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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. 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

  4. The good funeral: toward an understanding of funeral participation and satisfaction.

    PubMed

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

    2011-09-01

    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 evaluated the most recent funeral they had actually attended. The resulting model indicated that religiosity and favorable attitudes, when enacted through participation and involvement, tend to predict funeral satisfaction, in combination with favorable comparisons, and when the deceased was close and the death unexpected or tragic. Evaluations of the funeral, in turn, independently influence a person's general attitudes about funerals. Theoretical and practical implications for understanding funerals and bereavement are explored. PMID:24501820

  5. 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…

  6. 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...

  7. 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...

  8. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true 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...

  9. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 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...

  10. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true 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...

  11. Beyond Accreditation: What Defines a Quality Funeral Service Education Program? An Investigation of the Relationship between Educational Correlates and Program Quality in Funeral Service Education

    ERIC Educational Resources Information Center

    Fritch, John Bradley

    2011-01-01

    This study sought to determine what defines a quality funeral service education program beyond accreditation. The study examined the opinions of funeral service education chairs (N = 45, representing 80% of the population) who are leaders of funeral service education programs accredited by the American Board of Funeral Service Education.…

  12. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... cremation provisions—(1) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods... provider, or a crematory, to require that a casket be purchased for direct cremation. (2) Preventive... container available for direct cremations, if they arrange direct cremations. (b) Other required...

  13. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... cremation provisions—(1) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods... provider, or a crematory, to require that a casket be purchased for direct cremation. (2) Preventive... container available for direct cremations, if they arrange direct cremations. (b) Other required...

  14. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... cremation provisions—(1) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods... provider, or a crematory, to require that a casket be purchased for direct cremation. (2) Preventive... container available for direct cremations, if they arrange direct cremations. (b) Other required...

  15. 16 CFR 453.4 - Required purchase of funeral goods or funeral services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... cremation provisions—(1) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods... provider, or a crematory, to require that a casket be purchased for direct cremation. (2) Preventive... container available for direct cremations, if they arrange direct cremations. (b) Other required...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... cremation provisions—(1) Unfair or deceptive acts or practices. In selling or offering to sell funeral goods... provider, or a crematory, to require that a casket be purchased for direct cremation. (2) Preventive... container available for direct cremations, if they arrange direct cremations. (b) Other required...

  17. 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…

  18. Emaciation and larval filarioid nematode infection in boreal owls (Aegolius funereus).

    PubMed

    Larrat, Sylvain; Dallaire, André D; Lair, Stéphane

    2012-01-01

    Microfilariae are considered non-pathogenic in wild birds. The objective of the current communication is to report host reactions to microfilarial infection of unusual intensity in emaciated boreal owls (Aegolius funereus). An unusually large number of boreal owls (n = 21) were submitted to the Canadian Cooperative Wildlife Health Center-Quebec Region for post-mortem examination during the winter of 2009. Nineteen out of 21 birds were considered emaciated based on atrophy of adipose tissue and pectoral muscles and suboptimal weight. A microscopic examination of a subset of nine owls revealed the presence of microfilariae in six owls. Three of the birds with a heavy parasite burden had masses of larval nematodes obstructing large vessels of the lungs. The emaciated owls are believed to have died from starvation due to a cyclic decrease in prey abundance in the boreal forest. This cycle also drives winter movements of boreal owls to urbanized areas of southern Quebec, presumably accounting for the large number of birds submitted in 2009. In the most severely infected owls, the extreme microfilarial burden might have caused an alteration in circulatory dynamics, gaseous exchanges and also probably some metabolic cost. Consequently, microfilariae could have significantly contributed to the death of some of these owls. PMID:22834547

  19. Miniprobe EUS in management of pancreatic pseudocyst

    PubMed Central

    De Angelis, Paola; Romeo, Erminia; Rea, Francesca; Torroni, Filippo; Caldaro, Tamara; Federici di Abriola, Giovanni; Foschia, Francesca; Caloisi, Claudia; Lucidi, Vincenzina; Dall'Oglio, Luigi

    2013-01-01

    Pancreatic pseudocysts (PP) arise from trauma and pancreatitis; endoscopic gastro-cyst drainage (EGCD) under endoscopic ultrasonography (EUS) in symptomatic PP is the treatment of choice. Miniprobe EUS (MEUS) allows EGCD in children. We report our experience on MEUS-EGCD in PP, reviewing 13 patients (12 children; male:female = 9:3; mean age: 10 years, 4 mo; one 27 years, malnourished male Belardinelli-syndrome; PP: 10 post-pancreatitis, 3 post-traumatic). All patients underwent ultrasonography, computed tomography and magnetic resonance imaging. Conservative treatment was the first option. MEUS EGCD was indicated for retrogastric cysts larger than 5 cm, diameter increase, symptoms or infection. EGCD (stent and/or nasogastrocystic tube) was performed after MEUS (20-MHz-miniprobe) identification of place for diathermy puncture and wire insertion. In 8 cases (61.5%), there was PP disappearance; one, surgical duodenotomy and marsupialization of retro-duodenal PP. In 4 cases (31%), there was successful MEUS-EGCD; stent removal after 3 mo. No complications and no PP relapse in 4 years of mean follow-up. MEUS EGCD represents an option for PP, allowing a safe and effective procedure. PMID:23678380

  20. 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. PMID:26365667

  1. Funerals and families: locating death as a relational issue.

    PubMed

    Woodthorpe, Kate; Rumble, Hannah

    2016-06-01

    Situated at the intersection of the Sociology of Death and Sociology of the Family, this paper argues that the organization and funding of funerals is an overlooked and available lens through which to examine cultural and political norms of familial obligation. Drawing on interviews with claimants to the Department for Work and Pensions' Social Fund Funeral Payment, the paper shows how both responsibility for the organization and payment of a funeral is assumed within families, and how at times this can be overridden by the state. In highlighting the tension between reflexive choice and political norms of family espoused in this policy context, it supports Gilding's () assertion that understanding family practice through reflexivity alone neglects the institutions and conventions within which 'doing' family takes place. In so doing, the paper further makes a case for families and relational negotiations and tensions to be more explicitly included within sociological understanding(s) of death more generally. PMID:27149075

  2. 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…

  3. 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.

  4. 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 §...

  5. 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 §...

  6. 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 §...

  7. 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 §...

  8. 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 §...

  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. Search for Spin Filtering By Electron Tunneling Through Ferromagnetic EuS Barriers in Pbs

    NASA Technical Reports Server (NTRS)

    Figielski, T.; Morawski, A.; Wosinski, T.; Wrotek, S.; Makosa, A.; Lusakowska, E.; Story, T.; Sipatov, A. Yu.; Szczerbakow, A.; Grasza, K.; Curreri, Peter A. (Technical Monitor)

    2002-01-01

    Perpendicular transport through single- and double-barrier heterostructures consisting of ferromagnetic EuS layers embedded into PbS matrix was investigated. Manifestations of both resonant tunneling and spin filtering through EuS barrier have been observed.

  11. EUS-Guided Vascular Procedures: A Literature Review

    PubMed Central

    Kujundzic, Milan

    2013-01-01

    Endoscopic ultrasound (EUS) is continuously stepping into the therapeutic arena, simultaneously evolving in different directions, such as the management of pancreatic and biliary diseases, celiac neurolysis, delivering local intratumoral therapy, and EUS-guided endosurgery. EUS-guided vascular procedures are also challenging, considering the variety of vascular pathology, proximity of the vascular structures to the GI tract wall, high resolution, and real-time guidance offering an attractive access route and precise delivery of the intervention. The literature on vascular therapeutic EUS demonstrates techniques for the management of upper GI variceal and nonvariceal bleeding, pseudoaneurysms, and coiling and embolization procedures, as well as the creation of intrahepatic portosystemic shunts. The paucity of studies, diversity of study designs, and the number of animal model studies hamper a systematic approach to the conclusion and decision making important to clinicians and healthcare policy makers. Nevertheless, theoretical benefits and findings up to date concerning technical feasibility, efficacy, and safety of the procedures drive further research and development in this rather young therapeutic arena. PMID:23737766

  12. 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,…

  13. 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…

  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. Current role of radial and curved-linear arrayed EUS scopes for diagnosis of pancreatic abnormalities in Japan.

    PubMed

    Irisawa, Atsushi

    2011-05-01

    To elucidate the current status of radial and curved-linear arrayed endoscopic ultrasonography (EUS), the author conducted a survey using a questionnaire at different institutions to assess the following. 1. Number of EUS procedures conducted annually for pancreatic malignancies. 2. Role of radial arrayed EUS for pancreatic abnormalities. 3. Role of curved-linear arrayed EUS for pancreatic abnormalities. 4. Indication of EUS-guided fine-needle aspiration biopsy (EUS-FNA) for pancreatic abnormalities. 5. Percentage of EUS-FNA among the cases carried out with EUS for pancreatic abnormalities. 6. Experience of EUS with contrast harmonic echo for pancreatic malignancies and its indications. 7. Experience of elastography on EUS for pancreatic abnormalities. In Japan, although usage of curved-linear arrayed EUS has become popular for both EUS-FNA and for screening, radial EUS is widely used for diagnosing pancreatic abnormalities. Endosonographers must understand the respective advantages and disadvantages of EUS devices and carry out EUS procedures appropriately. PMID:21535192

  16. Optimizing Diagnostic Yield for EUS-Guided Sampling of Solid Pancreatic Lesions: A Technical Review

    PubMed Central

    Weston, Brian R.

    2013-01-01

    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has a higher diagnostic accuracy for pancreatic cancer than other techniques. This article will review the current advances and considerations for optimizing diagnostic yield for EUS-guided sampling of solid pancreatic lesions. Preprocedural considerations include patient history, confirmation of appropriate indication, review of imaging, method of sedation, experience required by the endoscopist, and access to rapid on-site cytologic evaluation. New EUS imaging techniques that may assist with differential diagnoses include contrast-enhanced harmonic EUS, EUS elastography, and EUS spectrum analysis. FNA techniques vary, and multiple FNA needles are now commercially available; however, neither techniques nor available FNA needles have been definitively compared. The need for suction depends on the lesion, and the need for a stylet is equivocal. No definitive endosonographic finding can predict the optimal number of passes for diagnostic yield. Preparation of good smears and communication with the cytopathologist are essential to optimize yield. PMID:23935542

  17. "A sound track of your life": music in contemporary UK funerals.

    PubMed

    Adamson, Sue; Holloway, Margaret

    2012-01-01

    This article considers the role that music plays in contemporary UK funerals and the meaning that the funeral music has for bereaved families. It is based on findings from a recently completed study of 46 funerals funded by the UK Arts and Humanities Research Council. Music contributes to the public ceremony and the personal existential quest of the bereaved. It is important to both the content and process of the contemporary funeral, an event of deep cultural significance in our response as individuals and communities to death and the loss of a significant relationship. There is evidence that for many people, the music chosen and used also evokes and conveys their spirituality. Spirituality may not be intrinsic to the music but spiritual experience may result from the meaning that the music has for that particular person. PMID:22852420

  18. 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)

  19. 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. PMID:23115893

  20. Paying the Piper: The High Cost of Funerals in South Africa.

    PubMed

    Case, Anne; Garrib, Anu; Menendez, Alicia; Olgiati, Analia

    2013-10-01

    We analyze funeral arrangements following the deaths of 3,751 people who died between January 2003 and December 2005 in the Africa Centre Demographic Surveillance Area. We find that, on average, households spend the equivalent of a year's income for an adult's funeral, measured at median per capita African (Black) income. Approximately one-quarter of all individuals had some form of insurance, which helped surviving household members defray some fraction of funeral expenses. However, an equal fraction of households borrowed money to pay for the funeral. We develop a model, consistent with ethnographic work in this area, in which households respond to social pressure to bury their dead in a style consistent with the observed social status of the household and that of the deceased. Households that cannot afford a funeral commensurate with social expectations must borrow money to pay for the funeral. The model leads to empirical tests, and we find results consistent with our model of household decision-making. PMID:24235777

  1. 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

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

    PubMed

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

    2016-03-01

    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

  3. 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…

  4. [EUS-FNA: how to improve biopsy results? An evidence based review].

    PubMed

    Hollerbach, S; Juergensen, C; Hocke, M; Freund, U; Wellmann, A; Burmester, E

    2014-09-01

    Endosonography with fine-needle aspiration biopsy (EUS-FNA) has become a widespreadly available clinical tool to diagnose numerous different lesions in humans. EUS-FNA is frequently used for tissue-based diagnoses such as lymphatic diseases (ranging from tuberculosis / sarcoidosis to malignant lymphoma) or solid tumors (such as pancreatic carcinoma, neuroendocrine tumors, sub-epithelial gastrointestinal tumors and others). Outcomes of EUS-FNA results, however, vary which is caused by several different factors ranging from experience of the endoscopist over technical factors such as use of stylet or suction for puncture through the skills of the cyto-pathologist who takes care of the specimen obtained by EUS-FNA. Though introduced since more than 20 years ago EUS-FNA has still not yet been perfectionized and several issues remain controversial among endoscopist. These issues include needle size and type (FNA versus TNB needles), use of a stylet and suction for FNA sampling, pure cytologic assessment versus cyto-histologic techniques, grading of the investigator´s and pathologist´s experience and improvement of EUS training for novices. In this report we briefly review the actual literature and summarize the available evidence on some controversely discussed issues. The results support the view that use of a stylet rarely aids to increase the amount of tissue obtained during EUS-FNA, whereas use of suction can be helpful in certain situations. Novel cutting needles may potentially improve number and size of core biopsies that can be rendered for special histologic tissue processing techniques. An in-room-cytopathologist not necessarily improves outcome of EUS-FNA results but may have a role during build-up of EUS units to become more successful. EUS-FNA education requires skilled endoscopists on both sides and can presumably be improved by objective testing of practical expertise by peer review and introducing objective sampling parameters. Novel techniques and

  5. 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

  6. International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches

    PubMed Central

    Khashab, Mouen A.; Messallam, Ahmed A.; Penas, Irene; Nakai, Yousuke; Modayil, Rani J.; De la Serna, Carlos; Hara, Kazuo; El Zein, Mohamad; Stavropoulos, Stavros N.; Perez-Miranda, Manuel; Kumbhari, Vivek; Ngamruengphong, Saowanee; Dhir, Vinay K.; Park, Do Hyun

