providers must retain and make available for inspection by Commission...

  20. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Price disclosures. 453.2 Section 453.2 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.2 Price disclosures. (a) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods...

  1. 16 CFR 453.6 - Retention of documents.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Retention of documents. 453.6 Section 453.6 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.6... of this rule, funeral providers must retain and make available for inspection by Commission...

  2. 16 CFR 453.6 - Retention of documents.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Retention of documents. 453.6 Section 453.6 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.6... of this rule, funeral providers must retain and make available for inspection by Commission...

  3. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Price disclosures. 453.2 Section 453.2 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.2 Price disclosures. (a) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods...

  4. 16 CFR 453.6 - Retention of documents.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Retention of documents. 453.6 Section 453.6 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.6... of this rule, funeral providers must retain and make available for inspection by Commission...

  5. 16 CFR 453.6 - Retention of documents.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Retention of documents. 453.6 Section 453.6 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.6... of this rule, funeral providers must retain and make available for inspection by Commission...

  6. Semiotics and the Study of Occupational and Organizational Cultures.

    ERIC Educational Resources Information Center

    Barley, Stephen R.

    1983-01-01

    After a review of semiotic theory, this paper describes an ethnosemantic study of a funeral home that demonstrates how semiotically identical codes structure a funeral director's understanding of his work and how semiotic research can reveal rules by which members of an occupational culture generate meaning. (MJL)

  7. Consumer Aspects of Death and Dying. The Forgotten Dimension.

    ERIC Educational Resources Information Center

    Eddy, James M.; And Others

    1980-01-01

    The consumer aspects of death and dying are discussed as part of a comprehensive death education program. Suggested areas to be covered include traditional funeral procedures and costs; alternatives including cremation, body donation, and funeral and memorial societies; and drawing up a will. Some suggested teaching strategies are outlined. (JMF)

  8. 38 CFR 3.1605 - Death while traveling under prior authorization or while hospitalized by the Department of...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... hospitalized under section 5 of Executive Order 10122 (15 FR 2173; 3 CFR 1950 Supp.) issued pursuant to Pub. L... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... purpose of: (1) Examination; or (2) Treatment; or (3) Care dies enroute, burial, funeral, plot,...

  9. 38 CFR 3.1605 - Death while traveling under prior authorization or while hospitalized by the Department of...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... hospitalized under section 5 of Executive Order 10122 (15 FR 2173; 3 CFR 1950 Supp.) issued pursuant to Pub. L... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... purpose of: (1) Examination; or (2) Treatment; or (3) Care dies enroute, burial, funeral, plot,...

  10. 38 CFR 3.1605 - Death while traveling under prior authorization or while hospitalized by the Department of...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... hospitalized under section 5 of Executive Order 10122 (15 FR 2173; 3 CFR 1950 Supp.) issued pursuant to Pub. L... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... purpose of: (1) Examination; or (2) Treatment; or (3) Care dies enroute, burial, funeral, plot,...

  11. 38 CFR 3.1605 - Death while traveling under prior authorization or while hospitalized by the Department of...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... hospitalized under section 5 of Executive Order 10122 (15 FR 2173; 3 CFR 1950 Supp.) issued pursuant to Pub. L... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... purpose of: (1) Examination; or (2) Treatment; or (3) Care dies enroute, burial, funeral, plot,...

  12. 7 CFR 1944.417 - Servicing actions after grant closing.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) Equivalent units (EUs). Is the number of EUs completed representative of lapse in time of the grant? For... scheduled between the grantee, District Director, and the County supervisor since this is an opportune time... previously identified as a problem grantee or will be identified as a problem grantee at this...

  13. Imaging of the pancreatic duct by linear endoscopic ultrasound

    PubMed Central

    Sharma, Malay; Rai, Praveer; Rameshbabu, Chittapuram Srinivasan; Arya, Shalini

    2015-01-01

    The current gold standard investigation for anatomic exploration of the pancreatic duct (PD) is endoscopic retrograde cholangiopancreatography. Magnetic resonance cholangiopancreatography is a noninvasive method for exploration of the PD. A comprehensive evaluation of the course of PD and its branches has not been described by endoscopic ultrasound (EUS). In this article, we describe the techniques of imaging of PD using linear EUS. PMID:26374577

  14. The role of endoscopic ultrasound on the preoperative T staging of gastric cancer

    PubMed Central

    Han, Chaoqun; Lin, Rong; Shi, Huiying; Liu, Jun; Qian, Wei; Ding, Zhen; Hou, Xiaohua

    2016-01-01

    Abstract Endoscopic ultrasonography (EUS) is used for preoperative assessment of gastric cancer. However, recent studies suggested that EUS staging accuracy is lower than previously thought. We aimed to assess EUS efficacy and image characteristics in preoperative gastric cancer T staging. A retrospective review of clinical and imaging features of 232 gastric carcinoma patients who underwent preoperative EUS assessment of T stage was performed. Only cases with tumor-free resection margin status and no metastases were enrolled. Comparisons of preoperative EUS and postoperative histopathological stagings were also performed to identify vital EUS image features for evaluating gastric carcinoma. EUS accuracy for T staging was 64.2% (149/232) with the highest accuracy for T3 (75.0%). Enlarged lymph nodes, well differentiated histological type and Borrmann IV type were associated with diagnostic accuracy in predicting tumor invasion. Although no factors were associated with overstaging, circumferential lesions ≥1/2, signet ring cell adenocarcinoma, and Borrmann IV type had significantly higher risks of understaging. Gastric wall outer edge irregularity was also an indicator of serosal involvement with a sensitivity of 82.0%. The pancreas and colon were more frequent disease extension sites than previously predicted. Although EUS is likely the best and most accurate option that we have used to stage gastric cancer, the finding that factors including circumferential lesions, signet ring cell adenocarcinoma, and Borrmann IV type carcinoma were more frequently related to incorrect staging warrants attention. PMID:27603347

  15. The role of endoscopic ultrasound on the preoperative T staging of gastric cancer: A retrospective study.

    PubMed

    Han, Chaoqun; Lin, Rong; Shi, Huiying; Liu, Jun; Qian, Wei; Ding, Zhen; Hou, Xiaohua

    2016-09-01

    Endoscopic ultrasonography (EUS) is used for preoperative assessment of gastric cancer. However, recent studies suggested that EUS staging accuracy is lower than previously thought. We aimed to assess EUS efficacy and image characteristics in preoperative gastric cancer T staging.A retrospective review of clinical and imaging features of 232 gastric carcinoma patients who underwent preoperative EUS assessment of T stage was performed. Only cases with tumor-free resection margin status and no metastases were enrolled. Comparisons of preoperative EUS and postoperative histopathological stagings were also performed to identify vital EUS image features for evaluating gastric carcinoma.EUS accuracy for T staging was 64.2% (149/232) with the highest accuracy for T3 (75.0%). Enlarged lymph nodes, well differentiated histological type and Borrmann IV type were associated with diagnostic accuracy in predicting tumor invasion. Although no factors were associated with overstaging, circumferential lesions ≥1/2, signet ring cell adenocarcinoma, and Borrmann IV type had significantly higher risks of understaging. Gastric wall outer edge irregularity was also an indicator of serosal involvement with a sensitivity of 82.0%. The pancreas and colon were more frequent disease extension sites than previously predicted.Although EUS is likely the best and most accurate option that we have used to stage gastric cancer, the finding that factors including circumferential lesions, signet ring cell adenocarcinoma, and Borrmann IV type carcinoma were more frequently related to incorrect staging warrants attention. PMID:27603347

  16. Endosonographic examination of thyroid gland among patients with nonthyroid cancers

    PubMed Central

    Alkhatib, Amer A.; Mahayni, Abdulah A.; Chawki, Ghaleb R.; Yoder, Leon; Elkhatib, Fateh A.; Al-Haddad, Mohammad

    2016-01-01

    Objectives: There is limited endosonographic literature regarding thyroid gland pathology, which is frequently visualized during upper endoscopic ultrasound (EUS). Our objective was to assess the prevalence of benign and malignant thyroid lesions encountered during routine upper EUS within a cancer center setting. Materials and Methods: The data were prospectively collected and retrospectively analyzed. All upper EUS procedures performed between October 2012 and July 2014 were reviewed at a large referral cancer center. Data collected included patient demographics, preexisting thyroid conditions, thyroid gland dimensions, the presence or absence of thyroid lesions, and EUS morphology of lesions if present, and interventions performed to characterize thyroid lesions and pathology results when applicable. Results: Two hundred and forty-five EUS procedures were reviewed. Of these, 100 cases reported a detailed endosonographic examination of the thyroid gland. Most of the thyroid glands were endosonographically visualized when the tip of the scope was at 18 cm from the incisors. Twelve cases showed thyroid lesions, out of which three previously undiagnosed thyroid cancers were visualized during EUS (two primary papillary thyroid cancers and one anaplastic thyroid cancer). Transesophageal EUS-guided fine needle aspiration of thyroid lesions was feasible when the lesion was in the inferior portion of the thyroid gland, and the tip of the scope was at 18 cm or more from the incisors. Conclusions: Routine EUS examination may detect unexpected thyroid lesions including malignant ones. We encourage endosonographers to screen the visualized portions of the thyroid gland during routine withdrawal of the echoendoscope. PMID:27803906

  17. [Endosonographic diagnostics of hepatobiliary and pancreatic diseases].

    PubMed

    Starkov, Iu G; Solodinina, E N; Shishin, K V; Plotnikova, A S; Kobesova, T A; Dubova, E A

    2009-01-01

    Clinical use of endoscopic ultrasound (EUS) diagnostics of 550 patients with diseases of hepatobiliary and pancreas was analyzed. The procedure of the examination was thoroughly described. Ultrasound semiotics of the pancreas, papilla Vateri and bile ducts' lesions was defined. Accuracy of EUS in the diagnostics of solid pancreas tumors was 81,6%. Accuracy of the method in the diagnostics of the vessel invasion was 81,6%. EUS was considered to be leading in the diagnostics of papilla Vateri and duodenal tumors, its accuracy was up to 97,2%, which is much higher then other radiological and endoscopic methods. EUS was highly effective in diagnostics of choledocholithiasis and comprised 90,2%. The introduction of thin-needle biopsy, Doppler mapping and elastography in the EUS protocol permitted further increase of the accuracy and value of the method for the surgical practice.

  18. Diagnosing Pancreatic Tumors Using Contrast-enhanced Harmonic Endoscopic Ultrasonography with Sonazoid.

    PubMed

    Yamamoto, Naoki; Kato, Hironari; Mizukawa, Sho; Muro, Shinichiro; Akimoto, Yutaka; Uchida, Daisuke; Tomoda, Takeshi; Matsumoto, Kazuyuki; Horiguchi, Shigeru; Tsutsumi, Koichiro; Okada, Hiroyuki

    2016-08-01

    Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) with contrast agent enabled us to assess the hemodynamics closely, despite limited data in pancreatic tumors. We have initiated a prospective, single arm, and non-randomized study to clarify the accuracy and safety of CH-EUS with Sonazoid and time-intensity curve (TIC) analysis for diagnosing benign or malignant pancreatic tumors. A total of 200 patients will undergo CH-EUS and TIC analysis. Receiver operating characteristic (ROC) analysis will be used to determine the optimal parameter cutoff values for TIC analysis. This will clarify whether CH-EUS and TIC can further improve the diagnosis of pancreatic tumors over conventional EUS. PMID:27549682

  19. Endoscopic ultrasound-fine needle injection for oncological therapy

    PubMed Central

    Kaplan, Jeremy; Khalid, Amaara; Cosgrove, Natalie; Soomro, Ayesha; Mazhar, Syed Mohsin; Siddiqui, Ali A

    2015-01-01

    The minimal invasiveness and precision of endoscopic ultrasound (EUS) has lead to both its widespread use as a diagnostic and staging modality for gastrointestinal and pancreaticobiliary malignancies, and to its expanding role as a therapeutic modality. EUS-guided celiac plexus neurolysis is now a well-accepted modality for palliation of pain in patients with pancreatic cancer. EUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described as methods of performing minimally invasive oncological therapy. EUS-fine needle injection may be performed as adjunctive, alternative, or palliative treatment. This review summarizes the studies to date that have described these methods. A literature search using the PubMed/MEDLINE databases was performed. While most published studies to date are limited with disappointing outcomes, the concept of a role of EUS in oncological therapy seems promising. PMID:26691224

  20. Endoscopic Ultrasound-Guided Treatment beyond Drainage: Hemostasis, Anastomosis, and Others

    PubMed Central

    Widmer, Jessica L.

    2014-01-01

    Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice. PMID:25325004

  1. Representation of regional urban development conditions using a watershed-based gradient study design

    USGS Publications Warehouse

    Terziotti, Silvia; McMahon, Gerard; Bell, Amanda H.

    2012-01-01

    As part of the U.S. Geological Survey National Water-Quality Assessment Program, the effects of urbanization on stream ecosystems (EUSE) have been intensively investigated in nine metropolitan areas in the United States, including Boston, Massachusetts; Atlanta, Georgia; Birmingham, Alabama; Raleigh, North Carolina; Salt Lake City, Utah; Denver, Colorado; Dallas–Fort Worth, Texas; Portland, Oregon; and Milwaukee–Green Bay, Wisconsin. Each of the EUSE study area watersheds was associated with one ecological region of the United States. This report evaluates whether each metropolitan area can be generalized across the ecological regions (ecoregions) within which the EUSE study watersheds are located. Seven characteristics of the EUSE watersheds that affect stream ecosystems were examined to determine the similarities in the same seven characteristics of the watersheds in the entire ecoregion. Land cover (percentage developed, forest and shrubland, and herbaceous and cultivated classes), average annual temperature, average annual precipitation, average surface elevation, and average percentage slope were selected as human-influenced, climate, and topography characteristics. Three findings emerged from this comparison that have implications for the use of EUSE data in models used to predict stream ecosystem condition. One is that the predominant or "background" land-cover type (either forested or agricultural land) in each ecoregion also is the predominant land-cover type within the associated EUSE study watersheds. The second finding is that in all EUSE study areas, the watersheds account for the range of developed land conditions that exist in the corresponding ecoregion watersheds. However, six of the nine EUSE study area watersheds have significantly different distributions of developed land from the ecoregion watersheds. Finally, in seven of the nine EUSE/ecoregion comparisons, the distributions of the values of climate variables in the EUSE watersheds are

  2. Staging accuracy of esophageal cancer by endoscopic ultrasound: A meta-analysis and systematic review

    PubMed Central

    Puli, Srinivas R; Reddy, Jyotsna BK; Bechtold, Matthew L; Antillon, Daphne; Ibdah, Jamal A; Antillon, Mainor R

    2008-01-01

    AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer. PMID:18330935

  3. Role of Endoscopic Ultrasonography in Guiding Treatment Plans for Upper Gastrointestinal Subepithelial Tumors.

    PubMed

    Moon, Jeong Seop

    2016-05-01

    Gastrointestinal (GI) subepithelial tumors (SETs) are usually observed incidentally by endoscopy and have diverse prognoses, varying from benign to potentially malignant. When a GI SET is suspected, endoscopic ultrasonography (EUS) is the most accurate diagnostic method to differentiate it from extraluminal compression. To determine the nature of GI SETs, EUS is also the most accurate diagnostic method, and reveals the precise sonographic nature of the lesion. There are some SETs with typical EUS findings of GI SETs, but most hypoechoic lesions are difficult to diagnose based on EUS images alone. EUS is also helpful to determine GI wall involvement in SETs and optimal treatment methods. For the diagnosis of GI SETs, obtaining a proper specimen is essential. EUS-guided cytology or biopsy methods such as fine-needle aspiration, Tru-Cut biopsy, and the newly introduced fine-needle biopsy (FNB) provide good results. To increase the diagnostic yield for GI SETs, cytology with immunocytochemical staining is used for cytological interpretation, resulting in good diagnostic yields. Recently, EUS-FNB using cheese slicer technology has been introduced, and has been reported to provide good diagnostic results for GI SETs.

  4. The Diagnostic Accuracy of Linear Endoscopic Ultrasound for Evaluating Symptoms Suggestive of Common Bile Duct Stones

    PubMed Central

    He, Xu; Li, Jian; Min, Feng; Li, Hong-yan

    2016-01-01

    Background. In order to assess the diagnostic accuracy of linear EUS for evaluating clinically suggestive CBD stones in high-risk groups. Methods. 202 patients with clinically suggestive CBD stones in high-risk groups who underwent linear EUS examination between January 2012 and January 2015 were retrospectively reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction or surgical choledochoscopy was only performed when a CBD stone was detected by linear EUS. Cases that were negative for CBD stones were followed up for at least 6 months. Results. Of 202 enrolled patients, 126 were positive for CBD stones according to linear EUS findings. 124 patients successfully underwent ERCP, and ERCP failed in 2 who were later successfully treated by surgical intervention. There were 2 false-positive cases with positive findings for CBD stones on ERCP. Among 76 patients without CBD stones, no false-negative cases were identified during the mean 6-month follow-up. Linear EUS had sensitivity, specificity, and positive and negative predictive values for the detection of CBD stones of 100%, 92.88%, 98.21%, and 100%, respectively. Conclusions. Linear EUS is a safe and efficacious diagnostic tool for evaluating clinically suggestive CBD stones with high risk of choledocholithiasis. Performing linear EUS prior to ERCP in patients with symptoms suggestive of CBD stones can reduce unnecessary ERCP procedures.

  5. The Diagnostic Accuracy of Linear Endoscopic Ultrasound for Evaluating Symptoms Suggestive of Common Bile Duct Stones

    PubMed Central

    He, Xu; Li, Jian; Min, Feng; Li, Hong-yan

    2016-01-01

    Background. In order to assess the diagnostic accuracy of linear EUS for evaluating clinically suggestive CBD stones in high-risk groups. Methods. 202 patients with clinically suggestive CBD stones in high-risk groups who underwent linear EUS examination between January 2012 and January 2015 were retrospectively reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction or surgical choledochoscopy was only performed when a CBD stone was detected by linear EUS. Cases that were negative for CBD stones were followed up for at least 6 months. Results. Of 202 enrolled patients, 126 were positive for CBD stones according to linear EUS findings. 124 patients successfully underwent ERCP, and ERCP failed in 2 who were later successfully treated by surgical intervention. There were 2 false-positive cases with positive findings for CBD stones on ERCP. Among 76 patients without CBD stones, no false-negative cases were identified during the mean 6-month follow-up. Linear EUS had sensitivity, specificity, and positive and negative predictive values for the detection of CBD stones of 100%, 92.88%, 98.21%, and 100%, respectively. Conclusions. Linear EUS is a safe and efficacious diagnostic tool for evaluating clinically suggestive CBD stones with high risk of choledocholithiasis. Performing linear EUS prior to ERCP in patients with symptoms suggestive of CBD stones can reduce unnecessary ERCP procedures. PMID:27610131

  6. High Frequency Sacral Root Nerve Block Allows Bladder Voiding

    PubMed Central

    Boger, Adam S.; Bhadra, Narendra; Gustafson, Kenneth J

    2013-01-01

    1) Aims Dyssynergic reflexive external urethral sphincter (EUS) activity following spinal cord injury can prevent bladder voiding, resulting in significant medical complications. Irreversible sphincterotomies or neurotomies can prevent EUS activation and allow bladder voiding, but may cause incontinence or loss of sacral reflexes. We investigated whether kilohertz frequency (KF) electrical conduction block of the sacral roots could prevent EUS activation and allow bladder voiding. 2) Methods The S2 sacral nerve roots were stimulated bilaterally to generate bladder pressure in 6 cats. One S1 nerve root was stimulated proximally (20 Hz biphasic pulse trains) to evoke EUS pressure, simulating worst-case dyssynergic EUS reflexes. KF waveforms (12.5 kHz biphasic square wave) applied to an electrode implanted distally on the S1 nerve root blocked nerve conduction, preventing the increase in EUS pressure and allowing voiding. 3) Results Applying KF waveforms increased bladder voiding in single, limited-duration trials from 3 ± 6% to 59 ± 12%. Voiding could be increased to 82 ± 9% of the initial bladder volume by repeating or increasing the duration of the trials. 4) Conclusions Sacral nerve block can prevent EUS activation and allow complete bladder voiding, potentially eliminating the need for a neurotomy. Eliminating neurotomy requirements could increase patient acceptance of bladder voiding neuroprostheses, increasing patient quality of life and reducing the cost of patient care. PMID:22473837

  7. The Diagnostic Accuracy of Linear Endoscopic Ultrasound for Evaluating Symptoms Suggestive of Common Bile Duct Stones.

    PubMed

    Wang, Min; He, Xu; Tian, Chuan; Li, Jian; Min, Feng; Li, Hong-Yan

    2016-01-01

    Background. In order to assess the diagnostic accuracy of linear EUS for evaluating clinically suggestive CBD stones in high-risk groups. Methods. 202 patients with clinically suggestive CBD stones in high-risk groups who underwent linear EUS examination between January 2012 and January 2015 were retrospectively reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction or surgical choledochoscopy was only performed when a CBD stone was detected by linear EUS. Cases that were negative for CBD stones were followed up for at least 6 months. Results. Of 202 enrolled patients, 126 were positive for CBD stones according to linear EUS findings. 124 patients successfully underwent ERCP, and ERCP failed in 2 who were later successfully treated by surgical intervention. There were 2 false-positive cases with positive findings for CBD stones on ERCP. Among 76 patients without CBD stones, no false-negative cases were identified during the mean 6-month follow-up. Linear EUS had sensitivity, specificity, and positive and negative predictive values for the detection of CBD stones of 100%, 92.88%, 98.21%, and 100%, respectively. Conclusions. Linear EUS is a safe and efficacious diagnostic tool for evaluating clinically suggestive CBD stones with high risk of choledocholithiasis. Performing linear EUS prior to ERCP in patients with symptoms suggestive of CBD stones can reduce unnecessary ERCP procedures. PMID:27610131

  8. Superficial esophageal lesions detected by endoscopic ultrasound enhanced with submucosal edema

    PubMed Central

    Li, Jian-Jun; He, Long-Jun; Shan, Hong-Bo; Wang, Thomas D; Xiong, Huan; Chen, Li-Ming; Xu, Guo-Liang; Li, Xiao-Hai; Huang, Xin-Xin; Luo, Guang-Yu; Li, Yin; Zhang, Rong

    2013-01-01

    AIM: To determine if there is consistency between endoscopic ultrasound (EUS) findings and pathological results for detecting lesions of different depth in the esophageal mucosa. METHODS: A canine (Beagle) model was established in which lesions of different depths were created in the esophageal mucosa by thermal burning. Seventy-two hours later, these lesions and adjacent tissue in the esophagus were examined by EUS. EUS findings including infiltrating depth, strength of echogenicity and homogeneity were recorded. Dogs were sacrificed and tissue specimens were obtained. We then compared the EUS findings with the pathology reports. RESULTS: Thermal burns created at different power settings caused lesions of different depth in the esophageal mucosa. When the echo strength was shifted from high, medium, to low echogenicity, an increase in the infiltrating depth of the lesion was noted, which coincided with results of the pathology examination. Obvious submucosal edema visualized by EUS was also detected by pathology. Furthermore, because of the enhancement caused by the submucosal edema, the lesions invading into the submucosa were easily visualized by EUS. CONCLUSION: There is consistency between EUS findings and pathological results of esophageal lesions with different depths. Submucosal edema can serve as an ultrasonic contrast agent. PMID:24379628

  9. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video).

    PubMed

    Peñas-Herrero, Irene; de la Serna-Higuera, Carlos; Perez-Miranda, Manuel

    2015-01-01

    Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been introduced as an alternative to percutaneous transhepatic gallbladder drainage for the treatment of acute cholecystitis in non-surgical candidates. A systematic review of the English language literature through PubMed search until June 2014 was conducted. One hundred and fifty-five patients with acute cholecystitis treated with EUS-GBD in eight studies and 12 case reports, and two patients with EUS-GBD for other causes were identified. Overall, technical success was obtained in 153 patients (97.45%) and clinical success in 150 (99.34%) patients with acute cholecystitis. Adverse events developed in less than 8% of patients, all of them managed conservatively. EUS-GBD has been performed with plastic stents, nasobiliary drainage tubes, standard or modified tubular self-expandable metal stents (SEMS) and lumen-apposing metal stents (LAMS) by different authors with apparently similar outcomes. No comparison studies between stent types for EUS-GBD have been reported. EUS-GBD is a promising novel alternative intervention for the treatment of acute cholecystitis in high surgical risk patients. Feasibility, safety and efficacy in published studies from expert centers are very high compared to currently available alternatives. Further studies are needed to establish the safety and long-term outcomes of this procedure in other practice settings before EUS-GBD can be widely disseminated.

  10. Role of Endoscopic Ultrasonography in Guiding Treatment Plans for Upper Gastrointestinal Subepithelial Tumors

    PubMed Central

    Moon, Jeong Seop

    2016-01-01

    Gastrointestinal (GI) subepithelial tumors (SETs) are usually observed incidentally by endoscopy and have diverse prognoses, varying from benign to potentially malignant. When a GI SET is suspected, endoscopic ultrasonography (EUS) is the most accurate diagnostic method to differentiate it from extraluminal compression. To determine the nature of GI SETs, EUS is also the most accurate diagnostic method, and reveals the precise sonographic nature of the lesion. There are some SETs with typical EUS findings of GI SETs, but most hypoechoic lesions are difficult to diagnose based on EUS images alone. EUS is also helpful to determine GI wall involvement in SETs and optimal treatment methods. For the diagnosis of GI SETs, obtaining a proper specimen is essential. EUS-guided cytology or biopsy methods such as fine-needle aspiration, Tru-Cut biopsy, and the newly introduced fine-needle biopsy (FNB) provide good results. To increase the diagnostic yield for GI SETs, cytology with immunocytochemical staining is used for cytological interpretation, resulting in good diagnostic yields. Recently, EUS-FNB using cheese slicer technology has been introduced, and has been reported to provide good diagnostic results for GI SETs. PMID:27209643

  11. Endoscopic ultrasound-guided ethanol ablation of a large metastatic carcinoid tumor: success with a note of caution.

    PubMed

    Mathers, Bradley W; Harvey, Harold A; Dye, Charles E; Dougherty-Hamod, Brandy; Moyer, Matthew T

    2014-12-01

    Endoscopic ultrasonography with fine needle infusion (EUS-FNI) of alcohol is the most reported method for EUS-guided tumor ablation. Several studies have reported successful EUS-guided ablation of pancreatic neuroendocrine tumors. However, these tumors have been relatively small (< 3 cm). In this report, a 50-year-old man with a metastatic carcinoid tumor with a large porta hepatis mass was referred to our clinic for EUS-guided ethanol ablation. After two separate EUS-FNI ablations, there was a 36 % reduction in tumor size (9.0 × 11.4 cm to 6.7 × 9.8 cm) with associated tumor lysis syndrome. Chromogranin A levels decreased from 460 to 132 ng/mL. The patient reported complete resolution of abdominal pain within 2 weeks, but only mild improvement in flushing and diarrhea. In conclusion, large metastatic neuroendocrine tumors can be successfully treated with EUS-guided ethanol ablation. Evidence-based guidelines are needed with regard to the appropriate volume of ethanol injected in EUS-guided ablation to promote the efficacy and safety of this emerging procedure. PMID:26135103

  12. The Role of Endoscopic Ultrasonography in T Staging: Early Gastric Cancer and Esophageal Cancer

    PubMed Central

    2013-01-01

    While a number of diagnostic methods have been developed, endoscopic ultrasound (EUS) still takes the most important role in the preoperative evaluation of esophageal cancer. EUS can detect lesions of all esophageal cancer and can accurately perform T staging. In a recent meta-analysis of EUS in esophageal cancer, the sensitivity and specificity of EUS on esophageal cancer were 81.6% and 99.4% in T1, 81.4% and 96.3% in T2, 91.4% and 94.4% in T3, and 92.4% and 97.4% in T4, respectively. The use of EUS can reduce unnecessary surgeries and lead to apply proper treatments to patients. The advance of endoscopic submucosal dissection have necessitated the presurgical detection of early cancer lesions without lymph node metastasis. Understanding the practical meanings of images shown by EUS is important to decide patients for whom endoscopic treatments can be effective. In early gastric cancer, EUS can accurately predict mucosal and SM1 (invasion into the submucosal layer of less than 500 µm from muscularis mucosa) lesions, which are considered as good indications for endoscopic treatments. PMID:23767033

  13. Endoscopic ultrasonography-guided placement of a transhepatic portal vein stent in a live porcine model

    PubMed Central

    Park, Tae Young; Seo, Dong Wan; Kang, Hyeon-Ji; Cho, Min Keun; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

    2016-01-01

    Background and Objectives: Percutaneous portal vein (PV) stent placement is used to manage PV occlusion or stenosis caused by malignancy. The use of endoscopic ultrasonography (EUS) has expanded to include vascular interventions. The aim of this study was to examine the technical feasibility and safety of EUS-guided transhepatic PV stent placement in a live porcine model. Materials and Methods: EUS-guided transhepatic PV stent placement was performed in six male miniature pigs under general anesthesia using forward-viewing echoendoscope. Under EUS guidance, the left intrahepatic PV was punctured with a 19-gauge fine-needle aspiration (FNA) needle and a 0.025 inch guidewire inserted through the needle and into the main PV. The FNA needle was then withdrawn and a needle-knife inserted to dilate the tract. Under EUS and fluoroscopic guidance, a noncovered metal stent was inserted over the guidewire and released into the main PV. Results: A PV stent was placed successfully in all six pigs with no technical problems or complications. The patency of the stent in the main PV was confirmed using color Doppler EUS and transhepatic portal venography. Necropsy of the first three animals revealed no evidence of bleeding and damage to intra-abdominal organs or vessels. No complications occurred in the remaining three animals during the 8 weeks observation period. Conclusions: EUS-guided transhepatic PV stent placement can be both technically feasible and safe in a live animal model. PMID:27803904

  14. 29 CFR 541.301 - Learned professionals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... science accredited by the American Board of Funeral Service Education, generally meet the duties... DELIMITING THE EXEMPTIONS FOR EXECUTIVE, ADMINISTRATIVE, PROFESSIONAL, COMPUTER AND OUTSIDE SALES EMPLOYEES... science or learning customarily acquired by a prolonged course of specialized intellectual...

  15. 29 CFR 541.301 - Learned professionals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... science accredited by the American Board of Funeral Service Education, generally meet the duties... DELIMITING THE EXEMPTIONS FOR EXECUTIVE, ADMINISTRATIVE, PROFESSIONAL, COMPUTER AND OUTSIDE SALES EMPLOYEES... science or learning customarily acquired by a prolonged course of specialized intellectual...

  16. 29 CFR 541.301 - Learned professionals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... science accredited by the American Board of Funeral Service Education, generally meet the duties... DELIMITING THE EXEMPTIONS FOR EXECUTIVE, ADMINISTRATIVE, PROFESSIONAL, COMPUTER AND OUTSIDE SALES EMPLOYEES... science or learning customarily acquired by a prolonged course of specialized intellectual...

  17. 29 CFR Non - Mandatory Appendix A to Subpart B of Part 1904-Partially Exempt Industries

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Hardware Stores 725 Shoe Repair and Shoeshine Parlors. 542 Meat and Fish Markets 726 Funeral Service and..., & Computer Stores 792 Producers, Orchestras, Entertainers. 58 Eating and Drinking Places 793 Bowling...

  18. 29 CFR Non - Mandatory Appendix A to Subpart B of Part 1904-Partially Exempt Industries

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Hardware Stores 725 Shoe Repair and Shoeshine Parlors. 542 Meat and Fish Markets 726 Funeral Service and..., & Computer Stores 792 Producers, Orchestras, Entertainers. 58 Eating and Drinking Places 793 Bowling...

  19. 29 CFR Non - Mandatory Appendix A to Subpart B of Part 1904-Partially Exempt Industries

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Hardware Stores 725 Shoe Repair and Shoeshine Parlors. 542 Meat and Fish Markets 726 Funeral Service and..., & Computer Stores 792 Producers, Orchestras, Entertainers. 58 Eating and Drinking Places 793 Bowling...

  20. 7 CFR 1956.109 - General requirements for debt settlement.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... necessary to abandon security through the debt settlement process. For example, a community may be rendered... minor children and surviving spouse, allowable funeral expenses, dower and curtesy rights, and...

  1. 7 CFR 1956.109 - General requirements for debt settlement.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... necessary to abandon security through the debt settlement process. For example, a community may be rendered... minor children and surviving spouse, allowable funeral expenses, dower and curtesy rights, and...

  2. 7 CFR 1956.109 - General requirements for debt settlement.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... necessary to abandon security through the debt settlement process. For example, a community may be rendered... minor children and surviving spouse, allowable funeral expenses, dower and curtesy rights, and...

  3. 7 CFR 1956.109 - General requirements for debt settlement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... necessary to abandon security through the debt settlement process. For example, a community may be rendered... minor children and surviving spouse, allowable funeral expenses, dower and curtesy rights, and...

  4. 7 CFR 1956.109 - General requirements for debt settlement.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... necessary to abandon security through the debt settlement process. For example, a community may be rendered... minor children and surviving spouse, allowable funeral expenses, dower and curtesy rights, and...

  5. 44 CFR 206.119 - Financial assistance to address other needs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) established under the National Flood Insurance Program (NFIP) regulations at 44 CFR 61.17. (1) The premium for... generally limited to the following (i) Funeral services; (ii) Burial or cremation; and (iii) Other...

  6. 44 CFR 206.119 - Financial assistance to address other needs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) established under the National Flood Insurance Program (NFIP) regulations at 44 CFR 61.17. (1) The premium for... generally limited to the following (i) Funeral services; (ii) Burial or cremation; and (iii) Other...

  7. 20 CFR 1002.150 - Which non-seniority rights and benefits is the employee entitled to during a period of service?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... significant factor to compare. For instance, a two-day funeral leave will not be “comparable” to an extended leave for service in the uniformed service. In addition to comparing the duration of the absences,...

  8. Doing Well by Doing Good

    ERIC Educational Resources Information Center

    Johnson, Nicholas

    1976-01-01

    Argues that television programing is inadequate because the medium is not being used for what it can do best--transmit such live events as Kennedy's funeral, the walk on the moon, and the Watergate hearings. (RB)

  9. Ritual vicissitudes: the uncertainties of Singaporean suicide rites.

    PubMed

    Toulson, Ruth E

    2012-06-01

    In this article, I examine how Singaporean Chinese families and funeral professionals work together to ritually manage the meaning and consequences of a death by suicide. While the now dated literature on Chinese mortuary practice emphasizes the formality and rigidity of death rituals, during fieldwork I noted many moments of confusion within ritual, moments of innovation, when relatives broke away from the already uncertain ritual script, and moments of deceit, when relatives conspired with funeral directors to hide the reason for a death. Through an examination of three funerals for suicide victims, including two cases in which the fact that the death was a suicide was hidden, I suggest that a focus on moments of confusion and of innovation paradoxically better captures the dynamism and efficacy of Chinese funeral rituals: here indeterminacy is indispensable to ritual form.

  10. LAND APPLICATION AND SLUDGE TREATMENT

    EPA Science Inventory

    Fecal matter potentially containing pathogenic microorganisms and chemical contaminants enters community wastewater collection systems from hospitals, funeral homes, animal slaughtering operations, and dwellings. While these wastewaters are cleansed in the wastewater treatment p...

  11. Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis

    PubMed Central

    Matsubayashi, Hiroyuki; Matsui, Toru; Yabuuchi, Yohei; Imai, Kenichiro; Tanaka, Masaki; Kakushima, Naomi; Sasaki, Keiko; Ono, Hiroyuki

    2016-01-01

    Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis. PMID:26811612

  12. Endoscopic ultrasound guided interventional procedures

    PubMed Central

    Sharma, Vishal; Rana, Surinder S; Bhasin, Deepak K

    2015-01-01

    Endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunity to target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS. PMID:26078831

  13. Patterns of Response After Preoperative Intensity-Modulated Radiation Therapy and Capecitabine/Oxaliplatin in Rectal Cancer: Is There Still a Place for Ecoendoscopic Ultrasound?