    2016-01-01

    Background and study aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be performed entirely transgastrically (hepatogastrostomy/EUS-HG) or transduodenally (choledochoduodenostomy/EUS-CDS). It is unknown how both techniques compare. The aims of this study were to compare efficacy and safety of both techniques and identify predictors of adverse events. Patients and methods: Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EUS-BD at multiple international centers were included. Technical/clinical success, adverse events, stent complications, and survival were assessed. Results: A total of 121 patients underwent EUS-BD (CDS 60, HG 61). Technical success was achieved in 112 (92.56 %) patients (EUS-CDS 93.3 %, EUS-HG 91.8 %, P = 0.75). Clinical success was attained in 85.5 % of patients who underwent EUS-CDS group as compared to 82.1 % of patients who underwent EUS-HG (P = 0.64). Adverse events occurred more commonly in the EUS-HG group (19.67 % vs. 13.3 %, P = 0.37). Both plastic stenting (OR 4.95, 95 %CI 1.41 – 17.38, P = 0.01) and use of non-coaxial electrocautery (OR 3.95, 95 %CI 1.16 – 13.40, P = 0.03) were independently associated with adverse events. Length of hospital stay was significantly shorter in the CDS group (5.6 days vs. 12.7 days, P < 0.001). Mean follow-up duration was 151 ± 159 days. The 1-year stent patency probability was greater in the EUS-CDS group [0.98 (95 %CI 0.76 – 0.96) vs 0.60 (95 %CI 0.35 – 0.78)] but overall patency was not significantly different. There was no difference in median survival times between the groups (P = 0.36) Conclusions: Both EUS-CDS and EUS-HG are effective and safe techniques for the treatment of distal biliary obstruction after failed ERCP. However, CDS is associated with shorter hospital stay, improved stent patency, and fewer procedure- and stent-related complications. Metallic stents

  7. 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

  8. 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

  9. Rare condition of needle tract seeding after EUS-guided FNA for intraductal papillary mucinous carcinoma

    PubMed Central

    Yamabe, Akane; Irisawa, Atsushi; Shibukawa, Goro; Hoshi, Koki; Fujisawa, Mariko; Igarashi, Ryo; Sato, Ai; Maki, Takumi; Hojo, Hiroshi

    2016-01-01

    Background and study aims: We report on a 75-year-old man who was admitted due to pancreatic cystic lesion accompanied by a solid mass with liver metastasis. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed on the solid mass, and pathological findings revealed the lesion to be an adenocarcinoma diagnosed as intraductal papillary mucinous carcinoma (IPMC). Approximately 3 months after, a cystic subepithelial lesion appeared in the posterior gastric wall where the EUS-FNA had been performed. We performed EUS-FNA again, which revealed that the cystic mass was IPMC with pathology similar to the original lesion. This is a rare case demonstrating needle tract seeding of EUS-FNA for IPMC.

  10. Endoscopic ultrasonography (EUS) as a method used in spatial localization of digestive tract tumors

    NASA Astrophysics Data System (ADS)

    Skrzywanek, Pawel; Sowier, Aleksander; Cysewska-Sobusiak, Anna R.

    2004-07-01

    The subject of the paper is devoted to a modern diagnostic method called the endoscopic ultrasonography (EUS) that is still not widely implemented in many countries. This method bases on two imaging techniques: videoendoscopy and ultrasonography, making possible effective aiding of diagnostics as well as evaluating possibilities of performing radical surgical therapy. Rotating USG probes enable acquiring images vertical to an axis for the round angle area. Small diameters and adequate frequencies of these microprobes make possible their deep penetration into such difficult sites as the biliary and pancreatic ducts. The EUS advantages are presented here on the basis of several examples of real minimally invasive interventions as well diagnostic procedures practiced by the authors. EUS has allowed precise diagnostics without disturbances occurring at conventional ultrasound imaging. The presented images concern EUS used for examination of different digestive tract diseases, including biliary and pancreatic ducts.

  11. 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.

  12. Diagnostic potency of EUS-guided FNA for the evaluation of pancreatic mass lesions

    PubMed Central

    Alizadeh, Amir Houshang Mohammad; Shahrokh, Shabnam; Hadizadeh, Mohammad; Padashi, Maryam; Zali, Mohammad Reza

    2016-01-01

    Background and Objectives: Diagnosis of pancreatic lesions remains a clinical challenge. This study aimed to evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic mass lesions. Patients and Methods: Clinical data, laboratory tests, and cytopathological and imaging reports were collected from 185 pancreatic EUS cases performed from March 2010 to January 2014. The final diagnosis was based on surgical findings, EUS-FNA or computed tomography (CT)-guided biopsy. Results: A total of 100 pancreatic FNAs were obtained by EUS. Most positive diagnoses of malignancy were pancreatic adenocarcinomas (n = 61). The site of pancreatic adenocarcinoma was the head in 50 (82.0%), body in seven (11.5%), and tail in four (6.5%). The sensitivity, specificity, and positive and negative predictive values of EUS-FNA for diagnosing adenocarcinoma were 80.3%, 92.3%, 94.2%, and 75.0%, respectively. Discussion: We concluded that EUS-FNA of pancreatic lesion accurately diagnoses pancreatic adenocarcinoma and should be considered for the standard management of pancreatic adenocarcinoma. PMID:26879164

  13. 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.

  14. 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

  15. 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) establishments. 779.369 Section 779.369 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS THE FAIR LABOR STANDARDS ACT...

  16. 29 CFR 779.369 - Funeral home establishments may qualify as exempt 13(a)(2) establishments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Funeral home establishments may qualify as exempt 13(a)(2) establishments. 779.369 Section 779.369 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS THE FAIR LABOR STANDARDS ACT...

  17. 38 CFR 3.1611 - Official Department of Veterans Affairs representation at funeral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Official Department of Veterans Affairs representation at funeral. 3.1611 Section 3.1611 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Burial Benefits § 3.1611 Official Department of Veterans...

  18. 38 CFR 3.1611 - Official Department of Veterans Affairs representation at funeral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Official Department of Veterans Affairs representation at funeral. 3.1611 Section 3.1611 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Burial Benefits § 3.1611 Official Department of Veterans...

  19. 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

  20. 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

  1. 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

  2. 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

  3. Comparing the Roles of EUS, ERCP and MRCP in Idiopathic Acute Recurrent Pancreatitis

    PubMed Central

    Safari, Mohammad Taghi; Miri, Mohammad Bager; Ebadi, Shahram; Shahrokh, Shabnam; Alizadeh, Amir Houshang Mohammad

    2016-01-01

    Acute recurrent pancreatitis (ARP) is defined as more than two attacks of acute pancreatitis with complete or almost complete resolution of symptoms and signs of pancreatitis between episodes. The initial evaluation fails to detect the cause of ARP in 10%–30% of patients, whose condition is classified as idiopathic ARP. Endoscopic ultrasound (EUS) has gained increasing attention as a useful imaging modality for the pancreas and the extrahepatic biliary tree. The close proximity of the pancreas to the digestive tract allows EUS to obtain detailed images of this organ. This review aims to record pancreaticobiliary endoscopic ultrasound (EUS) and other imaging modalities in the clinical management of patients with idiopathic ARP. PMID:27375362

  4. 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. PMID:26825894

  5. EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

    PubMed Central

    Onda, Saori; Ogura, Takeshi; Kurisu, Yoshitaka; Masuda, Daisuke; Sano, Tatsushi; Takagi, Wataru; Fukunishi, Shinya; Higuchi, Kazuhide

    2016-01-01

    Background: Few reports have described endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for biliary lesions. In addition, adverse events were not completely examined in previous reports, due to the inclusion of cases in which biliary stents had already been placed. The present study aimed to investigate the diagnostic yield and adverse events of EUS-FNA for biliary lesions as the first-line diagnostic modality for consecutive prospectively registered patients. Methods: Inclusion criteria were as follows: (1) patients with suspected cholangiocarcinoma (CCA) based on computed tomography or other imaging modalities; (2) patients who had not previously undergone endoscopic retrograde cholangiopancreatography or EUS-FNA; (3) absence of surgically altered anatomy, such as Roux-en-Y anastomosis or duodenal obstruction caused by tumor invasion, through which an endoscope could not pass; and (4) provision of written informed consent to all procedures associated with the study. Results: A total of 47 consecutive patients with suspected CCA were registered to this study. Sensitivity and accuracy were 89% and 87%, respectively. On multivariate analysis, puncture site was the only factor associated with reduced diagnostic yield (hazard ration, 6.879; 95% confidence interval, 1.172–40.374; P = 0.033). Remarkably, no adverse events such as bleeding or bile leakage were associated with EUS-FNA in any of the 47 patients. Conclusions: Our results suggest that EUS-FNA can be safely performed for biliary disease without biliary stenting. Furthermore, this procedure may warrant use as the first-line diagnostic method, although our results need to be validated in future prospective studies. PMID:27134660

  6. Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery

    PubMed Central

    Law, Joanna K.; Singh, Vikesh K.; Khashab, Mouen A.; Hruban, Ralph H.; Canto, Marcia Irene; Shin, Eun Ji; Saxena, Payal; Weiss, Matthew J.; Pawlik, Timothy M.; Wolfgang, Christopher L.

    2014-01-01

    Background Parenchymal-sparing pancreatic surgery is ideal for lesions such as small pancreatic neuroendocrine tumors (PanNET). However, precise localization of these small tumors at surgery can be difficult. The placement of fiducials under endoscopic ultrasound (EUS) guidance (EUS-F) has been used to direct stereotactic radiation therapy for pancreatic adenocarcinoma. This report describes two cases in which placement of fiducials was used to guide surgical resection. This study aimed to assess the feasibility, safety, and efficacy of using EUS-F for intraoperative localization of small PanNETs. Methods A retrospective study analyzed two consecutive patients with small PanNETs who underwent EUS-F followed by enucleation in a tertiary-care referral hospital. The following features were examined: technical success and complication rates of EUS-F, visibility of the fiducial at the time of surgery, and fiducial migration. Results In the study, EUS-F was performed for two female patients with a 7-mm and a 9-mm PanNET respectively in the uncinate process and neck of the pancreas. In both patients, EUS-F was feasible with two Visicoil fiducials (Core Oncology, Santa Barbara, CA, USA) placed either within or adjacent to the tumors using a 22-gauge Cook Echotip needle. At surgery, the fiducials were clearly visible on intraoperative ultrasound, and both the tumor and the fiducials were successfully enucleated in both cases. No complications were associated with EUS-F, and no evidence of pancreatitis was shown either clinically or on surgical pathology. This investigation had the limitations of a small single-center study. Conclusions For patients undergoing enucleation, EUS-F is technically feasible and safe and aids intraoperative localization of small PanNETs. PMID:23636530

  7. 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…

  8. Cluster of Ebola Virus Disease Linked to a Single Funeral - Moyamba District, Sierra Leone, 2014.

    PubMed

    Curran, Kathryn G; Gibson, James J; Marke, Dennis; Caulker, Victor; Bomeh, John; Redd, John T; Bunga, Sudhir; Brunkard, Joan; Kilmarx, Peter H

    2016-03-01

    As of February 17, 2016, a total of 14,122 cases (62% confirmed) of Ebola Virus Disease (Ebola) and 3,955 Ebola-related deaths had been reported in Sierra Leone since the epidemic in West Africa began in 2014. A key focus of the Ebola response in Sierra Leone was the promotion and implementation of safe, dignified burials to prevent Ebola transmission by limiting contact with potentially infectious corpses. Traditional funeral practices pose a substantial risk for Ebola transmission through contact with infected bodies, body fluids, contaminated clothing, and other personal items at a time when viral load is high; however, the role of funeral practices in the Sierra Leone epidemic and ongoing Ebola transmission has not been fully characterized. In September 2014, a sudden increase in the number of reported Ebola cases occurred in Moyamba, a rural and previously low-incidence district with a population of approximately 260,000. The Sierra Leone Ministry of Health and Sanitation and CDC investigated and implemented public health interventions to control this cluster of Ebola cases, including community engagement, active surveillance, and close follow-up of contacts. A retrospective analysis of cases that occurred during July 11-October 31, 2014, revealed that 28 persons with confirmed Ebola had attended the funeral of a prominent pharmacist during September 5-7, 2014. Among the 28 attendees with Ebola, 21 (75%) reported touching the man's corpse, and 16 (57%) reported having direct contact with the pharmacist before he died. Immediate, safe, dignified burials by trained teams with appropriate protective equipment are critical to interrupt transmission and control Ebola during times of active community transmission; these measures remain important during the current response phase. PMID:26938950

  9. Plate motions, Gondwana dinosaurs, Noah's arks, beached Viking funeral ships, ghost ships, and landspans.

    PubMed

    Jacobs, Louis L; Strganac, Christopher; Scotese, Christopher

    2011-03-01

    Gondwana landmasses have served as large-scale biogeographic Noah's Arks and Beached Viking Funeral Ships, as defined by McKenna. The latitudinal trajectories of selected Gondwana dinosaur localities were traced through time in order to evaluate their movement through climate zones relative to those in which they originally formed. The dispersal of fauna during the breakup of Gondwana may have been facilitated by the presence of offshelf islands forming landspans (sensu Iturralde-Vinent and MacPhee) in the Equatorial Atlantic Gateway and elsewhere. PMID:21437374

  10. A rule-based screening environmental risk assessment tool derived from EUSES.

    PubMed

    Verdonck, Frederik A M; Boeije, Geert; Vandenberghe, Veronique; Comber, Mike; de Wolf, Watze; Feijtel, Tom; Holt, Martin; Koch, Volker; Lecloux, André; Siebel-Sauer, Angela; Vanrolleghem, Peter A

    2005-03-01

    Within the context and scope of the forthcoming European Union chemical regulations (REACH), there is a need to be able to prioritise the chemicals for evaluation. Therefore, a simple, pragmatic and adequately conservative approach for the identification of substances of very low or no immediate concern at an early stage is presented. The fundamental principles and basic concepts are derived from the EU Technical Guidance Document and EUSES, and are translated into an easy-to-use rule-based system. For this development, the effect on risk characterisation ratios (RCRs) of the key environmental parameters in EUSES was quantified (taking into account several standardised chemical release scenarios). Using statistical analysis, ranges were identified for each key parameter, within which the end result of the assessment was not significantly affected. This information was then translated into a lookup table from which environmental risk characterisation ratios can be directly read as a function of a few parameters. PMID:15667838

  11. Quick, safe and effective repair of EUS-related duodenal perforation using over-the-scope clip system (with video).

    PubMed

    Grande, Giuseppe; Manno, Mauro; Alberghina, Nadia; Barbera, Carmelo; Zulli, Claudio; Tontini, Gian Eugenio; Pigò, Flavia; Conigliaro, Rita

    2016-09-01

    Duodenal perforation is a rare but potentially life-threating complication of bilio-pancreatic endoscopic-ultrasound (EUS) examination. Here we report a case of 90 yeas-old patient underwent to EUS with curvilinear ecoendoscope and complicated by duodenal wall perforation. As reported in our case, Over-the-scope clipping system represents a quick, safe and effective approach in order close the leak and prevent further complication. PMID:27211883

  12. 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.

  13. EUS-guided celiac plexus interventions in pancreatic cancer pain: An update and controversies for the endosonographer

    PubMed Central

    Luz, Leticia Perondi; Al-Haddad, Mohammad Ali; DeWitt, John A.

    2014-01-01

    Patients with pancreatic cancer (pancreatic ductal adenocarcinoma [PDAC]) can develop abdominal pain that can be debilitating. Celiac plexus neurolysis (CPN) is a chemical ablation of the celiac plexus that can be used to treat pain caused by pancreatic malignancy. It can be performed by an anterior or posterior approach, and also can be done percutaneously or under guidance of transabdominal ultrasound, computed tomography, intra-operatively or most recently under linear endoscopic ultrasound (EUS) guidance (EUS-CPN). EUS is well-suited for identification of the celiac plexus due to the close proximity of the gastric wall to the origin of the celiac artery. EUS-CPN is now widely practiced, and different EUS approaches have been developed in order to improve the efficacy of this technique. Our objective is to review the use of EUS-CPN in PDAC, including a description of different techniques, review of its efficacy, predictors of pain response, and describe its limitations and safety, as well as new developments. PMID:25485268

  14. Major Late Miocene cooling of the middle crust associated with extensional orogenesis in the Funeral Mountains, California

    NASA Astrophysics Data System (ADS)

    Holm, Daniel K.; Dokka, Roy K.

    1991-09-01

    The Funeral Mountains of the Death Valley region consist of a metamorphic core complex that underlies the Miocene Boundary Canyon detachment fault. Fissiontrack age determinations on sphene, zircon, and apatite from the highest grade portions of the Funeral Mountains (collected in Monarch Canyon) indicate rapid cooling from above ˜285°C at 9-10 Ma. The steep dT/dt slope implied by the cooling path envelope as well as its synchroneity with development of the Boundary Canyon detachment suggests tectonic unroofing of between 9.5 and 17 km since ˜10 Ma (assuming typical geothermal gradients prior to detachment development of between ˜20-30°C/km). Previous studies report muscovite 40Ar/39Ar plateau ages from the same area indicating that the Funeral Mountains core may have cooled below ˜350°C between 110-55 Ma. These data, when combined with the fission track ages, suggest residence of the metamorphic terrain at 285-350°C from Late Cretaceous to late Miocene time. Recent studies, using petrologic constraints, have suggested that much of the unroofing of the Funeral Mountains, as well as development of tectonite fabrics, occurred during Mesozoic extension. Recognition of temperatures in the 300°C range during Miocene time suggests some of the ductile extensional fabrics may be late Miocene in age.

  15. Death anxiety in a national sample of United States funeral directors and its relationship with death exposure, age, and sex.

    PubMed

    Harrawood, Laura K; White, Lyle J; Benshoff, John J

    The purpose of this study is to examine the relationship between the level of death anxiety among a national sample of United States funeral directors with varying levels of death exposure, age, and sex. Utilizing the Multidimensional Fear of Death Scale (MFODS), the results showed a significant, but weak negative relationship between levels of death anxiety and the participants' reported number of funerals attended per year. The correlation between death anxiety scores and the number of reported embalming cases performed yearly was, however, not significant. We found a significant negative correlation between death anxiety and age in both men and women funeral directors. The difference in the death anxiety scores between men (n=166) and women (n=38) funeral directors was not significant. There was a significant negative correlation with age in both men and women in several fears of death including fear of the dying process, fear for significant others, and fear of premature death. The significant negative correlations were stronger for women than men across all three subscales. Results, direction for further research, and implications of the findings for mental health workers are discussed. PMID:19227002

  16. 25 CFR 15.301 - May I receive funds from the decedent's IIM account for funeral services?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false May I receive funds from the decedent's IIM account for funeral services? 15.301 Section 15.301 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR PROBATE PROBATE OF INDIAN ESTATES, EXCEPT FOR MEMBERS OF THE OSAGE NATION AND THE FIVE CIVILIZED...

  17. 25 CFR 15.301 - May I receive funds from the decedent's IIM account for funeral services?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false May I receive funds from the decedent's IIM account for funeral services? 15.301 Section 15.301 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR PROBATE PROBATE OF INDIAN ESTATES, EXCEPT FOR MEMBERS OF THE OSAGE NATION AND THE FIVE CIVILIZED...

  18. Funerals during the 1994 cholera epidemic in Guinea-Bissau, West Africa: the need for disinfection of bodies of persons dying of cholera.

    PubMed

    Gunnlaugsson, G; Einarsdóttir, J; Angulo, F J; Mentambanar, S A; Passa, A; Tauxe, R V

    1998-02-01

    The 1994 cholera epidemic in Guinea-Bissau resulted in 15,878 reported cases and 306 deaths. Early in the epidemic, although the health ministry mandated that the bodies of persons dying of cholera be disinfected, outbreaks occurred in several villages following funerals in the region of Biombo. To determine the influence of disinfection and funeral activities on cholera transmission, we analysed surveillance data and conducted a case-control study following a funeral. The attack rate during the week following funerals was higher in villages where bodies were not disinfected (risk ratio = 2.6, 95% confidence interval [CI] 1.9-3.8). Cholera was strongly associated with eating at a funeral with a non-disinfected corpse (odds ratio [OR] = 14.5, 95% CI 0.9-786) and with touching (i.e., transporting, washing) the body (OR = 36.2, 95% CI 2.6-1769). During cholera epidemics, in addition to other cholera prevention activities, health officials should inform community leaders about the risk of cholera transmission during funerals, meals should not be served at funerals, and bodies of persons dying of cholera should be disinfected. PMID:9528812

  19. 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. PMID:20119894

  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. 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

  2. Developing Federated Services within Seismology: IRIS' involvement in the CoopEUS Project

    NASA Astrophysics Data System (ADS)

    Ahern, T. K.; Trabant, C. M.; Stults, M.

    2014-12-01

    As a founding member of the CoopEUS initiative, IRIS Data Services has partnered with five data centers in Europe and the UC Berkeley (NCEDC) in the US to implement internationally standardized web services to access seismological data using identical methodologies. The International Federation of Digital Seismograph Networks (FDSN) holds commission status within IASPEI/IUGG and as such is the international body that governs data exchange formats and access protocols within seismology. The CoopEUS project involves IRIS and UNAVCO as part of the EarthScope project and the European collaborators are all members of the European Plate Observing System (EPOS). CoopEUS includes one work package that attempts to coordinate data access between EarthScope and EPOS facilities. IRIS has worked with its partners in the FDSN to develop and adopt three key international service standards within seismology. These include 1) fdsn-dataselect, a service that returns time series data in a variety of standard formats, 2) fdsn-station, a service that returns related metadata about a seismic station in stationXML format, and 3) fdsn-event, a service that returns information about earthquakes and other seismic events in QuakeML format. Currently the 5 European data centers supporting these services include the ORFEUS Data Centre in the Netherlands, the GFZ German Research Centre for Geosciences in Potsdam, Germany, ETH Zurich in Switzerland, INGV in Rome, Italy, and the RESIF Data Centre in Grenoble France. Presently these seven centres can all be accessed using standardized web services with identical service calls and returns results in standardized ways. IRIS is developing an IRIS federator that will allow a client to seamlessly access information across the federated centers. Details and current status of the IRIS Federator will be presented.

  3. Radial EUS Examination Can be Helpful in Predicting the Severity of Acute Biliary Pancreatitis.

    PubMed

    Alper, Emrah; Arabul, Mahmut; Aslan, Fatih; Cekic, Cem; Celik, Mustafa; Ipek, Serkan; Unsal, Belkis

    2016-01-01

    We investigated the utility of noncontrast enhanced endosonography (EUS) in predicting the severity of acute pancreatitis (AP) during the first 72 to 96 h of admission.In total, 187 patients with acute biliary pancreatitis were included. The patients were classified into 2 groups as having severe and mild AP according to the Modified Glasgow scoring and computerized tomography severity index (SI). The 158 cases with mild and 29 cases with severe AP had a similar age and sex distribution.Although none of the cases with mild AP developed morbidity and death, of the cases with severe AP, 16 developed serious morbidities and 5 died. On EUS examination, we looked for parenchymal findings, peripancreatic inflammatory signs, free or loculated fluid collections, and abnormalities of the common bile duct and the pancreatic channel. Statistical analysis indicated a significant relationship between the severity of AP with diffuse parenchymal edema, periparenchymal plastering, and/or diffuse retroperitoneal free fluid accumulation, and peri-pancreatic edema. We also defined an EUSSI and found that the EUSSI had sensitivity of 89.7%, specificity of 84.2%, positive predictivity value (PPV) of 88.9%, negative predictivity value (NPV) of 91.2%, and an accuracy of 87.9% in the differentiation of mild and severe AP. We found that the EUSSI had an accuracy of 72.4%, sensitivity of 75.4%, specificity of 65.1%, PPV of 69.3%, and NPV of 73.1% for determining mortality.Our data suggest that EUS allowed us to accurately predict the severity and mortality in nearly 90% of cases with AP. PMID:26817865

  4. Fabrication and magnetic characterization of nanometer-sized ellipses of the ferromagnetic insulator EuS

    NASA Astrophysics Data System (ADS)

    Wolf, M. J.; Sürgers, C.; Fischer, G.; Scherer, T.; Beckmann, D.

    2014-11-01

    The magnetic properties of ferromagnetic elements can be tailored by making use of the shape anisotropy of finite-size systems. One material class of particular interest are ferromagnetic insulators, which can be used as spin filters for spintronics applications. Here we present a way to fabricate nanoscale ellipses of the ferromagnetic insulator europium sulfide (EuS) and investigate their magnetic properties. We observe a distinct influence of the magnetic field orientation on the shape of the magnetization curve. This could be used to separately control the individual magnetic elements of a magnetoresistive device using a ferromagnetic insulator.

  5. [KRAS mutation assay on EUS-FNA specimens from pacients with pancreatic mass].

    PubMed

    Bunganič, Bohuš; Hálková, Tereza; Benešová, Lucie; Belšánová, Barbora; Laclav, Martin; Hrůzová, Martina; Traboulsi, Eva; Frič, Přemysl; Suchánek, Štěpán; Minárik, Marek; Zavoral, Miroslav

    2016-01-01

    Differential diagnosis of solid pancreatic masses using EUS FNA is in 1015 % of cases still challenging. Promising method, which helps to distinguish between chronic pancreatitis and cancer, is point mutations of the proto-oncogene KRAS test. This method is not established in routine clinical practice yet.Objectives were the determination of the sensitivity of the KRAS assay using various kinds of samples of patients with pancreatic mass and testing the effect of the presence of KRAS mutations on the prognosis of survival. 147 patients underwent EUS-FNA examination of pancreatic mass, accompanied by blood sampling with subsequent separation of plasma for the detection of circulating tumor DNA. Part of biopsy sample was left native in a stabilizing solution and part as cytological smear. Samples (native aspirates, cytological smears, plasma) were examined for the presence of KRAS mutation by heteroduplex analysis, denaturing capillary electrophoresis.Among 147 patients with pancreatic masses, 118 were diagnosed as a cancer, 26 chronic pancreatitis, 3 neuroendocrine tumor. In total 147 native aspirates, 118 cytological smears and 94 plasma samples were examined. The highest sensitivity of KRAS mutation was reached in the group of pancreatic cancer patients using cytology, in which 90 % of KRAS mutation was detected (106/118 of the samples). When using the native cellular aspirates, mutation was detected in 78 % (92/118 samples), and examination of plasma was positive in 27 % (24/90 samples). In four patients with chronic pancreatitis KRAS mutations was detected, although none has been cytologically confirmed as a cancer. Two of these four patients were confirmed in the course of the disease as a cancer, one patient died because of alcoholic delirium and the last one was indicated for surgery recently.Examination of KRAS mutations can be performed in all patients undergoing EUS-FNA, with the cytology being the most reliable type of sample for genetic tests. KRAS

  6. 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.

  7. 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.

  8. 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

  9. Numerical study on microbubble-enhanced heating for various parameters in EUS-FUS

    NASA Astrophysics Data System (ADS)

    Okita, Kohei; Maezawa, Miyuki; Takagi, Shu; Matsumoto, Yoichiro

    2012-11-01

    Endoscopic ultrasonography guided focused ultrasound surgery (EUS-FUS) have been developed as a less-invasive treatment for pancreatic cancer. In the present study, microbubble-enhanced heating for various parameters in EUS-FUS is investigated numerically. Mass and momentum equations for bubbly mixture are solved to reproduce the propagation of ultrasound of 4.8MHz through the gel containing microbubbles as Sonazoid®. The dynamics of bubble is governed by the equation which considers the elasticity of both shell and surrounding media. Additionally, the heat equation with the time averaged heat source is solved to obtain a temperature distribution. The basic equations are discretized by the 6th-order finite difference method and developed based on FDTD method. The mixture and bubbles are coupled by Euler-Lagrange method. As the results, the temperature around the target increased due to the microbubble oscillation with increasing the initial void fraction fG0 from 10-5 to 10-4%. However, at fG0=10-3%, ultrasounds were too attenuated to heat the target. The heating region moved from the target to the transducer side. By comparing the results with and without shell, the shell of bubble induced the heating around focus. This is because the decrease of the attenuation due to the elasticity of the shell and the increase of the viscous dissipation rate due to the viscosity of the shell.

  10. Synthesis and magnetic properties of Gd doped EuS nanocrystals with enhanced Curie temperatures.

    PubMed

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

    2010-11-17

    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(1-x)Gd(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(1-x)Gd(x)S NCs to be predominantly Gd(3+). 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 (T(C)) was observed for samples with low Gd concentrations (x ≤ 10%) with a maximum T(C) of 29.4 K observed for NCs containing 5.3% Gd. Overall, the observed T(C), Weiss temperature (θ), and hysteretic behavior correspond directly to the doping level in Eu(1-x)Gd(x)S NCs and the trends qualitatively follow those previously reported for bulk and thin film samples. PMID:20964293

  11. Measuring spirituality, religiosity, and denial in individuals working in funeral service to predict death anxiety.

    PubMed

    Harrawood, Laura K

    The aim of the present study was to examine predictors of death anxiety in U.S. funeral directors/embalmers who were part of a larger study (n = 234). Backward stepwise multiple regression was conducted to determine whether or not spirituality, intrinsic religiosity, extrinsic religiosity, and denial predicted levels of death anxiety. Results indicated that spirituality along with age of the participants accounted for 19% of the variance of death anxiety, R2 = .190, R2(adj) = .180, F(2, 168) = 19.64, p < .001. Intrinsic religiosity, extrinsic religiosity, and denial were not significant in the regression model. Several items, however, in the model had a significant positive correlation with each other at the .01 alpha level including spirituality with intrinsic religiosity (r = .63) and age (r = .21), and intrinsic religiosity with denial (r = .22) and age (r = .24). Other variables correlated negatively with one another at the .01 alpha level. Namely, death anxiety with spirituality (-.38), intrinsic religiosity (r = -.36), and age (-.28); spirituality with extrinsic religiosity (-.22); intrinsic religiosity with extrinsic religiosity (-.45); and extrinsic religiosity with age (r = -.19). Limitations of the study and implications for practice were discussed. PMID:20222233

  12. 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.