    SciTech Connect

    Arbea, Leire; Diaz-Gonzalez, Juan A.; Subtil, Jose Carlos; Sola, Josu; Hernandez-Lizoain, Jose Luis; Martinez-Monge, Rafael; Moreno, Marta; Aristu, Javier

    2011-10-01

    Purpose: The main goals of preoperative chemoradiotherapy (CHRT) in rectal cancer are to achieve pathological response and to ensure tumor control with functional surgery when possible. Assessment of the concordance between clinical and pathological responses is necessary to make decisions regarding alternative conservative procedures. The present study evaluates the patterns of response after a preoperative CHRT regimen, and the value of endoscopic ultrasound (EUS) in assessing response. Methods and Materials: A total of 51 EUS-staged T3 to T4 and/or N0 to N+ rectal cancer patients received preoperative CHRT (intensity-modulated radiation therapy and capecitabine/oxaliplatin (XELOX) followed by radical resection. Clinical response was assesed by EUS. Rates of pathological tumor regression grade (TRG) and lymph node (LN) involvement were determined in the surgical specimen. Clinical and pathological responses were compared, and the accuracy of EUS in assessing response was calculated. Results: Twenty-four patients (45%) achieved a major pathological response (complete or >95% pathological response (TRG 3+/4)). Sensitivity, specificity, negative predictive value, and positive predictive value of EUS in predicting pathological T response after preoperative CHRT were 77.8%, 37.5%, 60%, and 58%, respectively. The EUS sensitivity, specificity, negative predictive value, and positive predictive value for nodal staging were 44%, 88%, 88%, and 44%, respectively. Furthermore, EUS after CHRT accurately predicted the absence of LN involvement in 7 of 7 patients (100%) with major pathological response of the primary tumor. Conclusion: Preoperative IMRT with concomitant XELOX induces favorable rates of major pathological response. EUS has a limited ability to predict primary tumor response after preoperative CHRT, but it is useful for accurately determining LN status. EUS may have a potential value in identifying patients with a very low risk of LN involvement in association

  14. Confirming Mycobacterium tuberculosis transmission from a cadaver to an embalmer using molecular epidemiology.

    PubMed

    Anderson, Janelle A; Meissner, Jeanne Sullivan; Ahuja, Shama Desai; Shashkina, Elena; O'Flaherty, Tholief; Proops, Douglas C

    2015-05-01

    Genotyping results and epidemiologic investigation were used to confirm tuberculosis transmission from a cadaver to an embalmer. This investigation highlights the utility of genotyping in identifying unsuspected epidemiologic links and unusual transmission settings. In addition, the investigation provides additional evidence for the occupational risk of tuberculosis among funeral service workers and indicates a need for education about tuberculosis risk and the importance of adhering to appropriate infection control measures among funeral service workers.

  15. Clinical application of endoscopic ultrasonography for esophageal achalasia.

    PubMed

    Minami, Hitomi; Inoue, Haruhiro; Isomoto, Hajime; Urabe, Shigetoshi; Nakao, Kazuhiko

    2015-04-01

    Endoscopic ultrasonography (EUS) has been widely used for evaluating the nature of diseases of various organs. The possibility of applying EUS for esophageal motility diseases has not been well discussed despite its versatility. At present, peroral endoscopic myotomy (POEM) for esophageal achalasia and related diseases has brought new attention to esophageal diseases because POEM provides a more direct approach to the inner structures of the esophageal wall. In the present study, we discuss the clinical utility of EUS in evaluating and treating esophageal motility diseases such as esophageal achalasia and related diseases. PMID:25573637

  16. Diagnosis of cystic lymphangioma of the colon by endoscopic ultrasound: Biopsy is not needed!

    PubMed Central

    Bhutani, Manoop S.; Annangi, Srinadh; Koduru, Pramoda; Aggarwal, Aakash; Suzuki, Rei

    2016-01-01

    Cystic lymphangioma of the colon (CLC) is a rare benign lesion that is usually asymptomatic and found incidentally during colonoscopy. Limitations in the conventional noninvasive diagnostic techniques have led to surgical resection of these lesions for diagnostic confirmation. Classic endoscopic ultrasound (EUS) findings of colonic cystic lymphangioma are submucosal anechoic cystic spaces with septations, intact muscularis propria, and no solid component. Patients who are asymptomatic with lesions having classic appearance as cystic lymphangioma with EUS can be observed without any intervention. We herein report a case of cystic lymphangioma of distal transverse colon in an asymptomatic patient diagnosed noninvasively using 20-MHz miniprobe EUS and managed conservatively without any surgical intervention. PMID:27803907

  17. Advances in endoscopic ultrasound imaging of colorectal diseases.

    PubMed

    Cârțână, Elena Tatiana; Gheonea, Dan Ionuț; Săftoiu, Adrian

    2016-02-01

    The development of endoscopic ultrasound (EUS) has had a significant impact for patients with digestive diseases, enabling enhanced diagnostic and therapeutic procedures, with most of the available evidence focusing on upper gastrointestinal (GI) and pancreatico-biliary diseases. For the lower GI tract the main application of EUS has been in staging rectal cancer, as a complementary technique to other cross-sectional imaging methods. EUS can provide highly accurate in-depth assessments of tumour infiltration, performing best in the diagnosis of early rectal tumours. In the light of recent developments other EUS applications for colorectal diseases have been also envisaged and are currently under investigation, including beyond-rectum tumour staging by means of the newly developed forward-viewing radial array echoendoscope. Due to its high resolution, EUS might be also regarded as an ideal method for the evaluation of subepithelial lesions. Their differential diagnosis is possible by imaging the originating wall layer and the associated echostructure, and cytological and histological confirmation can be obtained through EUS-guided fine needle aspiration or trucut biopsy. However, reports on the use of EUS in colorectal subepithelial lesions are currently limited. EUS allows detailed examination of perirectal and perianal complications in Crohn's disease and, as a safe and less expensive investigation, can be used to monitor therapeutic response of fistulae, which seems to improve outcomes and reduce the need for additional surgery. Furthermore, EUS image enhancement techniques, such as the use of contrast agents or elastography, have recently been evaluated for colorectal indications as well. Possible applications of contrast enhancement include the assessment of tumour angiogenesis in colorectal cancer, the monitoring of disease activity in inflammatory bowel disease based on quantification of bowel wall vascularization, and differentiating between benign and

  18. Repeat endoscopic ultrasound fine needle aspiration after a first negative procedure is useful in pancreatic lesions

    PubMed Central

    Téllez-Ávila, Félix I.; Martínez-Lozano, Jorge Adolfo; Rosales-Salinas, Anamaría; Bernal-Méndez, Ambrosio Rafael; Guerrero-Velásquez, Camilo; Ramírez-Luna, Miguel Ángel; Valdovinos-Andraca, Francisco

    2016-01-01

    Background and Objectives: There is no consensus about the ideal method for diagnosis in patients who have already undergone endoscopic ultrasound fine needle aspiration (EUS-FNA), and the inconclusive material is often obtained. The aim was to evaluate the diagnostic yield of the second EUS-FNA of pancreatic lesions. Materials and Methods: A retrospective analysis of prospectively collected data of patients with EUS-FNA of pancreatic lesions is performed. All patients who underwent more than one EUS-FNA for the evaluation of suspected pancreatic cancer over a 7-year period were included in the analysis. Results: A total of 296 EUS-FNAs of the pancreas were performed in 257 patients. The diagnostic yield with the first EUS-FNA was 78.6% (202/257). Thirty-nine (13.3%) FNAs were repeated in 34 patients; 17 (50%) patients were women. The mean ± standard deviation (SD) age was 58.8 ± 16.1 years. The location of the lesions in the pancreatic gland, from which the second biopsies were taken, was head of the pancreas, n = 28 (82.4%), body of the pancreas, n = 3 (8.8%), and tail, n = 3 (8.8%). The mean ± SD of the size of the lesion was 36.3 ± 14.6 mm. The second EUS-FNA was more likely to be positive for diagnosis in patients with an “atypical“ histological result in the first EUS-FNA (odds ratio [OR]: 4.04; 95% confidence interval [CI]: 0.9–18.3), in contrast to patients with a first EUS-FNA reported as “normal” (OR: 0.21; 95% CI: 0.06–0.71). Overall, the diagnostic yield of the second EUS-FNA was 58.8% (20/34) with an increase to 86.3% overall (222/257). Conclusion: Repeat EUS-FNA in pancreatic lesions is necessary in patients with a negative first EUS-FNA because it improves the diagnostic yield. PMID:27503159

  19. Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer

    PubMed Central

    Minaga, Kosuke; Kitano, Masayuki; Sakamoto, Hiroki; Miyata, Takeshi; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Omoto, Shunsuke; Kadosaka, Kumpei; Sakurai, Toshiharu; Nishida, Naoshi; Chiba, Yasutaka; Kudo, Masatoshi

    2016-01-01

    Background: Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain. Methods: This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by ⩾3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications. Results: A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean ± SD) were 4.98 ± 1.08 and 4.15 ± 1.12 in patients treated with the combination method and single method, respectively (p < 0.001). There was no significant predictor of complications. Conclusions: EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment. PMID:27366217

  20. Efforts to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic tumors

    PubMed Central

    Yamabe, Akane; Irisawa, Atsushi; Bhutani, Manoop S.; Shibukawa, Goro; Fujisawa, Mariko; Sato, Ai; Yoshida, Yoshitsugu; Arakawa, Noriyuki; Ikeda, Tsunehiko; Igarashi, Ryo; Maki, Takumi; Yamamoto, Shogo

    2016-01-01

    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to obtain a definitive diagnosis of pancreatic tumors. Good results have been reported for its diagnostic accuracy, with high sensitivity and specificity of around 90%; however, technological developments and adaptations to improve it still further are currently underway. The endosonographic technique can be improved when several tips and tricks useful to overcome challenges of EUS-FNA are known. This review provides various techniques and equipment for improvement in the diagnostic accuracy in EUS-FNA. PMID:27503153

  1. Endoscopic Ultrasound-guided Antegrade Stenting in an Occluded Biliary Self-expandable Metal Stent

    PubMed Central

    Almadi, Majid A.; Eltayeb, Mohanned; Thaniah, Salem

    2016-01-01

    Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an attractive option for patients who cannot undergo conventional endoscopic retrograde cholangiopancreatography (ERCP) and do not want surgery or percutaneous drainage procedures. We present the use of EUS-antegrade (EUS-AG) insertion of a self-expandable metal stent (SEMS) in a patient with a common hepatic duct cholangiocarcinoma, as well as a huge gastric lipoma, after recurrent biliary obstruction of a prior SEMS inserted via ERCP in the same session as a duodenal stent insertion for gastric outlet obstruction. PMID:27488330

  2. Needle Fracture during Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspicious Thoracic Lymph Nodes.

    PubMed

    Adamowicz, Bartosz; Manière, Thibaut; Déry, Vincent; Désilets, Étienne

    2016-01-01

    Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is used to make a cytopathologic diagnosis of suspicious lesions located around the gastrointestinal tract. It is a safe technique with few complications. The most common complications of EUS-FNA are related to pancreatic lesions (pancreatitis, bleeding, and abdominal pain). Rare complications have been noted such as stent malfunction, air embolism, infection, neural and vascular injuries, and tumor cell seeding. There are very few studies examining equipment malfunctions. We report a case of needle fracture during the EUS-FNA of suspicious thoracic lymph nodes in a 79-year-old man investigated for unexplained weight loss. PMID:27555874

  3. Needle Fracture during Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspicious Thoracic Lymph Nodes

    PubMed Central

    Manière, Thibaut; Déry, Vincent

    2016-01-01

    Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is used to make a cytopathologic diagnosis of suspicious lesions located around the gastrointestinal tract. It is a safe technique with few complications. The most common complications of EUS-FNA are related to pancreatic lesions (pancreatitis, bleeding, and abdominal pain). Rare complications have been noted such as stent malfunction, air embolism, infection, neural and vascular injuries, and tumor cell seeding. There are very few studies examining equipment malfunctions. We report a case of needle fracture during the EUS-FNA of suspicious thoracic lymph nodes in a 79-year-old man investigated for unexplained weight loss. PMID:27555874

  4. Therapeutic Endoscopic Ultrasound

    PubMed Central

    Cheriyan, Danny

    2015-01-01

    Endoscopic ultrasound (EUS) technology has evolved dramatically over the past 20 years, from being a supplementary diagnostic aid available only in large medical centers to being a core diagnostic and therapeutic tool that is widely available. Although formal recommendations and practice guidelines have not been developed, there are considerable data supporting the use of EUS for its technical accuracy in diagnosing pancreaticobiliary and gastrointestinal pathology. Endosonography is now routine practice not only for pathologic diagnosis and tumor staging but also for drainage of cystic lesions and celiac plexus neurolysis. In this article, we cover the use of EUS in biliary and pancreatic intervention, ablative therapy, enterostomy, and vascular intervention. PMID:27118942

  5. Endoscopic ultrasonography in diseases of the gallbladder.

    PubMed

    O'Neill, Darby E Robinson; Saunders, Michael D

    2010-06-01

    In recent years, endoscopic ultrasonography (EUS) has emerged as an important tool for the diagnosis and management of pancreaticobiliary disease. The close proximity of the echoendoscope to the biliary system allows detailed imaging of the gallbladder and adjacent structures. EUS is useful for the detection of occult cholelithiasis and biliary sludge and in the evaluation of suspected choledocholithiasis. It can be used to classify and predict neoplasia in polypoid lesions of the gallbladder and also to diagnose and stage gallbladder carcinoma. This article reviews the use of EUS in these diseases of the gallbladder.

  6. Electron tunneling transport across heterojunctions between europium sulfide and indium arsenide

    NASA Astrophysics Data System (ADS)

    Kallaher, Raymond L.

    This dissertation presents research done on utilizing the ferromagnetic semiconductor europium sulfide (EuS) to inject spin polarized electrons into the non-magnetic semiconductor indium arsenide (InAs). There is great interest in expanding the functionality of modern day electronic circuits by creating devices that depend not only on the flow of charge in the device, but also on the transport of spin through the device. Within this mindset, there is a concerted effort to establish an efficient means of injecting and detecting spin polarized electrons in a two dimensional electron system (2DES) as the first step in developing a spin based field effect transistor. Thus, the research presented in this thesis has focused on the feasibility of using EuS, in direct electrical contact with InAs, as a spin injecting electrode into an InAs 2DES. Doped EuS is a concentrated ferromagnetic semiconductor, whose conduction band undergoes a giant Zeeman splitting when the material becomes ferromagnetic. The concomitant difference in energy between the spin-up and spin-down energy bands makes the itinerant electrons in EuS highly spin polarized. Thus, in principle, EuS is a good candidate to be used as an injector of spin polarized electrons into non-magnetic materials. In addition, the ability to adjust the conductivity of EuS by varying the doping level in the material makes EuS particularly suited for injecting spins into non-magnetic semiconductors and 2DES. For this research, thin films of EuS have been grown via e-beam evaporation of EuS powder. This growth technique produces EuS films that are sulfur deficient; these sulfur vacancies act as intrinsic electron donors and the resulting EuS films behave like heavily doped ferromagnetic semiconductors. The growth parameters and deposition procedures were varied and optimized in order to fabricate films that have minimal crystalline defects. Various properties and characteristics of these EuS films were measured and compared to

  7. Endoscopic ultrasound in gastroenterology: From diagnosis to therapeutic implications

    PubMed Central

    Mekky, Mohamed A; Abbas, Wael A

    2014-01-01

    Since its advent in 1980, the scope of endoscopic ultrasound (EUS) has grown to include a wide range of indications, and it is now being incorporated as an integral part of everyday practice in the field of gastroenterology. Its use is extending from an adjuvant imaging aid to utilization as a therapeutic tool for various gastrointestinal disorders. EUS was first used to visualize remote organs, such as the pancreas and abdominal lymph nodes. When fine needle aspiration was introduced, the indications for EUS expanded to include tissue sampling for diagnostic purposes. At the same time, the needle can be used to convey a potential therapy to the internal organs, allowing access to remote sites. In this review, we aim to highlight the expanding spectrum of EUS indications and uses in the field of gastroenterology. PMID:24976718

  8. Endoscopic Ultrasound Guided Embolization of a Pancreatic Pseudoaneurysm

    PubMed Central

    Robb, Paul M.; Yeaton, Paul; Bishop, Thomas; Wessinger, John

    2012-01-01

    Pseudoaneurysms are rare complications of chronic pancreatitis and are associated with a high mortality. In this article we demonstrate a novel utilization of endoscopic ultrasound (EUS) technology to embolize a large pancreatic pseudoaneurysm when gold standard therapies had proven futile.

  9. Thymic carcinoma diagnosed by using endoscopic ultrasound with fine-needle aspiration.

    PubMed

    Patel, Pragnesh; Guider, Julie; Rahimi, Erik; Guha, Sushovan; Zhang, Songlin; Thosani, Nirav

    2016-01-01

    There is a paucity of literature on the use of endoscopic ultrasound (EUS) for evaluating superior mediastinal structures, especially the thymus gland. We report a case of thymic carcinoma diagnosed by using EUS elastography with strain ratio and fine-needle aspiration (FNA). A 64-year-old woman presented with altered mental status and was diagnosed with autoimmune encephalitis. Further work-up suggested a superior mediastinal mass, for which she underwent EUS. A hypoechoic mass was found in the superior mediastinum at the level of the aortic arch. Real-time EUS elastography showed a predominantly blue hue to the mass concerning for malignancy. FNA of the mass was performed, which revealed numerous large neoplastic cells under a background of a small lymphoid infiltrate. Immunohistochemistry was strongly positive for PAX8, pancytokeratin, and CAM5.2. The pathologic and immunohistochemical stains were consistent with thymic carcinoma. PMID:27386480

  10. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions.

    PubMed

    Patil, Rashmee; Ona, Mel A; Papafragkakis, Charilaos; Duddempudi, Sushil; Anand, Sury; Jamil, Laith H

    2016-01-01

    The use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) appears to be a safe and feasible means of confirming or excluding malignancy in the adrenal glands. EUS-FNA with biopsy of suspicious masses in either adrenal gland allows for assessment of these lesions while keeping complications relatively rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity, and a short hospital stay. Nevertheless, EUS-FNA of adrenal masses should be indicated only in selected cases, in which there is potential to either decrease unnecessary treatment or guide therapy in cancer patients by aiding in either staging of malignancy or treatment of recurrence.v. PMID:27366030

  11. Endoscopic ultrasound-guided intravascular therapy.

    PubMed

    Binmoeller, Kenneth F; Sendino, Oriol; Kane, Steven D

    2015-01-01

    The gastrointestinal tract provides a unique "window" to access vascular structures in the mediastinum and abdomen. The advent of interventional endoscopic ultrasound (EUS) has enabled access to these structures with a standard fine-needle aspiration (FNA) needle. Sclerosants, cyanoacrylate, and coils can be delivered through the lumen of the FNA needle. EUS-guided treatment of gastric varices has theoretical advantages over conventional endoscopy-guided treatment. Controlled studies are needed to determine the role of EUS-guided treatment for primary and secondary prevention of variceal bleeding. There is a growing list of novel indications for EUS-guided vascular therapy that include portal vein angiography and pressure measurements, intrahepatic portosystemic shunt placement, and micro coil embolization of vascular structures. Additionally, access and therapy of the heart and surrounding structures appears feasible. PMID:25366271

  12. New Scopes, New Accessories, New Stents for Interventional Endoscopic Ultrasound

    PubMed Central

    Chapman, Christopher G.; Siddiqui, Uzma D.

    2016-01-01

    Technological advances have rapidly expanded the therapeutic potential of endoscopic ultrasound (EUS). Innovations in stent technology; directed adjunctive therapy for pancreatic tumors, including radiofrequency ablation and fiducial marker placement; advanced imaging modalities, including needle-based confocal laser endomicroscopy; and new echoendoscopes, such as the forward-viewing linear echoendoscope, are emerging as safe and effective tools and devices for providing a broad range of treatments and therapies previously not thought possible. In this review, we summarize and discuss the new echoendoscopes, accessories, and stents for interventional EUS and highlight the recent literature on technical and therapeutic efficacy. The therapeutic role and indications for EUS are rapidly evolving well beyond its current limits as new EUS-specific designed tools are designed, and ultimately, should help achieve the goal of improving patient outcomes. PMID:26855923

  13. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions

    PubMed Central

    Patil, Rashmee; Ona, Mel A.; Papafragkakis, Charilaos; Duddempudi, Sushil; Anand, Sury; Jamil, Laith H.

    2016-01-01

    The use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) appears to be a safe and feasible means of confirming or excluding malignancy in the adrenal glands. EUS-FNA with biopsy of suspicious masses in either adrenal gland allows for assessment of these lesions while keeping complications relatively rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity, and a short hospital stay. Nevertheless, EUS-FNA of adrenal masses should be indicated only in selected cases, in which there is potential to either decrease unnecessary treatment or guide therapy in cancer patients by aiding in either staging of malignancy or treatment of recurrence.v PMID:27366030

  14. New Scopes, New Accessories, New Stents for Interventional Endoscopic Ultrasound.

    PubMed

    Chapman, Christopher G; Siddiqui, Uzma D

    2016-01-01

    Technological advances have rapidly expanded the therapeutic potential of endoscopic ultrasound (EUS). Innovations in stent technology; directed adjunctive therapy for pancreatic tumors, including radiofrequency ablation and fiducial marker placement; advanced imaging modalities, including needle-based confocal laser endomicroscopy; and new echoendoscopes, such as the forward-viewing linear echoendoscope, are emerging as safe and effective tools and devices for providing a broad range of treatments and therapies previously not thought possible. In this review, we summarize and discuss the new echoendoscopes, accessories, and stents for interventional EUS and highlight the recent literature on technical and therapeutic efficacy. The therapeutic role and indications for EUS are rapidly evolving well beyond its current limits as new EUS-specific designed tools are designed, and ultimately, should help achieve the goal of improving patient outcomes. PMID:26855923

  15. New Scopes, New Accessories, New Stents for Interventional Endoscopic Ultrasound.

    PubMed

    Chapman, Christopher G; Siddiqui, Uzma D

    2016-01-01

    Technological advances have rapidly expanded the therapeutic potential of endoscopic ultrasound (EUS). Innovations in stent technology; directed adjunctive therapy for pancreatic tumors, including radiofrequency ablation and fiducial marker placement; advanced imaging modalities, including needle-based confocal laser endomicroscopy; and new echoendoscopes, such as the forward-viewing linear echoendoscope, are emerging as safe and effective tools and devices for providing a broad range of treatments and therapies previously not thought possible. In this review, we summarize and discuss the new echoendoscopes, accessories, and stents for interventional EUS and highlight the recent literature on technical and therapeutic efficacy. The therapeutic role and indications for EUS are rapidly evolving well beyond its current limits as new EUS-specific designed tools are designed, and ultimately, should help achieve the goal of improving patient outcomes.

  16. Barrett's esophagus.

    PubMed

    Canto, Marcia Irene

    2005-01-01

    Esophageal cancer staging is a widely accepted indication for endoscopic ultrasonography (EUS). The evaluation of Barrett's esophagus (BE) with EUS is indicated only when there is high-grade dysplasia or a concern for malignancy in an endoscopic lesion. Because the options for the management of BE and early adenocarcinoma are diverse, proper selection of patients by accurate staging with EUS is critical, particularly when nonoperative management is considered. For example, patients with BE with high-grade dysplasia may be offered esophagectomy in some medical centers, but nonoperative therapies such as endoscopic ablative therapy or mucosal resection may be the preferred treatment options in other gastroenterology practices. This article discusses the scientific evidence for the use of EUS in BE or early esophageal adenocarcinoma.

  17. Endoscopic Ultrasound for Preoperative Esophageal Squamous Cell Carcinoma: a Meta-Analysis

    PubMed Central

    Huang, Xin-xin; Shan, Hong-bo; Luo, Guang-yu; Li, Yin; Lin, Shi-yong; Wang, Guo-bao; Zhang, Rong; Xu, Guo-liang; Li, Jian-jun

    2016-01-01

    Background Treatment options and prognosis of esophageal squamous cell carcinoma (ESCC) depend on the primary tumor depth (T-staging) and regional lymph node status (N-staging). Endoscopic ultrasound (EUS) has emerged as a useful staging tool, but studies regarding its benefits have been variable. The objective of this study was to evaluate the diagnostic accuracy of EUS for detecting preoperative ESCC. Methods We included in our meta-analysis studies involving EUS-based staging of preoperative ESCC compared with pathological staging. Using a random-effects model, we performed a meta-analysis of the accuracy of EUS by calculating pooled estimates of sensitivity, specificity and the diagnostic odds ratio. In addition, we created a summary receiver operating characteristic (SROC) curve. Results Forty-four studies (n = 2880) met the inclusion criteria. The pooled sensitivity and specificity of T1 were 77% (95%CI: 73 to 80) and 95% (95%CI: 94 to 96). Among the T1 patients, EUS had a pooled sensitivity in differentiating T1a and T1b of 84% (95%CI: 80 to 88) and 83% (95%CI: 80 to 86), and a specificity of 91% (95%CI: 88 to 94) and 89% (95%CI: 86 to 92). To stage T4, EUS had a pooled sensitivity of 84% (95%CI: 79 to 89) and a specificity of 96% (95%CI: 95 to 97). The overall accuracy of EUS for T-staging was 79% (95%CI: 77 to 80), and for N-staging, 71% (95%CI: 69 to 73). Conclusions EUS has good diagnostic accuracy for staging ESCC, which has better performance in T1 sub-staging (T1a and T1b) and advanced disease (T4). PMID:27387830

  18. Endoscopic ultrasonography in the management of pancreatic cancer

    NASA Astrophysics Data System (ADS)

    Trowers, Eugene A.

    2001-05-01

    Pancreatic cancer diagnosis and management has been enhanced with the application of endoscopic ultrasound. The close proximity of the pancreas to the stomach and duodenum permits detailed imaging with intraluminal ultrasonography and staging of pancreatic tumors. EUS directed fine needle aspiration and injection may be successfully employed with patients with pancreatic cancer. Expandable metal stents can palliate patients with obstruction of the pancreaticobiliary tract as well as the gastroduodenum. The efficacy of EUS in the management of pancreatic cancer is critically reviewed.

  19. Design and Stability of an On-Orbit Attitude Control System Using Reaction Control Thrusters

    NASA Technical Reports Server (NTRS)

    Hall, Robert A.; Hough, Steven; Orphee, Carolina; Clements, Keith

    2016-01-01

    NASA is providing preliminary design and requirements for the Space Launch System Exploration Upper Stage (EUS). The EUS will provide upper stage capability for vehicle ascent as well as on-orbit control capability. Requirements include performance of on-orbit burn to provide Orion vehicle with escape velocity. On-orbit attitude control is accommodated by a on-off Reaction Control System (RCS). Paper provides overview of approaches for design and stability of an attitude control system using a RCS.

  20. Imaging of pancreas divisum by linear-array endoscopic ultrasonography

    PubMed Central

    Sharma, Malay; Pathak, Amit; Rameshbabu, Chittapuram Srinivasan; Rai, Praveer; Kirnake, Vijendra; Shoukat, Abid

    2016-01-01

    Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. Endoscopic ultrasound (EUS) is often performed to evaluate idiopathic pancreatitis and has been shown to have high accuracy in diagnosis of PD. The different techniques to identify PD by linear EUS have been described differently by different authors. If EUS is done with a proper technique it can be a valuable tool in the diagnosis of PD. The anatomical and technical background of different signs has not been described so far. This article summarizes the different techniques of imaging of pancreatic duct in a suspected case of PD and gives a technical explanation of various signs. The common signs seen during evaluation of pancreatic duct in PD are stack sign of linear EUS, crossed duct sign on linear EUS, the dominant duct and ventral dorsal duct (VD) transition. Few other signs are described which include duct above duct, short ventral duct /absent ventral duct, separate opening of ducts with no communication, separate opening of ducts with filamentous communication, stacking of duct of Santorini and indirect signs like santorinecele. The principles of the sign have been explained on an anatomical basis and the techniques and the principles described in the review will be helpful in technical evaluation of PD during EUS. PMID:26879163

  1. Imaging of pancreas divisum by linear-array endoscopic ultrasonography.

    PubMed

    Sharma, Malay; Pathak, Amit; Rameshbabu, Chittapuram Srinivasan; Rai, Praveer; Kirnake, Vijendra; Shoukat, Abid

    2016-01-01

    Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. Endoscopic ultrasound (EUS) is often performed to evaluate idiopathic pancreatitis and has been shown to have high accuracy in diagnosis of PD. The different techniques to identify PD by linear EUS have been described differently by different authors. If EUS is done with a proper technique it can be a valuable tool in the diagnosis of PD. The anatomical and technical background of different signs has not been described so far. This article summarizes the different techniques of imaging of pancreatic duct in a suspected case of PD and gives a technical explanation of various signs. The common signs seen during evaluation of pancreatic duct in PD are stack sign of linear EUS, crossed duct sign on linear EUS, the dominant duct and ventral dorsal duct (VD) transition. Few other signs are described which include duct above duct, short ventral duct /absent ventral duct, separate opening of ducts with no communication, separate opening of ducts with filamentous communication, stacking of duct of Santorini and indirect signs like santorinecele. The principles of the sign have been explained on an anatomical basis and the techniques and the principles described in the review will be helpful in technical evaluation of PD during EUS.

  2. Endoscopic approach to the diagnosis of pancreatic cystic tumor

    PubMed Central

    Kawaguchi, Yoshiaki; Mine, Tetsuya

    2016-01-01

    Because of the aging of the population, prevalence of medical checkups, and advances in imaging studies, the number of pancreatic cystic lesions detected has increased. Once these lesions are detected, neoplastic cysts should be differentiated from non-neoplastic cysts. Furthermore, because of the malignant potential of some neoplastic pancreatic cysts, further differentiation between benign and malignant cysts should be made regardless of their size. Although endoscopic ultrasound (EUS) has a very high diagnostic performance for pancreatic cystic lesions among the various imaging modalities, EUS findings alone are insufficient for the differentiation of pancreatic cysts and diagnosis of malignancy. In addition, cytology by EUS-guided fine-needle aspiration (FNA) has a high specificity but a low sensitivity for diagnosing malignancy in pancreatic cystic tumors. The levels of amylase, lipase, and tumor markers in pancreatic cystic fluid are considered auxiliary parameters for diagnosis of benign and malignant cysts, and a definitive diagnosis of malignancy using these parameters is difficult. Thus, in addition to EUS, cytology by EUS-FNA, and cystic fluid analysis, new techniques based on EUS-guided through-the-needle imaging, such as confocal laser endomicroscopy and cystoscopy, have been explored in recent years. PMID:26909130

  3. What are the current and potential future roles for endoscopic ultrasound in the treatment of pancreatic cancer?

    PubMed Central

    Oh, Stephen Y; Irani, Shayan; Kozarek, Richard A

    2016-01-01

    Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound (EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUS-guided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer. PMID:27076870

  4. Endoscopic ultrasound characteristics of pancreatic lymphoepithelial cysts: A case series from a large referral center

    PubMed Central

    Dalal, Kunal S.; DeWitt, John M.; Sherman, Stuart; Cramer, Harvey M.; Tirkes, Temel; Al-Haddad, Mohammad A.

    2016-01-01

    Background and Objectives: Lymphoepithelial cysts (LECs) of the pancreas are benign lesions that can mimic cystic neoplasms on imaging. Endoscopic ultrasound (EUS) features have not been well described. We aimed to describe the clinical and EUS characteristics of LECs and the present outcomes of management at a high-volume referral center. Materials and Methods: We identified patients who underwent EUS and were found to have LECs based on fine-needle aspiration (FNA) cytology or surgical pathology from existing databases. EUS features, imaging characteristics, and pathology results were described. Results: Sixteen patients were found to have 17 LECs. The mean size was 33 mm ± 15 mm. Locations within the pancreas included 10 lesions in the tail, 3 in the body, 1 in the uncinate process; the remaining 3 were exophytic. Six lesions were anechoic, 6 were hypoechoic, and 5 had mixed echogenicity. Nine lesions had mixed solid/cystic components, 7 were purely cystic, and 1 was solid. Cyst fluid was thick or viscous in six cases and thin in three. Eleven patients had diagnostic cytopathology. Six patients ultimately underwent surgery due to symptoms, nondiagnostic FNA, or other clinical concerns for malignancy. Conclusions: Pancreatic LECs have variable morphology and echogenicity on EUS, but the appearance of a cyst with variable solid and cystic components combined with the appearance of thick, turbid, and viscous aspirate should raise suspicion for an LEC. The majority of patients with LECs at our center avoided surgery for LECs on the basis of diagnostic EUS-FNA. PMID:27503157

  5. [Endosonography of stomach tumors].

    PubMed

    Nattermann, C; Dancygier, H

    1992-11-01

    Based on own experience and on the published literature we report about indications and efficiency of endosonography (EUS) in gastric tumors. The following conclusions can be drawn at the present time. Submucous tumors can be clearly differentiated from extragastric compressions. Although the endosonographic aspect does not allow to formulate an etiologic diagnosis, EUS findings can give hints regarding the nature of the submucous tumor (e.g. leiomyoma, lipoma, cyst). In 75% of cases malignant submucous tumors can be visualized and a correct preoperative staging can be performed. EUS is of special importance in the description of gastric carcinoma. The pT stage can be correctly determined preoperatively in about 80% (69-92%) of cases. Accompanying inflammation in early gastric cancer can lead to overstaging. The sensitivity for local lymph node metastases reaches about 77% (50-88%). Gastric non-Hodgkin lymphomas can be excellently visualized with EUS. The sensitivity amounts to 90-100% and in about 90% of cases the extent of the tumor can be correctly determined preoperatively. The response to radio-chemotherapy of gastric non-Hodgkin lymphomas can be monitored easily with the method. At the present time EUS is the most sensitive imaging tool in visualizing and staging of gastric tumors. Its main advantage is the exact demonstration of intramural and paragastric alterations. However, despite the use of high ultrasonic frequencies and the excellent demonstration of even tiny details with EUS, biopsies for histologic evaluation are still mandatory, especially when dealing with gastric ulcer.

  6. Endosonography guided management of pancreatic fluid collections.

    PubMed

    Vilmann, Andreas S; Menachery, John; Tang, Shou-Jiang; Srinivasan, Indu; Vilmann, Peter

    2015-11-01

    The revised Atlanta classification of acute pancreatitis was adopted by international consensus, and is based on actual local and systemic determinants of disease severity. The local determinant is pancreatic necrosis (sterile or infected), and the systemic determinant is organ failure. Local complications of pancreatitis can include acute peri-pancreatic fluid collection, acute necrotic collection, pseudocyst formation, and walled-off necrosis. Interventional endoscopic ultrasound (EUS) has been increasing utilized in managing these local complications. After performing a PubMed search, the authors manually applied pre-defined inclusion criteria or a filter to identify publications relevant to EUS and pancreatic collections (PFCs). The authors then reviewed the utility, efficacy, and risks associated with using therapeutic EUS and involved EUS devices in treating PFCs. Due to the development and regulatory approval of improved and novel endoscopic devices specifically designed for transmural drainage of fluid and necrotic debris (access and patency devices), the authors predict continuing evolution in the management of PFCs. We believe that EUS will become an indispensable part of procedures used to diagnose PFCs and perform image-guided interventions. After draining a PFC, the amount of tissue necrosis is the most important predictor of a successful outcome. Hence, it seems logical to classify these collections based on their percentage of necrotic component or debris present when viewed by imaging methods or EUS. Finally, the authors propose an algorithm for managing fluid collections based on their size, location, associated symptoms, internal echogenic patterns, and content.

  7. Advances in the Management of Upper Gastrointestinal Subepithelial Tumor: Pathologic Diagnosis Using Endoscopy without Endoscopic Ultrasound-Guided Biopsy

    PubMed Central

    Lee, Hang Lak

    2016-01-01

    Until now, biopsy methods for subepithelial tumors (SETs) have focused on endoscopic ultrasound (EUS)-guided biopsy; however, these methods have several limitations. We devised a simple method for pathologic diagnosis of SETs. SETs are occasionally diagnosed during endoscopy, and lesions are generally small and asymptomatic. It can be challenging to decide on a management plan for large asymptomatic SETs. EUS imaging provides information regarding the size, layer, and echo pattern of the lesions. Patient management plans have traditionally been determined based on EUS images, whereby the endoscopist chooses to either monitor or remove the tumor. However, EUS alone cannot diagnose and evaluate upper gastrointestinal SETs with high accuracy. As sufficient tissue samples are required for the accurate diagnosis of SETs, EUS-guided biopsy techniques such as EUS fine-needle aspiration and trucut biopsy are currently used. However, these methods have a relatively low diagnostic accuracy and do not always provide information upon immunohistochemical staining. Endoscopists can easily detect a submucosal mass after creating an iatrogenic mucosal ulcer, after which tissue sampling is performed by using endoscopic biopsy. Furthermore, pathologic results can differentiate between benign and premalignant lesions. Here, we introduce a simple method for the pathologic diagnosis of SETs. PMID:27246253

  8. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis

    PubMed Central

    Aravena, Carlos; Ortega, Francisco; Arenas, Alex; Majid, Adnan; Folch, Erik; Jantz, Michael A.; Fernandez-Bussy, Sebastian

    2016-01-01

    Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89%) and the specificity was 99% (CI 98–100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.

  9. [Endoluminal ultrasonography in diagnosing and treating upper urinary tract diseases].

    PubMed

    Martov, A G; Saliukova, Iu R; Saliukov, R V

    2002-01-01

    Endoluminal ultrasound scanning (EUS) of the upper urinary tracts (UUT) with intracavitary catheter sensor was performed in 15 patients (7 men and 8 women) aged 21 to 61 years. In 8 patients EUS was diagnostic (in one patient it was made twice, in 2 cases--in combination with ureteroscopy and biopsy), in 7 patients it was a diagnostic stage of the following surgical intervention, in 6--in combination with roentgenoendoscopic correction of strictures of the ureteropelvic segment (UPS) and in 1--in combination with transurethral pyelolithotripsy. A total of 16 procedures were made: 15 transurethral and 1--percutaneous. Endoluminal ultrasonography was conducted not only of the whole ureter but also of renal calycopelvic system (RAPS) which presented endosonographic semiotics of UUT. EUS has diagnosed urate concrement in 4 cases, "cross" vessels which narrowed UPS in 3 cases with late hydronephrotic transformation. In one patient EUS was carried out in combination with ureteroscopy and biopsy as a control examination 6 and 18 months after transurethral endoresection of ureteral tumor. In 6 patients with UPS strictures EUS was made for diagnosis of suspected cross vessels before endopyelotomy. No complications during EUS were encountered. Pilot experience with intracavitary ultrasonography of the UUT shows its high diagnostic potential and clinical value. This technique details inner structures of the ureter and RAPS with adjacent tissues due to minimal distance between the sensor and studied object.

  10. Feasibility and Diagnostic Yield of Endoscopic Ultrasonography-Guided Fine Needle Biopsy With a New Core Biopsy Needle Device in Patients With Gastric Subepithelial Tumors

    PubMed Central

    Lee, Minju; Min, Byung-Hoon; Lee, Hyuk; Ahn, Sangjeong; Lee, Jun Haeng; Rhee, Poong-Lyul; Kim, Jae J.; Sohn, Tae Sung; Kim, Sung; Kim, Kyoung-Mee

    2015-01-01

    Abstract As treatment decisions for patients with gastric subepithelial tumors (SETs) largely depend on the histopathologic diagnosis, noninvasive and effective tissue acquisition methods are definitely required for proper management of gastric SETs. Recently, a new endoscopic ultrasonography-guided fine needle biopsy (EUS-FNB) device with ProCore reverse bevel technology was developed. We aimed to elucidate the feasibility and diagnostic yield of EUS-FNB with this new core biopsy needle device in patients with gastric SETs. A prospectively maintained database was retrospectively reviewed to identify consecutive patients who underwent EUS-FNB with a 22-gauge ProCore needle for gastric SETs 2 cm or larger. The main outcome measurement was the diagnostic yield of EUS-FNB. Procedure results were categorized into diagnostic, suggestive, or nondiagnostic. Of the 43 patients, needle punctures were successful in all cases irrespective of tumor location. EUS-FNB procedure results were diagnostic in 86.0%, suggestive in 4.7%, and nondiagnostic in 9.3% of cases, respectively. The diagnostic yield was the highest in fundus (100.0%), followed by body (89.5%), cardia (83.3%), and antrum (50.0%). All 18 patients with cardiac SET were finally diagnosed to have leiomyoma, and 16 patients with diagnostic or suggestive results avoided surgery. A heterogeneous echo pattern on EUS was found in 33.3% of cases with nondiagnostic or suggestive results and in 5.4% with diagnostic results. In multivariate analysis, no independent predictor of unsuccessful EUS-FNB with nondiagnostic or suggestive results was identified. Agreement between EUS-FNB and surgical pathology was 100% with respect to the diagnosis of gastrointestinal stromal tumor. However, there was a significant discrepancy in mitotic counts observed between the EUS-FNB and surgical specimens in patients with gastrointestinal stromal tumor. There were no significant procedure-related adverse events during and after the

  11. Endoscopic ultrasound-guided fine needle aspiration in the differentiation of type 1 and type 2 autoimmune pancreatitis

    PubMed Central

    Ishikawa, Takuya; Itoh, Akihiro; Kawashima, Hiroki; Ohno, Eizaburo; Matsubara, Hiroshi; Itoh, Yuya; Nakamura, Yosuke; Hiramatsu, Takeshi; Nakamura, Masanao; Miyahara, Ryoji; Ohmiya, Naoki; Goto, Hidemi; Hirooka, Yoshiki

    2012-01-01

    AIM: To investigate the usefulness of endoscopic ultra-sound-guided fine needle aspiration (EUS-FNA) in the differentiation of autoimmune pancreatitis (AIP). METHODS: We retrospectively reviewed 47 of 56 AIP patients who underwent EUS-FNA and met the Asian diagnostic criteria. On 47 EUS-FNA specimens, we evaluated the presence of adequate material and characteristic features of lymphoplasmacytic sclerosing pancreatitis (LPSP) and idiopathic duct-centric pancreatitis (IDCP) mentioned in the International Consensus Diagnostic Criteria and examined if these findings make a contribution to the differential diagnosis of type 1 and type 2 AIP. A disposable 22-gauge needle was used for EUS-FNA. RESULTS: Adequate specimens including pancreatic tissue for differentiating AIP from cancer were obtained from 43 of 47 patients who underwent EUS-FNA. EUS-FNA was performed from the pancreatic head in 21 cases, which is known to be technically difficult when performed by core biopsy; there was no significant difference in the results compared with pancreatic body-tail. Nine of 47 patients met level 1 findings of LPSP and 5 patients met level 2 findings of LPSP. No one met level 1 findings of IDCP, but 3 patients met level 2 findings of IDCP. Of 10 seronegative cases, 2 cases were diagnosed with “definitive type 1 AIP”, and 3 cases were diagnosed with “probable type 2 AIP” when considering both the level 2 histological findings and response to steroids. CONCLUSION: EUS-FNA is useful in the differentiation of type 1 and type 2 AIP, particularly in seronegative cases. PMID:22876041

  12. Endoscopic ultrasound-guided fine needle aspiration cytology of metastatic renal cell carcinoma to the pancreas: A multi-center experience

    PubMed Central

    Pannala, Rahul; Hallberg-Wallace, Karyn M.; Smith, Amber L.; Nassar, Aziza; Zhang, Jun; Zarka, Matthew; Reynolds, Jordan P.; Chen, Longwen

    2016-01-01

    Introduction: The increasing use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology to examine pancreatic neoplasms has led to an increase in the diagnosis of metastases to the pancreas. Renal cell carcinoma (RCC) is the most common metastasis to the pancreas. Our study examines 33 cases of metastatic RCC to the pancreas sampled by EUS-FNA from four large tertiary care hospitals. Materials and Methods: We searched the cytopathology database for RCC metastatic to the pancreas diagnosed by EUS-FNA from January 2005 to January 2015. Patient age, history of RCC, nephrectomy history, follow-up postnephrectomy, radiological impression, and EUS-FNA cytologic diagnosis were reviewed. Results: Thirty-three patients were identified. The average age was 67.5 years (range, 49–84 years). Thirty-two patients had a previous documented history of RCC. One patient had the diagnosis of pancreatic metastasis at the same time of the kidney biopsy. Thirty-one patients had been treated with nephrectomy. Twenty-seven patients were being monitored annually by computed tomography or magnetic resonance imaging. Twenty-five patients had multiple masses by imaging, but 8 patients had a single mass in the pancreas at the time of EUS-FNA. EUS-FNA of 20 cases showed classic morphology of RCC. Thirteen cases had either “atypical” clinical-radiologic features or morphologic overlaps with primary pancreatic neoplasms or other neoplasms. Cell blocks were made on all 13 cases and immunochemical stains confirmed the diagnosis. Conclusions: EUS-FNA cytology is useful for the diagnosis of metastatic RCC to the pancreas. Cytomorphology can be aided with patient history, imaging analyses, cell blocks, and immunochemical stains. PMID:27761149

  13. Accuracy of endoscopic ultrasound-guided fine-needle aspiration in the suspicion of pancreatic metastases

    PubMed Central

    2013-01-01

    Background Metastases to the pancreas are rare, and usually mistaken for primary pancreatic cancers. This study aimed to describe the histology results of solid pancreatic tumours obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosis of metastases to the pancreas. Methods In a retrospective review, patients with pancreatic solid tumours and history of previous extrapancreatic cancer underwent EUS-FNA from January/1997 to December/2010. Most patients were followed-up until death and some of them were still alive at the end of the study. The performance of EUS-FNA for diagnosis of pancreatic metastases was analyzed. Symptoms, time frame between primary tumour diagnosis and the finding of metastases, and survival after diagnosis were also analyzed. Results 37 patients underwent EUS-FNA for probable pancreas metastases. Most cases (65%) presented with symptoms, especially upper abdominal pain (46%). Median time between detection of the first tumour and the finding of pancreatic metastases was 36 months. Metastases were confirmed in 32 (1.6%) cases, 30 of them by EUS-FNA, and 2 by surgery. Other 5 cases were non-metastatic. Most metastases were from lymphoma, colon, lung, and kidney. Twelve (32%) patients were submitted to surgery. Median survival after diagnosis of pancreatic metastases was 9 months, with no difference of survival between surgical and non-surgical cases. Sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA with histology analysis of the specimens for diagnosis of pancreatic metastases were, respectively, 93.8%, 60%, 93.8%, 60% and 89%. Conclusion EUS-FNA with histology of the specimens is a sensitive and accurate method for definitive diagnosis of metastatic disease in patients with a previous history of extrapancreatic malignancies. PMID:23578194

  14. Concordance of studies for nodal staging is prognostic for worse survival in esophageal cancer.

    PubMed

    Dhupar, R; Correa, A M; Ajani, J; Betancourt, S; Mehran, R J; Swisher, S G; Hofstetter, W L

    2014-01-01

    Pretreatment clinical staging in esophageal cancer influences prognosis and treatment strategy. Current staging strategies utilize multiple imaging modalities, and often the results are contradictory. No studies have examined the implications of concordance of computed tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS) when used for the evaluation of nodal disease. The objective of this study was to determine if concordance of CT, PET, or EUS for nodal disease predicts worse overall survival. We reviewed 615 esophageal cancer patients with pretreatment CT, PET, and EUS that underwent esophagectomy for survival outcomes based on concordance of studies for nodal disease. Concordant N+ is defined as two or three studies positive for nodal disease; non-concordant N+ is defined as only one positive study. Node-positive disease by any study predicted shorter survival than node-negative disease (42% vs. 73% 5-year survival; P<0.001). Additionally, non-concordant N+ patients had shorter survival than N- patients (52% vs. 73% 5-year survival; P<0.001). Concordant N+ patients had shorter survival than non-concordant N+ patients (38- vs. 61-month median survival; P=0.017). There were no statistically significant differences in survival based on specific combinations of studies. When PET was disregarded, patients with both CT+ and EUS+ had shorter survival than patients with either CT+ or EUS+ (39- vs. 58-month median survival; P=0.029). Pretreatment CT, PET, or EUS concordance for node-positive disease predicts shorter overall survival in patients that undergo esophagectomy for esophageal cancer. Predicting survival in esophageal cancer should consider the synergistic capabilities of CT, PET, and EUS in evaluating nodal status.

  15. Pathologic evaluation of a new endoscopic ultrasound needle designed to obtain core tissue samples: A pilot study

    PubMed Central

    Adler, Douglas G.; Witt, Benjamin; Chadwick, Barbara; Wells, Jason; Taylor, Linda Jo; Dimaio, Christopher; Schmidt, Robert

    2016-01-01

    Background and Objectives: Standard endoscopic ultrasound-fine-needle aspiration (EUS-FNA) needles are in widespread use. Meaningful differences between the available needles have been difficult to identify. Recently, a new EUS needle (Shark Core®, Covidien, Dublin, Leinster, Ireland), has been introduced in an attempt to improve diagnostic accuracy, tissue yield, and to potentially obtain a core tissue sample. We performed a pilot study prospectively to evaluate this new needle when compared to a standard EUS-FNA needle. Materials and Methods: Analysis of the first 15 patients undergoing EUS-FNA with the Shark Core needle was performed and it was compared to EUS-FNA in 15 patients who underwent EUS-FNA with a standard needle. Results: The Shark Core needle required fewer needle passes to obtain diagnostic adequacy than the standard needle [(χ2(1) = 11.3, P < 0.001]. The Shark Core needle required 1.5 passes to reach adequacy, whereas the standard needle required three passes. For cases with cell blocks, the Shark Core needle produced diagnostic material in 85% of cases [95% confidence interval (CI): 54–98], whereas the standard needle produced diagnostic material in 38% of the cases (95% CI: 9-76). The Shark Core needle produced actual tissue cores 82% of the time (95% CI: 48–98) and the standard needle produced no tissue cores (95% CI: 0-71) (P = 0.03). Conclusion: This pilot study found that the Shark Core needle had a high rate of producing adequate cytologic material for the diagnosis of pancreatic and peri-pancreatic lesions sampled by EUS with fewer passes required to obtain a definitive diagnosis and with a high rate of tissue cores being obtained when compared to a standard FNA needle. PMID:27386475

  16. Long-Term Effects of Simulated Childbirth Injury on Function and Innervation of the Urethra

    PubMed Central

    Song, Qi-Xiang; Balog, Brian M.; Kerns, James; Lin, Dan Li; Sun, Yinghao; Damaser, Margot S.; Jiang, Hai-Hong

    2016-01-01

    Aims Pudendal nerve and external urethral sphincter (EUS) injury during vaginal delivery are risk factors for stress urinary incontinence (SUI). Although most patients with short-term postpartum SUI regain continence within 1 year, they have a higher predisposition to develop recurrent SUI years later, suggesting a possible mechanistic relationship. In contrast, animal models generally recover spontaneously and have not been studied much in the long term. The aim of this study was to investigate the long-term effects of simulated childbirth injury in rats. Methods Thirty-four Sprague–Dawley female rats underwent sham injury or pudendal nerve crush and vaginal distension (PNC + VD), a simulated childbirth injury. Nine weeks later, leak point pressure (LPP) and EUS electromyography (EMG) were recorded simultaneously. The pudendal nerve was harvested for histological analysis. EUS neuromuscular junctions (NMJs) and their innervation were qualitatively assessed using immunofluorescence. A t-test was used to compare quantitative outcomes between groups, with P <0.05 indicating a significant difference. Results There was no significant difference in LPP or EUS EMG amplitude or firing rate between the two groups. Nonetheless after PNC + VD, NMJs in the EUS were diffuse and were innervated by tortuous and multiple axons, demonstrating that reinnervation of the EUS was still in progress. Conclusions Although continence function recovered 9 weeks after simulated childbirth injury, innervation of EUS was not complete at this time point, suggestive of persistent neurogenic deficiency which when compounded by the effects of aging may lead to a delayed recurrence of SUI in this animal model with increased age. PMID:24501018

  17. Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

    PubMed Central

    Kawakami, Hiroshi; Itoi, Takao; Sakamoto, Naoya

    2014-01-01

    Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris. PMID:25071899

  18. Uncommon complications of therapeutic endoscopic ultrasonography: What, why, and how to prevent

    PubMed Central

    Chantarojanasiri, Tanyaporn; Aswakul, Pitulak; Prachayakul, Varayu

    2015-01-01

    There is an increasing role for endoscopic ultrasound (EUS)-guided interventions in the treatment of many conditions. Although it has been shown that these types of interventions are effective and safe, they continue to be considered only as alternative treatments in some situations. This is in part due to the occurrence of complications with these techniques, which can occur even when performed by experienced endosonographers. Although common complications have been described for many procedures, it is also crucial to be aware of uncommon complications. This review describes rare complications that have been reported with several EUS-guided interventions. EUS-guided biliary drainage is accepted as an alternative treatment for malignant biliary obstruction. Most of the uncommon complications related to this procedure involve stent malfunction, such as the migration or malposition of stents. Rare complications of EUS-guided pancreatic pseudocyst drainage can result from air embolism and infection. Finally, a range of uncommon complications has been reported for EUS-guided celiac plexus neurolysis, involving neural and vascular injuries that can be fatal. The goal of this review is to identify possible complications and promote an understanding of how they occur in order to increase general awareness of these adverse events with the hope that they can be avoided in the future. PMID:26265989

  19. Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy.

    PubMed

    Nieuwoudt, Martin; Lameris, Roeland; Corcoran, Craig; Rossouw, Theresa M; Slavik, Tomas; Du Plessis, Johannie; Omoshoro-Jones, Jones A O; Stivaktas, Paraskevi; Potgieter, Fritz; Van der Merwe, Schalk W

    2014-09-01

    Abdominal lymphadenopathy in human immunodeficiency virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study by recruiting 31 symptomatic HIV + patients with abdominal lymphadenopathy and assessing the diagnostic yield of endoscopic ultrasound fine-needle aspiration (EUS-FNA). Mean age was 38 years; 52% were female; and mean CD4 count and viral load were 124 cells/μL and 4 log, respectively. EUS confirmed additional mediastinal nodes in 26%. The porta hepatis was the most common abdominal site. Aspirates obtained by EUS-FNA were subjected to cytology, culture and polymerase chain reaction (PCR) analysis. Mycobacterial infections were confirmed in 67.7%, and 31% had reactive lymphadenopathy. Cytology and culture had low sensitivity, whereas PCR identified 90% of mycobacterial infections. By combining the appearance of aspirates obtained by EUS-FNA and cytologic specimens, we developed a diagnostic algorithm to indicate when analysis with PCR would be useful. PCR performed on material obtained by EUS-FNA was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.

  20. A novel fusion imaging system for endoscopic ultrasound

    PubMed Central

    Gruionu, Lucian Gheorghe; Săftoiu, Adrian; Gruionu, Gabriel

    2016-01-01

    Background and Objective: Navigation of a flexible endoscopic ultrasound (EUS) probe inside the gastrointestinal (GI) tract is problematic due to the small window size and complex anatomy. The goal of the present study was to test the feasibility of a novel fusion imaging (FI) system which uses electromagnetic (EM) sensors to co-register the live EUS images with the pre-procedure computed tomography (CT) data with a novel navigation algorithm and catheter. Methods: An experienced gastroenterologist and a novice EUS operator tested the FI system on a GI tract bench top model. Also, the experienced gastroenterologist performed a case series of 20 patients during routine EUS examinations. Results: On the bench top model, the experienced and novice doctors reached the targets in 67 ± 18 s and 150 ± 24 s with a registration error of 6 ± 3 mm and 11 ± 4 mm, respectively. In the case series, the total procedure time was 24.6 ± 6.6 min, while the time to reach the clinical target was 8.7 ± 4.2 min. Conclusions: The FI system is feasible for clinical use, and can reduce the learning curve for EUS procedures and improve navigation and targeting in difficult anatomic locations. PMID:26879165

  1. Emergence of Epizootic Ulcerative Syndrome in Native Fish of the Murray-Darling River System, Australia: Hosts, Distribution and Possible Vectors

    PubMed Central

    Boys, Craig A.; Rowland, Stuart J.; Gabor, Melinda; Gabor, Les; Marsh, Ian B.; Hum, Steven; Callinan, Richard B.

    2012-01-01

    Epizootic ulcerative syndrome (EUS) is a fish disease of international significance and reportable to the Office International des Epizootics. In June 2010, bony herring Nematalosa erebi, golden perch Macquaria ambigua, Murray cod Maccullochella peelii and spangled perch Leiopotherapon unicolor with severe ulcers were sampled from the Murray-Darling River System (MDRS) between Bourke and Brewarrina, New South Wales Australia. Histopathology and polymerase chain reaction identified the fungus-like oomycete Aphanomyces invadans, the causative agent of EUS. Apart from one previous record in N. erebi, EUS has been recorded in the wild only from coastal drainages in Australia. This study is the first published account of A. invadans in the wild fish populations of the MDRS, and is the first confirmed record of EUS in M. ambigua, M. peelii and L. unicolor. Ulcerated carp Cyprinus carpio collected at the time of the same epizootic were not found to be infected by EUS, supporting previous accounts of resistance against the disease by this species. The lack of previous clinical evidence, the large number of new hosts (n = 3), the geographic extent (200 km) of this epizootic, the severity of ulceration and apparent high pathogenicity suggest a relatively recent invasion by A. invadans. The epizootic and associated environmental factors are documented and discussed within the context of possible vectors for its entry into the MDRS and recommendations regarding continued surveillance, research and biosecurity are made. PMID:22558170

  2. Endoscopic Ultrasound-Guided Biliary Drainage Using a Fully Covered Metallic Stent after Failed Endoscopic Retrograde Cholangiopancreatography.

    PubMed

    Guo, Jintao; Sun, Siyu; Liu, Xiang; Wang, Sheng; Ge, Nan; Wang, Guoxin

    2016-01-01

    Background and Study Aims. Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) is an alternative treatment for biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). In this study, we present the outcomes of inpatients with obstructive jaundice treated with EUS-BD using a fully covered metallic stent after failed ERCP. Patients and Methods. A total of 21 patients with biliary obstruction due to malignant tumors and prior unsuccessful ERCP underwent EUS via an intra- or extrahepatic approach with fully covered metallic stent between March 2014 and October 2015. A single endoscopist performed all procedures. Results. Seven patients underwent hepatogastrostomy (HGS) and 14 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were both 100%. There was no difference in efficacy between HGS and CDS. Adverse events occurred in three patients, including two in the HGS group (1 bile leakage and 1 sepsis) and one in the CDS group (sepsis). Four patients died as a result of their primary tumors during a median follow-up period of 13 months (range: 3-21 months). No patient presented with stent migration. Conclusion. EUS-BD using a fully covered metallic stent appears to be a safe and effective method for the treatment of obstructive jaundice. PMID:27594881

  3. The Accuracies of Diagnosing Pancreas Divisum by Magnetic Resonance Cholangiopancreatography and Endoscopic Ultrasound: A Systematic Review and Meta-analysis

    PubMed Central

    Shen, Zhe; Munker, Stefan; Zhou, Boyan; Li, Lin; Yu, Chaohui; Li, Youming

    2016-01-01

    Magnetic resonance cholangiopancreatography (MRCP), MRCP after secretin stimulation (S-MRCP) and endoscopic ultrasonography (EUS) are all selected to diagnose pancreas divisum. However, the accuracies of three diagnosis remain unclear. The aim is to address the diagnostic accuracies of MRCP, S-MRCP and EUS on pancreas divisum. We searched PubMed, MEDLINE and EMBASE databases from inception to January, 2015. Of the 536 citations retrieved, 16 studies were included. For MRCP diagnosis on pancreas divisum, the area under the hierarchical summary receiver-operating characteristic (HSROC) curve was 0.90 (95% confidence interval [CI] 0.87 to 0.92), and for S-MRCP and EUS, 0.99 (95% CI 0.97 to 0.99) and 0.97 (95% CI 0.96 to 0.98). Sensitivity and specificity for MRCP were 0.59 (95% CI 0.45 to 0.71) and 0.99 (95% CI 0.96 to 1.00); for S-MRCP, 0.83 (95% CI 0.66 to 0.92) and 0.99 (95% CI 0.96 to 1.00); for EUS, 0.85 (95% CI 0.67 to 0.94) and 0.97 (95% CI 0.90 to 0.99). Comprehensive comparison of three diagnostic techniques to pancreas divisum, S-MRCP was more reliable than MRCP and EUS on the effect of the diagnostic test. PMID:27734952

  4. Endoscopic Ultrasonography-Guided Ethanol Ablation for Small Pancreatic Neuroendocrine Tumors: Results of a Pilot Study

    PubMed Central

    Choi, Jun-Ho; Oh, Dongwook; Lee, Sang Soo; Seo, Dong-Wan; Lee, Sung Koo; Kim, Myung-Hwan

    2015-01-01

    Background/Aims Endoscopic ultrasonography (EUS)-guided ethanol ablation is gaining popularity for the treatment of focal pancreatic lesions. The aim of this study was to evaluate the safety, feasibility, and treatment response after EUS-guided ethanol injection for small pancreatic neuroendocrine tumors (p-NETs). Methods This was a retrospective analysis of a prospectively collected database including 11 consecutive patients with p-NETs who underwent EUS-guided ethanol injection. Results EUS-guided ethanol injection was successfully performed in 11 patients with 14 tumors. The final diagnosis was based on histology and clinical signs as follows: 10 non-functioning neuroendocrine tumors and four insulinomas. During follow-up (median, 370 days; range, 152 to 730 days), 10 patients underwent clinical follow-up after treatment, and one patient was excluded because of loss to follow-up. A single treatment session with an injection of 0.5 to 3.8 mL of ethanol resulted in complete responses (CRs) at the 3-month radiologic imaging for seven of 13 tumors (response rate, 53.8%). Multiple treatment sessions performed in three tumors with residual viable enhancing tissue increased the number of tumors with CRs to eight of 13 (response rate, 61.5%). Mild pancreatitis occurred in three of 11 patients. Conclusions EUS-guided ethanol injection appears to be a safe, feasible, and potentially effective method for treating small p-NETs in patients who are poor surgical candidates. PMID:25844345

  5. Resected tumor seeding in stomach wall due to endoscopic ultrasonography-guided fine needle aspiration of pancreatic adenocarcinoma

    PubMed Central

    Tomonari, Akiko; Katanuma, Akio; Matsumori, Tomoaki; Yamazaki, Hajime; Sano, Itsuki; Minami, Ryuki; Sen-yo, Manabu; Ikarashi, Satoshi; Kin, Toshifumi; Yane, Kei; Takahashi, Kuniyuki; Shinohara, Toshiya; Maguchi, Hiroyuki

    2015-01-01

    Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is a useful and relatively safe tool for the diagnosis and staging of pancreatic cancer. However, there have recently been several reports of tumor seeding after EUS-FNA of adenocarcinomas. A 78-year-old man was admitted to our hospital due to upper gastric pain. Examinations revealed a 20 mm mass in the pancreatic body, for which EUS-FNA was performed. The cytology of the lesion was adenocarcinoma, and the stage of the cancer was T3N0M0. The patient underwent surgery with curative intent, followed by adjuvant chemotherapy with S-1. An enlarging gastric submucosal tumor was found on gastroscopy at 28 mo after surgery accompanied by a rising level of CA19-9. Biopsy result was adenocarcinoma, consistent with a pancreatic primary tumor. Tumor seeding after EUS-FNA was strongly suspected. The patient underwent surgical resection of the gastric tumor with curative intent. The pathological result of the resected gastric specimen was adenocarcinoma with a perfectly matched mucin special stain result with the previously resected pancreatic cancer. This is the first case report of tumor seeding after EUS-FNA which was surgically resected and inspected pathologically. PMID:26217099

  6. Endoscopic diagnosis and treatment of pancreatic neuroendocrine tumors.

    PubMed

    Rustagi, Tarun; Farrell, James J

    2014-01-01

    Pancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms comprising only 1% to 2% of all pancreatic tumors. In recent years, the number of incidentally discovered PNETs has greatly increased given the widespread use of axial imaging. However, a significant proportion of PNETs may not be visualized on conventional imaging such as computed tomography, magnetic resonance imaging, and somatostatin receptor scintigraphy. Endoscopic ultrasound (EUS) has become an integral part of the diagnosis of PNETs because of its high sensitivity for detecting, localizing, and diagnosing PNETs. EUS-guided tissue acquisition provides histologic and immunologic confirmation, and may also allow prognostication about tumor behavior. In addition to preoperative assessment of these tumors, EUS has also been shown to have an important role in nonoperative management of small nonfunctional PNETs. Finally, recent developments suggest that interventional EUS may be used to aid intraoperative localization of PNETs and to deliver therapeutic agents for the treatment of PNETs. This review will discuss the endoscopic diagnosis and treatment of PNETs, with focus on recent advances in the utility of EUS in the clinical management of these tumors.

  7. Somatomotor and sensory urethral control of micturition in female rats

    PubMed Central

    Cruz, Yolanda; Pastelín, César; Balog, Brian M.; Zaszczurynski, Paul J.

    2014-01-01

    In rats, axons of external urethral sphincter (EUS) motoneurons travel through the anastomotic branch of the pudendal nerve (ABPD) and anastomotic branch of the lumbosacral trunk (ABLT) and converge in the motor branch of the sacral plexus (MBSP). The aim of the present study was to determine in female rats the contribution of these somatomotor pathways and urethral sensory innervation from the dorsal nerve of the clitoris on urinary continence and voiding. EUS electromyographic (EMG) activity during cystometry, leak point pressure (LPP), and voiding efficiency (VE) were assessed in anesthetized virgin Sprague-Dawley female rats before and after transection of the above nerve branches. Transection of the MBSP eliminated EUS EMG, decreased LPP by 50%, and significantly reduced bladder contraction duration, peak pressure, intercontraction interval, and VE. Transection of the ABPD or ABLT decreased EUS EMG discharge and LPP by 25% but did not affect VE. Transection of the dorsal nerve of the clitoris did not affect LPP but reduced contraction duration, peak pressure, intercontraction interval, and VE. We conclude that somatomotor control of micturition is provided by the MBSP with axons travelling through the ABPD and ABLT. Partial somatomotor urethral denervation induces mild urinary incontinence, whereas partial afferent denervation induces voiding dysfunction. ABPD and ABLT pathways could represent a safeguard ensuring innervation to the EUS in case of upper nerve damage. Detailed knowledge of neuroanatomy and functional innervation of the urethra will enable more accurate animal models of neural development, disease, and dysfunction in the future. PMID:25339694

  8. Prospective evaluation of endoscopic ultrasonography in the diagnosis of biliary microlithiasis in patients with normal transabdominal ultrasonography.

    PubMed

    Mirbagheri, Seyed Amir; Mohamadnejad, Mehdi; Nasiri, Jafar; Vahid, Ahad Atef; Ghadimi, Ramin; Malekzadeh, Reza

    2005-01-01

    Prior investigators have proposed microlithiasis as a causative factor for occult gallbladder diseases. Endoscopic ultrasonography (EUS) is potentially far more sensitive than transabdominal ultrasonography (TUS) in visualizing small stones. The aim of this study was to investigate the role of endoscopic ultrasonography (EUS) in the diagnosis of microlithiasis in patients with upper abdominal pain and normal TUS. Thirty-five patients with biliary-type abdominal pain and normal TUS results were prospectively studied. All patients underwent radial EUS by means of a GF UM-20 echoendoscope (Olympus Optical, Tokyo, Japan). Of 35 patients, 33 were revealed to have gallbladder sludge or small stones, and 21 had CBD sludge or microlithiasis. Nine patients were not available for follow-up; of the remaining patients, 13 underwent combined endoscopic biliary sphincterotomy and cholecystectomy, 10 underwent cholecystectomy, and 3 underwent biliary sphincterotomy alone. In a postoperative follow-up at 9.2 months, 25 patients (96.2%) were symptom free. EUS is an important diagnostic tool in patients with unexplained biliary colic. Cholecystectomy with or without EUS is an effective treatment modality in these settings.

  9. Endoscopic Ultrasound of the Upper Gastrointestinal Tract and Mediastinum: Diagnosis and Therapy

    SciTech Connect

    Prasad, Priyajit; Wittmann, Johannes; Pereira, Stephen P.

    2006-12-15

    Endoscopic ultrasound (EUS) has developed significantly over the last two decades and has had a considerable impact on the imaging and staging of mass lesions within or in close proximity to the gastrointestinal (GI) tract. In conjunction with conventional imaging such as helical computed tomography and magnetic resonance imaging, the indications for EUS include (1) differentiating between benign and malignant lesions of the mediastinum and upper GI tract, (2) staging malignant tumors of the lung, esophagus, stomach, and pancreas prior to surgery or oncological treatment, (3) excluding common bile duct stones before laparoscopic cholecystectomy, thereby avoiding the need for endoscopic retrograde cholangiopancreatography (ERCP) in some patients, and (4) assessing suspected lesions that are either equivocal or not seen on conventional imaging. In recent years, EUS has charted a course similar to that taken by ERCP, evolving from a purely diagnostic modality to one that is interventional and therapeutic. These indications include (5) obtaining a tissue diagnosis by EUS-guided fine-needle aspiration or trucut-type needle biopsy and (6) providing therapy such as coeliac plexus neurolysis and pancreatic pseudocyst drainage-in many cases, more accurately and safely than conventional techniques. Emerging investigational techniques include EUS-guided enteric anastomosis formation and fine-needle injection therapy for malignant disease.

  10. Tectonic and neotectonic framwork of the Yucca Mountain region, Task 5

    SciTech Connect

    Schweickert, R.A.

    1993-09-30

    Research continued on the tectonic and neotectonics of the Yucca Mountain region. Highlights from projects include: structural studies in Grapevine Mountains, Funeral Mountains, Bullfrog Hills, and Bare Mountain; development of structural models for pre-Middle Miocene normal and strike-slip faulting at Bare Mountain; Paleomagnetic analysis of Paleozoic and Cenozoic units at Bare Mountain; sampling of pegmatites in Bullfrog Hills and Funeral Mountains for U-Pb isotopic analysis; and review and analysis of Mesozoic structure between eastern sierra and Nevada test Site.

  11. [Parasite fauna of Austrian owls (Strigiformes)].

    PubMed

    Kutzer, E; Frey, H; Nöbauer, H

    1982-11-01

    During the examination of 182 owls--Asio otus (51), Strix aluco (44), Bubo bubo (34), Nyctea scandiaca (15), Athene noctua (14), Otus scops (9), Tyto alba (4), Aegolius funereus (3), Glaucidium passerinum (2), Asio flammeus (2), indigenous "owls" (4)--5 protozoan species, 3 trematode species, 1 cestode species, 6 nematode species, 3 acanthocephalan species, 2 acaride species and 7 insect species could be discovered. Dermanyssus hirundinis was proved on the Long-eared Owl and Carnus hemapterus on the Barn Owl for the first time. The infestation frequency of endo- and ectoparasites was from medium to intense on an average, whereas the infestation intensity was from small to medium. The highest rates of infestation were found at nematodes. A case of "pseudoparasitism" was detected and the significance of the analyses of stomach-contents as a guarantee of diagnosis was pointed out.

  12. Are mature female voles more susceptible than immature ones to avian predation?

    NASA Astrophysics Data System (ADS)

    Koivunen, Vesa; Korpimäki, Erkki; Hakkarainen, Harri

    1998-08-01

    It is well known that a number of activities related to reproduction can increase the predation risk for individuals. Both in the aviary and in the field, we studied whether maturity of female field voles ( Microtus agrestis) affected their behaviour and consequently their risk of predation by Tengmalm's owls ( Aegolius funereus). In an aviary, we recorded the behaviour of mature and immature voles in control (owl absent) and predator (owl present) treatments, but did not find obvious differences in behaviour or vulnerability between mature and immature female voles. In the field, we compared maturity status of female field voles snap-trapped in owl territories with those caught by breeding owls in 1992 and 1994. In accordance with the results from an aviary experiment, there were no obvious differences in vulnerability to Tengmalm's owls between mature and immature individuals. This suggests that mature and immature female field voles are equally exposed to avian predation.

  13. Dye-coated europium monosulfide

    SciTech Connect

    Kar, Srotoswini; Dollahon, Norman R.; Stoll, Sarah L.

    2011-05-15

    Nanoparticles of EuS were synthesized using europium dithiocarbamate complexes. The resulting nanoparticles were coated with the dye, 1-pyrene carboxylic acid and the resulting material was characterized using X-ray powder diffraction, TEM, and UV-visible spectroscopy. Fluorescence spectroscopy was used to determine the relative energy of the conduction band edge to the excited state energy of the dye. -- Graphical abstract: Dye sensitized magnetic semiconductor materials were prepared by synthesizing EuS nanoparticles using single source precursors and coating with the dye, 1-pyrene carboxylic acid. Display Omitted highlights: > Synthesized EuS nanoparticles, 11{+-}2.4 nm characterized using XRD, TEM, and UV-vis. spect. > Grafted a dye to the surface and characterized the product using XRD, FTIR, UV-vis., and TEM. > Studied the photophysical properties using fluorescence spectroscopy. > Determined the relative dye excited state to the conduction band of the semiconductor.