  13. 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.

  14. EUS-guided drainage and stent placement for postoperative intra-abdominal and pelvic fluid collections in oncological surgery

    PubMed Central

    Vilar-Cao, Zenaida; Sardina-Ferreiro, Raquel

    2012-01-01

    Objectives: The objective of this study was to evaluate the role and benefits of endoscopic ultrasonography (EUS) in the management of postoperative intra-abdominal fluid collections after attempted curative surgery for abdominal cancer. Methods: The authors retrospectively analysed the Endobase from 1 July 2007 to 30 January 2011 for patients with a postoperative intra-abdominal fluid collection who had undergone EUS-guided drainage and the placement of a stent. The data analysed included the demographics, type of surgery and clinical indications of each patient as well as their clinical and radiological findings. Results: Six patients (three men and three women; mean age, 61.8 years [range, 38–78 years]) with intra-abdominal and pelvic fluid collections after abdominal surgery for cancer had undergone EUS-guided internal drainage. All procedures had been performed using linear EUS guidance and 8-Fr stent drainage catheters (‘one step device’, Giovannini, NWOA system Needle-Wire, Cook). The collection types included perigastric abscess (n = 3), perigastric hematoma and rectal hematoma (n = 1), perirectal biloma (n = 1), and perirectal abscess (n = 1). Patients had undergone the following types of surgery: lower-anterior rectal resection (n = 2), Whipple’s duodenopancreatectomy type (n = 1), total gastrectomy (n = 1), splenectomy (n = 1), and distal pancreatectomy (n = 1). The number of stents inserted for each collection was one (five patients) and two (one patient). Conclusions: EUS-guided drainage and stenting provide another option for the management of postoperative collections. It allows access to areas that are difficult to reach with the CT-guided approach and it can be performed accurately, efficiently and safely. In addition to this, the internal nature of the drainage offers patients more comfort. PMID:22423258

  15. 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

  16. 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.

  17. Magnetic ordering and transitions of EuSe studied by x-ray diffraction

    NASA Astrophysics Data System (ADS)

    Díaz, B.; Granado, E.; Abramof, E.; Torres, L.; Lechner, R. T.; Springholz, G.; Bauer, G.

    2010-05-01

    The magnetic phase diagram and thermal expansion of EuSe is revisited using a high-quality 3200-Å -thick epitaxial film grown over a (111)BaF2 substrate. Resonant magnetic x-ray diffraction experiments reveal a highly hysteretic magnetic phase diagram between 1.8 and TN˜4.7K , in which two antiferromagnetic phases with propagation vectors k⃗I=[(1)/(4),(1)/(4),-(1)/(4)] (represented by ↑↑↓↓ ) and k⃗II=[(1)/(2),(1)/(2),-(1)/(2)](↑↓↑↓) are observed. In addition, a defective phase with k⃗III=[h,h,-h]((1)/(4)

  18. Ultrasound techniques in the evaluation of the mediastinum, part I: endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques

    PubMed Central

    Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin Wu; Borst, Mathias Maximilian; Jenssen, Christian

    2015-01-01

    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 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 (EUS and EBUS) should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [EBUS combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [EUS fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all mediastinal lymph nodes 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 I is dealing with an introduction into ultrasound techniques, mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques and part II with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. PMID:26543620

  19. EUS-guided cholecystoduodenostomy for acute cholecystitis with an anti-stent migration and anti-food impaction system; a pilot study

    PubMed Central

    Takagi, Wataru; Ogura, Takeshi; Sano, Tatsushi; Onda, Saori; Okuda, Atsushi; Masuda, Daisuke; Imoto, Akira; Takeuchi, Toshihisa; Fukunishi, Shinya; Higuchi, Kazuhide

    2016-01-01

    Background: Recently, endoscopic ultrasound-guided gall bladder drainage (EUS-GBD) has been reported using a self-expandable metallic stent. To prevent stent migration and food flowing into the common bile duct through the cystic duct, we perform a novel EUS-guided cholecystoduodenostomy. The aim of our study was to evaluate the safety and feasibility of EUS-guided cholecystoduodenostomy with an anti-stent migration and anti-food impaction system. Methods: A total of 16 consecutive patients who underwent EUS-guided cholecystoduodenostomy for acute cholecystitis were included in this study. Results: Technical and clinical success was obtained in all patients. The median procedure time was 26.9 min (range 19–42 min). Median follow-up time was 181.5 days (range 18–604 days), and in this time, recurrence of acute cholecystitis was not seen in all patients. Adverse events such as stent migration and cholangitis were not seen in any patients, although pneumoperitoneum was seen in one patient. Conclusion: Our technique may be favorable and effective for the prevention of adverse events on EUS-GBD. PMID:26770264

  20. Endoscopic and anesthetic feasibility of EUS and ERCP combined in a single session versus two different sessions

    PubMed Central

    Vila, Juan J; Kutz, Marcos; Goñi, Silvia; Ostiz, Miriam; Amorena, Edurne; Prieto, Carlos; Rodriguez, Cristina; Fernández-Urien, Ignacio; Jiménez, Francisco J

    2011-01-01

    AIM: To discuss the feasibility of single session endoscopic ultrasonography (EUS) to discuss and endoscopic retrograde cholangiopancreatography (ERCP) execution. METHODS: Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session (Group I) versus performing each procedure in two different sessions (Group II) was made. The following variables were evaluated: epidemiological variables, American Society of Anesthesiologists Physical Status Classification (ASA) level, procedural time, propofol dose, anesthetic complications, endoscopic complications and diagnostic yield, and therapeutic procedures on both groups. T-student, Chi-Square and Fisher test were used for comparison. RESULTS: We included 39 patients in Group I (mean age: 69.85 ± 9.25; 27 men) and 46 in Group II (mean age: 67.46 ± 12.57; 25 men). Procedural time did not differ significantly between both groups (Group Ivs Group II: 93 ± 32.78 vs 98.98 ± 38.17; P >0.05) but the dose of propofol differed (Group I vs Group II: 322.28 ± 250.54 mg vs 516.96 ± 289.06 mg; P = 0.001). Three patients had normal findings on both explorations. Three anesthetic complications [O2 desaturation (2), broncoaspiration (1)] and 9 endoscopic complications [pancreatitis (6), bleeding (1), perforation (1), cholangitis (1)] occurred without significant differences between both groups (P > 0.05). We did not find any significant difference regarding age, sex, ASA scale level, diagnostic yield or therapeutic maneuvers between both groups. CONCLUSION: The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield, does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session. PMID:21455343

  1. Performing forward-viewing endoscopy at time of pancreaticobiliary EUS and ERCP may detect additional upper gastrointestinal lesions

    PubMed Central

    Thomas, Ashby; Vamadevan, Arunan S; Slattery, Eoin; Sejpal, Divyesh V; Trindade, Arvind J

    2016-01-01

    Background and study aims: It is unknown whether significant incidental upper gastrointestinal lesions are missed when using non-forward-viewing endoscopes without completing a forward-viewing exam in linear endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) exams. We evaluated whether significant upper GI lesions are missed during EUS and ERCP when upper endoscopy is not performed routinely with a gastroscope. Patients and methods: A retrospective analysis was performed in which an EGD with a forward-viewing gastroscope was performed after using a non-forward-viewing endoscope (linear echoendoscope, duodenoscope, or both) during a single procedure. Upper gastrointestinal tract findings were recorded separately for each procedure. Significant lesions found with a forward-viewing gastroscope were defined as findings that led to a change in the patient’s medication regimen, additional endoscopic surveillance/interventions, or the need for other imaging studies. Results: A total of 168 patients were evaluated. In 83 patients, a linear echoendoscope was used, in 52 patients a duodenoscope was used, and in 33 patients both devices were used. Clinically significant additional lesions diagnosed with a gastroscope but missed by a non-forward-viewing endoscope were found in 30 /168 patients (18 %). EGD after linear EUS resulted in additional lesion findings in 17 /83 patients (20.5 %, χ2 = 13.385, P = 0.00025). EGD after use of a duodenoscope resulted in additional lesions findings in 10 /52 patients (19.2 %, χ2 = 9.987, P = 0.00157). EGD after the use of both a linear echoendoscope and a duodenoscope resulted in additional lesions findings in 3/33 patients (9 %, χ2 = 3.219, P = 0.07). Conclusion: Non forward-viewing endoscopes miss a significant amount of incidental upper gastrointestinal lesions during pancreaticobiliary endoscopy. Performing an EGD with a gastroscope at the time of linear EUS or

  2. EUS-guided biliary drainage with placement of a new partially covered biliary stent for palliation of malignant biliary obstruction: a case series.

    PubMed

    Fabbri, C; Luigiano, C; Fuccio, L; Polifemo, A M; Ferrara, F; Ghersi, S; Bassi, M; Billi, P; Maimone, A; Cennamo, V; Masetti, M; Jovine, E; D'Imperio, N

    2011-05-01

    Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been developed as an alternative drainage technique in patients with obstructive jaundice where endoscopic retrograde cholangiopancreatography (ERCP) has failed. Between July 2008 and December 2009, 16 patients (9 men; median age 79 years) with biliopancreatic malignancy, who were candidates for alternative techniques of biliary decompression because ERCP had been unsuccessful, underwent EUS-BD with placement of a transmural or transpapillary partially covered nitinol self-expandable metal stent (SEMS). EUS-assisted cholangiography was successful in all patients, with definition of the relevant anatomy, but biliary drainage was successfully performed in only 12 (75 %) of the 16 patients (9 choledochoduodenostomies with SEMS placement and 3 biliary rendezvous procedures with papillary SEMS placement), with regression of the cholestasis. No major complications and no procedure-related deaths occurred. There was one case of pneumoperitoneum which was managed conservatively. The median follow-up was 170 days. During the follow-up, eight patients of the 12 patients in whom biliary draining was successful died; four are currently alive. None of the patients required endoscopic reintervention. This series demonstrated that EUS-BD with a partially covered SEMS has a high rate of clinical success and low complication rates, and could represent an alternative choice for biliary decompression. PMID:21271507

  3. 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.

  4. Hydrogeologic Framework of the Southeastern Funeral Mountains, California-Nevada, and Implications for the Major Water-Supply Springs in Death Valley National Park

    NASA Astrophysics Data System (ADS)

    Fridrich, C.; Workman, J.; Blakely, R.; Bredehoeft, J.; Jansen, J.; Thompson, R.; King, M.

    2003-12-01

    We are using a combination of geologic mapping, geophysical surveys, hydrologic computer modeling, and a drilling-and-testing program to evaluate the hydrologic framework of the southeastern Funeral Mountains. Our work addresses: (1) the hydrologic connection of the Furnace Creek springs on the south side of the Funeral Mountains to the regional aquifer system on the north side, and (2) potential impacts on these springs from human activities, including possible leakage from the proposed radioactive waste repository under Yucca Mountain, ~50 km to the northeast, and ongoing agricultural overdrafting of groundwater in the southern Amargosa Desert, ~25 km to the northeast. Discharge from the springs at Furnace Creek provides the major water supply for Death Valley National Park and, at 5000 acre-ft/yr, is at least 10 times larger than that attributable to recharge in the adjacent, arid Funeral Mountains. Moreover, hydrochemical data indicate that the spring water is derived mainly from interbasin groundwater flow through the regional carbonate aquifer. This aquifer extends northeastward across much of southeastern Nevada. Our geologic map data indicate that the carbonate aquifer is continuous under the southeastern Funeral Mountains. The base of this aquifer is, however, structurally uplifted under the axis of the range, to an elevation that is much higher than most of the springs at Furnace Creek, but that is locally lower than the water table on the opposite (northeast) side of the range. Rather than forming a barrier that blocks groundwater flow under the Funeral Mountains, as previously interpreted, this uplift evidently forms a spillway. The ~700 m drop in the water-table elevation across this range, into Death Valley, thus does not indicate the presence of any feature that would divert or slow groundwater flow. Because of the spillway mechanism, flow from the springs at Furnace Creek may be sensitive to the water-mining activities that have been progressively

  5. Grading of EUS-FNA cytologic specimens from patients with pancreatic neuroendocrine neoplasms: it is time move to tissue core biopsy?

    PubMed Central

    Vinayek, Rakesh; Capurso, Gabriele

    2014-01-01

    Pancreatic neuroendocrine neoplasms (p-NENs) are rare and characterized by an indolent course, with a much better prognosis than non-neuroendocrine tumors of the pancreas. In the non-functional class of p-NENS, surgery remains the only curative treatment for early localized disease, but there are few therapeutic options for advanced disease. The prognosis of non-functional p-NENs is determined by many clinical criteria. In 2010, however, the World Health Organization (WHO) introduced a grading system in which determination of the Ki-67 proliferative index has become essential with key role in determining therapeutic decision in both advanced and early diseases. Conventionally, Ki-67 has been assessed on surgical specimens. In last decade, however, the availability of EUS-guided fine needle aspiration (EUS-FNA) has provided the opportunity to sample pancreatic lesions and to assess the value of this parameter pre-operatively. The few studies reporting the use of EUS-FNA cytological specimens for Ki-67 measurement showed promising results. As shown by Weynand and colleagues FNA-cytology may underestimate the staging and caution in using this method to classify tumors as low-grade (G1) should be adopted. Thus, Ki-67 expression on cytological specimens remains unsatisfactory and the need for tissue biopsy specimens has been strongly advocated. Based on a recent study that has reported a high concordance of EUS-guided core biopsy for histologic examination and surgical specimens, especially when a cut-off of 5% is used to differentiate G1 and G2 tumors, EUS tissue acquisition by core biopsy is ready for prime time and should be adopted as a standard of practice. PMID:25493252

  6. Significance of orthogonal flow in the Funeral Mountains metamorphic core complex, Death Valley, California: Insights from geochronology and microstructural analysis

    NASA Astrophysics Data System (ADS)

    Sauer, K. M.; Wells, M. L.; Hoisch, T. D.