  14. Endoscopic ultrasonography of duodenal aberrant pancreas: comparison with histology after endoscopic resection.

    PubMed

    Watanabe, Takashi; Aoyagi, Kunihiko; Tomioka, Yoshitaka; Ishibashi, Hideki; Nimura, Satoshi; Sakisaka, Shotaro

    2015-04-01

    We present the case of a 45-year-old man with an aberrant pancreas in the duodenum. He was referred to our hospital for gastric cancer screening. On upper gastrointestinal endoscopy, a submucosal tumor was noted in the second portion of the duodenum; it was 10 mm in diameter, with a smooth surface and bridging fold. Endoscopic ultrasonography (EUS) showed a hypoechoic lesion with small anechoic areas located in the third sonographic layer of the duodenum wall. To confirm the exact diagnosis, endoscopic resection was performed. The histological diagnosis was aberrant pancreas, Heinrich type II. The hypoechoic lesion and anechoic areas on EUS findings clearly corresponded with pancreatic acinus cells and duct dilation on histological findings, respectively. EUS findings are useful to diagnosis a duodenal aberrant pancreas that has ductal structures.

  15. Endoscopic Ultrasound-Guided Liver Biopsy in the Hands of a Chest Physician.

    PubMed

    Fally, Markus; Nessar, Rafi; Behrendt, Nille; Clementsen, Paul Frost

    2016-01-01

    Liver biopsy using transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) has never been described before and biopsies of infradiaphragmatic lesions using this technique are not considered to be standard. A patient suspected for primary lung cancer with multiple lesions in the liver was referred to our department. We conducted bronchoscopy and endobronchial ultrasound-guided (EBUS) biopsy from several enlarged mediastinal lymph nodes. Thereafter, we conducted EUS-B-FNA from a lesion in the left liver lobe. Pathology showed that the liver lesion represented a metastasis from a pulmonary adenocarcinoma. Bronchoscopy and EBUS samples were not able to establish diagnosis. We hereby demonstrated that a diagnostic EUS-B-FNA from a liver metastasis in a patient with lung cancer is possible. This underlines that chest physicians should not forget the esophagus when staging lung cancer. PMID:27287428

  16. Endoscopic ultrasonography: Challenges and opportunities in the developing world.

    PubMed

    Ahmed, Furqaan

    2014-05-01

    Endoscopic ultrasonography (EUS) has become a vital diagnostic modality for the evaluation of mediastinal lymphadenopathy, pancreatic cysts and masses, anorectal pathology, subepithelial gastrointestinal lesions, and for the staging of many gastrointestinal and pulmonary malignancies. Establishing a EUS program in a developing country presents many challenges. Doing so in Pakistan has led to the identification of the following challenges: initial investment, ongoing costs (particularly fine needle aspiration needle costs), awareness and cytopathology. Endoscopic ultrasonography has revolutionized aspects of the practice of gastroenterology and oncology in the West. This technique is becoming increasingly available in the developing world, where it poses unique challenges to its practice. These challenges include those relating to service initiation and maintenance costs, physician awareness, and on-site cytopathology access. If these issues are anticipated and addressed in ways appropriate to local circumstances, obstacles to the institution of EUS programs can be overcome.

  17. In vivo cytological observation of liver and spleen by using high-resolution microendoscopy system under endoscopic ultrasound guidance: A preliminary study using a swine model

    PubMed Central

    Suzuki, Rei; Shin, Dongsuk; Richards-Kortum, Rebecca; Coghlan, Lezlee; Bhutani, Manoop S.

    2016-01-01

    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is useful to obtain specimens from lesions underlying deep parts of the liver and spleen. However, the development of novel ancillary techniques must be explored to reduce the number of needle passes and potential adverse effects during this procedure. We conducted an animal study using a swine to demonstrate technical feasibility of in vivo cytological observation of liver and spleen using the high-resolution microendoscopy (HRME) system under EUS guidance. We successfully performed the study. No significant acute adverse events occurred during the procedure. The HRME system could obtain clear images representing cytology-level morphology of spleen and liver. Hence, it is found out that in vivo cytological observation of liver and spleen using the HRME system under EUS guidance is technically feasible. PMID:27503155

  18. Effective screening for early diagnosis of pancreatic cancer.

    PubMed

    Hanada, Keiji; Okazaki, Akihito; Hirano, Naomichi; Izumi, Yoshihiro; Minami, Tomoyuki; Ikemoto, Juri; Kanemitsu, Kozue; Hino, Fumiaki

    2015-12-01

    Diagnosis of pancreatic cancer (PC) at an early stage with curative surgery should improve long-term patient outcome. At present, improving survival should lie in identifying those cases with high-risk factors or precursor lesions through an effective screening including ultrasonography, some biological markers, or national familial pancreatic cancer registration. Recently, cases with PC < 10 mm with a favorable prognosis have been reported. For the diagnoses of cases with PC < 10 mm, the rate of tumor detection was higher on endoscopic ultrasonography (EUS) than on CT or other modalities, and EUS-guided fine needle aspiration was helpful in confirming the histologic diagnosis. Additionally, for the diagnosis of cases with PC in situ, EUS and magnetic resonance cholangiopancreatography (MRCP) may play important roles in detecting the local irregular stenosis of the pancreatic duct. Cytodiagnosis of pancreatic juice using endoscopic nasopancreatic drainage multiple times may be useful in the final diagnosis. PMID:26651254

  19. Early Gastric Cancer Just above a Heterotopic Pancreas

    PubMed Central

    Murabayashi, Toji; Kawaguchi, Shinya; Okuda, Naoko; Oyamada, Jun; Yabana, Tadashi

    2016-01-01

    We report the first case of early gastric cancer just above a heterotopic pancreas for which the differential diagnosis was carcinoma arising from heterotopic pancreas. Routine upper gastrointestinal endoscopy in an 83-year-old man with sigmoid colon cancer revealed a gastric cancer in the lesser curvature of the antrum. Endoscopic ultrasonography (EUS) for evaluating the depth of tumor invasion revealed a hypoechoic mass in the submucosal layer. The depth of tumor invasion was diagnosed as muscularis propria. Distal gastrectomy and sigmoidectomy were performed. Histologically, the resected specimen of the stomach unexpectedly revealed a heterotopic pancreas just below the gastric cancer. They were not linked, and the heterotopic pancreas had no dysplasia. The gastric cancer had slightly invaded the submucosa. The hypoechoic mass on EUS was not the invasive tumor but the heterotopic pancreas. The preoperative staging of the gastric cancer on EUS was confounded by the presence of the heterotopic pancreas just below the gastric cancer. PMID:27482189

  20. Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis

    PubMed Central

    Minaga, Kosuke; Kitano, Masayuki; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Miyata, Takeshi; Omoto, Shunsuke; Kadosaka, Kumpei; Yoshikawa, Tomoe; Kudo, Masatoshi

    2016-01-01

    Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis. PMID:27122677

  1. Identifying Patients Most Likely to Have a Common Bile Duct Stone After a Positive Intraoperative Cholangiogram

    PubMed Central

    Conway, Jason; Mishra, Girish; Baillie, John; Gilliam, John; Fernandez, Adolfo; Evans, John

    2014-01-01

    The false-positive rates of a positive intraoperative cholangiogram (IOC) are as high as 60%. Endoscopic retrograde cholangiopancreatography (ERCP) for stone removal is required after a positive IOC. It is unclear which clinical factors identify patients most likely to have a stone after a positive IOC. This study was conducted to identify factors predictive of common bile duct (CBD) stone(s) on ERCP after a positive IOC. A retrospective review of our endoscopic database identified all ERCP and/or endoscopic ultrasound (EUS) procedures performed for a positive IOC between August 2003 and August 2009. Collected data included patient demographics; indication for cholecystectomy; IOC findings; blood tests before and after cholecystectomy, including liver function tests, complete blood count, and amylase and lipase measurements; and ERCP and/or EUS results. Patients who had a negative EUS for CBD stones and no subsequent ERCP were contacted by phone to see if they eventually required an ERCP. Univariate and multi-variable analyses were performed. A total of 114 patients were included in the study. IOC findings included a single stone, multiple stones, nonpassage of contrast into the duodenum, dilated CBD, and poor visualization of the bile duct. Eighty-four percent of patients had ERCP only, 9% had EUS only, and 7% had EUS followed by ERCP. Sixty-five patients (57%) had CBD stones on ERCP or EUS. Older age, multiple stones, dilated CBD on IOC, and elevated postcholecystectomy bilirubin levels were the clinical variables with statistically significant differences on univariate analysis. On multivariable analysis, older age and elevated postcholecystectomy total bilirubin levels correlated with the presence of CBD stones on ERCP. Fifty-seven percent of patients referred for endoscopic evaluation after a positive IOC had CBD stones on ERCP. Patients with CBD stones after a positive IOC were more likely to be older with elevated post-cholecystectomy total serum bilirubin

  2. Endoscopic ultrasound examination of the upper gastrointestinal tract using a curved-array transducer. A preliminary report.

    PubMed

    Vilmann, P; Khattar, S; Hancke, S

    1991-01-01

    Endoscopic ultrasound examination (EUS) of the upper gastrointestinal (GI) tract for the assessment of mural and extramural pathology has attracted growing international interest in recent years. Since February 1989, EUS has been performed on selected patients in our institution using a new Picker-Pentax fiber-optic ultrasound (US) gastroscope. The instrument consists of a forward-view fiber-optic gastroscope with a 5-MHz curved-array linear US transducer mounted directly behind the lens. The scanning plane lies in the long axis of the scope. Based on in vitro US examinations and EUS of 118 patients over an 18-month period, our preliminary experience with the instrument is described. Using EUS, various lesions in the esophageal wall as well as in the gastric and duodenal walls can be visualized. Furthermore, organs and structures outside the GI tract can be seen, and lesions such as enlarged lymph nodes in the mediastinum and abdomen; solid and cystic masses in the liver, pancreas and retroperitoneum; arterial aneurysms; esophageal varices; and gall stones and calcifications can be demonstrated. The 5-MHz transducer does not provide very detailed information on the GI wall. The direction of the ultrasound scanning planes is difficult to define, as the transducer cannot be seen through the optic lens. The method demands great expertise in endoscopy and ultrasound. Indications for EUS have not been definitively established. Evaluation of the diagnostic accuracy of this technique requires further controlled studies. We believe that EUS using a curved-array linear transducer will provide significant diagnostic information of clinical relevance to gastroenterology. PMID:1948619

  3. Scientific publications in endoscopic ultrasonography: changing trends in the third millennium.

    PubMed

    Fusaroli, Pietro; Kypreos, Dimitrios; Alma Petrini, Chiara Ada; Caletti, Giancarlo

    2011-01-01

    The literature about endoscopic ultrasonography (EUS) is still very prolific although it was introduced in the early 1980s. We aimed to review last decade's scientific production and to compare it with our earlier data about the period from 1980 to 2000. EUS publications of the period January 2001 to January 2010 were retrieved. Reviews, prospective, and retrospective studies, randomized controlled trials, meta-analyses, surveys, guidelines, and case-series were assessed. Data were collected on the subject-matter, type of publication, number of patients included, publishing journal, most recent impact factor, year of publication, and country accredited for publication. A total of 1763 relevant papers were published in more than 250 journals. The main areas of research were pancreatic disorders, tumors of the gastrointestinal wall, the extrahepatic biliary tree, submucosal lesions, lung cancer, and mediastinal masses. It is interesting to note that the therapeutic applications of EUS accounted for a new field of investigation. The majority of articles comprised retrospective trials and reviews, followed by prospective studies and case series. However, a considerable number of randomized controlled trials and meta-analyses was retrieved, which were absent in the earlier survey. United States, Europe, and Japan still possessed a pivotal role on EUS research, but an increasing number of publications has also emerged from other countries. The available literature on EUS keeps expanding, encompassing not only its well-established diagnostic role, but also novel indications and therapeutic interventions. EUS has evolved into a valuable implement of modern clinical practice, with a critical effect on patients' management. A trend toward well-structured studies is evident.

  4. Endoscopic ultrasound-guided fiducial marker placement for image-guided radiation therapy without fluoroscopy: safety and technical feasibility

    PubMed Central

    Dhadham, Gautamy Chitiki; Hoffe, Sarah; Harris, Cynthia L.; Klapman, Jason B.

    2016-01-01

    Background and study aims: Endoscopic ultrasound (EUS)-guided fiducial marker placement for image-guided radiation treatment (IGRT) is becoming more widespread. Most case series report the procedure performed using fluoroscopy for spatial geometry although the benefits of this are unclear. The aim of our study is to report the technical feasibility, safety, and migration rate of fiducial marker placement in a large cohort of patients with gastrointestinal malignancies who underwent EUS-guided fiducial marker placement for IGRT without fluoroscopy. Patients and methods: A retrospective chart review was performed on all patients referred for EUS-guided fiducial marker placement from 08/1/07 to 7/31/14 at Moffitt Cancer Center. Results: During the study period, 514 patients underwent placement of 1093 gold fiducial markers under EUS-guidance. Two hundred and forty patients with esophageal/gastro-esophageal junction cancer had 405 fiducials placed. In 188 patients with pancreatic ancer, 510 fiducials were placed. In 54 patients with rectal cancer, 103 fiducials were placed and 32 patients had 75 fiducials placed into other gastrointestinal tract lesions. Minor bleeding, which resolved spontaneously, occurred in two patients. Technical difficulty in placing fiducials was noted in 18 patients. Intraprocedural fiducial migration was noted in two patients and only 2/1093 fiducials (.002%) in two esophageal patients migrated as noted on simulation computed tomography scan. Conclusions: EUS-guided fiducial marker placement without fluoroscopy is technically feasible and safe. There were minimal intraprocedure/post-procedure complications. Imaging at the time of simulation also revealed the migration rate to be extremely low. These results may allow for more widespread adoption of EUS-guided fiducial marker placement. PMID:27004258

  5. [Endosonography in tumors of the pancreas and bile ducts].

    PubMed

    Nattermann, C; Dancygier, H

    1993-01-01

    The sensitivity of EUS in demonstrating pancreatic tumors lies above 90% and tumors smaller than 2 cm in diameter can be visualized. Therefore EUS can be applied e.g. in the early diagnosis of symptomatic endocrine tumors. However, it is not suited as a screening method for pancreatic carcinoma in asymptomatic patients. The EUS findings do not permit a clear differentiation between malignant and inflammatory (pseudo) tumors. The specificity for the demonstration of malignant tumors is 74%. Its main importance is in the locoregional staging of tumors. EUS is superior to all other imaging tools in determining tumor extension and infiltration into the portal or splenic vein. The pT-stage is determined correctly preoperatively in 90% and lymph node metastases (N1) in about 73% (sensitivity 80-90%/specificity 50%) of the cases. Malignant tumors of Vater's papilla (ampullary tumors) and of extrahepatic bile ducts can be demonstrated endosonographically in nearly all cases. However, tumors of the proximal bile ducts, especially of the right hepatic duct are difficult and sometimes impossible to visualize. The value of EUS in bile duct cancer is in local tumor staging. The pT-stage is determined correctly in 80-90%, the sensitivity and specificity for N1-stage is 80-90% and 30% respectively. Comparative studies with other methods are lacking at the present time. The value of EUS in gall bladder tumors is not yet determined. Stones in the gall bladder may hinder the visualization of the gall bladder wall. In one study the pT-stage for gall bladder carcinoma was determined correctly preoperatively in 76.9% and the N1-stage in 80.7% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid pseudopapillary tumor of the pancreas: a case report and literature review.

    PubMed

    Salla, Charitini; Chatzipantelis, Paschalis; Konstantinou, Panagiotis; Karoumpalis, Ioannis; Pantazopoulou, Akrivi; Dappola, Victoria

    2007-10-14

    We describe the clinical, imaging and cytopathological features of solid pseudopapillary tumor of the pancreas (SPTP) diagnosed by endoscopic ultrasound-guided (EUS-guided) fine-needle aspiration (FNA). A 17-year-old woman was admitted to our hospital with complaints of an unexplained episodic abdominal pain for 2 mo and a short history of hypertension in the endocrinology clinic. Clinical laboratory examinations revealed polycystic ovary syndrome, splenomegaly and low serum amylase and carcinoembryonic antigen (CEA) levels. Computed tomography (CT) analysis revealed a mass of the pancreatic tail with solid and cystic consistency. EUS confirmed the mass, both in body and tail of the pancreas, with distinct borders, which caused dilation of the peripheral part of the pancreatic duct (major diameter 3.7 mm). The patient underwent EUS-FNA. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform malignant cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores and nuclear overlapping. Naked capillaries were also seen. The nuclei of malignant cells were round or oval, eccentric with fine granular chromatin, small nucleoli and nuclear grooves in some of them. The malignant cells were periodic acid Schiff (PAS)-Alcian blue (+) and immunocytochemically they were vimentin (+), CA 19.9 (+), synaptophysin (+), chromogranin (-), neuro-specific enolase (-), a1-antitrypsin and a1-antichymotrypsin focal positive. Cytologic findings were strongly suggestive of SPTP. Biopsy confirmed the above cytologic diagnosis. EUS-guided FNA diagnosis of SPTP is accurate. EUS findings, cytomorphologic features and immunostains of cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma and papillary mucinous carcinoma. PMID:17876886

  7. Experimental infection of Aphanomyces invadans and susceptibility in seven species of tropical fish

    PubMed Central

    Afzali, Seyedeh F.; Mohd Daud, Hassan Hj.; Sharifpour, Issa; Afsharnasab, Mohammad; Shankar, Shiv

    2015-01-01

    Aim: Epizootic ulcerative syndrome (EUS) causes by aquatic oomycete fungus, Aphanomyces invadans is a dangerous fish disease of a wide range of fresh and brackish water, wild and farmed fish throughout the world. The objective of the present study was to determine the susceptibility of a number of tropical fish species to the EUS and compare the severity of infection between experimental groups. Materials and Methods: Snakehead, Channa striata (Bloch, 1793); snakeskin gourami, Trichopodus pectoralis (Regan, 1910); koi carp, Cyprinus carpio (Linnaeus, 1758); broadhead catfish, Clarias macrocephalus (Günther, 1864); goldfish, Carassius auratus (Linnaeus, 1758); climbing perch, Anabas testudineus (Bloch, 1792); and Nile tilapia, Oreochromis niloticus (Linnaeus, 1758) were challenged by intramuscular injection using zoospores of Aphanomyces invadans (NJM9701). The infected fish skins and muscles were examined for EUS histopathological characteristics, and the results on the severity of lesions and mortality were analyzed using SPSS program. Results: All zoospore-injected fish were shown to be susceptible to the EUS infection except Nile tilapia. Although, the general histopathological pattern was similar in the zoospore-injected group, but there were some variation in granulomatous reaction, that is the presence or absence of giant cells, and time of mortality were detected. The result of statistical analysis showed that there was a significant difference between species, (c2=145.11 and p<0.01). Conclusion: Gourami, koi carp, and catfish were demonstrated to be highly susceptible while goldfish and climbing perch were found to be moderately susceptible to the EUS infection. These findings suggested that the cellular response of fish to mycotic infection and granulomatous reaction varied in different fish species, which could not be an indicator of susceptibility or resistant to the EUS itself, although it was shown that the granulation rate and the level of maturity

  8. Scientific publications in endoscopic ultrasonography: changing trends in the third millennium.

    PubMed

    Fusaroli, Pietro; Kypreos, Dimitrios; Alma Petrini, Chiara Ada; Caletti, Giancarlo

    2011-01-01

    The literature about endoscopic ultrasonography (EUS) is still very prolific although it was introduced in the early 1980s. We aimed to review last decade's scientific production and to compare it with our earlier data about the period from 1980 to 2000. EUS publications of the period January 2001 to January 2010 were retrieved. Reviews, prospective, and retrospective studies, randomized controlled trials, meta-analyses, surveys, guidelines, and case-series were assessed. Data were collected on the subject-matter, type of publication, number of patients included, publishing journal, most recent impact factor, year of publication, and country accredited for publication. A total of 1763 relevant papers were published in more than 250 journals. The main areas of research were pancreatic disorders, tumors of the gastrointestinal wall, the extrahepatic biliary tree, submucosal lesions, lung cancer, and mediastinal masses. It is interesting to note that the therapeutic applications of EUS accounted for a new field of investigation. The majority of articles comprised retrospective trials and reviews, followed by prospective studies and case series. However, a considerable number of randomized controlled trials and meta-analyses was retrieved, which were absent in the earlier survey. United States, Europe, and Japan still possessed a pivotal role on EUS research, but an increasing number of publications has also emerged from other countries. The available literature on EUS keeps expanding, encompassing not only its well-established diagnostic role, but also novel indications and therapeutic interventions. EUS has evolved into a valuable implement of modern clinical practice, with a critical effect on patients' management. A trend toward well-structured studies is evident. PMID:21063209

  9. Endoscopic Ultrasound-Guided Self-Expandable Metal Stent Placement for the Treatment of Infected Pancreatic Pseudocysts

    PubMed Central

    Masrour, Farbod; Mallat, Damien

    2014-01-01

    The standard endoscopic ultrasound (EUS) approach of cystogastrostomy involves the use of series of plastic pigtail stents that are placed through the wall of the cyst. The use of a single stent has also been described in the literature. Here we describe five cases of EUS-guided cystogastrostomy with irrigation of infected pancreatic pseudocysts using a single self-expandable metal stent (SEMS). To our knowledge this has not been described in the literature in the United States. This novice approach will have significant implications in the management of infected pseudocysts with a lower morbidity, mortality and overall cost compared to conventional management such as surgery or percutaneous drainage.

  10. Recoilless fractions calculated with the nearest-neighbour interaction model by Kagan and Maslow

    NASA Astrophysics Data System (ADS)

    Kemerink, G. J.; Pleiter, F.

    1986-08-01

    The recoilless fraction is calculated for a number of Mössbauer atoms that are natural constituents of HfC, TaC, NdSb, FeO, NiO, EuO, EuS, EuSe, EuTe, SnTe, PbTe and CsF. The calculations are based on a model developed by Kagan and Maslow for binary compounds with rocksalt structure. With the exception of SnTe and, to a lesser extent, PbTe, the results are in reasonable agreement with the available experimental data and values derived from other models.

  11. Endoscopic management of benign biliary strictures

    PubMed Central

    Visrodia, Kavel H; Tabibian, James H; Baron, Todd H

    2015-01-01

    Endoscopic management of biliary obstruction has evolved tremendously since the introduction of flexible fiberoptic endoscopes over 50 years ago. For the last several decades, endoscopic retrograde cholangiopancreatography (ERCP) has become established as the mainstay for definitively diagnosing and relieving biliary obstruction. In addition, and more recently, endoscopic ultrasonography (EUS) has gained increasing favor as an auxiliary diagnostic and therapeutic modality in facilitating decompression of the biliary tree. Here, we provide a review of the current and continually evolving role of gastrointestinal endoscopy, including both ERCP and EUS, in the management of biliary obstruction with a focus on benign biliary strictures. PMID:26322153

  12. Multiple pancreatic metastases from malignant melanoma: Conclusive diagnosis with endoscopic ultrasound-guided fine needle aspiration.

    PubMed

    Jana, Tanima; Caraway, Nancy P; Irisawa, Atsushi; Bhutani, Manoop S

    2015-01-01

    Pancreatic metastases are rare, ranging from 2% to 5% of pancreatic malignancies. Differentiating a primary pancreatic malignancy from a metastasis can be difficult due to similarities on imaging findings, but is crucial to ensure proper treatment. Although transabdominal ultrasound, computed tomography, and magnetic resonance imaging provide useful images, endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is often needed to provide a cytologic diagnosis. Here, we present a unique case of malignant melanoma with pancreatic metastases. It is important for clinicians to recognize the possibility of melanoma metastasizing to the pancreas and the role of EUS with FNA in providing cytological confirmation.

  13. Efficacy and Safety of Endoscopic Ultrasound-guided Ethanol Ablation Therapy for Pancreatic Neuroendocrine Tumors.

    PubMed

    Matsumoto, Kazuyuki; Kato, Hironari; Tsutsumi, Koichiro; Mizukawa, Sho; Yabe, Syuntaro; Seki, Hiroyuki; Akimoto, Yutaka; Uchida, Daisuke; Tomoda, Takeshi; Yamamoto, Naoki; Horiguchi, Shigeru; Okada, Hiroyuki

    2016-08-01

    Recently, endoscopic ultrasonography (EUS)-guided ethanol ablation for small pancreatic neuroendocrine tumors (p-NETs) has been reported. However, the efficacy and safety of the technique remain unclear. We have launched a prospective pilot study of EUS-guided ethanol ablation for p-NETs. The major eligibility criteria are the presence of a pathologically diagnosed grade (G) 1 or G2 p-NET, a tumor size of 2cm, and being a poor candidate for surgery. A total of 5 patients will be treated. The primary endpoint will be the complete ablation rate at 1 month after treatment. PMID:27549680

  14. Multiple pancreatic metastases from malignant melanoma: Conclusive diagnosis with endoscopic ultrasound-guided fine needle aspiration.

    PubMed

    Jana, Tanima; Caraway, Nancy P; Irisawa, Atsushi; Bhutani, Manoop S

    2015-01-01

    Pancreatic metastases are rare, ranging from 2% to 5% of pancreatic malignancies. Differentiating a primary pancreatic malignancy from a metastasis can be difficult due to similarities on imaging findings, but is crucial to ensure proper treatment. Although transabdominal ultrasound, computed tomography, and magnetic resonance imaging provide useful images, endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is often needed to provide a cytologic diagnosis. Here, we present a unique case of malignant melanoma with pancreatic metastases. It is important for clinicians to recognize the possibility of melanoma metastasizing to the pancreas and the role of EUS with FNA in providing cytological confirmation. PMID:26020050

  15. Pancreatic gout and the role of multimodality imaging in its management.

    PubMed

    Koh, Huiliang; Low, How Cheng; Seet, Ju Ee; Chua, Wynne Yuru

    2016-01-01

    Uric acid deposition in the pancreas is very rare and neither an endoscopic ultrasound (EUS) nor a contrast-enhanced CT image of this condition has ever been published. We describe a case of asymptomatic pancreatic gout that was detected incidentally on CT. Imaging features mimicked pancreatic neoplasm, warranting further evaluation with EUS-guided fine-needle aspiration. Samples revealed debris encrusted with monosodium urate crystals. Follow-up CT showed complete resolution with urate-lowering therapy. We aim to augment current knowledge on the imaging of pancreatic gout and discuss its management. PMID:27190122

  16. 28 CFR 570.42 - Non-medical escorted trips.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... member of an inmate's immediate family. For purposes of this rule, immediate family refers to mother... persons (e.g., attending physician, hospital staff, funeral home staff, family members, U.S. Probation... expenses, including transportation costs, are assumed by the inmate, the inmate's family, or...

  17. A Door Is a Big Wooden Thing with a Knob: Getting a Handle on Metaphorical Interface Design.

    ERIC Educational Resources Information Center

    Bishop, M. J.; Cates, Ward Mitchell

    This paper chronicles the evolution of a metaphorical graphical user interface (MGUI) at Lehigh University (Pennsylvania). From its inception, "The Funeral of Edgar" has been a guided exploration of Edgar Allan Poe's poem, "The Raven," aimed at modeling high school students' critical and analytical reading skills. This product is targeted for the…

  18. Campuses Offer Policies and Support Groups for Students Facing Loss

    ERIC Educational Resources Information Center

    Peterkin, Caitlin

    2012-01-01

    At many colleges, taking time off to care for a relative, or missing a few days of class to attend a funeral, can be difficult for students. They may encounter a professor who tells them, in so many words, to suck it up. They might have difficulty negotiating extensions for assignments and make-up dates for exams. Although most institutions have a…

  19. Responding to a Death in the Yeshivah Family: A Handbook/Checklist for Yeshivah Educators.

    ERIC Educational Resources Information Center

    Wolowelsky, Joel B.

    Points to consider when responding to a death in the yeshivah family for yeshivah educators are presented in this pamphlet. Using a checklist approach, questions to ask and actions to take in the event of a death in the yeshivah are listed. These include the following: (1) going to the bereaved student's home the night before the funeral; (2)…

  20. Bereavement on the College Campus: Establishing an Effective Ritual for the Classroom and beyond

    ERIC Educational Resources Information Center

    McCusker, Kristine M.; Witherow, Laurie B.

    2012-01-01

    On a Thursday night in December 2010, a Middle Tennessee State University (MTSU) first-year student stepped in front of a train and killed himself. Because it took some time for the news to reach campus and be confirmed, the student was "funeralized," as they say in the South, and buried before his professors or peers could be informed. That left…

  1. 5 CFR 630.802 - Coverage.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 630.802 Section 630.802 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Funeral Leave § 630.802 Coverage. This subpart applies to: (a) An employee as defined in section 2105 of title...

  2. 5 CFR 630.802 - Coverage.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 630.802 Section 630.802 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Funeral Leave § 630.802 Coverage. This subpart applies to: (a) An employee as defined in section 2105 of title...

  3. 5 CFR 630.802 - Coverage.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 630.802 Section 630.802 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Funeral Leave § 630.802 Coverage. This subpart applies to: (a) An employee as defined in section 2105 of title...

  4. 5 CFR 630.802 - Coverage.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 630.802 Section 630.802 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Funeral Leave § 630.802 Coverage. This subpart applies to: (a) An employee as defined in section 2105 of title...

  5. 5 CFR 630.802 - Coverage.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 630.802 Section 630.802 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Funeral Leave § 630.802 Coverage. This subpart applies to: (a) An employee as defined in section 2105 of title...

  6. The Psychological Effects of a Stillbirth on Surviving Family Members.

    ERIC Educational Resources Information Center

    DeFrain, John; And Others

    1991-01-01

    Interview and written testimony from over 300 mothers and fathers who had experienced a stillbirth suggest themes common to these bereaved families: shock, blame, guilt and hardship; desperate need to remember; utility of autopsies and funerals; irrational and terrifying thoughts; need for support systems; issues surrounding surviving siblings and…

  7. 28 CFR 570.42 - Non-medical escorted trips.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... trip for such purposes as allowing an inmate to attend the funeral of, or to make a bedside visit to, a...-medical escorted trip. An escorted trip for such purposes as allowing inmates to participate in program... account prior to the trip. Funds paid by the inmate for purposes of the escorted trip are then...

  8. 28 CFR 570.42 - Non-medical escorted trips.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... trip for such purposes as allowing an inmate to attend the funeral of, or to make a bedside visit to, a...-medical escorted trip. An escorted trip for such purposes as allowing inmates to participate in program... account prior to the trip. Funds paid by the inmate for purposes of the escorted trip are then...

  9. 28 CFR 570.42 - Non-medical escorted trips.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... trip for such purposes as allowing an inmate to attend the funeral of, or to make a bedside visit to, a...-medical escorted trip. An escorted trip for such purposes as allowing inmates to participate in program... account prior to the trip. Funds paid by the inmate for purposes of the escorted trip are then...

  10. Latinos and Anglos: Cultural Experiences of Grief Intensity.

    ERIC Educational Resources Information Center

    Grabowski, Jo-Anne; Frantz, Thomas T.

    1993-01-01

    Examined grief intensity among 50 Latino and 50 Anglo Americans. Latinos grieving sudden death had significantly greater grief intensity than Latinos grieving expected death and Anglos grieving either sudden or expected death. Funeral attendance, time since death, closeness of relationships had no significant effect on grief intensity, nor did…

  11. The Oral Tradition: Springboard for Teaching Black Literature.

    ERIC Educational Resources Information Center

    Wilson, Velez H.

    Black Americans have inherited a rich store of oral literature (folk music, folk tales, folk customs, and superstitions). When approached from the point of view of the students' experience, this oral tradition can be an effective springboard for discussion, reading, and writing in the classroom. Brass band funeral processions can be viewed as a…

  12. Star Power: Piecing Together Tradition and Community

    ERIC Educational Resources Information Center

    Peterson, Richard

    2013-01-01

    In this article, the author discusses the history and practice of "star quilt" making. The star quilt has become synonymous with the Fort Peck Indian Reservation, home to the Assiniboine and several bands of Lakota and Dakota. Receiving a quilt is considered a great honor and often takes place at powwows, funerals, memorials, and even…

  13. Educating Children to Cope with Death: A Preventive Model.

    ERIC Educational Resources Information Center

    Aspinall, S. Y.

    1996-01-01

    Reviews what is known about children's conceptions of death, how children grieve, and relevant research. Presents clinicians' guidelines on such issues as explaining death to children, attending funerals, and treating bereaved youths and their families. Outlines a death education program which incorporates developmental and theoretical principles…

  14. Diana's Eulogy: Breaking New Ground in Epideictic Rhetoric?

    ERIC Educational Resources Information Center

    Scott, David K.

    A speech in response to an individual's death is by nature a recurring form of rhetoric. Based on audience expectations and needs, certain generic aspects have emerged to characterize eulogies. The funeral oration has generally been recognized as a form of epideictic rhetoric. Modern scholars have generally broadly defined epideictic rhetoric to…

  15. Family reaction to homicide.

    PubMed

    Burgess, A N

    1975-04-01

    This pilot study identifies a two-phased syndrome experienced by families of homicide victims. The crisis phase consists of an acute grief process, including immediate reactions to the homicide, the funeral details, and police investigations. The long-term reorganization phase includes the psychological issues of bereavement and the socio-legal issues of the criminal justice process. PMID:1146971

  16. Perspectives on Death: An Experiential Course on Death Education.

    ERIC Educational Resources Information Center

    Stefan, Edwin S.

    1978-01-01

    Describes and evaluates a college psychology course on death education (thanatology). Course objectives were to help students become aware of the feelings involved in facing death, encourage discussion on the subject of death, motivate students to change their attitudes about death, and encourage practical planning for funeral arrangements.…

  17. Meeting the Needs of Our Clients Creatively: The Impact of Art and Culture on Caregiving. Death, Value and Meaning Series.

    ERIC Educational Resources Information Center

    Morgan, John D., Ed.

    This book integrates traditional understandings of care of the dying and bereaved with the use of arts and other forms of cultural creativity in therapy and funeralization. Authors provide insights into the practical aspects of caring for the dying and bereaved as well as new understandings of creativity. Chapters include: (1) "The Knowledge of…

  18. 16 CFR 453.9 - State exemptions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.9 State exemptions. If, upon application to the Commission by an appropriate state agency, the Commission determines... great as, or greater than, the protection afforded by this rule; then the Commission's rule will not...

  19. 16 CFR 453.5 - Services provided without prior approval.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Services provided without prior approval. 453.5 Section 453.5 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.5 Services provided without prior approval. (a) Unfair or deceptive acts...

  20. 16 CFR 453.7 - Comprehension of disclosures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Comprehension of disclosures. 453.7 Section 453.7 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.7 Comprehension of disclosures. To prevent the unfair or deceptive acts or practices specified...

  1. 16 CFR 453.9 - State exemptions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.9 State exemptions. If, upon application to the Commission by an appropriate state agency, the Commission determines... great as, or greater than, the protection afforded by this rule; then the Commission's rule will not...

  2. 16 CFR 453.9 - State exemptions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.9 State exemptions. If, upon application to the Commission by an appropriate state agency, the Commission determines... great as, or greater than, the protection afforded by this rule; then the Commission's rule will not...

  3. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.1 Definitions. (a..., fiberglass, plastic, or like material, and ornamented and lined with fabric. (d) Commission. “Commission” refers to the Federal Trade Commission. (e) Cremation. “Cremation” is a heating process which...

  4. 16 CFR 453.3 - Misrepresentations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.3... rebate, commission or trade or volume discount upon a cash advance item. ... federal, state, or local laws, or particular cemeteries or crematories, require the purchase of...

  5. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... and severable from one another. If any provision is determined to be invalid, it is the...

  6. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.1 Definitions. (a..., fiberglass, plastic, or like material, and ornamented and lined with fabric. (d) Commission. “Commission” refers to the Federal Trade Commission. (e) Cremation. “Cremation” is a heating process which...

  7. 16 CFR 453.3 - Misrepresentations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.3... rebate, commission or trade or volume discount upon a cash advance item. ... federal, state, or local laws, or particular cemeteries or crematories, require the purchase of...

  8. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... and severable from one another. If any provision is determined to be invalid, it is the...

  9. 16 CFR 453.7 - Comprehension of disclosures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Comprehension of disclosures. 453.7 Section 453.7 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.7 Comprehension of disclosures. To prevent the unfair or deceptive acts or practices specified...

  10. 16 CFR 453.7 - Comprehension of disclosures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Comprehension of disclosures. 453.7 Section 453.7 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.7 Comprehension of disclosures. To prevent the unfair or deceptive acts or practices specified...