    2013-12-01

    The Funeral Mountains metamorphic core complex (FMMCC) in Death Valley, California, exposes middle to lower crustal rocks of the Sevier-Laramide orogen in the footwall of the Boundary Canyon detachment (BCD). Monarch Canyon, located in the northwest section of the Funeral Mountains, exposes the structurally deepest rocks in the FMMCC. These Mesoproterozoic to Neoproterozoic metasedimentary rocks record upper amphibolite facies metamorphism with migmatites developed at the deepest levels. The Monarch Spring fault (MSF) juxtaposes migmatitic paragneisses below against pelitic schists, calcsilicate schists, and marbles above, and represents a deformed anatectic front. In the footwall of the BCD above the MSF, distributed ductile deformation and stratigraphically localized high-strain zones, termed intracore shear zones, are responsible for attenuation and local stratigraphic omission during top-northwest non-coaxial deformation. The relative contributions of Late Cretaceous-early Tertiary and Miocene extensional strains which manifest in the top-northwest fabrics remains unclear, and is being addressed by ongoing and combined thermochronologic, microstructural, and EBSD studies. Our working hypothesis is a polystage extensional history in the FMMCC, with Late Cretaceous extensional intracore shear zones locally reactivated during the Miocene. Below the MSF, migmatitic paragneisses lack similar greenschist to lower amphibolite facies top-northwest fabrics. These rocks instead exhibit heterogeneous strain and a weak to moderately developed northeast-trending mineral lineation, and a local, strong fabric asymmetry indicative of a top-southwest sense of shear. We propose that the anatectic front is an apparent zone of structural decoupling between top-southwest shear below and top-northwest shear above the MSF. Structural and geochronologic studies are currently underway to establish whether the orthogonally directed flow above and below the anatectic front were coeval or

  7. 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.

  8. 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

  9. 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 ...

  10. 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 ...

  11. 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.

  12. 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.

  13. 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 ...

  14. Prognosis of environmental concentrations by geo-referenced and generic models: a comparison of GREAT-ER and EUSES exposure simulations for some consumer-product ingredients in the Itter.

    PubMed

    Wind, T

    2004-02-01

    The aim of this study was the comparison between predicted environmental concentrations (PEC) derived using a generic aspacial model, European Union System for the Evaluation of Substances (EUSES), and a geo-referenced model, the Geo-referenced Regional Environmental Assessment Tool for European Rivers (GREAT-ER). The PECs of some consumer-product ingredients (boron, LAS) and professional uses (EDTA, NTA and Triclosan) were calculated for the river catchment of the Itter, a small tributary to the river Rhine. The PEClocal and PECregional for the water compartment generated by EUSES (default scenario) were subsequently refined with data that realistically reflects the region of North Rhine-Westphalia (NRW scenario) and the Itter catchment (Itter scenario). The results of the three scenarios were then compared with the PECinitial and PECcatchment calculated by GREAT-ER, that was designed as a higher-tiered exposure assessment tool, and with concrete concentrations in the Itter, measured as 24-h composite samples. While the PECregional of all scenarios was close to the lower end of the measured concentrations, the geo-referenced PECs described equally well the real spacial situation. The measured environmental concentrations confirmed the built-in conservatism of the PEClocal calculations by EUSES showing for all investigated chemicals an unrealistically high PEClocal (default). The refinement in the more realistic scenarios could not provide a straight forward general improvement of the PEClocal. In conclusion, when the EUSES prognosis is refined using more detailed substance and regional specific data, it may provide a fairly accurate modelling especially of substances that are not eliminated in the environment. However, in the case of eliminable substances, it does not match the accuracy of higher-tiered geo-referenced exposure models like GREAT-ER. PMID:14664842

  15. 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

  16. "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

  17. 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...

  18. 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...

  19. 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... 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...

  20. 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... 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...

  1. The Molecular Autopsy: Should the Evaluation Continue After the Funeral?

    PubMed Central

    Tester, David J.; Ackerman, Michael J.

    2012-01-01

    Sudden cardiac death (SCD) is one of the most common causes of death in developed countries, with most SCDs involving the elderly, and structural heart disease evident at autopsy. Each year, however, thousands of sudden deaths involving individuals younger than 35 years of age remain unexplained after a comprehensive medicolegal investigation that includes an autopsy. In fact, several epidemiologic studies have estimated that at least 3% and up to 53% of sudden deaths involving previously healthy children, adolescents, and young adults show no morphologic abnormalities identifiable at autopsy. Cardiac channelopathies associated with structurally normal hearts such as long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome (BrS) yield no evidence to be found at autopsy, leaving coroners, medical examiners, and forensic pathologists only to speculate that a lethal arrhythmia might lie at the heart of a sudden unexplained death (SUD). In cases of autopsy-negative SUD, continued investigation through either a cardiologic and genetic evaluation of first- or second-degree relatives or a molecular autopsy may elucidate the underlying mechanism contributing to the sudden death and allow for identification of living family members with the pathogenic substrate that renders them vulnerable, with an increased risk for cardiac events including syncope, cardiac arrest, and sudden death. PMID:22307399

  2. 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…

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. "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…

  9. Colon adenocarcinoma with dome-like phenotype: characteristic endoscopic ultrasonography (EUS) findings.

    PubMed

    Takagi, Wataru; Yamamoto, Katsumi; Amano, Takahiro; Sakamoto, Aisa; Otake, Yuriko; Saiki, Hirotsugu; Kondo, Hisashi; Urabe, Makiko; Takahashi, Kei; Yamamoto, Masashi; Hayashi, Shiro; Nakajima, Sachiko; Nishida, Tsutomu; Komori, Takamichi; Morita, Shunji; Adachi, Shiro; Inada, Masami

    2015-08-01

    An 80-year-old man underwent colonoscopy for proctorrhagia. Conventional white-light imaging showed a superficially flat and elevated lesion that appeared to be a submucosal tumor of the sigmoid colon. Chromoendoscopy with Indigo Carmine showed that the margin of the tumor was covered with normal epithelium but that there was a slight depression on its surface. Magnification endoscopy with Crystal Violet staining revealed the amorphous surface structure of the depressed lesion, but the surrounding mucosa showed a normal pit pattern. Endoscopic ultrasonography demonstrated that a hypoechoic mass was located in the submucosal layer, and a biopsy specimen obtained from the surface of the lesion showed evidence of adenocarcinoma. We then performed sigmoidectomy on the patient. Immunohistochemically, the tumor cells were positive for two mismatch repair proteins (MLH1 and MSH2), but in situ hybridization revealed that the specimen was negative for the Epstein - Barr virus. We finally diagnosed the lesion as adenocarcinoma with a dome-like phenotype of the sigmoid colon. PMID:26355327

  10. 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.

  11. Emergency catheter probe endoscopic sonography (CP-EUS): an effective procedure in the assessment of a bleeding gangliocytic paraganglioma.

    PubMed

    Carucci, P; Leone, N; Repici, A; De Paolis, P; Garabello, D; Galliano, D; Curri, F; Rizzetto, M; De Angelis, C

    2006-02-01

    Catheter probe endoscopic sonography is a relatively rapid and safe procedure, carried out during standard endoscopy, capable of distinguishing solid from cystic lesions and vascular from avascular masses. Herein we discuss the role of catheter probe endoscopic sonography in the emergency assessment of a patient with recent and severe bleeding from an ulcerated polyp, arising from the papilla. During the endoscopy, catheter probe endoscopic sonography showed the solid and submucosal nature of the lesion, suggesting its localised and benign nature and, most importantly, demonstrating the high risk of rebleeding from vascular structures communicating with the ulcer. Because of this finding three metallic endoclips were positioned. The lesion was not removed endoscopically because of its difficult position and the high risk of haemorrhage. The mass, removed through a duodenotomy, was shown to be a gangliocytic paraganglioma, an uncommon tumour, frequently resulting in surgery because of abdominal pain and gastrointestinal bleeding. PMID:16389000

  12. 76 FR 26297 - Agency Information Collection Activities; Proposed Collection; Comment Request; Extension

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-06

    ... Control Number 3084-0025). The Funeral Rule ensures that consumers who are purchasing funeral goods and services have access to accurate itemized price information so they can purchase only the funeral goods and... copy they can keep of the funeral provider's General Price List (``GPL'') that itemizes the goods...

  13. 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

  14. 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.

  15. 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…

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

    PubMed Central

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

    2016-01-01

    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

  17. Possibilities of interventional endoscopic ultrasound.

    PubMed

    Nishimura, Makoto; Togawa, Osamu; Matsukawa, Miho; Shono, Takashi; Ochiai, Yasutoshi; Nakao, Masamitsu; Ishikawa, Keiko; Arai, Shin; Kita, Hiroto

    2012-07-16

    Since endoscopic ultrasound (EUS) was developed in the 1990s, EUS has become widely accepted as an imaging tool. EUS is categorized into radial and linear in design. Radial endoscopes provide cross-sectional imaging of the mediastinum, gastrointestinal tract, liver, spleen, kidney, adrenal gland, and pancreas, which has highly accuracy in the T and N staging of esophageal, lung, gastric, rectal, and pancreatic cancer. Tumor staging is common indication of radial-EUS, and EUS-staging is predictive of surgical resectability. In contrast, linear array endoscope uses a side-viewing probe and has advantages in the ability to perform EUS-guides fine needle aspiration (EUS-FNA), which has been established for cytologic diagnosis. For example, EUS-FNA arrows accurate nodal staging of esophageal cancer before surgery, which provides more accurate assessment of nodes than radial-EUS imaging alone. EUS-FNA has been also commonly used for diagnose of pancreatic diseases because of the highly accuracy than US or computed tomography. EUS and EUS-FNA has been used not only for TNM staging and cytologic diagnosis of pancreatic cancer, but also for evaluation of chronic pancreatitis, pancreatic cystic lesions, and other pancreatic masses. More recently, EUS-FNA has developed into EUS-guided fine needle injection including EUS-guided celiac plexus neurolysis, celiac plexus block, and other "interventional EUS" procedures. In this review, we have summarized the new possibilities offered by "interventional EUS". PMID:22816010

  18. 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

  19. 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

  20. 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

  1. [Endoscopic Ultrasound-guided Local Therapy of Pancreatic Tumors].

    PubMed

    Yoon, Won Jae; Seo, Dong Wan

    2015-09-01

    The development of curvilinear EUS has enabled EUS-guided fine-needle aspiration of intra-abdominal mass lesions. With the introduction of interventional EUS, this technology has undergone several modifications in order to be applied to clinical medicine. One of the potential uses of interventional EUS is the EUS-guided local therapy of pancreatic tumors. Various treatment modalities such as fine-needle injection, radiofrequency ablation, photodynamic therapy, laser ablation, and brachytherapy have been tried under EUS guidance. Some of these modalities are being applied clinically. These methods for EUS-guided local therapy of pancreatic tumors will be reviewed in this article. PMID:26387698

  2. Possibilities of interventional endoscopic ultrasound

    PubMed Central

    Nishimura, Makoto; Togawa, Osamu; Matsukawa, Miho; Shono, Takashi; Ochiai, Yasutoshi; Nakao, Masamitsu; Ishikawa, Keiko; Arai, Shin; Kita, Hiroto

    2012-01-01

    Since endoscopic ultrasound (EUS) was developed in the 1990s, EUS has become widely accepted as an imaging tool. EUS is categorized into radial and linear in design. Radial endoscopes provide cross-sectional imaging of the mediastinum, gastrointestinal tract, liver, spleen, kidney, adrenal gland, and pancreas, which has highly accuracy in the T and N staging of esophageal, lung, gastric, rectal, and pancreatic cancer. Tumor staging is common indication of radial-EUS, and EUS-staging is predictive of surgical resectability. In contrast, linear array endoscope uses a side-viewing probe and has advantages in the ability to perform EUS-guides fine needle aspiration (EUS-FNA), which has been established for cytologic diagnosis. For example, EUS-FNA arrows accurate nodal staging of esophageal cancer before surgery, which provides more accurate assessment of nodes than radial-EUS imaging alone. EUS-FNA has been also commonly used for diagnose of pancreatic diseases because of the highly accuracy than US or computed tomography. EUS and EUS-FNA has been used not only for TNM staging and cytologic diagnosis of pancreatic cancer, but also for evaluation of chronic pancreatitis, pancreatic cystic lesions, and other pancreatic masses. More recently, EUS-FNA has developed into EUS-guided fine needle injection including EUS-guided celiac plexus neurolysis, celiac plexus block, and other “interventional EUS” procedures. In this review, we have summarized the new possibilities offered by “interventional EUS”. PMID:22816010

  3. 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

  4. 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

  5. Nonfluoroscopic endoscopic ultrasound-guided transmural drainage of pseudocysts: A pictorial technical review

    PubMed Central

    Rana, Surinder Singh; Bhasin, Deepak Kumar

    2015-01-01

    Pancreatic pseudocysts (PP) are one of the important local complications of pancreatitis and can be treated by surgical, laparoscopic, percutaneous, or endoscopic methods. The endoscopic methods of drainage include transpapillary or transmural drainage or a combination of these two routes. The transmural drainage can be done using conventional duodenoscope without endoscopic ultrasound (EUS) guidance or under EUS guidance. The EUS-guided transmural drainage of PP is done under EUS and fluoroscopic guidance. We have earlier reported nonfluoroscopic EUS-guided transmural drainage of walled-off pancreatic necrosis. In this pictorial technical review, we will discuss in detail this method of nonfluoroscopic EUS-guided drainage of PP. PMID:26020042

  6. 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…

  7. 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:

  8. 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

  9. 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.

  10. Role of Diagnostic and Therapeutic Endoscopic Ultrasonography in Benign Pancreatic Diseases

    PubMed Central

    Singla, Vikas; Garg, Pramod Kumar

    2013-01-01

    Standard imaging of pancreas is generally obtained by computed tomography and magnetic resonance imaging. However endoscopic ultrasound (EUS) has become an indispensable tool for the diagnosis of various pancreatic diseases. Because of the close proximity of the EUS probe to the pancreas, EUS provides excellent images of the pancreas. In this review, we discuss the role of EUS in the clinical management of patients with benign pancreatic diseases, i.e., various forms of pancreatitis. PMID:24949381

  11. 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

  12. 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.