  11. 16 CFR 453.9 - State exemptions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.9 State exemptions. If, upon application to the Commission by an appropriate state agency, the Commission determines... great as, or greater than, the protection afforded by this rule; then the Commission's rule will not...

  12. 16 CFR 453.5 - Services provided without prior approval.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Services provided without prior approval. 453.5 Section 453.5 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.5 Services provided without prior approval. (a) Unfair or deceptive acts...

  13. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... and severable from one another. If any provision is determined to be invalid, it is the...

  14. 16 CFR 453.7 - Comprehension of disclosures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Comprehension of disclosures. 453.7 Section 453.7 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.7 Comprehension of disclosures. To prevent the unfair or deceptive acts or practices specified...

  15. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... and severable from one another. If any provision is determined to be invalid, it is the...

  16. 16 CFR 453.3 - Misrepresentations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.3... rebate, commission or trade or volume discount upon a cash advance item. ... federal, state, or local laws, or particular cemeteries or crematories, require the purchase of...

  17. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... and severable from one another. If any provision is determined to be invalid, it is the...

  18. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.1 Definitions. (a..., fiberglass, plastic, or like material, and ornamented and lined with fabric. (d) Commission. “Commission” refers to the Federal Trade Commission. (e) Cremation. “Cremation” is a heating process which...

  19. 16 CFR 453.5 - Services provided without prior approval.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Services provided without prior approval. 453.5 Section 453.5 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.5 Services provided without prior approval. (a) Unfair or deceptive acts...

  20. 16 CFR 453.7 - Comprehension of disclosures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Comprehension of disclosures. 453.7 Section 453.7 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.7 Comprehension of disclosures. To prevent the unfair or deceptive acts or practices specified...

  1. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.1 Definitions. (a..., fiberglass, plastic, or like material, and ornamented and lined with fabric. (d) Commission. “Commission” refers to the Federal Trade Commission. (e) Cremation. “Cremation” is a heating process which...

  2. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.1 Definitions. (a..., fiberglass, plastic, or like material, and ornamented and lined with fabric. (d) Commission. “Commission” refers to the Federal Trade Commission. (e) Cremation. “Cremation” is a heating process which...

  3. 16 CFR 453.9 - State exemptions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.9 State exemptions. If, upon application to the Commission by an appropriate state agency, the Commission determines... great as, or greater than, the protection afforded by this rule; then the Commission's rule will not...

  4. 16 CFR 453.5 - Services provided without prior approval.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Services provided without prior approval. 453.5 Section 453.5 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.5 Services provided without prior approval. (a) Unfair or deceptive acts...

  5. 16 CFR 453.5 - Services provided without prior approval.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Services provided without prior approval. 453.5 Section 453.5 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.5 Services provided without prior approval. (a) Unfair or deceptive acts...

  6. 16 CFR 453.3 - Misrepresentations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.3... rebate, commission or trade or volume discount upon a cash advance item. ... federal, state, or local laws, or particular cemeteries or crematories, require the purchase of...

  7. 16 CFR 453.3 - Misrepresentations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.3... rebate, commission or trade or volume discount upon a cash advance item. ... federal, state, or local laws, or particular cemeteries or crematories, require the purchase of...

  8. Factor Analysis of the Omega Scale: A Scale Designed To Measure the Attitudes of College Students toward Their Own Deaths and the Disposition of Their Bodies.

    ERIC Educational Resources Information Center

    Staik, Irene M.

    A study was undertaken to provide a factor analysis of the Omega Scale, a 25-item, Likert-type scale developed in 1984 to assess attitudes toward death and funerals and other body disposition practices. The Omega Scale was administered to 250 students enrolled in introductory psychology classes at two higher education institutions in Alabama.…

  9. Dear Simba Is Dead Forever.

    ERIC Educational Resources Information Center

    Sandstrom, Susan

    1999-01-01

    Examines the reaction of a kindergarten class at the unexpected death of their pet rabbit. Describes their spontaneous acts of writing, talking, playacting, and planning a funeral to process the rabbit's death. Asserts that if teachers had taken charge, much of the rich experience would have been lost. (EV)

  10. Mortuary Science Programs: Examination of the External Evaluation Team

    ERIC Educational Resources Information Center

    Reinhard, D. Elaine

    2010-01-01

    The purpose of this study is to expand the literature on mortuary science accreditation site visit teams. This study used a mixed methodology design to examine: (1) who serves on the American Board of Funeral Service Education accreditation external site visit teams; (2) reasons for involvement in accreditation; (3) perceptions of important site…

  11. Attitudes on Death and Dying.

    ERIC Educational Resources Information Center

    Andrus, Charles E.

    This paper explored attitudes toward death and dying revealed through interviews with members of the clergy, the medical profession, funeral directors, nursing home residents, and selected others. The sampling was small and results are not intended to be representative of the groups to which these people belong. Rather, the study may be used as a…

  12. 77 FR 64378 - Proposed Collection; Comment Request for Form 1041-QFT

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-19

    ... Internal Revenue Service Proposed Collection; Comment Request for Form 1041-QFT AGENCY: Internal Revenue...(c)(2)(A)). Currently, the IRS is soliciting comments concerning Form 1041-QT, U.S. Income Tax Return...: 1041-QFT. Abstract: Internal Revenue Code section 685 allows the trustee of a qualified funeral...

  13. A Comparative Analysis of the Availability of Information Resources on Ibibio Culture in the University of Uyo and Akwa Ibom State Public Library

    ERIC Educational Resources Information Center

    Okon, Henry Itohowo; Simon, Jehu S.; Akai, Iniobong

    2015-01-01

    This study reports the results of a survey of the available holdings of information resources on Ibibio culture in the University of Uyo Library and Akwa Ibom State Library. The specific objectives of the study were to determine the different size of information resources on funeral, fattening (Mbobo), taboos, myths as well as dissemination in the…

  14. Virginia Tech: The Challenge of Assuring Safety

    ERIC Educational Resources Information Center

    Rikleen, Lauren Stiller

    2007-01-01

    The recent events at Virginia Tech reinforce the idea that nothing is more fundamental for college leaders to address than campus security and safety. After the tears, the makeshift memorials, and the intensely painful series of funerals, higher education must come to grips with the fact that it has just had its own September 11. Assessing and…

  15. The Importance of Group Support for Widowed Persons.

    ERIC Educational Resources Information Center

    Folken, Molly Hill

    1991-01-01

    Notes that widowed persons in the United States have little support following funeral. Describes Widowed Persons Service (WPS), service which offers one-to-one outreach to newly widowed by persons previously widowed and trained to help the newly widowed; and Talk Group, ongoing, open-ended support group for newly widowed formed by the WPS in…

  16. 75 FR 4469 - Food Distribution Program on Indian Reservations: Resource Limits and Exclusions, and Extended...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-28

    ... be counted as a resource. For example, funeral expenses are often covered under life insurance policies and current FDPIR policy allows a resource exclusion for the cash value of life insurance policies... Program. (2) * * * (i) The cash value of life insurance policies; pension funds, including funds...

  17. Alex Haley: At Home in the Hills of East Tennessee.

    ERIC Educational Resources Information Center

    Hawthorne, Ann

    1992-01-01

    An interview with Alex Haley six months before his death in February 1992 discusses his impressions of life in Appalachia; the media image of Appalachia; reminiscences of his hometown, Henning, Tennessee; race relations in Appalachia; and his plans for future books. Included are photographs and a eulogy from his funeral. (SV)

  18. A case of necrophilia in Medunsa.

    PubMed

    Dubasi, P M; Fosseus, C G

    1995-06-01

    Necrophilia is the erotic attraction to or a sexual interest in corpses. It is a rare sexual perversion that is seldom reported to police, published in the journals, or found in the forensic literature. It usually involves people who work with cadavers at mortuaries and funeral parlors. This case involved a teenage girl who had already been examined at autopsy.

  19. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be... for the plot or interment allowance (except for claims filed by a State or an agency or political... the plot or interment services, or advanced funds to pay for them, and if the entire bill for such...

  20. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be... for the plot or interment allowance (except for claims filed by a State or an agency or political... the plot or interment services, or advanced funds to pay for them, and if the entire bill for such...

  1. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be... for the plot or interment allowance (except for claims filed by a State or an agency or political... the plot or interment services, or advanced funds to pay for them, and if the entire bill for such...

  2. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will be... transportation services or furnished the burial plot will have priority over claims of persons whose personal... burial allowance or plot or interment allowance will be made where it would escheat....

  3. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will be... transportation services or furnished the burial plot will have priority over claims of persons whose personal... burial allowance or plot or interment allowance will be made where it would escheat....

  4. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be... for the plot or interment allowance (except for claims filed by a State or an agency or political... the plot or interment services, or advanced funds to pay for them, and if the entire bill for such...

  5. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be... for the plot or interment allowance (except for claims filed by a State or an agency or political... the plot or interment services, or advanced funds to pay for them, and if the entire bill for such...

  6. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will be... transportation services or furnished the burial plot will have priority over claims of persons whose personal... burial allowance or plot or interment allowance will be made where it would escheat....

  7. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will be... transportation services or furnished the burial plot will have priority over claims of persons whose personal... burial allowance or plot or interment allowance will be made where it would escheat....

  8. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will be... transportation services or furnished the burial plot will have priority over claims of persons whose personal... burial allowance or plot or interment allowance will be made where it would escheat....

  9. A coin in the airway.

    PubMed

    Rogers, C; Chang, B; Shibuya, R

    1994-03-01

    A 69-year-old Chinese woman with widely metastatic endometrial carcinoma was found at autopsy to have a quarter in her air passages. Inquiry showed that her family had placed the coin in her mouth at the time of death according to traditional Chinese funeral practices. This practice is apparently not widely known among forensic pathologists.

  10. "Waiting for an Aristotle": A Moment in the History of the Basic Writing Movement.

    ERIC Educational Resources Information Center

    Hunter, Paul

    1992-01-01

    Demonstrates how an issue of the "Journal of Basic Writing," published in 1980 as a memorial for theorist Mina Shaughnessy, resembles structurally the funeral orations of Ancient Greece. Divides the issue into three parts: praise, lament, and consolation. Discusses political implications of the issue. (HB)

  11. Bugen's Coping with Death Scale: Reliability and Further Validation.

    ERIC Educational Resources Information Center

    Robbins, Rosemary A.

    1991-01-01

    Tested Bugen's Coping with Death Scale. Individuals who had written wills, planned estates and funerals, and signed organ donor cards scored higher on the Coping with Death Scale. Because Coping with Death scores were more consistently different in those who prepared for death, this scale may help in efforts to predict those who will engage in…

  12. No Rhyme or Reason.

    ERIC Educational Resources Information Center

    Flannery, Maura C.

    1995-01-01

    Contains a summary of the latest research findings related to the topics of eye development, mimicry, evolution of llamas, hybridization between Arctic wolves and huskies, ultraviolet light and algae, acid rock, orchids and funerals, enzymes that can withstand heat, fungus-killing compounds, chaos theory and the treatment of epileptics, sleep and…

  13. "Our Guinea Pig Is Dead!" Young Children Cope with Death.

    ERIC Educational Resources Information Center

    Thomason, Nita Davison

    1999-01-01

    Describes how children develop a concept of death, and presents suggestions for classroom experiences to help young children cope with death. Considers children's attendance at funerals and how to answer children's questions about death. Lists 14 children's books about death. (KB)

  14. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

    PubMed Central

    Teoh, Anthony Yuen Bun; Dhir, Vinay; Jin, Zhen-Dong; Kida, Mitsuhiro; Seo, Dong Wan; Ho, Khek Yu

    2016-01-01

    AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage. METHODS: Comparative studies published between January 1980 and May 2014 were identified on PubMed, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities. RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits. CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities. PMID:27014427

  15. Gold-nanoparticle based electrochemical DNA sensor for the detection of fish pathogen Aphanomyces invadans.

    PubMed

    Kuan, Guan Chin; Sheng, Liew Pei; Rijiravanich, Patsamon; Marimuthu, Kasi; Ravichandran, Manickam; Yin, Lee Su; Lertanantawong, Benchaporn; Surareungchai, Werasak

    2013-12-15

    Epizootic ulcerative syndrome (EUS) is a devastating fish disease caused by the fungus, Aphanomyces invadans. Rapid diagnosis of EUS is needed to control and treat this highly invasive disease. The current diagnostic methods for EUS are labor intensive. We have developed a highly sensitive and specific electrochemical genosensor towards the 18S rRNA and internal transcribed spacer regions of A. invadans. Multiple layers of latex were synthesized with the help of polyelectrolytes, and labeled with gold nanoparticles to enhance sensitivity. The gold-latex spheres were functionalized with specific DNA probes. We describe here the novel application of this improved platform for detection of PCR product from real sample of A. invadans using a premix sandwich hybridization assay. The premix assay was easier, more specific and gave higher sensitivity of one log unit when compared to the conventional method of step-by-step hybridization. The limit of detection was 0.5 fM (4.99 zmol) of linear target DNA and 1 fM (10 amol) of PCR product. The binding positions of the probes to the PCR amplicons were optimized for efficient hybridization. Probes that hybridized close to the 5' or 3' terminus of the PCR amplicons gave the highest signal due to minimal steric hindrance for hybridization. The genosensor is highly suitable as a surveillance and diagnostic tool for EUS in the aquaculture industry.

  16. Fine needle aspiration biopsy of the islet cell tumor of pancreas: a comparison between computerized axial tomography and endoscopic ultrasound-guided fine needle aspiration biopsy.

    PubMed

    Jhala, Darshana; Eloubeidi, Mohammad; Chhieng, David C; Frost, Andra; Eltoum, Isam A; Roberson, Janie; Jhala, Nirag

    2002-04-01

    The objective of the present study is to compare the cytologic features of islet cell tumor (ICT) of pancreas obtained by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and computed tomography guided FNA (CT-FNA). We also describe the cytologic features associated with malignant ICT. Eleven cytology samples from 121 CT- FNA and 30 EUS- FNA of the pancreas were obtained from nine patients with ICT. Diff-Quik, Papanicolaou, and immunohistochemical stains to determine neuroendocrine differentiation and the hormonal status were evaluated. Cytologic features and specimen adequacy were compared between the two techniques. Cytologic features noted in both benign and malignant ICT were also compared. Nine patients (5 men, 4 women) ranging in age from 29 to 84 years (mean age, 53.8 years). Diagnoses consisted of benign (4) and malignant (5) ICT. EUS-FNA was superior to CT-FNA in obtaining adequate cells (2/2 v 7/9) for the diagnosis and increased cellularity to perform additional immunohistochemical stains (2/2 v 4/7). Single, plasmacytoid cells with finely granular chromatin distribution characterized ICT on cytology. Mitoses (3/5) and necrosis (1/5) were noted in malignant ICT but not in benign ICT. EUS-FNA is superior to CT- FNA for obtaining cells for the diagnosis of ICT. Detection of mitoses and or necrosis from patients with ICT should initiate a search for metastasis.

  17. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience

    PubMed Central

    Tyberg, Amy; Perez-Miranda, Manuel; Sanchez-Ocaña, Ramon; Peñas, Irene; de la Serna, Carlos; Shah, Janak; Binmoeller, Kenneth; Gaidhane, Monica; Grimm, Ian; Baron, Todd; Kahaleh, Michel

    2016-01-01

    Background: Surgical gastrojejunostomy and enteral self-expanding metal stents are efficacious for the management of gastric outlet obstruction but limited by high complication rates and short-term efficacy. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a novel alternative option. Patients and methods: Patients who underwent EUS-GJ between March 2014 and September 2015 as part of a prospective multicenter registry at four academic centers in two countries were included. Technical success was defined as successful placement of a gastrojejunal lumen-apposing metal stent. Clinical success was defined as the ability of the patient to tolerate an oral diet. Post-procedural adverse events were recorded. Results: The study included 26 patients, of whom 11 (42 %) were male. Technical success was achieved in 24 patients (92 %). Clinical success was achieved in 22 patients (85 %). Of the 4 patients in whom clinical success was not achieved, 2 had persistent nausea and vomiting despite a patent EUS-GJ and required enteral feeding for nutrition, 1 died before the initiation of an oral diet, and 1 underwent surgery for suspected perforation. Adverse events, including peritonitis, bleeding, and surgery, occurred in 3 patients (11.5 %). Conclusion: EUS-GJ is an emerging procedure that has efficacy and safety comparable with those of current therapies and should hold a place as a new minimally invasive option for patients with gastric outlet obstruction. Clinical trial identification number: NCT01522573 PMID:27004243

  18. Increased frequency of circulating Tc22/Th22 cells and polyfunctional CD38(-) T cells in HIV-exposed uninfected subjects.

    PubMed

    Oliveira, Luanda M S; Lima, Josenilson F; Cervantes, Cesar A C; Casseb, Jorge S; Mendonça, Marcelo; Duarte, Alberto J S; Sato, Maria N

    2015-09-08

    Some individuals are resistant to HIV-1 infection despite repeated exposure to the virus, suggesting the presence of a complex antiviral response. Innate factors like IL-22 exert gut mucosal protection and polyfunctional T cells have been associated with low progression in HIV infection; therefore, we evaluated the frequencies of CD4+ and CD8+ T cell-secreting cytokines, including Tc22/Th22 cells and polyfunctional T cells in HIV-1-exposed uninfected individuals (EUs), their HIV-1-infected partners and healthy controls. EUs exhibited an increased frequency of p15 Gag CD4+ IL-22+ secreting T cells, whereas HIV-infected partners demonstrated a high frequency of CD4+ IL-17+ T cells in response to p24. Similar responses of Th22 and Tc22 cells to Gag peptides and Staphylococcal enterotoxin B (SEB) stimulation were detected in the serodiscordant couples. However, polyfunctionality in HIV subjects was associated with an HIV Gag response of CD38+ T cells, whereas polyfunctionality for EUs was induced upon SEB stimulation by CD38- T cells. EUs demonstrated the presence of Tc22/Th22 cells and polyfunctional CD38- T cells with a low activation profile. These data suggest that SEB-induced polyfunctional CD4+ and CD8+ T cells together with Tc22/Th22 cells in EU individuals can provide an immunological advantage in the response to pathogens such as HIV-1.

  19. A Case Report of Esophageal Bronchogenic Cyst and Review of the Literature With an Emphasis on Endoscopic Ultrasonography Appearance.

    PubMed

    Han, Chaoqun; Lin, Rong; Yu, Jun; Zhang, Qin; Zhang, Yang; Liu, Jun; Ding, Zhen; Hou, Xiaohua

    2016-03-01

    Esophageal bronchogenic cysts are extremely rare. Here we report a more rare type of both presence of intra- and paraesophageal bronchogenic cyst that was safely removed via surgical resection. A 31-year-old male patient with space-occupying lesions in the mediastinum suddenly presented with persistent chest pain for 2 days and then transferred to dysphagia >1 week. Preoperative diagnosis is difficult. Endoscopic ultrasonography (EUS) showed a hypoechoic cystic-solid mass arising from the muscularis propria and local hyperechoic area in the deeper portion of cyst, concomitant with a heterogeneous center and tube-like structure lesion in mediastinum. Turbid coffee color paste contents were aspirated inside the tumor under endoscopic ultrasonography guided-fine needle aspiration (EUS-FNA). A subsequent surgery was performed and histologic finding was diagnostic of esophageal bronchogenic cyst. Immunohistochemical staining confirmed the cyst was positive for carbohydrate antigen 199 (CA199) and carbohydrate antigen 125 (CA125). At a follow-up visit 3 months later, the patient had a regular diet and no complaint. This study is to summarize the clinical manifestations and EUS features of esophageal bronchogenic cyst by retrospectively reviewing the literature and simultaneously to provide guide for the correct examination scheme. The appearance of esophageal bronchogenic cyst can be great variation; EUS seems to be a valuable option for diagnosis and surveillance. PMID:26986156

  20. The Suitability of Propofol Compared with Urethane for Anesthesia during Urodynamic Studies in Rats

    PubMed Central

    Moheban, Adam A; Chang, Huiyi H; Havton, Leif A

    2016-01-01

    Urethane anesthesia preserves many reflex functions and is often the preferred anesthetic for urodynamic studies in rats. Because of the toxicity profile of urethane, its use as an anesthetic typically is limited to acute and terminal investigations. Alternative anesthetic options are needed for longitudinal studies of micturition reflexes in rats. In this study, we evaluated propofol anesthesia administered at constant rate infusion at different planes of anesthesia in rats for combined cystometrography and external urethral sphincter (EUS) EMG in rats. No reflex micturition was noted after rats received 100%, 80%, or 60% of a previously reported anesthetic dose of propofol. At 40% of the standard propofol dose, a subset of rats showed reflex voiding, with bladder contractions and associated EUS EMG activity. In contrast, urethane anesthesia at a surgical plane allowed for reflex voiding with bladder contractions and EUS activation. Latency to leaking or voiding was longer in rats under propofol anesthesia than in those under urethane anesthesia. In a subset of rats with reflex voiding under propofol anesthesia, voiding efficiency was decreased compared with that of rats anesthetized with urethane. We conclude that propofol anesthesia suppresses micturition reflexes in rats more efficiently than did urethane. Propofol is a suitable anesthetic for longitudinal studies in rats, but its use for urodynamic evaluations is limited in these animals due to its marked suppression of both bladder contractions and EUS EMG activation. PMID:26817985

  1. Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review

    PubMed Central

    2013-01-01

    Gastric duplication cyst (GDC) with a pseudostratified columnar ciliated epithelium is an uncommon malformation supposed to originate from a respiratory diverticulum arising from the ventral foregut. Morphologic appearance of GDCs is variable, depending on the density of their contents. GDCs are often misdiagnosed as solid masses by imaging techniques, and as a consequence they may be wrongly overtreated. We report our case of a 56-year-old man with a 5 cm hypoechoic mass of the gastroesophageal junction, incidentally detected by transabdominal ultrasonography. Neither transabdominal ultrasonography nor magnetic resonance clearly outlined the features of the lesion. The patient underwent endoscopic ultrasound (EUS), which showed a hypoechoic mass arising from the fourth layer of the anterior gastric wall, just below the gastroesophageal junction. According to EUS features, a diagnosis of gastrointestinal stromal tumor was suggested. EUS-guided fine-needle aspiration cytology revealed a diagnosis of GDC with pseudostratified columnar ciliated epithelium. We therefore performed an endoscopically-assisted laparoscopic excision of the cyst. In conclusion, whenever a subepithelial gastric mass is found in the upper part of the gastric wall, a duplication cyst, although rare, should be considered. In this case, EUS-guided fine-needle aspiration cytology could provide a cytological diagnosis useful to arrange in advance the more adequate surgical treatment. PMID:23374143

  2. Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review.

    PubMed

    Napolitano, Vincenzo; Pezzullo, Angelo M; Zeppa, Pio; Schettino, Pietro; D'Armiento, Maria; Palazzo, Antonietta; Della Pietra, Cristina; Napolitano, Salvatore; Conzo, Giovanni

    2013-02-02

    Gastric duplication cyst (GDC) with a pseudostratified columnar ciliated epithelium is an uncommon malformation supposed to originate from a respiratory diverticulum arising from the ventral foregut. Morphologic appearance of GDCs is variable, depending on the density of their contents. GDCs are often misdiagnosed as solid masses by imaging techniques, and as a consequence they may be wrongly overtreated. We report our case of a 56-year-old man with a 5 cm hypoechoic mass of the gastroesophageal junction, incidentally detected by transabdominal ultrasonography. Neither transabdominal ultrasonography nor magnetic resonance clearly outlined the features of the lesion. The patient underwent endoscopic ultrasound (EUS), which showed a hypoechoic mass arising from the fourth layer of the anterior gastric wall, just below the gastroesophageal junction. According to EUS features, a diagnosis of gastrointestinal stromal tumor was suggested. EUS-guided fine-needle aspiration cytology revealed a diagnosis of GDC with pseudostratified columnar ciliated epithelium. We therefore performed an endoscopically-assisted laparoscopic excision of the cyst.In conclusion, whenever a subepithelial gastric mass is found in the upper part of the gastric wall, a duplication cyst, although rare, should be considered. In this case, EUS-guided fine-needle aspiration cytology could provide a cytological diagnosis useful to arrange in advance the more adequate surgical treatment.

  3. Assessing the imaging capabilities of radial mechanical and electronic echo-endoscopes using the resolution integral.

    PubMed

    Inglis, Scott; Janeczko, Anna; Ellis, William; Plevris, John N; Pye, Stephen D

    2014-08-01

    Over the past decade there have been significant advances in endoscopic ultrasound (EUS) technology. Although there is an expectation that new technology will deliver improved image quality, there are few methods or phantoms available for assessing the capabilities of mechanical and electronic EUS systems. The aim of this study was to investigate the possibility of assessing the imaging capability of available EUS technologies using measurements of the resolution integral made with an Edinburgh Pipe Phantom. Various radial EUS echo-endoscopes and probes were assessed using an Edinburgh Pipe Phantom. Measurements of the resolution integral (R), depth of field (LR) and characteristic resolution (DR) were made at all operating frequencies. The mean R value for Fuji miniprobes was 16.0. The GF-UM20 and GF-UM2000 mechanical radial scopes had mean R values of 24.0 and 28.5, respectively. The two electronic radial echo-endoscopes had similar mean R values of 34.3 and 34.6 for the Olympus GF-UE260 and Fujinon EG-530 UR scopes, respectively. Despite being older technology, the mechanical GF-UM2000 scope had superior characteristic resolution (DR), but could not compare with the depths of field (LR) delivered by the current generation of electronic radial scopes, especially at the standard operating frequencies of 7.5 and 12 MHz.

  4. An ugly duckling becomes a swan {hor_ellipsis}: How an organization becomes customer focused through listening

    SciTech Connect

    Asercion, R.E.; Myer, V.J.

    1995-04-01

    The story we`re about to tell is true and the names have not been changed to protect the innocent because BCS Richland, Inc. (BCSR), a subsidiary of the Boeing Company, is proud of its metamorphosis from the ugly duckling of computer support to the shining swan-like star of the Help Desk industry. The transformation occurred in the midst of an all but antiquated computer technology environment, rapid technology changes, low employee morale, and high amount of customer frustration. BCSR, located at the Hanford site in the southeastern corner of Washington State, provides information resource management and computer support to the Department of Energy (DOE) complex located at the site. The primary mission of DOE is environmental restoration and waste clean-up. End User Support (EUS), an organization within BCSR, is tasked with all aspects of microcomputer support, both hardware and software. EUS efficiently and effectively supports approximately 12,000 computer users across the entire 560 square mile site. With a small staff of 50 consultants and technicians, EUS provides support to a diverse customer base that includes engineers and scientists, as well as financial personnel, managers, and clerical support. But it wasn`t always this way. BCSR management recognized it and empowered the EUS staff to make the necessary changes. Here`s how they did it.

  5. Exploration under the dome: Esophageal ultrasound with the ultrasound bronchoscope is indispensible

    PubMed Central

    Meena, Nikhil; Hulett, Cidney; Patolia, Setu; Bartter, Thaddeus

    2016-01-01

    Background: Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) for fine needle aspiration biopsy of mediastinal structures is now well described. In contrast, there is little to no reporting, depending on the site of EUS-B for access to sub-diaphragmatic structures. Our practice has been accessing sub-diaphragmatic sites for years. This review documents our experience with EUS-B to biopsy liver, left adrenal glands, and coeliac lymph nodes. Methods: After Institutional Review Board's approval, all endosonographic procedures performed by interventional pulmonary between July 2013 and June 2015 were reviewed. Those including biopsy of sub-diaphragmatic sites were then selected for analysis. Results: Over the study interval, 45 sub-diaphragmatic biopsy procedures (25 left adrenal glands, 7 liver, and 13 celiac node) were performed with EUS-B. In all cases, cellular adequacy was present, and samples were large enough for immunohistochemistry and any relevant ancillary studies. Metastatic malignancy was documented in 58% of cases, 16% of cases contained benign diagnostic findings, and in 27% of cases, normal organ tissue was documented. There were no complications. Conclusions: Operators comfortable with the endobronchial ultrasound scope in both the airway and the esophagus can actively seek and successfully perform biopsy of sub-diaphragmatic abnormalities when present and can thereby add to the diagnostic value of the procedure. PMID:27503158

  6. Use of anionic clays for photoprotection and sunscreen photostability: Hydrotalcites and phenylbenzimidazole sulfonic acid

    NASA Astrophysics Data System (ADS)

    Perioli, Luana; Ambrogi, Valeria; Rossi, Carlo; Latterini, Loredana; Nocchetti, Morena; Costantino, Umberto

    2006-05-01

    Layered double hydroxides of hydrotalcite (HTlc) type have many applications as matrices in pharmaceutical and cosmetic fields when intercalated with active species in anionic form. The aim of this work was to intercalate 2-phenyl-1H-benzimidazole-5-sulfonic acid (Eusolex 232) (EUS) as sunscreen molecule into hydrotalcites in order to obtain the sunscreen stabilization, the reduction of its photodegradation and the elimination of close contact between skin and filter. Hydrotalcites MgAl and ZnAl were used as hosts and the intercalation products obtained were characterized by TG, RX and DSC. They were also submitted to spectrophotometric assays in order to study the matrix influence on sunlight protection and on sunscreen photostability. These experiments showed that both MgAl and ZnAl HTlc intercalation products maintained the sunscreen properties and eusolex photodegradation was reduced. The in vitro EUS release from both formulations was almost negligible when compared with formulations containing free EUS. The EUS intercalation in HTlc and the respective formulations provided advantages in the maintenance of photoprotection efficacy, filter photostabilization and avoidance of a close contact between skin and filter, with consequent elimination of allergy problems and photocross reactions.

  7. Comparison of surgical and endoscopic sample collection for pancreatic cyst fluid biomarker identification.

    PubMed

    Partyka, Katie; McDonald, Mitchell; Maupin, Kevin A; Brand, Randall; Kwon, Richard; Simeone, Diane M; Allen, Peter; Haab, Brian B

    2012-05-01

    Significant efforts are underway to develop new biomarkers from pancreatic cyst fluid. Previous research has made use of cyst fluid collected from surgically removed cysts, but the clinical implementation of biomarkers would use cyst fluid collected by endoscopic ultrasound-guided, fine-needle aspiration (EUS-FNA). The purpose of this study was to investigate the clinical applicability of cyst fluid research obtained using surgical specimens. Matched pairs of operating-room collected (OR) and EUS-FNA samples from 12 patients were evaluated for the levels of three previously described biomarkers, CA 19-9, CEA, and glycan levels detected by wheat germ agglutinin on MUC5AC (MUC5AC-WGA). CA 19-9 and MUC5AC-WGA correlated well between the sample types, although CEA was more variable between the sample types for certain patients. The variability was not due to the time delay between EUS-FNA and OR collection or differences in total protein concentrations but may be caused by contamination of the cyst fluid with blood proteins. The classification of each patient based on thresholds for each marker was perfectly consistent between sample types for CA 19-9 and MUC5AC-WGA and mostly consistent for CEA. Therefore, results obtained using OR-collected pancreatic cyst fluid samples should reliably transfer to the clinical setting using EUS-FNA samples.

  8. Endoscopic ultrasound-guided placement of AXIOS stent for drainage of pancreatic fluid collections

    PubMed Central

    Patil, Rashmee; Ona, Mel A.; Papafragkakis, Charilaos; Anand, Sury; Duddempudi, Sushil

    2016-01-01

    Pancreatic fluid collections (PFCs) have conventionally been treated with surgery, percutaneous drainage, or with the more recently established endoscopic ultrasound (EUS)-guided drainage modality. Currently, endoscopic plastic or metallic stents are used for PFC drainage. Plastic stents present issues with stent migration and premature occlusion requiring frequent stent exchanges or placement of additional stents. Metallic stents are tubular and may migrate, resulting in inefficient drainage, content leakage, retrieval and replacement, and possible mucosal injury. The aim of this review was to summarize and evaluate the clinical and technical effectiveness of EUS-guided placement of the recently developed AXIOS stent, a lumen-apposing self-expandable metallic stent (LASEMS)for PFC drainage. A literature review was performed to identify the studies describing this technique. In this review article we have summarized case series or reports describing EUS-guided LASEMS placement. The indications, techniques, limitations and complications reported are discussed. A total of 298 patients were included across all studies described thus far in the literature. Overall, a 97% technical success rate and a 96% clinical success rate have been reported. Early and late complications related to the placement or removal of LASEMS have been reported, however few cases have presented life-threatening results. EUS-guided PFC drainage and LASEMS placement can be a safe and effective alternative approach in the management of selected patients. PMID:27065729

  9. Endoscopic ultrasonography for pancreatic cancer: current and future perspectives

    PubMed Central

    Brizzi, Rosario Francesco; Pellicano, Rinaldo

    2013-01-01

    A suspected pancreatic lesion can be a difficult challenge for the clinician. In the last years we have witnessed tumultuous technological improvements of the radiological and nuclear medicine imaging. Taking this into account, we will try to delineate the new role of endoscopic ultrasound (EUS) in pancreatic imaging and to place it in a shareable diagnostic and staging algorithm of pancreatic cancer (PC). To date the most accurate imaging techniques for the PC remain contrast-enhanced computed tomography (CT) and EUS. The latter has the highest accuracy in detecting small lesions, in assessing tumor size and lymph nodes involvement, but helical CT or an up-to-date magnetic resonance imaging (MRI) must be the first choice in patients with a suspected pancreatic lesion. After this first step there is place for EUS as a second diagnostic level in several cases: negative results on CT/MRI scans and persistent strong clinical suspicion of PC, doubtful results on CT/MRI scans or need for cyto-histological confirmation. In the near future there will be great opportunities for the development of diagnostic and therapeutic EUS and pancreatic pathology could be the best testing bench. PMID:23730519

  10. The Suitability of Propofol Compared with Urethane for Anesthesia during Urodynamic Studies in Rats.

    PubMed

    Moheban, Adam A; Chang, Huiyi H; Havton, Leif A

    2016-01-01

    Urethane anesthesia preserves many reflex functions and is often the preferred anesthetic for urodynamic studies in rats. Because of the toxicity profile of urethane, its use as an anesthetic typically is limited to acute and terminal investigations. Alternative anesthetic options are needed for longitudinal studies of micturition reflexes in rats. In this study, we evaluated propofol anesthesia administered at constant rate infusion at different planes of anesthesia in rats for combined cystometrography and external urethral sphincter (EUS) EMG in rats. No reflex micturition was noted after rats received 100%, 80%, or 60% of a previously reported anesthetic dose of propofol. At 40% of the standard propofol dose, a subset of rats showed reflex voiding, with bladder contractions and associated EUS EMG activity. In contrast, urethane anesthesia at a surgical plane allowed for reflex voiding with bladder contractions and EUS activation. Latency to leaking or voiding was longer in rats under propofol anesthesia than in those under urethane anesthesia. In a subset of rats with reflex voiding under propofol anesthesia, voiding efficiency was decreased compared with that of rats anesthetized with urethane. We conclude that propofol anesthesia suppresses micturition reflexes in rats more efficiently than did urethane. Propofol is a suitable anesthetic for longitudinal studies in rats, but its use for urodynamic evaluations is limited in these animals due to its marked suppression of both bladder contractions and EUS EMG activation.