  13. Technical tips of endoscopic ultrasound-guided choledochoduodenostomy.

    PubMed

    Ogura, Takeshi; Higuchi, Kazuhide

    2015-01-21

    Endoscopic ultrasound (EUS) is clinically useful not only as a diagnostic tool during EUS-guided fine needle aspiration, but also during interventional EUS. EUS-guided biliary drainage has been developed and performed by experienced endoscopists. EUS-guided choledocoduodenostomy (EUS-CDS) is relatively well established as an alternative biliary drainage method for biliary decompression in patients with biliary obstruction. The reported technical success rate of EUS-CDS ranges from 50% to 100%, and the clinical success rate ranges from 92% to 100%. Further, the over-all technical success rate was 93%, and clinical success rate was 98%. Based on the currently available literature, the overall adverse event rate for EUS-CDS is 16%. The data on the cumulative technical and clinical success rate for EUS-CDS is promising. However, EUS-CDS can still lead to several problems, so techniques or devices that are more feasible and safe need to be established. EUS-CDS has the potential to become a first-line biliary drainage procedure, although standardizing the technique in multicenter clinical trials and comparisons with endoscopic biliary drainage by randomized clinical trials are still needed. PMID:25624715

  14. 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

  15. Learning models for endoscopic ultrasonography in gastrointestinal endoscopy.

    PubMed

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

    2015-05-01

    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

  16. 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

  17. Current status of endoscopic ultrasound for the upper gastrointestinal tract in Asia.

    PubMed

    Yoshinaga, Shigetaka; Hilmi, Ida Normiha; Kwek, Boon Eu Andrew; Hara, Kazuo; Goda, Kenichi

    2015-04-01

    We summarize the current status of endoscopic ultrasound (EUS) for the upper gastrointestinal (GI) tract solely in Asia, focusing on the staging of superficial cancers and the diagnosis of submucosal tumors (SMT), by analysis of questionnaire responses and a literature review. EUS for assessing the depth of superficial cancers of the upper GI tract is useful; however, evidence is lacking to support that EUS is superior to other modalities. The current status of EUS varies across different Asian countries, and standardization of the methods used both during the procedure and for depth subclassification is necessary to evaluate the diagnostic accuracy. Although EUS alone is limited in the diagnosis of SMT, EUS-guided fine-needle aspiration is an effective and safe diagnostic tool. Although there is a role for EUS, there are still many limitations both technically and in terms of accessibility. PMID:25537645

  18. 77 FR 49786 - National Advisory Committee on Institutional Quality and Integrity (NACIQI)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-17

    ... participate in the meeting (e.g., interpreting service, assistive listening device, or materials in an... Funeral Service Education (ABFSE) (Current Scope: The accreditation of institutions and programs within the United States awarding diplomas, associate degrees and bachelor's degrees in funeral service...

  19. 28 CFR Appendix A to Part 74 - Declarations of Eligibility by Persons Identified by the Office of Redress Administration and...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... attending physician, or intern of the institution where death occurred. 4. A certified copy, or extract from... of death. 3. A statement of the funeral director or attending physician, or intern of the institution.... 3. A statement of the funeral director or attending physician, or intern of the institution...

  20. 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)

  1. 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)

  2. 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,...

  3. 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,...

  4. 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,...

  5. 38 CFR 3.1605 - Death while traveling under prior authorization or while hospitalized by the Department of...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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,...

  6. 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,...

  7. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... another funeral home, together with a list of the services provided for any quoted price; (B) Receiving remains from another funeral home, together with a list of the services provided for any quoted price; (C... provided for any quoted price and, if the charge cannot be declined by the purchaser, the statement:...

  8. Opinion: How to manage subepithelial lesions of the upper gastrointestinal tract?

    PubMed Central

    Franco, Matheus Cavalcante; Schulz, Ricardo Teles; Maluf-Filho, Fauze

    2015-01-01

    Subepithelial lesions (SELs) in the upper gastrointestinal (GI) tract are relatively frequent findings in patients undergoing an upper GI endoscopy. These tumors, which are located below the epithelium and out of reach of conventional biopsy forceps, may pose a diagnostic challenge for the gastroenterologist, especially when SELs are indeterminate after endoscopy and endoscopic ultrasound (EUS). The decision to proceed with further investigation should take into consideration the size, location in the GI tract, and EUS features of SELs. Gastrointestinal stromal tumor (GIST) is an example of an SEL that has a well-recognized malignant potential. Unfortunately, EUS is not able to absolutely differentiate GISTs from other benign hypoechoic lesions from the fourth layer, such as leiomyomas. Therefore, EUS-guided fine needle aspiration (EUS-FNA) is an important tool for correct diagnosis of SELs. However, small lesions (size < 2 cm) have a poor diagnostic yield with EUS-FNA. Moreover, studies with EUS-core biopsy needles did not report higher rates of histologic and diagnostic yields when compared with EUS-FNA. The limited diagnostic yield of EUS-FNA and EUS-core biopsies of SELs has led to the development of more invasive endoscopic techniques for tissue acquisition. There are initial studies showing good results for tissue biopsy or resection of SELs with endoscopic submucosal dissection, suck-ligate-unroof-biopsy, and submucosal tunneling endoscopic resection. PMID:26675266

  9. The difference in the capability of delineation between convex and radial arrayed echoendoscope for pancreas and biliary tract; case reports from the standpoint of both convex and radial arrayed echoendoscope.

    PubMed

    Katanuma, Akio; Maguchi, Hiroyuki; Osanai, Manabu; Takahashi, Kuniyuki

    2011-05-01

    Endoscopic ultrasound (EUS) is useful in obtaining not only high-resolution images of organs and surrounding tissue but also the tissue itself for histopathological diagnosis using fine needle aspiration. Currently, there are two types of EUS available for use: radial and convex arrayed EUS. Each type of EUS has its own advantages and disadvantages. Because radial arrayed EUS can obtain 360 degree images, it is easy to see surrounding organs and vessels. In addition, a single longitudinal image of the pancreas, gallbladder and bile duct is easy to obtain. For this reason, radial arrayed EUS is highly effective in diagnostic examinations. In contrast, while scanning range of convex arrayed EUS limited to 180 degrees, it has the advantage of being able to obtain tissue samples. Additionally while using convex arrayed EUS, the upper part of the bile duct and neck of the pancreas are easily seen beyond the portal vein. It is important to understand the characteristics of each EUS in order to select the most suitable EUS technique for diagnostic assessment. PMID:21535191

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

    PubMed

    De Lisi, Stefania; Giovannini, Marc

    2016-02-01

    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

  11. Opinion: How to manage subepithelial lesions of the upper gastrointestinal tract?

    PubMed

    Franco, Matheus Cavalcante; Schulz, Ricardo Teles; Maluf-Filho, Fauze

    2015-12-10

    Subepithelial lesions (SELs) in the upper gastrointestinal (GI) tract are relatively frequent findings in patients undergoing an upper GI endoscopy. These tumors, which are located below the epithelium and out of reach of conventional biopsy forceps, may pose a diagnostic challenge for the gastroenterologist, especially when SELs are indeterminate after endoscopy and endoscopic ultrasound (EUS). The decision to proceed with further investigation should take into consideration the size, location in the GI tract, and EUS features of SELs. Gastrointestinal stromal tumor (GIST) is an example of an SEL that has a well-recognized malignant potential. Unfortunately, EUS is not able to absolutely differentiate GISTs from other benign hypoechoic lesions from the fourth layer, such as leiomyomas. Therefore, EUS-guided fine needle aspiration (EUS-FNA) is an important tool for correct diagnosis of SELs. However, small lesions (size < 2 cm) have a poor diagnostic yield with EUS-FNA. Moreover, studies with EUS-core biopsy needles did not report higher rates of histologic and diagnostic yields when compared with EUS-FNA. The limited diagnostic yield of EUS-FNA and EUS-core biopsies of SELs has led to the development of more invasive endoscopic techniques for tissue acquisition. There are initial studies showing good results for tissue biopsy or resection of SELs with endoscopic submucosal dissection, suck-ligate-unroof-biopsy, and submucosal tunneling endoscopic resection. PMID:26675266

  12. 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

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

    PubMed Central

    Bhutani, Manoop S.

    2014-01-01

    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

  14. Emerging applications of endoscopic ultrasound in gastrointestinal cancers.

    PubMed

    Hernandez, Lyndon V; Bhutani, Manoop S

    2008-07-01

    Endoscopic ultrasound (EUS) has been adopted into numerous interventional techniques and strategies that promise to improve diagnosis and management of gastrointestinal (GI) cancers. EUS-guided fine-needle aspiration (EUS-FNA) is recommended as a procedure of choice for tissue diagnosis of pancreatic cancer. Potential benefits of EUS-FNA in diagnosis of pancreatic cancer include the ability to detect small, discrete lesions compared with conventional imaging and the ability to provide staging information by examination of blood vessels surrounding the pancreas. EUS-FNA currently is being evaluated in strategies for improving diagnosis in pancreatic cancer through analysis of molecular markers, including strategies for distinguishing malignant pancreatic cysts. EUS-guided fineneedle injection currently is being investigated in a broad range of settings in GI cancers, including use in intratumoral injection in pancreas and esophageal cancers, ethanol lavage for nonmalignant pancreatic cystic tumors, and brachytherapy in nonresectable pancreatic cancer. Other applications of EUS currently being evaluated include EUS-guided biliary access in patients with unsuccessful endoscopic retrograde cholangiopancreatography and EUS-guided anastamoses in the GI tract. EUS-guided interventions have enormous potential to advance diagnosis and treatment of GI cancers. PMID:19259286

  15. 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

  16. 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.

  17. 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

  18. Evaluation of prognosis of squamous cell carcinoma of the oesophagus by endoscopic ultrasonography

    PubMed Central

    Shinkai, M; Niwa, Y; Arisawa, T; Ohmiya, N; Goto, H; Hayakawa, T

    2000-01-01

    BACKGROUND/AIMS—For pretherapeutic staging of squamous cell carcinoma of the oesophagus, endoscopic ultrasonography (EUS) is considered the most profitable modality because it can provide cross sectional imaging of the tumour. The aim of this study was to evaluate the relation between prognosis and EUS findings, especially tumour area, in squamous cell carcinoma of the oesophagus.
PATIENTS/METHODS—A total of 113 patients with squamous cell carcinoma of the oesophagus underwent EUS for pretherapeutic examination at Nagoya University Hospital. We compared EUS findings, histological results, and outcome. In addition, we measured the area of the tumour on EUS images (n=113) and evaluated if EUS area correlated with volume of the tumour on histological findings (n=50).
RESULTS—The overall accuracy rate of EUS was 83.2% (94/113) for depth of tumour invasion and 67.6% (69/102) for perioesophageal lymph node metastasis. The EUS area increased in proportion to the development of tumour infiltration, and patients with lymph node metastasis had a larger EUS area than patients without lymph node metastasis. There was a close correlation between EUS area and volume of the tumour on histological findings. If EUS area of the tumour was less than 50 mm2, the five year survival rate was 100%. As EUS area increased, the survival rate decreased.
CONCLUSIONS—Measurement of EUS area of the tumour is reliable for quantification of the tumour and prediction of prognosis in patients with squamous cell carcinoma of the oesophagus.


Keywords: squamous cell carcinoma; oesophagus; endoscopic ultrasonography; prognosis; preoperative staging PMID:10861273

  19. Ultrasound elastography for musculoskeletal applications

    PubMed Central

    Drakonaki, E E; Allen, G M; Wilson, D J

    2012-01-01

    Ultrasound elastography (EUS) is a method to assess the mechanical properties of tissue, by applying stress and detecting tissue displacement using ultrasound. There are several EUS techniques used in clinical practice; strain (compression) EUS is the most common technique that allows real-time visualisation of the elastographic map on the screen. There is increasing evidence that EUS can be used to measure the mechanical properties of musculoskeletal tissue in clinical practice, with the future potential for early diagnosis to both guide and monitor therapy. This review describes the various EUS techniques available for clinical use, presents the published evidence on musculoskeletal applications of EUS and discusses the technical issues, limitations and future perspectives of this method in the assessment of the musculoskeletal system. PMID:23091287

  20. 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

  1. [A Case of Intra-abdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration].

    PubMed

    Oh, Cho Rong; Kim, Mi Jin; Lee, Kwang Hyuck

    2015-07-01

    Paragonimiasis has been continuously decreasing in Korea. However, it still occurs by ingesting raw or incompletely cooked fresh water crab or crayfish. The diagnosis of paragonimiasis is challenging because of its rarity. It may be confused with other inflammatory disease or carcinomatosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has lower risk of complications such as bleeding, perforation than percutaneous fine needle aspiration. EUS-FNA is more accurate and popular method to find mucosal or submucosal tumors and the lesions of several organs. Benign and malignant tumors, infectious diseases have been diagnosed by EUS-FNA, but there was no report describing the use of EUS-FNA for diagnosing paragonimiasis. Herein, we present a 47-year-old male patient with paragonimiasis diagnosed by EUS-FNA. Imaging studies revealed mass lesions in the lung and peritoneal cavity, which was eventually confirmed as paragonimiasis using EUS-FNA. PMID:26194128

  2. The role of endoscopic ultrasound in the evaluation of rectal cancer

    PubMed Central

    Siddiqui, Ali A; Fayiga, Yomi; Huerta, Sergio

    2006-01-01

    Accurate staging of rectal cancer is essential for selecting patients who can undergo sphincter-preserving surgery. It may also identify patients who could benefit from neoadjuvant therapy. Clinical staging is usually accomplished using a combination of physical examination, CT scanning, MRI and endoscopic ultrasound (EUS). Transrectal EUS is increasingly being used for locoregional staging of rectal cancer. The accuracy of EUS for the T staging of rectal carcinoma ranges from 80-95% compared with CT (65-75%) and MR imaging (75-85%). In comparison to CT, EUS can potentially upstage patients, making them eligible for neoadjuvant treatment. The accuracy to determine metastatic nodal involvement by EUS is approximately 70-75% compared with CT (55-65%) and MR imaging (60-70%). EUS guided FNA may be beneficial in patients who appear to have early T stage disease and suspicious peri-iliac lymphadenopathy to exclude metastatic disease. PMID:17049086

  3. 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

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

    PubMed

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

    2015-12-14

    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

  5. 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

  6. 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

  7. Endoscopic Ultrasound Practice Survey in Latin America

    PubMed Central

    Drigo, Juliana Marques; Castillo, Cecilia; Wever, Wallia; Obaldía, José Ricardo Ruíz; Fillipi, Sheila; Ribeiro, Manoel C. S. A.; Rossini, Lucio G. B.

    2013-01-01

    Objective: Endoscopic ultrasound (EUS) has become an important imaging modality for the diagnosis, staging and treatment of gastrointestinal disorders. However, no official data exists regarding clinical EUS practice in Latin America (LA). This study assessed current EUS practice and training. Patients and Methods: A direct mail survey questionnaire was sent to 268 Capítulo Latino Americano de Ultrasonido Endoscópico members between August 2012 and January 2013. The questionnaire was sent out in English, Spanish and Portuguese languages and was available through the following site: http://www.cleus-encuesta.com. Responses were requested only from physicians who perform EUS. Results: A total of 70 LA physicians answered the questionnaire until January 2013. Most of the participants were under 42 years of age (53%) and 80% were men. Most participants (45.7%) perform EUS in Brazil, 53% work in a private hospital. The majority (70%) also perform endoscopic retrograde cholangiopancreatography. A total 42% had performed EUS for 2 years or less and 22.7% for 11 years or more. Only 10% performed more than 5000 EUS. The most common indication was an evaluation of pancreatic-biliary-ampullary lesions. Regarding training, 48.6% had more than 6 months of dedicated hands-on EUS and 37% think that at least 6 months of formal training is necessary to acquire competence. Furthermore, 64% think that more than 50 procedures for pancreatic-biliary lesions are necessary. Conclusion: This survey provides insight into the status of EUS in LA. EUS is performed mostly by young endoscopists in LA. Diagnostic upper EUS is the most common EUS procedure. Most endosonographers believe that formal training is necessary to acquire competence. PMID:24949398

  8. Placement of multiple metal stents for malignant intrahepatic biliary obstruction via an endoscopic ultrasound-guided choledochoduodenostomy fistula.

    PubMed

    Akiyama, Dai; Hamada, Tsuyoshi; Nakai, Yousuke; Isayama, Hiroyuki; Takagi, Kaoru; Mizuno, Suguru; Koike, Kazuhiko

    2015-01-01

    Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a fully-covered self-expandable metal stent (SEMS) is increasingly used as an alternative to failed endoscopic retrograde cholangiopancreatography. An EUS-CDS fistula can provide endoscopists with a new approach route for intrahepatic bile ducts. Here, we present successful placement of multiple SEMS for intrahepatic biliary obstruction via an EUS-CDS fistula. PMID:26462843

  9. Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers.

    PubMed

    Yoshinaga, Shigetaka; Oda, Ichiro; Nonaka, Satoru; Kushima, Ryoji; Saito, Yutaka

    2012-06-16

    Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection. PMID:22720122

  10. 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

  11. 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

  12. Clinical evaluation of new diagnostic modalities of endoscopic ultrasound for pancreaticobiliary diseases.

    PubMed

    Teoh, Anthony Yuen Bun; Tang, Raymond Shing Yan

    2015-04-01

    Endoscopic ultrasonography (EUS) is currently an integral tool for work-up of pancreaticobiliary neoplasms. Tissue acquisition by EUS is possible with fine-needle aspiration (FNA) cytology and histology. However, FNA still carries some limitations and risks of complications. The use of image-enhanced EUS may improve detection and characterization of pancreaticobiliary neoplasms and complement FNA. The present article aims to provide an overview of the current development of contrast-enhanced imaging and elastography in EUS and their potential application in the diagnosis of pancreaticobiliary diseases. PMID:25645516

  13. New endoscopic ultrasonography techniques for pancreaticobiliary diseases.

    PubMed

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

    2016-07-01

    Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer. PMID:27214660

  14. 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

  15. 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

  16. 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

  17. 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

  18. Pancreas divisum

    MedlinePlus

    Abdominal ultrasound Abdominal CT scan Amylase and lipase blood test Endoscopic retrograde cholangiopancreatography (ERCP) Magnetic resonance cholangiopancreatography (MRCP) Endoscopic ultrasound (EUS)

  19. Cannulation of the biliary tree under endoscopic control with an echoendoscope, without fluoroscopy: report of a case series

    PubMed Central

    Mangiavillano, Benedetto; Carrara, Silvia; Petrone, Maria Chiara; Santoro, Tara; Testoni, Pier Alberto

    2015-01-01

    Introduction: Endoscopic ultrasonography (EUS) is a validated technique allowing precise diagnosis and staging of pancreatic, biliary and ampullary disease. Developments in instruments and accessories have led to a more extensive use of this technology to perform operations. The use of EUS as an operative technique, alone or in conjunction with other endoscopic procedures, has already been described in the literature in several reports. However, despite the use of EUS, fluoroscopy has always been required to perform these operations. There are no data in the literature describing the feasibility, safety and efficacy of operative EUS in the treatment of common bile duct (CBD) obstruction, following a malignant or benign disease, performed completely under EUS guidance without fluoroscopic assistance. Methods: In this series we describe three cases of EUS treatment of CBD diseases performed without fluoroscopic assistance. Results: All the cases were treated by EUS without fluoroscopic assistance and no complications were encountered. Conclusion: Operative EUS without fluoroscopy appears to be a feasible technique. Its major advantages could be to shorten the examination time and to enable biliary or pancreatic operative endoscopy in patients in whom fluoroscopy could be dangerous, such as pregnant women. The endoscopist should have a good training both in EUS and endoscopic retrograde cholangiopancreatography. Prospective, larger studies are needed to confirm our preliminary data. PMID:25949525

  20. New endoscopic ultrasonography techniques for pancreaticobiliary diseases

    PubMed Central

    2016-01-01

    Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer. PMID:27214660

  1. 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

  2. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy.

    PubMed

    Ogura, Takeshi; Higuchi, Kazuhide

    2016-04-21

    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

  3. Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses

    PubMed Central

    Park, Jin-Seok; Kim, Hyung Kil; Bang, Byoung Wook; Kim, Sang Gu; Jeong, Seok; Lee, Don Haeng

    2014-01-01

    AIM: To evaluate the usefulness of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) in differentiating between pancreatic adenocarcinomas and other pancreatic disease. METHODS: This retrospective cohort study evaluated 90 patients who were seen between November 2010 and May 2013. All these patients had solid pancreatic masses that had a hypoechoic appearance on EUS. All patients underwent CH-EUS to evaluate this diagnostic method’s usefulness. The mass lesions observed on CH-EUS were classified into three categories based on their echo intensity: hypoenhanced, isoenhanced, and hyperenhanced lesions. We adjusted the sensitivity and the specificity of each category for detecting malignancies. We also estimated the accuracy of CH-EUS by comparing it to a pathological diagnosis. RESULTS: Of the 90 patients, 62 had a pancreatic adenocarcinoma. Fifty-seven out of 62 pancreatic adenocarcinomas showed a hypoenhanced pattern on CH-EUS. The sensitivity was 92%, the specificity 68% and the accuracy approximately 82%. The area under the curve of the receiver operating characteristic analysis for CH-EUS was 0.799. There is a significant association between the hypoenhanced pattern on CH-EUS and pancreatic duct adenocarcinoma (χ2 = 35.264, P < 0.001). In pathological examinations, the number of specimens for EUS-fine needle aspiration (EUS-FNA) was considered insufficient for diagnosis in three patients, and in two patients, the results were reported to be negative for malignancy. Pancreatic masses in all five patients revealed a hypoenhanced pattern with CH-EUS. Three patients were diagnosed with pancreatic adenocarcinoma based on the pathology results of a biopsy, and the remaining two patients were clinically diagnosed with malignancy. CONCLUSION: CH-EUS is useful for distinguishing between pancreatic adenocarcinoma and other pancreatic disease. When a pancreatic mass shows a hypoenhanced pattern on CH-EUS but involves either insufficient samples or negative

  4. 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

  5. Impact of endoscopic ultrasound quality assessment on improving endoscopic ultrasound reports and procedures

    PubMed Central

    Schwab, Ryan; Pahk, Eugene; Lachter, Jesse

    2016-01-01

    AIM: To evaluate the impact of endoscopic ultrasonography (EUS) quality assessment on EUS procedures by comparing the most recent 2013-2014 local EUS procedural reports against relevant corresponding data from a 2009 survey of EUS using standardized quality indicators (QIs). METHODS: Per EUS exam, 27 QIs were assessed individually and by grouping pre-, intra-, and post-procedural parameters. The recorded QI frequencies from 200 reports (2013-2014) were compared to corresponding data of 100 reports from the quality control study of EUS in 2009. Data for QIs added after 2009 to professional guidelines (added after 2010) were also tabulated. RESULTS: Significant differences (P-value < 0.05) were found for 13 of 20 of the relevant QIs examined. 4 of 5 pre-procedural QIs, 6 of 10 intra-procedural QIs, and 3 of 5 post-procedural QIs all demonstrated significant upgrading with a P-value < 0.05. CONCLUSION: Significant improvements were demonstrated in QI adherence and thus EUS reporting and delivery quality when the 2013-2014 reports were compared to 2009 results. QI implementation facilitates effective high-quality EUS exams by ensuring comprehensive documentation while limiting error. PMID:27114750

  6. 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

  7. Endoscopic ultrasound-guided interventions in special situations

    PubMed Central

    Prachayakul, Varayu; Aswakul, Pitulak

    2016-01-01

    Endoscopic ultrasound (EUS) was introduced in 1982 and has since become a popular advanced procedure for diagnosis and therapeutic intervention. Initially, EUS was most commonly used for the diagnosis of pancreatobiliary diseases and tissue acquisition. EUS was first used for guided cholangiography in 1996, followed by EUS-guided biliary drainage in 2001. Advancements in equipment and endoscopic accessories have led to an expansion of EUS-guided procedures, which now include EUS-guided drainage of intra-abdominal abscesses or collections, intra-vascular treatment of refractory variceal and nonvariceal bleeding, transmural pancreatic drainage, common bile duct stone clearance, enteral feeding tube placement and entero-enteric anastomosis. Patients with surgically altered upper gastrointestinal anatomies have greatly benefited from EUS also. This systematic review describes and discusses EUS procedures performed in uncommon diseases and conditions, as well as applications on more vulnerable patients such as young children and pregnant women. In these cases, routine approaches do not always apply, and thus may require the use of innovative and unconventional techniques. Increased knowledge of such special applications will help increase the success rates of these procedures and provide a foundation for additional advances and utilizations of the technique. PMID:26839650

  8. 32 CFR 564.41 - Burial.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... is in force (Army, Navy, or Air Force contracts), the amount to be allowed for each item will not... clothe the remains of _____ for funeral purposes. At the time of his/her death, the deceased was a...

  9. 32 CFR 564.41 - Burial.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... is in force (Army, Navy, or Air Force contracts), the amount to be allowed for each item will not... clothe the remains of _____ for funeral purposes. At the time of his/her death, the deceased was a...

  10. Frontotemporal Disorders: Common Symptoms

    MedlinePlus

    ... and Resources Research Portfolio (IADRP) AMP-AD Detecting Cognitive Impairment Database Federal Initiatives alzheimers.gov National Alzheimer’s ... For example, a person might hum at a business meeting or laugh at a funeral. Compulsive eating — ...

  11. 28 CFR 570.42 - Non-medical escorted trips.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... persons (e.g., attending physician, hospital staff, funeral home staff, family members, U.S. Probation Officer) who can contribute to a determination on whether an escorted trip should be approved. (1)...

  12. 28 CFR 570.42 - Non-medical escorted trips.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... persons (e.g., attending physician, hospital staff, funeral home staff, family members, U.S. Probation Officer) who can contribute to a determination on whether an escorted trip should be approved. (1)...

  13. 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...

  14. 44 CFR 206.119 - Financial assistance to address other needs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) 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...

  15. 44 CFR 206.119 - Financial assistance to address other needs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) 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...

  16. 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. PMID:22367238

  17. 32 CFR 53.2 - Policy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... of travel incidents thereto: (i) Military funerals, memorial services, weddings, and inaugurals. (ii... any active or reserve U.S. military unit is taking part. (2) Wearing of the uniform or any...

  18. 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

  19. Advances in endoscopic ultrasound-guided biliary drainage: a comprehensive review.

    PubMed

    Sarkaria, Savreet; Lee, Ho-Su; Gaidhane, Monica; Kahaleh, Michel

    2013-03-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage. In the hands of experienced endoscopists, conventional ERCP results in a failed cannulation rate of 3% to 5%. This failure can occur more commonly in the setting of altered anatomy or technically difficult cases due to either duodenal or biliary obstruction. In cases of ERCP failure, patients have traditionally been referred for either percutaneous transhepatic biliary drainage (PTBD) or surgery. However, both PTBD and surgery have higher than desirable complication rates. Within the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an attractive alternative to PTBD after failed ERCP. Many groups have reported on the feasibility, efficacy and safety of this technique. This article reviews the indications for ERCP and the currently practiced EUS-BD techniques, including EUS-guided rendezvous, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy. PMID:23560147

  20. Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats

    PubMed Central

    LaPallo, Brandon K.; Wolpaw, Jonathan R.; Chen, Xiang Yang

    2014-01-01

    The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2–8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. PMID:24990895

  1. Endoscopic ultrasound elastography: Current status and future perspectives

    PubMed Central

    Cui, Xin-Wu; Chang, Jian-Min; Kan, Quan-Cheng; Chiorean, Liliana; Ignee, Andre; Dietrich, Christoph F

    2015-01-01

    Elastography is a new ultrasound modality that provides images and measurements related to tissue stiffness. Endoscopic ultrasound (EUS) has played an important role in the diagnosis and management of numerous abdominal and mediastinal diseases. Elastography by means of EUS examination can assess the elasticity of tumors in the proximity of the digestive tract that are hard to reach with conventional transcutaneous ultrasound probes, such as pancreatic masses and mediastinal or abdominal lymph nodes, thus improving the diagnostic yield of the procedure. Results from previous studies have promised benefits for EUS elastography in the differential diagnosis of lymph nodes, as well as for assessing masses with pancreatic or gastrointestinal (GI) tract locations. It is important to mention that EUS elastography is not considered a modality that can replace biopsy. However, it may be a useful adjunct, improving the accuracy of EUS-fine needle aspiration biopsy (EUS-FNAB) by selecting the most suspicious area to be targeted. Even more, it may be useful for guiding further clinical management when EUS-FNAB is negative or inconclusive. In the present paper we will discuss the current knowledge of EUS elastography, including the technical aspects, along with its applications in the differential diagnosis between benign and malignant solid pancreatic masses and lymph nodes, as well as its aid in the differentiation between normal pancreatic tissues and chronic pancreatitis. Moreover, the emergent indication and future perspectives are summarized, such as the benefit of EUS elastography in EUS-guided fine needle aspiration biopsy, and its uses for characterization of lesions in liver, biliary tract, adrenal glands and GI tract. PMID:26715804

  2. Endoscopic ultrasound elastography: Current status and future perspectives.

    PubMed

    Cui, Xin-Wu; Chang, Jian-Min; Kan, Quan-Cheng; Chiorean, Liliana; Ignee, Andre; Dietrich, Christoph F

    2015-12-21

    Elastography is a new ultrasound modality that provides images and measurements related to tissue stiffness. Endoscopic ultrasound (EUS) has played an important role in the diagnosis and management of numerous abdominal and mediastinal diseases. Elastography by means of EUS examination can assess the elasticity of tumors in the proximity of the digestive tract that are hard to reach with conventional transcutaneous ultrasound probes, such as pancreatic masses and mediastinal or abdominal lymph nodes, thus improving the diagnostic yield of the procedure. Results from previous studies have promised benefits for EUS elastography in the differential diagnosis of lymph nodes, as well as for assessing masses with pancreatic or gastrointestinal (GI) tract locations. It is important to mention that EUS elastography is not considered a modality that can replace biopsy. However, it may be a useful adjunct, improving the accuracy of EUS-fine needle aspiration biopsy (EUS-FNAB) by selecting the most suspicious area to be targeted. Even more, it may be useful for guiding further clinical management when EUS-FNAB is negative or inconclusive. In the present paper we will discuss the current knowledge of EUS elastography, including the technical aspects, along with its applications in the differential diagnosis between benign and malignant solid pancreatic masses and lymph nodes, as well as its aid in the differentiation between normal pancreatic tissues and chronic pancreatitis. Moreover, the emergent indication and future perspectives are summarized, such as the benefit of EUS elastography in EUS-guided fine needle aspiration biopsy, and its uses for characterization of lesions in liver, biliary tract, adrenal glands and GI tract. PMID:26715804

  3. 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

  4. ENDOSCOPIC ULTRASONOGRAPHY IN ESOPHAGEAL CANCER LEADS TO IMPROVED SURVIVAL RATES: RESULTS FROM A POPULATION-BASED STUDY

    PubMed Central

    Wani, Sachin; Das, Ananya; Rastogi, Amit; Drahos, Jennifer; Ricker, Winifred; Parsons, Ruth; Bansal, Ajay; Yen, Roy; Hosford, Lindsay; Jankowski, Meghan; Sharma, Prateek; Cook, Michael B.