  11. Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique

    PubMed Central

    Jain, Deepanshu; Thosani, Nirav; Singhal, Shashideep

    2016-01-01

    Gastrointestinal bleeding can range from grossly visible blood in stool or vomitus to microscopic bleed. However, any kind of bleeding can lead to potential life-threatening consequences. A small proportion of patients with gastrointestinal bleeding remain refractory to initial endoscopic hemostasis. While some are successfully managed by repeat endoscopic intervention, a few fail to respond or are not amenable to endoscopic hemostasis. As of now, the next level of intervention is passed on to either surgeons or interventional radiologists. There is new evidence suggesting the increased utility of endoscopic ultrasound (EUS) in diagnosis and treatment of culprit vascular lesions across the gut. In addition, EUS-assisted technique has also been used in the primary prevention of bleeding from gastroesophageal varices. In this review article, we have summarized case series and reports describing the use of EUS-assisted hemostasis. Indications, techniques, complications and success rates reported are discussed. While most of the authors describe their experience with primary and secondary treatment of gastric varices, treatment of other gastrointestinal lesions with EUS assisted hemostatic techniques is also discussed. PMID:27366229

  12. Endoscopic ultrasound for staging of colonic cancer proximal to the rectum: A systematic review and meta-analysis

    PubMed Central

    Malmstrøm, Marie Louise; Săftoiu, Adrian; Vilmann, Peter; Klausen, Tobias Wirenfeldt; Gögenur, Ismail

    2016-01-01

    Background and Objectives: Treatment of colonic cancer patients is highly dependent on the depth of tumor invasion (T-stage) as well as the extension of lymph node involvement (N-stage). We aimed to systematically review the accuracy of endoscopic ultrasound (EUS) for staging of colonic cancer proximal to the rectum. Patients and Methods: Men and women with colonic adenocarcinomas were included in the study. EUS staging was compared to histopathology as the gold standard. Outcome measures were T- and N-staging accuracies. Articles were searched in PubMed, Web of Science, The Cochrane Library, and EMBASE. Results: Six studies were identified comparing EUS staging of colonic cancer to histopathology. The pooled-staging sensitivity and specificity were 0.90 and 0.98 for T1 tumors, 0.67 and 0.96 for T2 tumors, and 0.97 and 0.83 for T3/T4 tumors, respectively. Sensitivity and specificity for N + disease were 0.59 and 0.78, respectively. Conclusions: EUS is a feasible method for T-staging of cancers of the colon proximal to the rectum. The accuracy of lymph node staging needs to be verified by prospective multicenter studies including larger patient populations. PMID:27803903

  13. Endoscopic ultrasound fine-needle aspiration characteristics of primary adenocarcinoma versus other malignant neoplasms of the pancreas

    PubMed Central

    Gagovic, Veronika; Spier, Bret J; DeLee, Ryan J; Barancin, Courtney; Lindstrom, Mary; Einstein, Michael; Byrne, Siobhan; Harter, Josephine; Agni, Rashmi; Pfau, Patrick R; Frick, Terrence J; Soni, Anurag; Gopal, Deepak V

    2012-01-01

    BACKGROUND: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) is often used to assist in the evaluation of pancreatic lesions and may help to diagnose benign versus malignant neoplasms. However, there is a paucity of literature regarding comparative EUS characteristics of various malignant pancreatic neoplasms (primary and metastatic). OBJECTIVE: To compare and characterize primary pancreatic adenocarcinoma versus other malignant neoplasms, hereafter referred to as nonprimary pancreatic adenocarcinoma (NPPA), diagnosed by EUS-guided FNA. METHODS: The present study was a retrospective analysis of a prospectively maintained database. The setting was a tertiary care, academic medical centre. Patients referred for suspected pancreatic neoplasms were evaluated. Based on EUS-FNA characteristics, primary pancreatic adenocarcinoma was differentiated from other malignant neoplasms. The subset of other neoplasms was defined as malignant lesions that were ‘NPPAs’ (ie, predominantly solid or solid/cystic based on EUS appearance and primary malignant lesions or metastatic lesions to the pancreas). Pancreatic masses that were benign cystic lesions (pseudocyst, simple cyst, serous cystadenoma) and focal inflammatory lesions (acute, chronic and autoimmune pancreatitis) were excluded. RESULTS: A total of 230 patients were evaluated using EUS-FNA for suspected pancreatic mass lesions. Thirty-eight patients were excluded because they were diagnosed with inflammatory lesions or had purely benign cysts. One hundred ninety-two patients had confirmed malignant pancreatic neoplasms (ie, pancreatic adenocarcinoma [n=144], NPPA [n=48]). When comparing adenocarcinoma with NPPA lesions, there was no significant difference in mean age (P=0.0675), sex (P=0.3595) or average lesion size (P=0.3801). On average, four FNA passes were necessary to establish a cytological diagnosis in both lesion subtypes (P=0.396). Adenocarcinomas were more likely to be located in the pancreatic head

  14. Evaluating the Minimal Specimens From Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Pancreatic Masses

    PubMed Central

    Park, Joo Kyung; Kang, Ki Joo; Oh, Cho Rong; Lee, Jong Kyun; Lee, Kyu Taek; Jang, Kee Taek; Park, Sang-Mo; Lee, Kwang Hyuck

    2016-01-01

    Abstract Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become one of the most useful diagnostic modalities for the diagnosis of pancreatic mass. The aim of this study was to investigate the role of analyzing the minimal specimens obtained by EUS-FNA for the diagnosis of solid masses of pancreas. This study consisted of retrospective and prospective analyses. The retrospective study was performed on 116 patients who underwent EUS-FNA of solid masses for cytological smear, histological analysis, and combined analysis including immunohistochemical (IHC) staining. In the prospective study, 79 patients were enrolled to evaluate the quality and accuracy of EUS-FNA histological analysis and feasibility of IHC staining. The final diagnoses of all patients included pancreatic cancer (n = 126), nonpancreatic cancer (n = 21), other neoplasm (n = 27), and benign lesions (n = 21). In our retrospective study, the combined analysis was more sensitive than cytological analysis alone (P < 0.01). The overall sensitivity of cytology, histology, and combined analysis was 69.8%, 67.2%, and 81.8%, respectively. In the prospective analysis, 64.2% of all punctures were helpful for determining the diagnosis and 40.7% provided sufficient tissue for IHC staining. Histological analysis was helpful for diagnosis in 74.7% of patients. IHC staining was necessary for a definite diagnosis in 11.4% of patients, especially in the cases of nonmalignant pancreatic mass. Histological analysis and IHC study of EUS-FNA specimens was useful for the accurate diagnosis of pancreatic and peripancreatic lesions. Combined analysis showed significantly higher sensitivity than cytology alone because IHC staining was helpful for a diagnosis in some patients. PMID:27227937

  15. Investigation of the role of 5-HT2 receptor subtypes in the control of the bladder and the urethra in the anaesthetized female rat

    PubMed Central

    Mbaki, Y; Ramage, A G

    2008-01-01

    Background and purpose: Micturition is controlled by central 5-HT-containing pathways. 5-HT2 receptors have been implicated in this system especially in control of the urethra, which is a drug target for treating urinary incontinence. This study investigates the role of each of the three subtypes of this receptor with emphasis on sphincter regulation. Experimental approach: Recordings of urethral and bladder pressure, external urethral sphincter (EUS) EMG, as well as the micturition reflex induced by bladder distension along with blood pressure and heart rate were made in anaesthetized rats. The effects of agonists and antagonists for 5-HT2 receptor subtypes were studied on these variables. Key results: The 5-HT2C agonists Ro 60-0175, WAY 161503 and mCPP, i.v., activated the EUS, increased urethral pressure and inhibited the micturition reflex. The effects of Ro 60-0175 on the EUS were blocked by the 5-HT2C antagonist SB 242084 and the 5-HT2A antagonists, ketanserin and MDL 100907. SB 242084 also blocked the inhibitory action on the reflex, while the 5-HT2B antagonist RS 127445 only blocked the increase in urethral pressure. The 5-HT2A receptor agonist DOI given i.v. or i.t. but not i.c.v. activated the EUS. Conclusions and implications: 5-HT2A/2C receptors located in the sacral spinal cord activate the EUS, while central 5-HT2C receptors inhibit the micturition reflex and 5-HT2B receptors, probably at the level of the urethra, increase urethral smooth muscle tone. Furthermore, 5-HT2B and 5-HT2C receptors do not seem to play an important role in the physiological regulation of micturition. PMID:18604238

  16. Feasibility and safety of using Soehendra stent retriever as a new technique for biliary access in endoscopic ultrasound-guided biliary drainage

    PubMed Central

    Prachayakul, Varayu; Aswakul, Pitulak

    2015-01-01

    AIM: To assess the feasibility and safety of the use of soehendra stent retriever as a new technique for biliary access in endoscopic ultrasound-guided biliary drainage. METHODS: The medical records and endoscopic reports of the patients who underwent endoscopic ultrasound-guided biliary drainage (EUS-BD) owing to failed endoscopic retrograde cholangiopancreatography in our institute between June 2011 and January 2014 were collected and reviewed. All the procedures were performed in the endoscopic suite under intravenous sedation with propofol and full anaesthetic monitoring. Then we used the Soehendra stent retriever as new equipment for neo-tract creation and dilation when performing EUS-BD procedures. The patients were observed in the recovery room for 1-2 h and transferred to the regular ward, patients’ clinical data were reviewed and analysed, clinical outcomes were defined by using several different criteria. Data were analysed by using SPSS 13 and presented as percentages, means, and medians. RESULTS: A total of 12 patients were enrolled. The most common indications for EUS-BD in this series were failed common bile duct cannulation, duodenal obstruction, failed selective intrahepatic duct cannulation, and surgical altered anatomy for 50%, 25%, 16.7%, and 8.3%, respectively. Seven patients underwent EUS-guided hepaticogastrostomy (58.3%), and 5 underwent EUS-guided choledochoduodenostomy (41.7%). The technical success rate was 100%, while the clinical success rate was 91.7%. Major and minor complications occurred in 16.6% and 33.3% of patients, respectively, but there were no procedure-related death. CONCLUSION: Soehendra stent retriever could be used as an alternative instrument for biliary access in endoscopic ultrasound guided biliary drainage. PMID:25759542

  17. Projecting policy-relevant metrics for high summertime ozone pollution events over the eastern United States due to climate and emission changes during the 21st century

    NASA Astrophysics Data System (ADS)

    Rieder, Harald E.; Fiore, Arlene M.; Horowitz, Larry W.; Naik, Vaishali

    2015-01-01

    the eastern United States (EUS), nitrogen oxides (NOx) emission controls have led to improved air quality over the past two decades, but concerns have been raised that climate warming may offset some of these gains. Here we analyze the effect of changing emissions and climate, in isolation and combination, on EUS summertime surface ozone (O3) over the recent past and the 21st century in an ensemble of simulations performed with the Geophysical Fluid Dynamics Laboratory CM3 chemistry-climate model. The simulated summertime EUS O3 is biased high but captures the structure of observed changes in regional O3 distributions following NOx emission reductions. We introduce a statistical bias correction, which allows derivation of policy-relevant statistics by assuming a stationary mean state bias in the model, but accurate simulation of changes at each quantile of the distribution. We contrast two different 21st century scenarios: (i) representative concentration pathway (RCP) 4.5 and (ii) simulations with well-mixed greenhouse gases (WMGG) following RCP4.5 but with emissions of air pollutants and precursors held fixed at 2005 levels (RCP4.5_WMGG). We find under RCP4.5 no exceedance of maximum daily 8 hour average ozone above 75 ppb by mid-21st century, reflecting the U.S. NOx emissions reductions projected in RCP4.5, while more than half of the EUS exceeds this level by the end of the 21st century under RCP4.5_WMGG. Further, we find a simple relationship between the changes in estimated 1 year return levels and regional NOx emission changes, implying that our results can be generalized to estimate changes in the frequency of EUS pollution events under different regional NOx emission scenarios.

  18. Management of Patients With Pancreatic Cysts

    PubMed Central

    Siddiqui, Ali; Loren, David; Mertz, Howard R.; Mallat, Damien; Haddad, Nadim; Malhotra, Nidhi; Sadowski, Brett; Lybik, Mark J.; Patel, Sandeep N.; Okoh, Emuejevoke; Rosenkranz, Laura; Karasik, Michael; Golioto, Michael; Linder, Jeffrey; Catalano, Marc F.; Al-Haddad, Mohammad A.

    2016-01-01

    Goals: To examine the utility of integrated molecular pathology (IMP) in managing surveillance of pancreatic cysts based on outcomes and analysis of false negatives (FNs) from a previously published cohort (n=492). Background: In endoscopic ultrasound with fine-needle aspiration (EUS-FNA) of cyst fluid lacking malignant cytology, IMP demonstrated better risk stratification for malignancy at approximately 3 years’ follow-up than International Consensus Guideline (Fukuoka) 2012 management recommendations in such cases. Study: Patient outcomes and clinical features of Fukuoka and IMP FN cases were reviewed. Practical guidance for appropriate surveillance intervals and surgery decisions using IMP were derived from follow-up data, considering EUS-FNA sampling limitations and high-risk clinical circumstances observed. Surveillance intervals for patients based on IMP predictive value were compared with those of Fukuoka. Results: Outcomes at follow-up for IMP low-risk diagnoses supported surveillance every 2 to 3 years, independent of cyst size, when EUS-FNA sampling limitations or high-risk clinical circumstances were absent. In 10 of 11 patients with FN IMP diagnoses (2% of cohort), EUS-FNA sampling limitations existed; Fukuoka identified high risk in 9 of 11 cases. In 4 of 6 FN cases by Fukuoka (1% of cohort), IMP identified high risk. Overall, 55% of cases had possible sampling limitations and 37% had high-risk clinical circumstances. Outcomes support more cautious management in such cases when using IMP. Conclusions: Adjunct use of IMP can provide evidence for relaxed surveillance of patients with benign cysts that meet Fukuoka criteria for closer observation or surgery. Although infrequent, FN results with IMP can be associated with EUS-FNA sampling limitations or high-risk clinical circumstances. PMID:27332745

  19. Serotonergic 5-HT(1A) receptor agonist (8-OH-DPAT) ameliorates impaired micturition reflexes in a chronic ventral root avulsion model of incomplete cauda equina/conus medullaris injury.

    PubMed

    Chang, Huiyi H; Havton, Leif A

    2013-01-01

    Trauma to the thoracolumbar spine commonly results in injuries to the cauda equina and the lumbosacral portion of the spinal cord. Both complete and partial injury syndromes may follow. Here, we tested the hypothesis that serotonergic modulation may improve voiding function after an incomplete cauda equina/conus medullaris injury. For this purpose, we used a unilateral L5-S2 ventral root avulsion (VRA) injury model in the rat to mimic a partial lesion to the cauda equina and conus medullaris. Compared to a sham-operated series, comprehensive urodynamic studies demonstrated a markedly reduced voiding efficiency at 12 weeks after the VRA injury. Detailed cystometrogram studies showed injury-induced decreased peak bladder pressures indicative of reduced contractile properties. Concurrent external urethral sphincter (EUS) electromyography demonstrated shortened burst and prolonged silent periods associated with the elimination phase. Next, a 5-HT(1A) receptor agonist, 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT), was administered intravenously at 12 weeks after the unilateral L5-S2 VRA injury. Both voiding efficiency and maximum intravesical pressure were significantly improved by 8-OH-DPAT (0.3-1.0 mg/kg). 8-OH-DPAT also enhanced the amplitude of EUS tonic and bursting activity as well as duration of EUS bursting and silent period during EUS bursting. The results indicate that 8-OH-DPAT improves voiding efficiency and enhances EUS bursting in rats with unilateral VRA injury. We conclude that serotonergic modulation of the 5-HT(1A) receptor may represent a new strategy to improve lower urinary tract function after incomplete cauda equina/conus medullaris injuries in experimental studies.

  20. The Use of Standard Gastrointestinal Endoscopic Ultrasound to Assess Cardiac Anatomy.

    PubMed

    Sentissi, Kinza; Sawhney, Mandeep S; Pleskow, Douglas; Sepe, Paul; Mella, Jose M; Kwittken, Benjamin; Ketwaroo, Gyanprakash; Subramaniam, Balachundhar

    2016-09-01

    In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist. Eight of the 20 standard views of cardiovascular structures per the 1999 American Society of Echocardiography/Society of Cardiovascular Anesthesiologists guidelines for TEE could be obtained using the linear echoendoscope. The following cardiac valvular structures were visualized: aortic valve (100%), mitral valve (100%), tricuspid valve (33%), and pulmonic valve (11%). Left ventricular and right ventricular systolic function could be assessed in 89% and 67% of patients, respectively. Other structures such as the ascending and descending aorta, pericardium, left atrial appendage, and interatrial septum were identified in 100% of patients. Doppler-dependent functions could not be assessed. Given that the EUS images were not directly compared with TEE in these patients, we cannot comment definitively on the quality of these assessments and further studies would need to be performed to make a formal comparison. Based on this study, EUS technology can consistently assess the mitral valve, aortic valve, aorta, pericardium, and left ventricular function. Given its limitations, EUS technology, although not a substitute for formal echocardiography, could be a helpful early diagnostic tool in an emergency setting. PMID:27541718

  1. Endoscopic ultrasound guided fine needle aspiration and useful ancillary methods

    PubMed Central

    Tadic, Mario; Stoos-Veic, Tajana; Kusec, Rajko

    2014-01-01

    The role of endoscopic ultrasound (EUS) in evaluating pancreatic pathology has been well documented from the beginning of its clinical use. High spatial resolution and the close proximity to the evaluated organs within the mediastinum and abdominal cavity allow detection of small focal lesions and precise tissue acquisition from suspected lesions within the reach of this method. Fine needle aspiration (FNA) is considered of additional value to EUS and is performed to obtain tissue diagnosis. Tissue acquisition from suspected lesions for cytological or histological analysis allows, not only the differentiation between malignant and non-malignant lesions, but, in most cases, also the accurate distinction between the various types of malignant lesions. It is well documented that the best results are achieved only if an adequate sample is obtained for further analysis, if the material is processed in an appropriate way, and if adequate ancillary methods are performed. This is a multi-step process and could be quite a challenge in some cases. In this article, we discuss the technical aspects of tissue acquisition by EUS-guided-FNA (EUS-FNA), as well as the role of an on-site cytopathologist, various means of specimen processing, and the selection of the appropriate ancillary method for providing an accurate tissue diagnosis and maximizing the yield of this method. The main goal of this review is to alert endosonographers, not only to the different possibilities of tissue acquisition, namely EUS-FNA, but also to bring to their attention the importance of proper sample processing in the evaluation of various lesions in the gastrointestinal tract and other accessible organs. All aspects of tissue acquisition (needles, suction, use of stylet, complications, etc.) have been well discussed lately. Adequate tissue samples enable comprehensive diagnoses, which answer the main clinical questions, thus enabling targeted therapy. PMID:25339816

  2. A Case of Contested Cremains Analyzed Through Metric and Chemical Comparison.

    PubMed

    Bartelink, Eric J; Sholts, Sabrina B; Milligan, Colleen F; Van Deest, Traci L; Wärmländer, Sebastian K T S

    2015-07-01

    Since the 1980s, cremation has become the fastest growing area of the U.S. funeral industry. At the same time, the number of litigations against funeral homes and cremation facilities has increased. Forensic anthropologists are often asked to determine whether the contents of an urn are actually cremated bone, and to address questions regarding the identity of the remains. This study uses both metric and chemical analyses for resolving a case of contested cremains. A cremains weight of 2021.8 g was predicted based on the decedent's reported stature and weight. However, the urn contents weighed 4173.5 g. The urn contents also contained material inconsistent with cremains (e.g., moist sediment, stones, ferrous metal). Analysis using XRD and SEM demonstrated that the urn contained thermally altered bone as well as inorganic material consistent with glass fiber cement. Although forensically challenging, cremains cases such as this one can be resolved using a multidisciplinary approach.

  3. [Spiritual care of a terminal liver cancer patient: a nursing experience].

    PubMed

    Chien, Hui-Chi

    2010-04-01

    Death, an unavoidable event in the human experience, causes physical as well as mental and spiritual suffering. This paper reports on a nursing experience giving spiritual care to a terminal liver cancer patient between January 17 and February 9, 2009. Eleven nursing logs were used as the source of data for daily information. During the care period, patient religious needs featured prominently, including his desire to become a Christian and his eagerness to know about and help in the arrangement of his funeral. Taking the initiative, the nurse helped link him with religious resources, arranged a minister for his baptism ceremony, had the priest explain funeral proceedings, and assisted with the completion of his entrusted plans. The function of this nursing care intervention was to provide a personal touch to a patient who was in desperate need of warm spiritual care. It is hoped that this report can help caregivers increase their sensitivity toward patient spiritual needs and enhance routine nursing care quality.

  4. Predictors of Clergy's Ability to Fulfill a Suicide Prevention Gatekeeper Role.

    PubMed

    Mason, Karen; Geist, Monica; Kuo, Richard; Marshall, Day; Wines, James D

    2016-03-01

    Catholic, Jewish and Protestant clergy (n = 801) completed a survey to identify predictors of clergy's ability to fulfill a suicide gatekeeper role. Exploratory backward stepwise regression identified predictors of risk identification including suicide knowledge, religion, conducting suicide funerals, having an attitude that people have a right to die, age, and race. Predictors of ability to intervene include suicide knowledge, training, religion, right to die attitude, and ethnicity. Recommendations include more suicide training and clergy self-care.

  5. Predictors of Clergy's Ability to Fulfill a Suicide Prevention Gatekeeper Role.

    PubMed

    Mason, Karen; Geist, Monica; Kuo, Richard; Marshall, Day; Wines, James D

    2016-03-01

    Catholic, Jewish and Protestant clergy (n = 801) completed a survey to identify predictors of clergy's ability to fulfill a suicide gatekeeper role. Exploratory backward stepwise regression identified predictors of risk identification including suicide knowledge, religion, conducting suicide funerals, having an attitude that people have a right to die, age, and race. Predictors of ability to intervene include suicide knowledge, training, religion, right to die attitude, and ethnicity. Recommendations include more suicide training and clergy self-care. PMID:26956748

  6. Univariate time series modeling and an application to future claims amount in SOCSO's invalidity pension scheme

    NASA Astrophysics Data System (ADS)

    Chek, Mohd Zaki Awang; Ahmad, Abu Bakar; Ridzwan, Ahmad Nur Azam Ahmad; Jelas, Imran Md.; Jamal, Nur Faezah; Ismail, Isma Liana; Zulkifli, Faiz; Noor, Syamsul Ikram Mohd

    2012-09-01

    The main objective of this study is to forecast the future claims amount of Invalidity Pension Scheme (IPS). All data were derived from SOCSO annual reports from year 1972 - 2010. These claims consist of all claims amount from 7 benefits offered by SOCSO such as Invalidity Pension, Invalidity Grant, Survivors Pension, Constant Attendance Allowance, Rehabilitation, Funeral and Education. Prediction of future claims of Invalidity Pension Scheme will be made using Univariate Forecasting Models to predict the future claims among workforce in Malaysia.

  7. Synthesis and characterization of inorganic semiconducting nanocrystals for solar and spintronics applications

    NASA Astrophysics Data System (ADS)

    Selinsky, Rachel Sarah

    Due to novel properties which arise when a material is reduced to the nanoscale, colloidal semiconductor nanocrystals (NCs) are of interest for use in technologies ranging from solar energy conversion to quantum computing. The benefits of NCs over their bulk counterparts include high surface-to-volume ratio, potential quantum confinement, and increased heterojunction lattice mismatch tolerance. Utilizing these potential benefits requires both identification of desirable materials and development of size, morphology, and material specific synthetic strategies. This work looks at two NC materials systems, one for solar energy conversion and the other for spintronics applications. The first materials system presented is lead selenide NC -- hematite nanowire (NW) epitaxial heterostructures for solar energy conversion. Herein we combine tradition colloidal NCs and vapor-phase NW methods to synthesizing epitaxial quantum dot-nanowire (QD-NW) heterostructures consisting of high-quality, epitaxially-connected, colloidal PbSe QDs on furnace-grown hematite (alpha-Fe 2O3) NWs, synthesized through direct heterogeneous nucleation of the PbSe. NC diameter, diameter distribution, and NC surface coverage were shown to be tuned via the reaction temperature and the length of time of the surface dehydration. The second materials system presented is europium sulfide (EuS) and gadolinium doped EuS (Eu1--xGd xS) NCs for spintronics applications. As a ferromagnetic semiconductor and ideal Heisenberg ferromagnetic, EuS is interesting for applications which utilize both electron charge and spin such as spintronics and magneto-optics. EuS NCs were synthesized through high temperature decomposition of a dithiocarbamate single source precursor (SSP). Ferromagnetic hysteresis and Curie temperature (TC) were determined for ensembles of NCs by vibrating sample magnetometry (VSM). The element and oxidation state specific magnetic origin was determined to be Eu2+ using X-ray magnetic circular

  8. Early endoscopic ultrasonography in acute biliary pancreatitis: A prospective pilot study

    PubMed Central

    Anderloni, Andrea; Galeazzi, Marianna; Ballarè, Marco; Pagliarulo, Michela; Orsello, Marco; Del Piano, Mario; Repici, Alessandro

    2015-01-01

    AIM: To investigate the clinical usefulness of early endoscopic ultrasonography (EUS) in the management of acute biliary pancreatitis (ABP). METHODS: All consecutive patients entering the emergency department between January 2010 and December 2012 due to acute abdominal pain and showing biochemical and/or radiological findings consistent with possible ABP were prospectively enrolled. Patients were classified as having a low, moderate, or high probability of common bile duct (CBD) stones, according to the established risk stratification. Exclusion criteria were: gastrectomy or patient in whom the cause of biliary obstruction was already identified by ultrasonography. All enrolled patients underwent EUS within 48 h of their admission. Endoscopic retrograde cholangiopancreatography was performed immediately after EUS only in those cases with proven CBD stones or sludge. The following parameters were investigated: (1) clinical: age, sex, fever; (2) radiological: dilated CBD; and (3) biochemical: bilirubin, AST, ALT, gGT, ALP, amylase, lipasis, PCR. Association between presence of CBD stone at EUS and the individual predictors were assessed by univariate logistic regression. Predictors significantly associated with CBD stones (P < 0.05) were entered in a multivariate logistic regression model. RESULTS: A total of 181 patients with pancreatitis were admitted to the emergency department between January 2010 and December 2012. After exclusion criteria a total of 71 patients (38 females, 53.5%, mean age 58 ± 20.12 years, range 27-89 years; 33 males, 46.5%, mean age 65 ± 11.86 years, range 41-91 years) were included in the present study. The probability of CBD stones was considered low in 21 cases (29%), moderate in 26 (37%), and high in the remaining 24 (34%). The 71 patients included in the study underwent EUS, which allowed for a complete evaluation of the target sites in all the cases. The procedure was completed in a mean time of 14.7 min (range 9-34 min), without

  9. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography

    PubMed Central

    Khashab, Mouen A.; Van der Merwe, Schalk; Kunda, Rastislav; El Zein, Mohamad H.; Teoh, Anthony Y.; Marson, Fernando P.; Fabbri, Carlo; Tarantino, Ilaria; Varadarajulu, Shyam; Modayil, Rani J.; Stavropoulos, Stavros N.; Peñas, Irene; Ngamruengphong, Saowanee; Kumbhari, Vivek; Romagnuolo, Joseph; Shah, Raj; Kalloo, Anthony N.; Perez-Miranda, Manuel; Artifon, Everson L.

    2016-01-01

    Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon’s severity grading system. Overall survival and duration of stent patency were calculated using Kaplan–Meier analysis. Results: A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 – 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 – 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 – 86

  10. Performance characteristic of endoscopic ultrasound-guided fine needle aspiration is unaffected by pancreatic mass size

    PubMed Central

    Ramesh, Jayapal; Kim, Hwasoon; Reddy, Kartika; Eltoum, Isam-Eldin A.

    2016-01-01

    Background and study aims: Despite a well-established tool for diagnosis of pancreatic masses, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) studies have shown suboptimal diagnostic performance at divergent mass sizes. Since the impact of gold standard follow-up and presence of on-site evaluation on this observation is unknown, we aimed to study the performance characteristics of EUS-FNA under these strict conditions. Patients and methods: EUS-FNA results from pancreatic mass lesions performed between July 2000 and March 2013 were evaluated. All patients with histological follow-up were then stratified into four groups: Group A ( ≤ 10 mm), Group B (11 – 20 mm), Group C (21 – 40 mm), and Group D (> 40 mm). Sensitivity and diagnostic accuracy were calculated for each group and compared. Results: A total of 612 /3832 (16 %) patients with pancreatic masses who underwent EUS-FNA had histology confirmation. Of these, 81 were excluded due to unavailable lesion size, while the rest formed the study cohort. Mean age (SD) was 65.8 years (9.3) with 51.2 % female. The mean number of passes for the entire cohort was 2.9 (SD 1.9; range 1 – 12); patients in group D had a significantly higher number of passes for on-site diagnosis (P = 0.0124). There was no significant difference between the groups for sensitivity (P = 0.1134) or diagnostic accuracy (P = 0.2111). Proportional trend analysis revealed no significant correlation between size and sensitivity (P = 0.6192). The size of lesion measured by EUS was not associated with sensitivity or specificity after adjusting for age, sex, and pancreatic location. Conclusion: In the presence of rapid on-site cytopathology and when final histology is taken as the gold standard, pancreatic mass size does not affect the performance characteristics of EUS-FNA. PMID:27092323

  11. Interobserver agreement among cytopathologists in the evaluation of pancreatic endoscopic ultrasound-guided fine needle aspiration cytology specimens*

    PubMed Central

    Mounzer, Rawad; Yen, Roy; Marshall, Carrie; Sams, Sharon; Mehrotra, Sanjana; Said, Mohamed Sherif; Obuch, Joshua C.; Brauer, Brian; Attwell, Augustin; Fukami, Norio; Shah, Raj; Amateau, Stuart; Hall, Matthew; Hosford, Lindsay; Wilson, Robert; Rastogi, Amit; Wani, Sachin

    2016-01-01

    Background and aims: Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has become the standard of care in the evaluation of solid pancreatic lesions. Limited data exist on interobserver agreement (IOA) among cytopathologists in assessing solid pancreatic EUS-FNA specimens. This study aimed to evaluate IOA among cytopathologists in assessing EUS-FNA cytology specimens of solid pancreatic lesions using a novel standardized scoring system and to assess individual clinical and cytologic predictors of IOA. Methods: Consecutive patients who underwent EUS-FNA of solid pancreatic lesions at a tertiary care referral center were included. EUS-FNA slides were evaluated by four blinded cytopathologists using a standardized scoring system that assessed final cytologic diagnosis and quantitative (number of nucleated/diagnostic cells) and qualitative (bloodiness, inflammation/necrosis, contamination, artifact) cytologic parameters. Final clinical diagnosis was based on final cytology, surgical pathology, or 1-year clinical follow-up. IOA was calculated using multi-rater kappa (κ) statistics. Bivariate analyses were performed comparing cases with and without uniform agreement among the cytopathologists followed by logistic regression with backward elimination to model likelihood of uniform agreement. Results: Ninety-nine patients were included (49 % males, mean age 64 years, mean lesion size 26 mm). IOA for final diagnosis was moderate (κ = 0.45, 95 % confidence interval (CI) 0.4 – 0.49) with minimal improvement when combining suspicious and malignant diagnoses (κ = 0.54, 95 %CI 0.49 – 0.6). The weighted kappa value for overall diagnosis was 0.65 (95 %CI 0.54 – 0.76). IOA was slight to fair (κ = 0.04 – 0.32) for individual cytologic parameters. A final clinical diagnosis of malignancy was the most significant predictor of agreement [OR 3.99 (CI 1.52 – 10.49)]. Conclusions: Interobserver agreement among

  12. Social Pathways for Ebola Virus Disease in Rural Sierra Leone, and Some Implications for Containment

    PubMed Central

    Richards, Paul; Amara, Joseph; Ferme, Mariane C.; Kamara, Prince; Mokuwa, Esther; Sheriff, Amara Idara; Suluku, Roland; Voors, Maarten

    2015-01-01

    The current outbreak of Ebola Virus Disease in Upper West Africa is the largest ever recorded. Molecular evidence suggests spread has been almost exclusively through human-to-human contact. Social factors are thus clearly important to understand the epidemic and ways in which it might be stopped, but these factors have so far been little analyzed. The present paper focuses on Sierra Leone, and provides cross sectional data on the least understood part of the epidemic—the largely undocumented spread of Ebola in rural areas. Various forms of social networking in rural communities and their relevance for understanding pathways of transmission are described. Particular attention is paid to the relationship between marriage, funerals and land tenure. Funerals are known to be a high-risk factor for infection. It is suggested that more than a shift in awareness of risks will be needed to change local patterns of behavior, especially in regard to funerals, since these are central to the consolidation of community ties. A concluding discussion relates the information presented to plans for halting the disease. Local consultation and access are seen as major challenges to be addressed. PMID:25886400

  13. Female offspring desertion and male-only care increase with natural and experimental increase in food abundance

    PubMed Central

    Eldegard, Katrine; Sonerud, Geir A.

    2009-01-01

    In species with biparental care, one parent may escape the costs of parental care by deserting and leaving the partner to care for the offspring alone. A number of theoretical papers have suggested a link between uniparental offspring desertion and ecological factors, but empirical evidence is scarce. We investigated the relationship between uniparental desertion and food abundance in a natural population of Tengmalm's owl Aegolius funereus, both by means of a 5-year observational study and a 1-year experimental study. Parents and offspring were fitted with radio-transmitters in order to reveal the parental care strategy (i.e. care or desert) of individual parents, and to keep track of the broods post-fledging. We found that 70 per cent of the females from non-experimental nests deserted, while their partner continued to care for their joint offspring alone. Desertion rate was positively related to natural prey population densities and body reserves of the male partner. In response to food supplementation, a larger proportion of the females deserted, and females deserted the offspring at an earlier age. Offspring survival during the post-fledging period tended to be lower in deserted than in non-deserted broods. We argue that the most important benefit of deserting may be remating (sequential polyandry). PMID:19324835

  14. Comparative ecology of the Flammulated Owl and Northern Saw-whet Owl during fall migration

    USGS Publications Warehouse

    Stock, S.L.; Heglund, P.J.; Kaltenecker, G.S.; Carlisle, J.D.; Leppert, L.

    2006-01-01

    We compared the migration ecology of two owl species that exhibit different migration strategies: the Flammulated Owl (Otus flammeolus) and the Northern Saw-whet Owl (Aegolius acadicus). During fall 1999-2004, we captured 117 Flammulated Owls and 1433 Northern Saw-whet Owls in the southern Boise Mountains of southwestern Idaho. These owl species exhibited contrasting seasonal timing and body condition. Flammulated Owl captures peaked in mid-September and Northern Saw-whet Owl captures peaked in early to mid-October. Flammulated Owls displayed greater body condition than Northern Saw-whet Owls and increasing condition scores during the season, whereas Northern Saw-whet Owls had no apparent seasonal condition patterns. Based on seasonal timing of captures, both species showed unimodal movement patterns characteristic of fall migrants. However, in 1999 both species' capture rates were at least double those in other years of this study. Flammulated Owls' earlier arrival and departure, coupled with superior body condition, were consistent among years and typical of a long-distance migration strategy. In contrast, the Northern Saw-whet Owls' later arrival, more lengthy passage, and variable body condition were more characteristic of a short-distance migrant strategy. Furthermore, Northern Saw-whet Owls' body condition was significantly lower during the irruptive year than during nonirruptive years, supporting the notion that population density affects their migratory condition. ?? 2006 The Raptor Research Foundation, Inc.

  15. Do Tengmalm's owls see vole scent marks visible in ultraviolet light?

    PubMed

    Koivula; Korpimäki; Viitala

    1997-10-01

    Scent markings (urine and faeces) of small mammals are visible in ultraviolet (UV) light. Diurnal kestrels, Falco tinnunculususe them as a cue to find areas of food abundance. We studied whether vole-eating, nocturnal Tengmalm's owls, Aegolius funereuscan see vole scent marks using UV-vision. In a laboratory experiment, 14 young (less than 6 months old) and 14 adult (more than 6 months old) owls were individually given a choice between four adjacent arenas: (1) an arena with vole urine and faeces in UV light; (2) an arena with vole urine and faeces in visible light; (3) a clean arena in UV light; and (4) a clean arena in visible light. Owls did not prefer any of the four arenas. Our results suggest that Tengmalm's owls probably do not use UV light as a cue to detect vole scent marks.Copyright 1997 The Association for the Study of Animal Behaviour1997The Association for the Study of Animal Behaviour PMID:9344440

  16. Declining ecosystem health and the dilution effect

    PubMed Central

    Khalil, Hussein; Ecke, Frauke; Evander, Magnus; Magnusson, Magnus; Hörnfeldt, Birger

    2016-01-01

    The “dilution effect” implies that where species vary in susceptibility to infection by a pathogen, higher diversity often leads to lower infection prevalence in hosts. For directly transmitted pathogens, non-host species may “dilute” infection directly (1) and indirectly (2). Competitors and predators may (1) alter host behavior to reduce pathogen transmission or (2) reduce host density. In a well-studied system, we tested the dilution of the zoonotic Puumala hantavirus (PUUV) in bank voles (Myodes glareolus) by two competitors and a predator. Our study was based on long-term PUUV infection data (2003–2013) in northern Sweden. The field vole (Microtus agrestis) and the common shrew (Sorex araneus) are bank vole competitors and Tengmalm’s owl (Aegolius funereus) is a main predator of bank voles. Infection probability in bank voles decreased when common shrew density increased, suggesting that common shrews reduced PUUV transmission. Field voles suppressed bank vole density in meadows and clear-cuts and indirectly diluted PUUV infection. Further, Tengmalm’s owl decline in 1980–2013 may have contributed to higher PUUV infection rates in bank voles in 2003–2013 compared to 1979–1986. Our study provides further evidence for dilution effect and suggests that owls may have an important role in reducing disease risk. PMID:27499001

  17. Selective predation on hantavirus-infected voles by owls and confounding effects from landscape properties.

    PubMed

    Khalil, Hussein; Ecke, Frauke; Evander, Magnus; Hörnfeldt, Birger

    2016-06-01

    It has been suggested that predators may protect human health through reducing disease-host densities or selectively preying on infected individuals from the population. However, this has not been tested empirically. We hypothesized that Tengmalm's owl (Aegolius funereus) selectively preys on hantavirus-infected individuals of its staple prey, the bank vole (Myodes glareolus). Bank voles are hosts of Puumala hantavirus, which causes a form of hemorrhagic fever in humans. Selective predation by owls on infected voles may reduce human disease risk. We compared the prevalence of anti-Puumala hantavirus antibodies (seroprevalence), in bank voles cached by owls in nest boxes to seroprevalence in voles trapped in closed-canopy forest around each nest box. We found no general difference in seroprevalence. Forest landscape structure could partly account for the observed patterns in seroprevalence. Only in more connected forest patches was seroprevalence in bank voles cached in nest boxes higher than seroprevalence in trapped voles. This effect disappeared with increasing forest patch isolation, as seroprevalence in trapped voles increased with forest patch isolation, but did not in cached voles. Our results suggest a complex relationship between zoonotic disease prevalence in hosts, their predators, and landscape structure. Some mechanisms that may have caused the seroprevalence patterns in our results include higher bank vole density in isolated forest patches. This study offers future research potential to shed further light on the contribution of predators and landscape properties to human health. PMID:26873607

  18. Declining ecosystem health and the dilution effect.

    PubMed

    Khalil, Hussein; Ecke, Frauke; Evander, Magnus; Magnusson, Magnus; Hörnfeldt, Birger

    2016-01-01

    The "dilution effect" implies that where species vary in susceptibility to infection by a pathogen, higher diversity often leads to lower infection prevalence in hosts. For directly transmitted pathogens, non-host species may "dilute" infection directly (1) and indirectly (2). Competitors and predators may (1) alter host behavior to reduce pathogen transmission or (2) reduce host density. In a well-studied system, we tested the dilution of the zoonotic Puumala hantavirus (PUUV) in bank voles (Myodes glareolus) by two competitors and a predator. Our study was based on long-term PUUV infection data (2003-2013) in northern Sweden. The field vole (Microtus agrestis) and the common shrew (Sorex araneus) are bank vole competitors and Tengmalm's owl (Aegolius funereus) is a main predator of bank voles. Infection probability in bank voles decreased when common shrew density increased, suggesting that common shrews reduced PUUV transmission. Field voles suppressed bank vole density in meadows and clear-cuts and indirectly diluted PUUV infection. Further, Tengmalm's owl decline in 1980-2013 may have contributed to higher PUUV infection rates in bank voles in 2003-2013 compared to 1979-1986. Our study provides further evidence for dilution effect and suggests that owls may have an important role in reducing disease risk. PMID:27499001

  19. Lifetime reproduction of a forest-dwelling owl increases with age and area of forests.

    PubMed

    Laaksonen, Toni; Hakkarainen, Harri; Korpimäki, Erkki

    2004-12-01

    Loss and alteration of habitats by human actions are the largest worldwide hazard to biodiversity and viability of populations. In boreal forests of Eurasia and North America the natural habitat is changing, mainly because of forestry practices and agriculture. Although there is evidence that the diversity and abundance of animal species are lower in intensively managed than in natural forests, very little is known about how the changes in habitat composition affect reproduction and survival. The best available measure of individual performance in the wild is lifetime reproductive success (LRS), the number of offspring produced during a lifetime, because it combines both survival and reproductive success to a single measure. We show that the LRS of forest-dwelling Tengmalm's owls (Aegolius funereus) increases with the proportion of old forest in the territory because of a higher number of breeding attempts, whereas it decreases with the proportion of agricultural land because of declining fledging success in years when prey populations crashed during owl breeding. These unique results provide an interesting insight into how human influence on the landscape can affect life-history traits of animals through various pathways.

  20. Habitat selection as an antipredator behaviour in a multi-predator landscape: all enemies are not equal.

    PubMed

    Morosinotto, Chiara; Thomson, Robert L; Korpimäki, Erkki

    2010-03-01

    1. Breeding territory choice constitutes a crucial antipredator behaviour for animals that determines reproductive success and survival during the breeding season. On arrival to breeding grounds migrant prey face a multitude of 'waiting' predators already settled within the landscape. 2. We studied territory selection and reproductive investment of migrant pied flycatcher (Ficedula hypoleuca) relative to breeding pygmy owls (POs) (Glaucidium passerinum) and Tengmalm's owls (TOs) (Aegolius funereus). Diurnal POs present a greater predation threat to adult flycatchers (up to 80% songbirds in diet) compared with nocturnal TOs (up to 36%). 3. During territory selection, pied flycatchers strongly avoided POs (occupation: 42% in presence vs. 92% in absence of owl nest) but not TOs (80% vs. 75%). This suggests that flycatchers are able to distinguish between two potential predators, avoiding dangerous POs but not obviously responding to the less risky TOs. 4. Flycatchers responded to presence of PO nests with c. 4-day delay in the start of egg-laying. A significantly prolonged nest building period contributed to this potentially costly breeding delay. Flycatchers further significantly reduced initial reproductive investment in presence of POs by laying 8.2% smaller clutch sizes, even if laying date was controlled. No breeding delay and clutch size reduction was found relative to TO presence. 5. Our results highlight flexibility in breeding territory selection and reproductive strategies as antipredator responses to perceived risk in a multi-predator environment. This supports the idea that for prey, not all predators are equal. PMID:19912426

  1. Lifetime reproduction of a forest-dwelling owl increases with age and area of forests.

    PubMed

    Laaksonen, Toni; Hakkarainen, Harri; Korpimäki, Erkki

    2004-12-01

    Loss and alteration of habitats by human actions are the largest worldwide hazard to biodiversity and viability of populations. In boreal forests of Eurasia and North America the natural habitat is changing, mainly because of forestry practices and agriculture. Although there is evidence that the diversity and abundance of animal species are lower in intensively managed than in natural forests, very little is known about how the changes in habitat composition affect reproduction and survival. The best available measure of individual performance in the wild is lifetime reproductive success (LRS), the number of offspring produced during a lifetime, because it combines both survival and reproductive success to a single measure. We show that the LRS of forest-dwelling Tengmalm's owls (Aegolius funereus) increases with the proportion of old forest in the territory because of a higher number of breeding attempts, whereas it decreases with the proportion of agricultural land because of declining fledging success in years when prey populations crashed during owl breeding. These unique results provide an interesting insight into how human influence on the landscape can affect life-history traits of animals through various pathways. PMID:15801604

  2. Survival of male Tengmalm's owls increases with cover of old forest in their territory.

    PubMed

    Hakkarainen, Harri; Korpimäki, Erkki; Laaksonen, Toni; Nikula, Ari; Suorsa, Petri

    2008-03-01

    The loss and fragmentation of forest habitats have been considered to pose a worldwide threat to the viability of forest-dwelling animals, especially to species that occupy old forests. We investigated whether the annual survival of sedentary male Tengmalm's owls Aegolius funereus was associated with the cover of old coniferous forests in Finland. Survival and recapture probabilities varied annually with density changes in populations of the main prey (Microtus voles). When this variation was controlled for, and relationships between survival and proportions of the three different forest age classes (old-growth, middle-aged, and young) were modeled separately, the old-growth model was the most parsimonious. Survival increased with the cover of old forest, although the extent of old forest within owl territories was relatively small (mean approximately 12%, range 2-37%). This association, however, varied among years and appeared especially in years of increasing vole abundance. At such times, old forests may sustain high populations of bank voles Clethrionomys glareolus, shrews and small passerines. In addition, old forests may serve as refuges against large avian predator species, such as Ural owls Strix uralensis and goshawks Accipiter gentilis. Our results suggest that changes in habitat quality created by agriculture and forestry may have the potential to reduce adult survival, an essential component of fitness and population viability. PMID:18080142

  3. Female offspring desertion and male-only care increase with natural and experimental increase in food abundance.

    PubMed

    Eldegard, Katrine; Sonerud, Geir A

    2009-05-01

    In species with biparental care, one parent may escape the costs of parental care by deserting and leaving the partner to care for the offspring alone. A number of theoretical papers have suggested a link between uniparental offspring desertion and ecological factors, but empirical evidence is scarce. We investigated the relationship between uniparental desertion and food abundance in a natural population of Tengmalm's owl Aegolius funereus, both by means of a 5-year observational study and a 1-year experimental study. Parents and offspring were fitted with radio-transmitters in order to reveal the parental care strategy (i.e. care or desert) of individual parents, and to keep track of the broods post-fledging. We found that 70 per cent of the females from non-experimental nests deserted, while their partner continued to care for their joint offspring alone. Desertion rate was positively related to natural prey population densities and body reserves of the male partner. In response to food supplementation, a larger proportion of the females deserted, and females deserted the offspring at an earlier age. Offspring survival during the post-fledging period tended to be lower in deserted than in non-deserted broods. We argue that the most important benefit of deserting may be remating (sequential polyandry). PMID:19324835

  4. Fading out of vole and predator cycles?

    PubMed

    Hörnfeldt, Birger; Hipkiss, Tim; Eklund, Ulf

    2005-10-01

    Northern voles and lemmings are famous for their spectacular multiannual population cycles with high amplitudes. Such cyclic vole populations in Scandinavia have shown an unexpected and marked long-term decline in density since the early 1970s, particularly with a marked shift to lower spring densities in the early 1980s. The vole decline, mainly characterized by a strongly decreased rate of change in numbers over winter, is associated with an increased occurrence of mild and wet winters brought about by a recent change in the North Atlantic Oscillation. This has led to a decrease in winter stability and has shortened the period with protective snow cover, the latter considered as an important prerequisite for the occurrence of multiannual, high-amplitude cycles in vole populations. Although the vole decline is predicted to be negative for predators' reproduction and abundance, empirical data showing this are rare. Here we show that the dynamics of a predator-prey system (Tengmalm's owl, Aegolius funereus, and voles), have in recent years gradually changed from 3-4 yr, high-amplitude cycles towards more or less annual fluctuations only. PMID:16191615

  5. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic cysts by combined cytopathology and cystic content analysis

    PubMed Central

    Martin, Amanda K; Zhou, Zhongren

    2015-01-01

    Recent advances in imaging technology have resulted in an increase in incidental discoveries of pancreatic cystic lesions. Pancreatic cysts comprise a wide variety of lesions and include non-neoplastic cysts and neoplastic cysts. Because some pancreatic cysts have more of a malignant potential than others, it is absolutely essential that an accurate diagnosis is rendered so that effective care can be given to each patient. In many centers, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has emerged as the modality of choice that enables one to distinguish between mucinous and non-mucinous lesion, diagnose malignancy and collect cyst fluid for further diagnostic studies, such as pancreatic enzyme levels, molecular analysis and other tumor biomarkers. The current review will focus on EUS-guided FNA and the cytological diagnosis for pancreatic cysts. PMID:26504505

  6. Metastasis-Induced Acute Pancreatitis Successfully Treated with Chemotherapy and Radiotherapy in a Patient with Small Cell Lung Cancer

    PubMed Central

    Okutur, Kerem; Bozkurt, Mustafa; Korkmaz, Taner; Karaaslan, Ercan; Guner, Levent; Goksel, Suha; Demir, Gokhan

    2015-01-01

    Although involvement of pancreas is a common finding in small cell lung cancer (SCLC), metastasis-induced acute pancreatitis (MIAP) is very rare. A 50-year-old female with SCLC who had limited disease and achieved full response after treatment presented with acute pancreatitis during her follow-up. The radiologic studies revealed a small area causing obliteration of the pancreatic duct without mass in the pancreatic neck, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the metastasis of SCLC. The patient was treated successfully with systemic chemotherapy and radiotherapy delivered to pancreatic field. In SCLC, cases of MIAP can be encountered with conventional computed tomography with no mass image, and positron emission tomography and EUS-FNA can be useful for diagnosis of such cases. Aggressive systemic and local treatment can prolong survival, especially in patients with good performance status. PMID:26075124

  7. Opium-related sphincter of Oddi dysfunction causing double duct sign

    PubMed Central

    Sharma, Vishal; Rana, Surinder Singh; Chaudhary, Vinita; Dhaka, Narendra; Manrai, Manish; Sivalingam, Jegan; Sharma, Ravi; Dutta, Usha; Bhasin, Deepak Kumar

    2016-01-01

    Double duct sign where there is a simultaneous dilatation of both the common bile duct (CBD) and pancreatic duct is usually associated with sinister causes like malignancies of pancreatic head or ampulla. Occasionally, benign causes like chronic pancreatitis or sphincter of Oddi dysfunction (SOD) may cause double duct sign. Chronic opium abuse is a rare cause of the double duct sign, and endoscopic ultrasound (EUS) findings of this rare entity have been occasionally reported. We report about a 54-year-old male with a history of chronic alcohol and opioid abuse evaluated for episodes of abdominal pain and found to have opioid-related SOD and improved with biliary sphincterotomy. EUS was done to rule out malignancy and revealed hypoechoic prominence around terminal CBD suggestive of hypertrophied muscle. PMID:27503161

  8. New power for "Old Europe".

    PubMed

    Schapiro, Mark

    2005-01-01

    The European Union's growing political clout is leading to new paradigms of environmental and health regulation. The E.U. is putting teeth behind new guidelines governing the toxicity of chemicals in consumer products, cosmetics, and automobiles that are forcing American companies to reconsider longstanding production practices. While U.S. government oversight over environmental and health concerns is being weakened, the E.U.'s strengthened governance over these and other arenas is rapidly, through the leverage of international trade, setting the stage for a new global standard. Europe's new standards present a historic choice to U.S. manufacturers: either conform to the E.U.'s preemptive screening for toxicity, or risk sacrificing the 450-million strong European market. The author explores the American response, and how the United States is slipping to the lower rungs of a double standard for protecting the health of citizens.

  9. Pancreatic cystic neoplasms: Review of current knowledge, diagnostic challenges, and management options

    PubMed Central

    Jana, Tanima; Shroff, Jennifer; Bhutani, Manoop S.

    2015-01-01

    Pancreatic cystic lesions are being detected with increasing frequency, largely due to advances in cross-sectional imaging. The most common neoplasms include serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, solid pseudopapillary neoplasms, and cystic pancreatic endocrine neoplasms. Computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) are currently used as imaging modalities. EUS-guided fine needle aspiration has proved to be a useful diagnostic tool, and enables an assessment of tumor markers, cytology, chemistries, and DNA analysis. Here, we review the current literature on pancreatic cystic neoplasms, including classification, diagnosis, treatment, and recommendations for surveillance. Data for this manuscript was acquired via searching the literature from inception to December 2014 on PubMed and Ovid MEDLINE. PMID:25821410

  10. Mixture model of pottery decorations from Lake Chad Basin archaeological sites reveals ancient segregation patterns.

    PubMed

    O'Brien, John D; Lin, Kathryn; MacEachern, Scott

    2016-03-30

    We present a new statistical approach to analysing an extremely common archaeological data type--potsherds--that infers the structure of cultural relationships across a set of excavation units (EUs). This method, applied to data from a set of complex, culturally heterogeneous sites around the Mandara mountains in the Lake Chad Basin, helps elucidate cultural succession through the Neolithic and Iron Age. We show how the approach can be integrated with radiocarbon dates to provide detailed portraits of cultural dynamics and deposition patterns within single EUs. In this context, the analysis supports ancient cultural segregation analogous to historical ethnolinguistic patterning in the region. We conclude with a discussion of the many possible model extensions using other archaeological data types.

  11. Failed common bile duct cannulation during pregnancy: Rescue with endoscopic ultrasound guided rendezvous procedure.

    PubMed

    Singla, Vikas; Arora, Anil; Tyagi, Pankaj; Sharma, Praveen; Bansal, Naresh; Kumar, Ashish

    2016-01-01

    Common bile duct (CBD) stones can lead to serious complications and require intervention with either endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic techniques for urgent relief. On an average 10%-20% of the patients with gall bladder stones can have associated CBD stones. CBD stones during pregnancy can be associated with hazardous complications for both the mother and the fetus. Failed cannulation while performing ERCP during pregnancy is a technically demanding situation, which requires immediate rescue with special techniques. Conventional rescue techniques may not be feasible and can be associated with hazardous consequences. Endoscopic ultrasound (EUS) guided rendezvous technique has now emerged as a safe alternative, and in one of our patients, this technique was successfully attempted. To the best of our knowledge, this is the first case report in the literature on EUS-guided rendezvous procedure during pregnancy. PMID:27386479

  12. New power for "Old Europe".

    PubMed

    Schapiro, Mark

    2005-01-01

    The European Union's growing political clout is leading to new paradigms of environmental and health regulation. The E.U. is putting teeth behind new guidelines governing the toxicity of chemicals in consumer products, cosmetics, and automobiles that are forcing American companies to reconsider longstanding production practices. While U.S. government oversight over environmental and health concerns is being weakened, the E.U.'s strengthened governance over these and other arenas is rapidly, through the leverage of international trade, setting the stage for a new global standard. Europe's new standards present a historic choice to U.S. manufacturers: either conform to the E.U.'s preemptive screening for toxicity, or risk sacrificing the 450-million strong European market. The author explores the American response, and how the United States is slipping to the lower rungs of a double standard for protecting the health of citizens. PMID:16119575

  13. Vertical Electron Transport through PbS-EuS Structures

    NASA Technical Reports Server (NTRS)

    Wrotek, S.; Dybko, K.; Morawski, A.; Makosa, A.; Wosinski, T.; Figielski, T.; Tkaczyk, Z.; Lusakowska, E.; Story, T.; Sipatov, A. Yu

    2003-01-01

    Temperature dependence of current-voltage I-V characteristics and resistivity is studied in ferromagnetic PbS-EuS semiconductor tunnel structures grown on n-PbS (100) substrates. For the structures with a single (2-4 nm thick) ferromagnetic EuS electron barrier we observe strongly non-linear I-V characteristics with an effective tunneling barrier height of 0.3-0.7 eV. The experimentally observed non-monotonic temperature dependence of the (normal to the plane of the structure) electrical resistance of these structures is discussed in terms of the electron tunneling mechanism taking into account the temperature dependent shift of the band offsets at the EuS-PbS heterointerface as well as the exchange splitting of the electronic states at the bottom of the conduction band of EuS.

  14. Endoscopic ultrasound guided biliary and pancreatic duct interventions

    PubMed Central

    Prichard, David; Byrne, Michael F

    2014-01-01

    When endoscopic retrograde cholangio-pancreatography fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancreatography (ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound (EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The procedural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relating to EUS-guided biliary and pancreatic intervention. PMID:25400865

  15. Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

    PubMed Central

    Storm, Andrew C; Lee, Linda S

    2016-01-01

    The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings. Tools, in addition to radiologic imaging, currently employed in the initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS-FNA has grown to become the gold standard in tissue diagnosis of pancreatic lesions.

  16. Mixture model of pottery decorations from Lake Chad Basin archaeological sites reveals ancient segregation patterns.

    PubMed

    O'Brien, John D; Lin, Kathryn; MacEachern, Scott

    2016-03-30

    We present a new statistical approach to analysing an extremely common archaeological data type--potsherds--that infers the structure of cultural relationships across a set of excavation units (EUs). This method, applied to data from a set of complex, culturally heterogeneous sites around the Mandara mountains in the Lake Chad Basin, helps elucidate cultural succession through the Neolithic and Iron Age. We show how the approach can be integrated with radiocarbon dates to provide detailed portraits of cultural dynamics and deposition patterns within single EUs. In this context, the analysis supports ancient cultural segregation analogous to historical ethnolinguistic patterning in the region. We conclude with a discussion of the many possible model extensions using other archaeological data types. PMID:27009217

  17. Opium-related sphincter of Oddi dysfunction causing double duct sign.

    PubMed

    Sharma, Vishal; Rana, Surinder Singh; Chaudhary, Vinita; Dhaka, Narendra; Manrai, Manish; Sivalingam, Jegan; Sharma, Ravi; Dutta, Usha; Bhasin, Deepak Kumar

    2016-01-01

    Double duct sign where there is a simultaneous dilatation of both the common bile duct (CBD) and pancreatic duct is usually associated with sinister causes like malignancies of pancreatic head or ampulla. Occasionally, benign causes like chronic pancreatitis or sphincter of Oddi dysfunction (SOD) may cause double duct sign. Chronic opium abuse is a rare cause of the double duct sign, and endoscopic ultrasound (EUS) findings of this rare entity have been occasionally reported. We report about a 54-year-old male with a history of chronic alcohol and opioid abuse evaluated for episodes of abdominal pain and found to have opioid-related SOD and improved with biliary sphincterotomy. EUS was done to rule out malignancy and revealed hypoechoic prominence around terminal CBD suggestive of hypertrophied muscle. PMID:27503161

  18. Endoscopic ultrasonography for evaluating patients with recurrent pancreatitis.

    PubMed

    Petrone, Maria Chiara; Arcidiacono, Paolo G; Testoni, Pier Alberto

    2008-02-21

    Acute recurrent pancreatitis (ARP) is still a complex diagnostic and therapeutic challenge in clinical practice. In up to 30% of cases of ARP, it is not possible to establish the etiology of the disease. In the other 70%, many factors play an etiological role in ARP: microlithiasis, sphincter of Oddi dysfunction (SOD), pancreas divisum, hereditary pancreatitis, cystic fibrosis, a choledochocele, annular pancreas, an anomalous pancreatobiliary junction, pancreatic tumors or chronic pancreatitis are diagnosed. EUS should be useful in ARP as it is sensitive for diagnosing bile duct stones, gallbladder sludge, pancreatic lesions, ductal abnormalities and chronic pancreatitis. Endoscopic ultrasound (EUS) appears to be diagnostic in the majority of patients with previously unexplained pancreatitis, and offers an alternative to endoscopic retrograde cholangiopancreatography (ERCP) as the initial diagnostic test in patients with ARP.

  19. INDEPENDENT VERIFICATION SURVEY REPORT FOR ZONE 1 OF THE EAST TENNESSEE TECHNOLOGY PARK IN OAK RIDGE, TENNESSEE

    SciTech Connect

    King, David A.

    2012-08-16

    Oak Ridge Associated Universities (ORAU) conducted in-process inspections and independent verification (IV) surveys in support of DOE's remedial efforts in Zone 1 of East Tennessee Technology Park (ETTP) in Oak Ridge, Tennessee. Inspections concluded that the remediation contractor's soil removal and survey objectives were satisfied and the dynamic verification strategy (DVS) was implemented as designed. Independent verification (IV) activities included gamma walkover surveys and soil sample collection/analysis over multiple exposure units (EUs).

  20. Spin- and symmetry-filtering combined tunnel magnetoresistance through epitaxial MgO/EuS tunnel barriers

    NASA Astrophysics Data System (ADS)

    Gao, Zhiwei; Yang, Yihang; Liu, Fen; Xue, Qian; Miao, Guo-Xing

    2016-07-01

    We created epitaxial magnetic tunnel junctions of FeCo/MgO/EuS on MgO buffered Si (100). Tunnel magnetoresistance reached up to 64% at 4.2 K. An unexpected fast drop of magnetoresistance was recorded for MgO thickness above 1 nm, which is attributed to the forced nonspecular conductance across the EuS conduction band minimum located at the X points, rather than the desired ∆1 conductance centered around the Γ point.

  1. Needle-based confocal laser endomicroscopy

    PubMed Central

    Giovannini, Marc

    2015-01-01

    New applications of confocal laser endomicroscopy were developed as pCLE in the bile duct and nCLE for pancreatic cystic tumors, pancreatic masses and lymph nodes. The aim of this paper would be to give you an update in this new technology and to try to define its place in the diagnosis of cystic and solid pancreatic masses. The material used was a 19G EUS-needle in which the stylet was replaced by the Confocal mini-probe. The mini-probe (0.632 mm of diameter) is pre-loaded and screwed by a locking device in the EUS-Needle and guided endosonographically in the target. Regarding pancreatic cystic lesion, the presence of epithelial villous structures based on nCLE was associated with pancreatic cystic neoplasm (IPMN) (P = 0.004) and provided a sensitivity of 59%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 50%. A superficial vascular network pattern visualized on nCLE was identified in serous cystadenomas. It corresponded on pathological specimen to a dense and subepithelial capillary vascularization. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this sign for the diagnosis of SCA were 87%, 69%, 100%, 100%, and 82%, respectively. In pancreatic adenocarcinomas, nCLE found vascular leakage with irregular vessels with leakage of fluorescein into the tumor, large dark clumps which correspond to humps of malignant cells. These criteria correlate with the histological structure of those tumors which are characterized by tumoral glands, surrounded by fibrosis in case of fibrous stroma tumor. Neuroendocrine tumors showed a dense network of small vessels on a dark background, which fits with the histological structure based on cord of cells surrounded by vessels and by fibrosis. nCLE is feasible during a EUS examination; these preliminary results are very encouraging and may be used in the future in case of inconclusive EUS-FNA. PMID:26643694

  2. Endoscopic treatment of large pancreatic fluid collections (PFC) using self-expanding metallic stents (SEMS) – a two-center experience

    PubMed Central

    Chaves, Dalton Marques; Mönkemüller, Klaus; Carneiro, Fred; Medrado, Bruno; dos Santos, Marcos; Wodak, Stephanie; Reimão, Sílvia; Sakai, Paulo; de Moura, Eduardo

    2014-01-01

    Background/study aim: During the last several years, endoscopic ultrasound (EUS)-guided pancreatic fluid collections’ (PFC) drainage has evolved into the preferred drainage technique. Recently, self-expanding metallic stents (SEMS) have been used as an alternative to double pigtail stents, with the advantage of providing a larger diameter fistula, thereby decreasing the risk of early obstruction and also allowing for direct endoscopic exploration of the cavity. The aim of this study was to evaluate the technical and clinical success, safety, and outcome of patients undergoing EUS-guided drainage of complex PFC using SEMS. Patients/materials and methods: The study was conducted at two tertiary hospitals from January 2010 to January 2013. All patients with PFC referred for endoscopic drainage were enrolled in a prospective database. The inclusion criteria were: (1) patients with pseudocysts or walled-off necrosis based on the revised Atlanta classification; (2) symptomatic patients with thick PFC; (3) PFC that persisted more than 6 weeks; and (4) large PFC diameter (≥ 9 cm). The exclusion criteria consisted of coagulation disorders, PFC bleeding or infection, and failure-to-inform written consent. Results: A total of 16 patients (9 females, 7 males; mean age 52.6, range 20 – 82) underwent EUS drainage with SEMS. There were 14 cases of pseudocysts and 2 cases of walled-off necrosis. The etiologies of the PFC were mainly gallstones (8 of 16 patients, 50 %) and alcohol (5 of 16 patients, 31 %). Technical success was achieved in 100 % of the cases. All patients had a complete resolution of the PFC. Conclusion: Transmural EUS-guided drainage of complex PFC using SEMS is feasible, appears safe, and is efficacious. However, the exchange of the UC (uncovered)-SEMS for plastic stents is mandatory within 1 week. Future prospective studies, preferably multicenter studies, comparing SEMS versus traditional plastic stents for the drainage of PFC are

  3. Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer.

    PubMed

    Long, Eliza E; Van Dam, Jacques; Weinstein, Stefanie; Jeffrey, Brooke; Desser, Terry; Norton, Jeffrey A

    2005-08-01

    Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.

  4. Fortaleza Station Report for 2012

    NASA Technical Reports Server (NTRS)

    Kaufmann, Pierre; Pereira de Lucena, A. Macilio; Sombra da Silva, Adeildo

    2013-01-01

    This is a brief report about the activities carried out at the Fortaleza geodetic VLBI station (ROEN: R´adio Observat´orio Espacial do Nordeste), located in Eus´ebio, CE, Brazil, during the period from January until December 2012. The observing activities were resumed in May after the major maintenance that comprised the azimuth bearing replacement. The total observational experiments consisted of 103 VLBI sessions and continuous GPS monitoring recordings.

  5. Imaging of the pancreas: Recent advances

    PubMed Central

    Chaudhary, Vikas; Bano, Shahina

    2011-01-01

    A wide spectrum of anomalies of pancreas and the pancreatic duct system are commonly encountered at radiological evaluation. Diagnosing pancreatic lesions generally requires a multimodality approach. This review highlights the new advances in pancreatic imaging and their applications in the diagnosis and management of pancreatic pathologies. The mainstay techniques include computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), radionuclide imaging (RNI) and optical coherence tomography (OCT). PMID:21847450

  6. Prospective validation of microRNA signatures for detecting pancreatic malignant transformation in endoscopic-ultrasound guided fine-needle aspiration biopsies

    PubMed Central

    Frampton, Adam E.; Krell, Jonathan; Prado, Mireia Mato; Gall, Tamara M.H.; Abbassi-Ghadi, Nima; Del Vecchio Blanco, Giovanna; Funel, Niccola; Giovannetti, Elisa; Castellano, Leandro; Basyouny, Mohamed; Habib, Nagy A.; Kaltsidis, Harry; Vlavianos, Panagiotis; Stebbing, Justin; Jiao, Long R.

    2016-01-01

    Background Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease. Novel biomarkers are required to aid treatment decisions and improve patient outcomes. MicroRNAs (miRNAs) are potentially ideal diagnostic biomarkers, as they are stable molecules, and tumour and tissue specific. Results Logistic regression analysis revealed an endoscopic-ultrasound fine-needle aspiration (EUS-FNA) 2-miRNA classifier (miR-21 + miR-155) capable of distinguishing benign from malignant pancreatic lesions with a sensitivity of 81.5% and a specificity of 85.7% (AUC 0.930). Validation FNA cohorts confirmed both miRNAs were overexpressed in malignant disease, while circulating miRNAs performed poorly. Methods Fifty-five patients with a suspicious pancreatic lesion on cross-sectional imaging were evaluated by EUS-FNA. At echo-endoscopy, the first part of the FNA was sent for cytological assessment and the second part was used for total RNA extraction. Candidate miRNAs were selected after careful review of the literature and expression was quantified by qRT-PCR. Validation was performed on an independent cohort of EUS-FNAs, as well as formalin-fixed paraffin embedded (FFPE) and plasma samples. Conclusions We provide further evidence for using miRNAs as diagnostic biomarkers for pancreatic malignancy. We demonstrate the feasibility of using fresh EUS-FNAs to establish miRNA-based signatures unique to pancreatic malignant transformation and the potential to enhance risk stratification and selection for surgery. PMID:27086919

  7. Choose the best route: ultrasound-guided transbronchial and transesophageal needle aspiration with echobronchoscope in the diagnosis of mediastinal and pulmonary lesions.

    PubMed

    Mondoni, M; D'Adda, A; Terraneo, S; Carlucci, P; Radovanovic, D; DI Marco, F; Santus, P

    2015-10-01

    Nodal mediastinal staging is a crucial part of the diagnostic workup of patients with non-small-cell lung cancer (NSCLC) for planning optimal treatment. Transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and real-time endobronchial ultrasounds transbronchial needle aspiration (EBUS-TBNA) are accurate, minimally invasive and safe diagnostic techniques for mediastinal staging. Because of the different accessibility to the mediastinum, they are considered complementary and their combination increases the diagnostic yield as compared with the either alone. Recent studies have shown that endosonography represents the best initial test for invasive mediastinal evaluation in NSCLC. Endoscopic ultrasound (with bronchoscope)-guided fine needle aspiration (EUS-B-FNA) is a recently introduced procedure consisting of a transesophageal needle aspiration using an ultrasound bronchoscope. It allows to perform both transbronchial and transesophageal needle sampling with the same instrument, in the same session and by one operator only, thus maximizing time and costs savings. In a recent study Oki et al. randomized 110 patients with hilar/mediastinal adenopathies or lung abnormalities adjoining both the esophagus and the bronchi, to undergo EBUS-TBNA or EUS-FNA performed by pulmonologists with an echobronchoscope. The Authors demonstrated that both procedures provide a high diagnostic yield, without any difference in the number of adverse events and a good comparable tolerance. Nevertheless, the transesophageal approach guaranteed a significantly lower dose of anesthetics and sedatives, a shorter procedural time, fewer oxygen desaturations, a significantly lower cough score and a higher operator satisfaction. In this review our aim was to discuss the findings by Oki et al. in the context of medical literature, highlighting the importance of the EUS-B needle aspiration technique in diagnosing mediastinal and lung lesions, when EBUS-TBNA is deemed less

  8. Prominent gastroduodenal artery: Endosonographic sign of celiac artery stenosis

    PubMed Central

    Gonen, Can; Sürmelioğlu, Ali; Tilki, Metin; Kiliçoğlu, Gamze

    2016-01-01

    Celiac artery (CA) stenosis is a relatively common finding in patients undergoing pancreaticoduodenectomy (PD). In the presence of CA stenosis, arterial blood supply to the celiac territory is usually sustained from the superior mesenteric artery (SMA) through well-developed collaterals. In this paper, the authors report endosonographically identified prominent gastroduodenal artery as the sign of CA stenosis for the first time. Uncovering previously unidentified vascular abnormality, endoscopic ultrasound (EUS) has improved patient management. The patient had uneventful collateral preserving PD. PMID:27803908

  9. Endoscopic ultrasound-guided radiofrequency ablation of the pancreas: An experimental study with pathological correlation

    PubMed Central

    Ungureanu, Bogdan Silviu; Pirici, Daniel; Mărgăritescu, Claudiu; Săndulescu, Larisa; Fronie, Simona; Pătraşcu, Ştefan; Şurlin, Valeriu; Săftoiu, Adrian

    2015-01-01

    Background: The treatment of pancreatic cancer represents a major objective in clinical research, as it still remains the fourth leading cause of cancer deaths among men and women, with approximately 6% of all cancer-related deaths. Materials and Methods: We studied the assessment of an endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) probe through a 19G needle in order to achieve a desirable necrosis area in the pancreas. Radiofrequency ablation of the head of the pancreas was performed on 10 Yorkshire pigs with a weight between 25 kg and 35 kg and a length of 40-70 cm. Using an EUS-guided RFA experimental probe, we ablated an area of 2-3 cm width. The biological samples were harvested after 3 days and 5 days and necropsy was performed 1 week after the procedure. Results: All pigs showed no significant change regarding their behavior and no signs of complication was encountered. Blood analysis revealed increased values of amylase, alkaline phosphatase, and gamma-glutamyl transpeptidase on the 3rd day but a decrease on the 5th day. After necropsy and isolation of the pancreas, the ablated area was easily found, describing a solid necrosis. The pathological examination revealed a coagulative necrosis area with minimal invasion and inflammatory tissue at about 2 cm surrounding the lesion. Conclusion: EUS-RFA is a feasible technique and might represent a promising therapy for the future treatment of pancreatic cancer. However, further studies are necessary to investigate EUS-guided RFA as an option for palliation in pancreatic cancer until it can be successfully used in human patients. PMID:26643702

  10. Examples of Video to Communicate Scientific Findings to Non-Scientists-Bayesian Ecological Modeling

    NASA Astrophysics Data System (ADS)

    Moorman, M.; Harned, D. A.; Cuffney, T.; Qian, S.

    2011-12-01

    The U.S Geological Survey (USGS) National Water-Quality Assessment Program (NAWQA) provides information about (1) water-quality conditions and how those conditions vary locally, regionally, and nationally, (2) water-quality trends, and (3) factors that affect those conditions. As part of the NAWQA Program, the Effects of Urbanization on Stream Ecosystems (EUSE) study examined the vulnerability and resilience of streams to urbanization. Completion of the EUSE study has resulted in over 20 scientific publications. Video podcasts are being used in addition to these publications to communicate the relevance of these scientific findings to more general audiences such as resource managers, educational groups, public officials, and the general public. An example of one of the podcasts is a film about the results of modeling the effects urbanization on stream ecology. The film describes some of the results of the EUSE ecological modeling effort and the advantages of the Bayesian and multi-level statistical modeling approaches, while relating the science to fly fishing. The complex scientific discussion combined with the lighter, more popular activity of fly fishing leads to an entertaining forum while educating viewers about a complex topic. This approach is intended to represent the scientists as interesting people with diverse interests. Video can be an effective scientific communication tool for presenting scientific findings to a broad audience. The film is available for access from the EUSE website (http://water.usgs.gov/nawqa/urban/html/podcasts.html). Additional films are planned to be released in 2012 on other USGS project results and programs.

  11. [Endoscopic ultrasonography elastography in gastroenterology].

    PubMed

    Rustemović, Nadan; Opacić, Milorad; Cuković-Cavka, Silvija

    2009-12-01

    Endoscopic ultrasonography (EUS) elastography is a new technique for detecting the elastic properties of examined tissues during real time ultrasonography. The method is a very valuable tool for the diagnosis and evaluation of pathologic processes affecting the gastrointestinal tract and its adjacent organs. It represents a major advance in the diagnosis and staging of gastrointestinal malignancies, especially pancreatic carcinoma. EUS also provides guidance for fine needle aspiration (FNA) of undiagnosed masses and lymph nodes. Establishing the diagnosis of Crohn's disease or ulcerative colitis is sometimes very difficult. When inflammatory bowel disease (IBD) is confined to the colon, there is a lack of diagnostic tools for distinction between Crohn's colitis and ulcerative colitis, which is especially important in definitive phenotyping before surgical decision. Our ongoing studies emphasize the role of EUS elastography in the diagnosis of inflammatory bowel disease phenotype and primary sclerosing cholangitis. As there are no literature data on this issue, we recommend further investigations in this promising new area of research. PMID:20235372

  12. Facile construction of vertically aligned EuS-ZnO hybrid core shell nanorod arrays for visible light driven photocatalytic properties

    SciTech Connect

    Ranjith, K. S.; Kumar, D. Ranjith; Kumar, R. T. Rajendra

    2015-06-24

    We demonstrated the development of coupled semiconductor in the form of hybrid heterostructures for significant advancement in catalytic functional materials. In this article, we report the preparation of vertically aligned core shell ZnO-EuS nanorod photocatalyst arrays by a simple chemical solution process followed by sulfudation process. The XRD pattern confirmed formation of the hexagonal wurtzite structure of ZnO and cubic nature of the EuS. Cross sectional FESEM images show vertical rod array structure, and the size of the nanorods ranges from 80 to 120 nm. UV-Vis DRS spectra showed that the optical absorption of ZnO was significantly enhanced to the visible region by modification with EuS surfaces. TEM study confirmed that the surface of ZnO was drastically improved by the modification with EuS nanoparticle. The catalytic activity of EuS−ZnO core shell nanorod arrays were evaluated by the photodegradation of Methylene Blue (MB) dye under visible irradiation. The results revealed that the photocatalytic activity of EuS−ZnO was much higher than that of ZnO under natural sunlight. EuS−ZnO was found to be stable and reusable without appreciable loss of catalytic activity up to four consecutive cycles.

  13. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.

    PubMed

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian; Dietrich, Christoph Frank

    2015-10-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.

  14. High frequency electrical conduction block of the pudendal nerve

    NASA Astrophysics Data System (ADS)

    Bhadra, Narendra; Bhadra, Niloy; Kilgore, Kevin; Gustafson, Kenneth J.

    2006-06-01

    A reversible electrical block of the pudendal nerves may provide a valuable method for restoration of urinary voiding in individuals with bladder-sphincter dyssynergia. This study quantified the stimulus parameters and effectiveness of high frequency (HFAC) sinusoidal waveforms on the pudendal nerves to produce block of the external urethral sphincter (EUS). A proximal electrode on the pudendal nerve after its exit from the sciatic notch was used to apply low frequency stimuli to evoke EUS contractions. HFAC at frequencies from 1 to 30 kHz with amplitudes from 1 to 10 V were applied through a conforming tripolar nerve cuff electrode implanted distally. Sphincter responses were recorded with a catheter mounted micro-transducer. A fast onset and reversible motor block was obtained over this range of frequencies. The HFAC block showed three phases: a high onset response, often a period of repetitive firing and usually a steady state of complete or partial block. A complete EUS block was obtained in all animals. The block thresholds showed a linear relationship with frequency. HFAC pudendal nerve stimulation effectively produced a quickly reversible block of evoked urethral sphincter contractions. The HFAC pudendal block could be a valuable tool in the rehabilitation of bladder-sphincter dyssynergia.

  15. Clinical approach to incidental pancreatic cysts

    PubMed Central

    Chiang, Austin L; Lee, Linda S

    2016-01-01

    The approach to incidentally noted pancreatic cysts is constantly evolving. While surgical resection is indicated for malignant or higher risk cysts, correctly identifying these highest risk pancreatic cystic lesions remains difficult. Using parameters including cyst size, presence of solid components, and pancreatic duct involvement, the 2012 International Association of Pancreatology (IAP) and the 2015 American Gastroenterological Association (AGA) guidelines have sought to identify the higher risk patients who would benefit from further evaluation using endoscopic ultrasound (EUS). Not only can EUS help further assess the presence of solid component and nodules, but also fine needle aspiration of cyst fluid aids in diagnosis by obtaining cellular, molecular, and genetic data. The impact of new endoscopic innovations with novel methods of direct visualization including confocal endomicroscopy require further validation. This review also highlights the differences between the 2012 IAP and 2015 AGA guidelines, which include the thresholds for sending patients for EUS and surgery and methods, interval, and duration of surveillance for unresected cysts. PMID:26811661

  16. Clinical outcomes of endoscopic ultrasound-guided ethanol injection for hepatocellular carcinoma in the caudate lobe

    PubMed Central

    Nakaji, So; Hirata, Nobuto; Mikata, Rintaro; Kobayashi, Masayoshi; Shiratori, Toshiyasu; Ogasawara, Sadahisa; Ooka, Yoshihiko; Tsuyuguchi, Toshio; Yamaguchi, Taketo; Yokosuka, Osamu

    2016-01-01

    Background and study aims: Accurately puncturing hepatocellular carcinomas (HCC) that arise from the caudate lobe is generally considered to be technically difficult. We conducted a retrospective study to evaluate the feasibility and safety (the therapeutic outcomes and adverse events) of endoscopic ultrasound (EUS)-guided ethanol injection as a novel treatment for HCC in the caudate lobe. Patients and methods: Twelve patients with early-stage HCC of the caudate lobe that were treated with EUS-guided ethanol injection at two tertiary referral centers were reviewed retrospectively. To evaluate the therapeutic effect of the treatment, a local control curve and an overall survival curve were constructed using the Kaplan–Meier method. Results: The mean follow-up duration was 31.0 months. The 1-year local control rate was 80.2 %, and recurrent lesions developed in 2 cases (after 3 and 9 months, respectively). The overall survival rate was 91.7 %, 75.0 %, and 53.3 % at 1, 2, and 3 years, respectively. Concerning procedure-related adverse events (AEs), 2 patients suffered episodes of fever lasting a few days; however, no serious AEs occurred. Conclusions: EUS-guided ethanol injection could be a useful treatment for early-stage HCC in the caudate lobe because of its simplicity and reduced invasiveness. PMID:27747288

  17. Direct therapeutic intervention for advanced pancreatic cancer.

    PubMed

    Takakura, Kazuki; Koido, Shigeo

    2015-12-10

    Currently, chemotherapy is an accredited, standard treatment for unresectable, advanced pancreatic cancer (PC). However, it has been still showed treatment-resistance and followed dismal prognosis in many cases. Therefore, some sort of new, additional treatments are needed for the better therapeutic results for advanced PC. According to the previous reports, it is obvious that interventional endoscopic ultrasonography (EUS) is a well-established, helpful and low-risky procedure in general. As the additional treatments of the conventional therapy for advanced PC, many therapeutic strategies, such as immunotherapies, molecular biological therapies, physiochemical therapies, radioactive therapies, using siRNA, using autophagy have been developing in recent years. Moreover, the efficacy of the other potential therapeutic targets for PC using EUS-fine needle injection, for example, intra-tumoral chemotherapeutic agents (paclitaxel, irinotecan), several ablative energies (radiofrequency ablation and cryothermal treatment, neodymium-doped yttrium aluminum garnet laser, high-intensity focused ultrasound), etc., has already been showed in animal models. Delivering these promising treatments reliably inside tumor, interventional EUS may probably be indispensable existence for the treatment of locally advanced PC in near future. PMID:26677434

  18. Direct therapeutic intervention for advanced pancreatic cancer

    PubMed Central

    Takakura, Kazuki; Koido, Shigeo

    2015-01-01

    Currently, chemotherapy is an accredited, standard treatment for unresectable, advanced pancreatic cancer (PC). However, it has been still showed treatment-resistance and followed dismal prognosis in many cases. Therefore, some sort of new, additional treatments are needed for the better therapeutic results for advanced PC. According to the previous reports, it is obvious that interventional endoscopic ultrasonography (EUS) is a well-established, helpful and low-risky procedure in general. As the additional treatments of the conventional therapy for advanced PC, many therapeutic strategies, such as immunotherapies, molecular biological therapies, physiochemical therapies, radioactive therapies, using siRNA, using autophagy have been developing in recent years. Moreover, the efficacy of the other potential therapeutic targets for PC using EUS-fine needle injection, for example, intra-tumoral chemotherapeutic agents (paclitaxel, irinotecan), several ablative energies (radiofrequency ablation and cryothermal treatment, neodymium-doped yttrium aluminum garnet laser, high-intensity focused ultrasound), etc., has already been showed in animal models. Delivering these promising treatments reliably inside tumor, interventional EUS may probably be indispensable existence for the treatment of locally advanced PC in near future. PMID:26677434

  19. High EGFR mRNA expression is a prognostic factor for reduced survival in pancreatic cancer after gemcitabine-based adjuvant chemotherapy.

    PubMed

    Fujita, Hayato; Ohuchida, Kenoki; Mizumoto, Kazuhiro; Itaba, Soichi; Ito, Tetsuhide; Nakata, Kohei; Yu, Jun; Kayashima, Tadashi; Hayashi, Akifumi; Souzaki, Ryota; Tajiri, Tatsuro; Onimaru, Manabu; Manabe, Tatsuya; Ohtsuka, Takao; Tanaka, Masao

    2011-03-01

    Pancreatic ductal adenocarcinoma (PDAC) still presents a major therapeutic challenge and a phase III clinical trial has revealed that the combination of gemcitabine and a human epidermal growth factor receptor type I (HER1/EGFR) targeting agent presented a significant benefit compared to treatment with gemcitabine alone. The aim of this study was to investigate EGFR mRNA expression in resected PDAC tissues and its correlation with patient prognosis. We obtained formalin-fixed paraffin-embedded (FFPE) tissue samples from 88 patients with PDAC who underwent pancreatectomy, and measured EGFR mRNA levels by quantitative real-time reverse transcription-polymerase chain reaction. The high-level EGFR group had significantly shorter disease-free-survival (p=0.029) and overall-survival (p=0.014) as shown by univariate analyses, although these did not reach statistical significance, as shown by multivariate analyses. However, we found that high EGFR expression was an independent prognostic factor in patients receiving gemcitabine-based adjuvant chemotherapy (p=0.023). Furthermore, we measured EGFR mRNA levels in 20 endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytological specimens. Altered EGFR levels were distinguishable in microdissected neoplastic cells from EUS-FNA cytological specimens compared to those in whole cell pellets. In conclusion, quantitative analysis of EGFR mRNA expression using FFPE tissue samples and microdissected neoplastic cells from EUS-FNA cytological specimens could be useful in predicting prognosis and sensitivity to gemcitabine in PDAC patients.

  20. Methods and outcomes of screening for pancreatic adenocarcinoma in high-risk individuals.

    PubMed

    Capurso, Gabriele; Signoretti, Marianna; Valente, Roberto; Arnelo, Urban; Lohr, Matthias; Poley, Jan-Werner; Delle Fave, Gianfranco; Del Chiaro, Marco

    2015-07-25

    Pancreatic ductal adenocarcinoma (PDAC) is a lethal neoplasia, for which secondary prevention (i.e., screening) is advisable for high-risk individuals with "familiar pancreatic cancer" and with other specific genetic syndromes (Peutz-Jeghers, p16, BRCA2, PALB and mismatch repair gene mutation carriers). There is limited evidence regarding the accuracy of screening tests, their acceptability, costs and availability, and agreement on whom to treat. Successful target of screening are small resectable PDAC, intraductal papillary mucinous neoplasms with high-grade dysplasia and advanced pancreatic intraepithelial neoplasia. Both magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are employed for screening, and the overall yield for pre-malignant or malignant pancreatic lesions is of about 20% with EUS and 14% with MRI/magnetic resonance colangiopancreatography. EUS performs better for solid and MRI for cystic lesions. However, only 2% of these detected lesions can be considered a successful target, and there are insufficient data demonstrating that resection of benign or low grade lesions improves survival. Many patients in the published studies therefore seemed to have received an overtreatment by undergoing surgery. It is crucial to better stratify the risk of malignancy individually, and to better define optimal screening intervals and methods either with computerized tools or molecular biomarkers, possibly in large multicentre studies. At the moment, screening should be carefully performed within research protocols at experienced centres, offering involved individuals medical and psychological advice. PMID:26240684

  1. Genetic parameters of carcass and meat quality traits of double muscled Piemontese cattle.

    PubMed

    Boukha, A; Bonfatti, V; Cecchinato, A; Albera, A; Gallo, L; Carnier, P; Bittante, G

    2011-09-01

    Genetic parameters of meat quality (MQ) were estimated on Longissimus thoracis muscle of 1208 Piemontese young bulls, progeny of 109 AI sires. Carcass weight (CW), conformation (EUS) and pH (pH24h) were recorded at 24h and lightness (L*), redness (a*), yellowness (b*), pH (pH8d), drip loss (DL), cooking loss (CL) and shear force (SF) were assessed. The heritability (h(2)) of pH24h was very low (0.06), but h2 of pH8d was markedly higher (0.42). Heritability was 0.32, 0.33, and, 0.14, for L*, a* and b*, respectively, whereas was 0.24, 0.07 and 0.14, for DL, CL, and SF, respectively. The two pH measures showed opposite genetic relationships with color measures. Genetic correlations of DL and CL were positive with L* and b* and negative with a*. Genetic correlations between carcass traits and MQ suggest that animals with superior growth potential tend to exhibit reduced EUS scores and pale meat with lower tenderness and water holding capacity. Conversely, improvement of EUS score through selection would lead to light, bright, and tender meat with enhanced water holding capacity.

  2. Differential diagnosis between pancreatic neuroendocrine and solid pseudopapillary neoplasms on endoscopic ultrasound-guided fine-needle aspiration

    PubMed Central

    Raddaoui, Emad M.; Almadi, Majid A.; Aljebreen, Abdulrahman M.; Alsaif, Faisal A.; AlShedoukhy, Ahlam A.; Al-Lehibi, Abed H.; Almohameed, Khalid A.; Tsolakis, Apostolos V.; AlAbbadi, Mousa A.; Almutrafi, Amna R.

    2016-01-01

    Objectives: To evaluate the role of applying a limited panel of immunohistochemical stains on the cellblock preparation from samples obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the aim of differentiating solid pseudopapillary neoplasms (SPNs) from neuroendocrine tumors (NETs). Methods: We retrospectively retrieved all the EUS-FNAs of the pancreas that have a diagnosis of NET or SPN that were performed at 2 tertiary care hospitals in Riyadh, Kingdom of Saudi Arabia from May 2004 to December 2014. Diff-Quik, Papanicolaou, and Immunohistochemistry stains on cellblock preparations were performed. Results: Twenty cases were available (16 pancreatic neuroendocrine tumors (pNETs) and 4 SPNs). The pNETs were immunoreactive for synaptophysin, chromogranin A and CD56 while E-cadherin was diffusely to focally cytoplasmic positive. β-catenin was negative or showed focal cytoplasmic immunoreactivity. In comparison, SPNs were positive for vimentin, CD10, CD-56, focally positive for progesterone receptors and synaptophysin, and revealed nuclear immunostaining for β-catenin. They were negative for chromogranin A and E-cadherin. Conclusion: Based on EUS-FNA samples, nuclear immunoreactivity for β-catenin with loss of membranous immunostaining for E-Cadherin can potentially facilitate differentiating SPNs from pNETs. PMID:27381533

  3. Role of the preoperative usefulness of the pathological diagnosis of pancreatic diseases.

    PubMed

    Matsumoto, Kazuya; Takeda, Yohei; Onoyama, Takumi; Kawata, Soichiro; Kurumi, Hiroki; Ueki, Masaru; Miura, Norimasa; Isomoto, Hajime

    2016-09-15

    Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power, with a sensitivity and specificity of 85%-89% and 98%-99%, compared to pancreatic juice cytology (PJC), whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%. However, EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography, although PJC is able to detect them. As for the frequency of complications such as post endoscopic retrograde cholangiopancreatography pancreatitis, EUS-FNA is safer than PJC. To diagnose pancreatic cancer appropriately, it is necessary for us to master both procedures so that we can select the best methods of sampling tissues while considering the patient's safety and condition.

  4. Role of the preoperative usefulness of the pathological diagnosis of pancreatic diseases.

    PubMed

    Matsumoto, Kazuya; Takeda, Yohei; Onoyama, Takumi; Kawata, Soichiro; Kurumi, Hiroki; Ueki, Masaru; Miura, Norimasa; Isomoto, Hajime

    2016-09-15

    Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power, with a sensitivity and specificity of 85%-89% and 98%-99%, compared to pancreatic juice cytology (PJC), whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%. However, EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography, although PJC is able to detect them. As for the frequency of complications such as post endoscopic retrograde cholangiopancreatography pancreatitis, EUS-FNA is safer than PJC. To diagnose pancreatic cancer appropriately, it is necessary for us to master both procedures so that we can select the best methods of sampling tissues while considering the patient's safety and condition. PMID:27672423

  5. Primary Esophageal Intramural Squamous Cell Carcinoma Masquerading as a Submucosal Tumor: A Rare Presentation of a Common Disease

    PubMed Central

    Sonthalia, Nikhil; Jain, Samit S.; Surude, Ravindra G.; Pawar, Vinay B.; Udgirkar, Suhas; Rathi, Pravin M.

    2016-01-01

    Esophageal squamous cell carcinoma (ESCC) is the commonest primary malignant esophageal tumor, which typically presents as endoscopically visible surface mucosal ulcerations, irregularities, or polyploidal masses. We here report a rare case of primary ESCC with completely intramural growth under a normal looking intact nondysplastic surface squamous epithelium disguising as a submucosal tumor. Upper gastrointestinal endoscopy-guided mucosal biopsy was negative for malignancy. Endoscopic ultrasound (EUS) revealed a heteroechoic solid mass originating from the muscularis propria of the distal esophagus. Cytological study of EUS-guided fine needle aspiration from the mass was suggestive of squamous cell carcinoma, which was confirmed on immunohistochemistry. There was no evidence of metastatic origin of this tumor or continuous cancer involvement from the surrounding structures, including the head, neck, and lungs on bronchoscopy, computed tomography scan, and positron emission tomography scan. Exclusive intramural squamous cell carcinoma with normal overlying mucosa is an exceedingly rare presentation of primary ESCC with only four cases reported in the literature so far. A high index of suspicion is required by the gastroenterologists and pathologists in diagnosing these cases as these tumors closely mimic the mesenchymal submucosal tumors such as lipoma, leiomyoma, and gastrointestinal stromal tumors. EUS is an indispensable tool in making a preoperative diagnosis and therapeutic decision making. PMID:27721663

  6. Accuracy of diagnosis of solid pseudopapillary tumor of the pancreas on fine needle aspiration: A multi-institution experience of ten cases

    PubMed Central

    Jahangir, Sidra; Loya, Asif; Siddiqui, Momin T.; Akhter, Noreen; Yusuf, Muhammed Aasim

    2015-01-01

    Introduction: Solid pseudopapillary tumor of the pancreas (SPTP) is a neoplasm of uncertain origin and indolent biologic behavior with distinctive morphological features occurring predominantly in young women. This tumor has an excellent prognosis compared to neuroendocrine and acinar cell carcinoma, which are close differential diagnoses based on morphology, hence making it crucial to diagnose SPTP correctly. Objectives: To discuss the cytomorphological features of 10 cases of SPTP reported in two institutions and to evaluate the diagnostic accuracy of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) cytology in establishing the diagnosis of SPTP. Methods: Ten diagnosed cases of SPTP were retrieved from the computerized endoscopy and pathology databases of our two tertiary care institutions. Nine patients had subsequent histological follow-up available. Eight patients underwent EUS-FNA while one patient each had ultrasound and computed tomography-guided FNA. The rapid on-site evaluation was carried out in all 10 cases, and additional material was retained for cell block preparation. Immunohistochemical (IHC) stains ranging from synaptophysin, progesterone receptor, chromogranin, β-catenin, CD10, and NSE were applied on cell blocks. Histological sections of all resected specimens were reviewed, and findings were correlated with those obtained by FNA. Results: Adequate material was obtained in all ten cases. IHC stains helped to confirm the cytological impression of SPTP. Histological examination of resection specimens, available in 9/10 cases, confirmed the cytological diagnosis. Conclusions: FNA particularly that obtained with EUS guidance is an effective tool in the accurate diagnosis of SPTP. PMID:26884802

  7. Endoscopic Gallbladder Drainage for Acute Cholecystitis

    PubMed Central

    Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z.; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G.; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica

    2015-01-01

    Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities. PMID:26473125

  8. Verification of antiferromagnetic exchange coupling at room temperature using polar magneto-optic Kerr effect in thin EuS/Co multilayers with perpendicular magnetic anisotropy

    NASA Astrophysics Data System (ADS)

    Goschew, A.; Scott, M.; Fumagalli, P.

    2016-08-01

    We report on magneto-optic Kerr measurements in polar geometry carried out on a series of thin Co/EuS multilayers on suitable Co/Pd-multilayer substrates. Thin Co/EuS multilayers of a few nanometers individual layer thickness usually have their magnetization in plane. Co/Pd multilayers introduce a perpendicular magnetic anisotropy in the Co/EuS layers deposited on top, thus making it possible to measure magneto-optic signals in the polar geometry in remanence in order to study exchange coupling. Magneto-optic Kerr-effect spectra and hysteresis loops were recorded in the visible and ultraviolet photon-energy range at room temperature. The EuS contribution to the magneto-optic signal is extracted at 4.1 eV by combining hysteresis loops measured at different photon energies with polar magneto-optic Kerr-effect spectra recorded in remanence and in an applied magnetic field of 2.2 T. The extracted EuS signal shows clear signs of antiferromagnetic coupling of the Eu magnetic moments to the Co layers. This implies that the ordering temperature of at least a fraction of the EuS layers is above room temperature proving that magneto-optic Kerr-effect spectroscopy can be used here as a quasi-element-specific method.

  9. Appraisal of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic cysts

    PubMed Central

    Krishna, Somashekar G; Lee, Jeffery H

    2016-01-01

    Nearly 2.5% of cross-sectional imaging studies will report a finding of a cystic pancreatic lesion. Even though most of these are incidental findings, it remains very concerning for both patients and treating clinicians. Differentiating and predicting malignant transformation in pancreatic cystic lesions is clinically challenging. Current evaluation of suspicious cystic lesions includes a combination of radiologic imaging, endoscopic ultrasound (EUS) and cyst fluid analyses. Despite these attempts, precise diagnostic stratification among non-mucinous, mucinous, and malignant cystic lesions is often not possible until surgical resection. EUS-guided needle based confocal laser endomicroscopy (nCLE) for evaluation of pancreatic cysts is emerging as a powerful technique with remarkable potential. Though limited imaging data from 3 large clinical trials (INSPECT, DETECT and CONTACT) are currently the reference standard for nCLE imaging, nonetheless these have not been validated in large studies. The aim of this review article is to review the evolving role of EUS-guided nCLE in management of pancreatic cystic lesions in terms of its significance, adverse events, limitations, and implications. PMID:26819534

  10. Epizootic ulcerative syndrome caused by Aphanomyces invadans in captive bullseye snakehead Channa marulius collected from south Florida, USA

    SciTech Connect

    Saylor, Ryan; Miller, Debra; Vandersea, Mark; Bevelhimer, Mark S; Schofield, Pamela; Bennett, Wayne

    2010-02-01

    Epizootic ulcerative syndrome (EUS) caused by the oomycete Aphanomyces invadans is an invasive, opportunistic disease of both freshwater and estuarine fishes. Originally documented as the cause of mycotic granulomatosis of ornamental fishes in Japan and as the cause of EUS of fishes in southeast Asia and Australia, this pathogen is also present in estuaries and freshwater bodies of the Atlantic and gulf coasts of the USA. We describe a mass mortality event of 343 captive juvenile bullseye snakehead Channa marulius collected from freshwater canals in Miami-Dade County, Florida. Clinical signs appeared within the first 2 d of captivity and included petechiae, ulceration, erratic swimming, and inappetence. Histological examination revealed hyphae invading from the skin lesions deep into the musculature and internal organs. Species identification was confirmed using a species-specific PCR assay. Despite therapeutic attempts, 100% mortality occurred. This represents the first documented case of EUS in bullseye snakehead fish collected from waters in the USA. Future investigation of the distribution and prevalence of A. invadans within the bullseye snakehead range in south Florida may give insight into this pathogen-host system.

  11. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    PubMed Central

    Yamasaki, Shuuji

    2016-01-01

    Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

  12. Role of the preoperative usefulness of the pathological diagnosis of pancreatic diseases

    PubMed Central

    Matsumoto, Kazuya; Takeda, Yohei; Onoyama, Takumi; Kawata, Soichiro; Kurumi, Hiroki; Ueki, Masaru; Miura, Norimasa; Isomoto, Hajime

    2016-01-01

    Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power, with a sensitivity and specificity of 85%-89% and 98%-99%, compared to pancreatic juice cytology (PJC), whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%. However, EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography, although PJC is able to detect them. As for the frequency of complications such as post endoscopic retrograde cholangiopancreatography pancreatitis, EUS-FNA is safer than PJC. To diagnose pancreatic cancer appropriately, it is necessary for us to master both procedures so that we can select the best methods of sampling tissues while considering the patient’s safety and condition.

  13. Endoscopic management for congenital esophageal stenosis: A systematic review

    PubMed Central

    Terui, Keita; Saito, Takeshi; Mitsunaga, Tetsuya; Nakata, Mitsuyuki; Yoshida, Hideo

    2015-01-01

    Congenital esophageal stenosis (CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic review to assess outcomes of the treatment for CES, especially the role of endoscopic modalities. A total of 144 literatures were screened and reviewed. CES was categorized in fibromuscular thickening, tracheobronchial remnants (TBR) and membranous web, and the frequency was 54%, 30% and 16%, respectively. Therapeutic option includes surgery and dilatation, and surgery tends to be reserved for ineffective dilatation. An essential point is that dilatation for TBR type of CES has low success rate and high rate of perforation. TBR can be distinguished by using endoscopic ultrasonography (EUS). Overall success rate of dilatation for CES with or without case selection by using EUS was 90% and 29%, respectively. Overall rate of perforation with or without case selection was 7% and 24%, respectively. By case selection using EUS, high success rate with low rate of perforation could be achieved. In conclusion, endoscopic dilatation has been established as a primary therapy for CES except TBR type. Repetitive dilatation with gradual step-up might be one of safe ways to minimize the risk of perforation. PMID:25789088

  14. Diagnostic strategies for early pancreatic cancer.

    PubMed

    Hanada, Keiji; Okazaki, Akihito; Hirano, Naomichi; Izumi, Yoshihiro; Teraoka, Yuji; Ikemoto, Juri; Kanemitsu, Kozue; Hino, Fumiaki; Fukuda, Toshikatsu; Yonehara, Shuji

    2015-02-01

    Diagnosis of pancreatic cancer (PC) at an early stage with curative surgery is the approach with the potential to significantly improve long-term patient outcome. Recently, some reports showed that patients with pancreatic tumors smaller than 10 mm showed a favorable prognosis. However, the rate of tumor detection on computed tomography in patients with small pancreatic tumors is low. For the diagnoses of PC with tumors smaller than 10 mm, the rate of tumor detection was higher on endoscopic ultrasonography (EUS) than on computed tomography or other modalities, and histologic diagnosis using EUS-guided fine-needle aspiration was helpful in confirming the diagnosis. For the diagnosis of PC in situ, EUS and magnetic resonance cholangiopancreatography may play important roles in detecting the local irregular stenosis of the pancreatic duct. Endoscopic retrograde pancreatography and sequential cytodiagnosis using pancreatic juice obtained by endoscopic nasopancreatic drainage multiple times was useful in the final diagnosis of PC in situ. At present, improving survival lies in identifying those individuals with high-risk factors or precursor lesions through an effective screening method. For example, these should include ultrasonography, various biological markers, or national familial pancreatic cancer registration. Additionally, the relationship between specialists in PC from medical centers and practicing physicians plays an important role in the early diagnosis of PC. PMID:25501287

  15. Role of the preoperative usefulness of the pathological diagnosis of pancreatic diseases

    PubMed Central

    Matsumoto, Kazuya; Takeda, Yohei; Onoyama, Takumi; Kawata, Soichiro; Kurumi, Hiroki; Ueki, Masaru; Miura, Norimasa; Isomoto, Hajime

    2016-01-01

    Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power, with a sensitivity and specificity of 85%-89% and 98%-99%, compared to pancreatic juice cytology (PJC), whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%. However, EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography, although PJC is able to detect them. As for the frequency of complications such as post endoscopic retrograde cholangiopancreatography pancreatitis, EUS-FNA is safer than PJC. To diagnose pancreatic cancer appropriately, it is necessary for us to master both procedures so that we can select the best methods of sampling tissues while considering the patient’s safety and condition. PMID:27672423

  16. Epizootic ulcerative syndrome caused by Aphanomyces invadans in captive bullseye snakehead Channa marulius collected from south Florida, USA.

    PubMed

    Saylor, Ryan K; Miller, Debra L; Vandersea, Mark W; Bevelhimer, Mark S; Schofield, Pamela J; Bennett, Wayne A

    2010-01-25

    Epizootic ulcerative syndrome (EUS) caused by the oomycete Aphanomyces invadans is an invasive, opportunistic disease of both freshwater and estuarine fishes. Originally documented as the cause of mycotic granulomatosis of ornamental fishes in Japan and as the cause of EUS of fishes in southeast Asia and Australia, this pathogen is also present in estuaries and freshwater bodies of the Atlantic and gulf coasts of the USA. We describe a mass mortality event of 343 captive juvenile bullseye snakehead Channa marulius collected from freshwater canals in Miami-Dade County, Florida. Clinical signs appeared within the first 2 d of captivity and included petechiae, ulceration, erratic swimming, and inappetence. Histological examination revealed hyphae invading from the skin lesions deep into the musculature and internal organs. Species identification was confirmed using a species-specific PCR assay. Despite therapeutic attempts, 100% mortality occurred. This represents the first documented case of EUS in bullseye snakehead fish collected from waters in the USA. Future investigation of the distribution and prevalence of A. invadans within the bullseye snakehead range in south Florida may give insight into this pathogen-host system.

  17. Characteristics of a new reovirus isolated from epizootic ulcerative syndrome infected snakehead fish.

    PubMed

    John, K R; George, M R; Richards, R H; Frerichs, G N

    2001-09-12

    Epizootic ulcerative syndrome (EUS) has been infecting a wide range of fishes in the South and Southeast Asia for the last 2 decades. One reovirus-like agent (snakehead reovirus, SKRV), isolated from an EUS-infected snakehead fish and investigated in the present study, is the only reovirus so far isolated from an EUS-infected fish. SKRV was characterised by the presence of a double-stranded RNA genome with icosahedral symmetry and double capsid. The virus had an average size of 71 nm, a buoyant density of 1.36 g ml(-1) in CsCl and lacked a lipid-containing envelope. Apart from the above, the presence of a segmented genome and structural proteins falling into 3 specific size classes confirmed that the virus belongs to the family Reoviridae. SKRV differed from aquareoviruses by the lack of a cytopathic effect (CPE) with syncitium formation and in the segmentation pattern of RNA genome. The resistance to pH (3.0 to 9.0) and heat treatment and inability to multiply in mammalian cell lines and haemagglutinate human 'O' red blood cells (RBCs) differentiated SKRV from the rest of the similar genera in the family Reoviridae. Serological comparison indicated the antigenic distinctness of the isolate from selected American and European aquareoviruses. SKRV grew well in SSN-1 and SSN-3 cells at 25 to 30 degrees C but not in the most common Aquareovirus susceptible coldwater fish cell line--CHSE-214.

  18. Endoscopic imaging in the management of gastroenteropancreatic neuroendocrine tumors.

    PubMed

    Pellicano, Rinaldo; Fagoonee, Sharmila; Altruda, Fiorella; Bruno, Mauro; Saracco, Giorgio M; De Angelis, Claudio

    2016-12-01

    Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a heterogeneous group of tumors deriving from the gastrointestinal (GI) neuroendocrine system. Since these neoplasms are usually very small, located deeply within the retroperitoneum or into an extramucosal site of the GI tract and, lastly, because they may be multi-sited, radiological imaging modalities, in combination with endoscopy, are the diagnostic workhorses in patients with GEP-NETs. Endoscopic approach is useful for detection, bioptic diagnosis and curative resection of small GEP-NETs of stomach, duodenum, jejuno-ileum, and colon-rectum. Moreover, endoscopic ultrasonography (EUS), associated with high frequency miniprobes, is a valuable procedure in regional staging of lesions of the GI wall and can provide information which has a remarkable impact on therapeutic choices. EUS is still the sole technique, in a substantial number of cases, providing a definitive diagnosis of pancreatic insulinoma and it detects and follows small lesions of the pancreas in patients with Multiple Endocrine Neoplasia type 1 syndrome. EUS should be performed in those cases in which morphological or molecular imaging modalities need to be supported because of negative or dubious results. In this review we describe the applications of endoscopic procedures in the management of GEP-NETs. PMID:27600643

  19. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).

    PubMed

    Vilmann, Peter; Clementsen, Paul Frost; Colella, Sara; Siemsen, Mette; De Leyn, Paul; Dumonceau, Jean-Marc; Herth, Felix J; Larghi, Alberto; Vazquez-Sequeiros, Enrique; Vasquez-Sequeiros, Enrique; Hassan, Cesare; Crombag, Laurence; Korevaar, Daniël A; Konge, Lars; Annema, Jouke T

    2015-06-01

    This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and esophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence.The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. Recommendations 1 For mediastinal nodal staging in patients with suspected or proven non-small-cell lung cancer (NSCLC) with abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or positron emission tomography (PET), endosonography is recommended over surgical staging as the initial procedure (Recommendation grade A). The combination of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic (esophageal) ultrasound with fine needle aspiration, with use of a gastrointestinal (EUS-FNA) or EBUS (EUS-B-FNA) scope, is preferred over either test alone (Recommendation grade C). If the combination of EBUS and EUS-(B) is not available, we suggest that EBUS alone is acceptable (Recommendation grade C).Subsequent surgical staging is recommended, when endosonography does not show malignant nodal involvement (Recommendation grade B). 2 For mediastinal nodal staging in patients with suspected or proven non-small-cell peripheral lung cancer without mediastinal involvement at CT or CT-PET, we suggest that EBUS-TBNA and/or EUS-(B)-FNA should be performed before therapy, provided that one or more of the following conditions is present: (i) enlarged or fluorodeoxyglucose (FDG)-PET-avid ipsilateral hilar nodes; (ii) primary tumor without FDG uptake; (iii) tumor size ≥ 3 cm (Fig. 3a

  20. Epizootic ulcerative syndrome caused by Aphanomyces invadans in captive bullseye snakehead Channa marulius collected from south Florida, USA

    USGS Publications Warehouse

    Saylor, Ryan K.; Miller, Debra L.; Vandersea, Mark W.; Bevelhimer, Mark S.; Schofield, Pamela J.; Bennett, Wayne A.

    2010-01-01

    Epizootic ulcerative syndrome (EUS) caused by the oomycete Aphanomyces invadans is an invasive, opportunistic disease of both freshwater and estuarine fishes. Originally documented as the cause of mycotic granulomatosis of ornamental fishes in Japan and as the cause of EUS of fishes in southeast Asia and Australia, this pathogen is also present in estuaries and freshwater bodies of the Atlantic and gulf coasts of the USA. We describe a mass mortality event of 343 captive juvenile bullseye snakehead Channa marulius collected from freshwater canals in Miami-Dade County, Florida. Clinical signs appeared within the first 2 d of captivity and included petechiae, ulceration, erratic swimming, and inappetence. Histological examination revealed hyphae invading from the skin lesions deep into the musculature and internal organs. Species identification was confirmed using a species-specific PCR assay. Despite therapeutic attempts, 100% mortality occurred. This represents the first documented case of EUS in bullseye snakehead fish collected from waters in the USA. Future investigation of the distribution and prevalence of A. invadans within the bullseye snakehead range in south Florida may give insight into this pathogen-host system.