    2015-01-01

    Background and Aims The advantages of endoscopic ultrasound (EUS) and computed tomography-positron emission tomography (CT-PET) in relation to survival in esophageal cancer (EC) patients are unclear. This study aimed to assess the effect of EUS, CT-PET and its combination on overall survival relative to cases not receiving these procedures. Methods Patients aged ≥ 66 years diagnosed with EC were identified in the Surveillance, Epidemiology, and End Results-Medicare linked database. Cases were split into four analytic groups: EUS only (n=318), CT-PET only (853), EUS+CT-PET (189) and “no EUS or CT-PET” (2,439). Survival times were estimated by Kaplan-Meier method and compared by using log-rank test for each group versus the “no EUS or CT-PET” group. Multivariable Cox proportional hazards models were used to compare 1, 3 and 5-year survival rates. Results Kaplan-Meier analyses showed that patients undergoing EUS, CT-PET and EUS+CT-PET had improved survival for all stages, all compared with “no EUS or CT-PET”, with the exception of stage 0 disease. Receipt of EUS increased the likelihood of receiving endoscopic therapies, esophagectomy and chemoradiation. Multivariable Cox proportional hazards models showed that receipt of EUS was a significant predictor for improved 1-year (HR 0.49, 95% CI 0.39–0.59, p<0.0001), 3-year (HR 0.57, 95% CI 0.48–0.66, p<0.0001) and 5-year (HR 0.59, 95% CI 0.50–0.68) survival. Similar results were noted when results were stratified based on histology, as well as for CT-PET and EUS+CT-PET groups. Conclusions Receipt of either EUS or CT-PET alone in EC patients is associated with improved 1, 3 and 5-year survival. Future studies should identify barriers to dissemination of these staging modalities. PMID:25236485

  5. Endoscopic ultrasound-guided forceps biopsy from upper gastrointestinal subepithelial lesions using a forward-viewing echoendoscope

    PubMed Central

    Matsuzaki, Ippei; Miyahara, Ryoji; Hirooka, Yoshiki; Funasaka, Kohei; Yamamura, Takeshi; Ohno, Eizaburo; Nakamura, Masanao; Kawashima, Hiroki; Watanabe, Osamu; Kobayashi, Makoto; Shimoyama, Yoshie; Nakamura, Shigeo; Goto, Hidemi

    2016-01-01

    Background and study aims: Endoscopic tissue acquisition techniques using needle-knife and biopsy forceps allow abundant tissue acquisition from upper gastrointestinal subepithelial lesions; however, these techniques cannot capture real-time intratumor information. The aim of this study was to evaluate the feasibility of endoscopic ultrasound-guided forceps biopsy (EUS-FB) from upper gastrointestinal subepithelial lesions using a forward-viewing echoendoscope. Patients and methods: This study was a prospective case series. After mucosal cuts, several specimens were taken using a hot biopsy forceps under real-time EUS visualization. The incision was closed using hemoclips. Diagnostic yield, rate of diagnosable samples obtained under EUS visualization, procedure time, and adverse events were assessed. Results: Ten patients (median lesion size 16 mm, range 15 – 44 mm) underwent EUS-FB. The overall rate of histological diagnosis by EUS-FB was 100 % (10/10). The rate of diagnosable samples among all cases was 97.6 % (41/42). The median procedure times for EUS-FB and complete closure were 28.5 and 4.5 minutes, respectively. No adverse events occurred. Conclusions: This newly developed EUS-FB is feasible and allowed forceps biopsy from upper gastrointestinal subepithelial lesions. Study registration: UMIN000015364 PMID:27556070

  6. New developments in endoscopic ultrasound-guided therapies

    PubMed Central

    Bhutani, Manoop S.; Arora, Ayush

    2015-01-01

    Endoscopic ultrasound (EUS) has opened new horizons in minimally invasive therapies for diverse gastrointestinal pathologies. Digestive Disease Weak 2015 held in Washington, DC., USA featured exciting research articles on EUS-guided therapeutic procedures. EUS-guided biliary drainage has been attempted and described for many years. There seems to be a lot of interest among various international groups to compare this technique with other alternatives in terms of efficacy and safety. Similarly, EUS-guided pancreatic drainage of cysts and fluid collections continues to evolve with new stents and devices being developed specifically for deployment under endosonographic guidance. EUS-guided ablation of cystic pancreatic tumors is innovative but not always effective. Combining alcohol ablation with injecting chemotherapeutic agents may improve long-term results regarding efficacy. Similarly, for solid pancreatic tumors there appears to be ongoing interest and continuing efforts in injecting different chemotherapeutic or ablative agents, delivering fiducials for radiation guidance and even attempting ablation with radiofrequency. Gastric variceal treatment and EUS-guided anastomoses also continue to be investigated. This review article is focused on the recent developments in EUS-guided therapies presented at Digestive Disease Week (DDW) 2015. PMID:26643698

  7. Endoscopic ultrasound guided antitumor therapy.

    PubMed

    Bhutani, M S

    2003-08-01

    This paper will review the possibilities of EUS guided anti-tumor therapy. Ablative energy may be delivered to a tumor under EUS guidance to destruct tumor cells by ultrasound itself, radiofrequency or radiation. Pilot results of endoscopic high intensity focused ultrasound in a human trial have been reported. The feasibility of performing EUS guided radiofrequency ablation has been reported in a swine model. An EUS bases radiation target simulation method has been developed for anal cancer therapy. Targeted delivery of an anti-cancer agent into a tumor under EUS guidance is possible as reported in an early clinical trial of local immunotherapy (Cytoimplant) or modified viruses delivered by EUS guided fine needle injection in patients with advanced pancreatic carcinoma. Image guided injection of alcohol is another approach used for local tumor ablation. Application of other ablation therapies such as laser, microwave and cryo is also conceptually feasible. We will have to wait and see where these initial and ongoing attempts for applying EUS against cancer take us. PMID:12929056

  8. 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. PMID:27209643

  9. 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

  10. 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

  11. New developments in endoscopic ultrasound-guided therapies.

    PubMed

    Bhutani, Manoop S; Arora, Ayush

    2015-01-01

    Endoscopic ultrasound (EUS) has opened new horizons in minimally invasive therapies for diverse gastrointestinal pathologies. Digestive Disease Weak 2015 held in Washington, DC., USA featured exciting research articles on EUS-guided therapeutic procedures. EUS-guided biliary drainage has been attempted and described for many years. There seems to be a lot of interest among various international groups to compare this technique with other alternatives in terms of efficacy and safety. Similarly, EUS-guided pancreatic drainage of cysts and fluid collections continues to evolve with new stents and devices being developed specifically for deployment under endosonographic guidance. EUS-guided ablation of cystic pancreatic tumors is innovative but not always effective. Combining alcohol ablation with injecting chemotherapeutic agents may improve long-term results regarding efficacy. Similarly, for solid pancreatic tumors there appears to be ongoing interest and continuing efforts in injecting different chemotherapeutic or ablative agents, delivering fiducials for radiation guidance and even attempting ablation with radiofrequency. Gastric variceal treatment and EUS-guided anastomoses also continue to be investigated. This review article is focused on the recent developments in EUS-guided therapies presented at Digestive Disease Week (DDW) 2015. PMID:26643698

  12. 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

  13. Endoscopic ultrasonography for gastric submucosal lesions

    PubMed Central

    Papanikolaou, Ioannis S; Triantafyllou, Konstantinos; Kourikou, Anastasia; Rösch, Thomas

    2011-01-01

    Gastric submucosal tumors (SMTs) are a rather frequent finding, occurring in about 0.36% of routine upper GI-endoscopies. EUS has emerged as a reliable investigative procedure for evaluation of these lesions. Diagnostic Endoscopic ultrasonography (EUS) has the ability to differentiate intramural tumors from extraluminal compressions and can also show the layer of origin of gastric SMTs. Tumors can be further characterized by their layer of origin, echo pattern and margin. EUS-risk criteria of their malignant potential are presented, although the emergence of EUS-guided fne needle aspiration (EUS-FNA) has opened new indications for transmural tissue diagnosis and expanded the possibilities of EUS in SMTs of the stomach. Tissue diagnosis should address whether the SMT is a Gastrointestinal stromal tumour (GIST) or another tumor type and evaluate the malignant potential of a given GIST. However, there seems to be a lack of data on the optimal strategy in SMTs suspected to be GISTs with a negative EUS-FNA tissue diagnosis. The current management strategies, as well as open questions regarding their treatment are also presented. PMID:21772939

  14. Basic technique in endoscopic ultrasound-guided fine needle aspiration for solid lesions: How many passes?

    PubMed

    Petrone, Maria Chiara; Arcidiacono, Paolo Giorgio

    2014-01-01

    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has evolved to become an indispensable tool for tissue acquisition in patients with luminal and extra luminal gastrointestinal cancers. Despite the extensive use of EUS-FNA, there still exists a wide variation in the number of samples required to ensure acquisition of diagnostic material from different kind of lesions. There are several factors that may influence the number of fine needle passes made during EUS-FNA, but the main factor seems to be the presence of a Cytopathologist during the EUS procedure. The diagnostic yield of EUS-FNA with rapid on-site evaluation (ROSE) in most studies exceeds 90%. Nevertheless, ROSE is not available in many centers. Various studies have investigated the adequate number of needle passes that should be performed if ROSE is not used. Differences exist based on the nature of the target lesion: Five to seven passes for pancreatic masses, three passes for lymphnodes, only one pass for pancreatic cystic lesions. Consider using a core biopsy needle or a 19-G FNA needle for histology could improve the diagnostic yield. Even though EUS-FNA is widely available, some patients still do not receive conclusive diagnoses upon initial EUS-FNA. One way to maximize the benefits for patients might be to centralize cases to several well-equipped, high-volume centers with experienced endosonographers that have universal availability of ROSE. PMID:24949407

  15. Contrast-Enhanced Endoscopic Ultrasound

    PubMed Central

    Dietrich, Christoph F.; Sharma, M.; Hocke, M.

    2012-01-01

    The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced guidelines on the use of contrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB-document focused mainly on liver applications. However, new applications extending beyond the liver were developed thereafter. Increased interest in recent years in CEUS technique and in the application of CEUS in novel fields like endoscopic ultrasound (EUS) has revolutionized indications and applications. As a result, the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the contrast-enhanced EUS (CE-EUS) indications are established, whereas others are preliminary; these latter indications are categorized as emergent CEUS applications since the available evidence is insufficient for general recommendation. This article focuses on the use of CE-EUS in various clinical settings. The reader will get an overview of current indications and possible applications of CE-EUS. This involves the introduction of different contrast studies including color Doppler techniques (known as contrast-enhanced high mechanical index endosonography or CEHMI-EUS) as well as more modern high-resolution contrast-enhanced techniques (known as contrast-enhanced low mechanical index endosonography or CELMI EUS). PMID:24949350

  16. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of kidney lesions: A review.

    PubMed

    Lopes, Roberto Iglesias; Moura, Renata Nobre; Artifon, Everson

    2015-03-16

    Traditionally, treatment of renal lesions is indicated based only on imaging features. Although controversy exists about tissue sampling from small renal masses, renal biopsy is indicated in some cases. In this review, we discuss the rationale for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and summarize the recent advances in this field, providing recommendations for the practicing clinician. The use of EUS-FNA appears to be a safe and feasible means of confirming or excluding malignancy. EUS allows assessment and biopsy of masses or lesions within both kidneys and related complications are 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 renal masses should be indicated only in selected cases, in which there is potential to decrease unnecessary treatment of small renal masses and to best select tumors for active surveillance and minimally invasive ablative therapies. Additionally, some renal lesions may be ineligible for EUS-guided biopsy because of anatomical limitations. EUS-FNA renal biopsy will probably be best applied to central anterior renal masses, while tumors on the posterior aspect of the kidney, percutaneous access will probably be superior. PMID:25789096

  17. Forward-viewing linear echoendoscope: a new option in the endoscopic ultrasound armamentarium (with video).

    PubMed

    Fuccio, Lorenzo; Attili, Fabia; Larghi, Alberto

    2015-01-01

    The forward-viewing linear echoendoscope (FV-EUS) has been developed with the aim of overcoming limitations of standard curved linear-array echoendoscopes (CLA-EUS) and to further expand interventional applications of EUS. The main characteristic of the FV-EUS is a shifting in the orientation of both endoscopic and ultrasound views from oblique to forward, with the exit of the working channel at the tip of the instrument. This allows exit of the devices parallel to the longitudinal axis of the endoscope, thus resulting in a more direct and stable access to the lesion while increasing the precision and force applied to the target. Accumulating evidence has shown that the FV-EUS can be used instead of the standard CLA-EUS scope for routine fine needle aspiration, with extremely good performance for subepithelial lesions and for difficult to reach locations. Several areas of use of this echoendoscope are yet to be better defined, such as its potential for therapeutic and interventional procedures, as well as for natural orifice transluminal endoscopic surgery. The current report provides an updated overview of the available evidence for both diagnostic and interventional uses of the FV-EUS. PMID:25345848

  18. 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

  19. Interventional endoscopic ultrasound in pancreatic diseases.

    PubMed

    Buscail, Louis; Faure, Patrick; Bournet, Barbara; Selves, Janick; Escourrou, Jean

    2006-01-01

    During the last 15 years, endoscopic ultrasound (EUS) has become an important imaging procedure for diagnosis and management of pancreatic diseases. The clinical interest of EUS is now enhanced by interventional procedures. Noteworthy, fine-needle aspiration biopsy is one of the most important contributions of EUS, in particular for the investigation of patients with pancreatic cancer and cystic tumors. EUS-guided fine-needle aspiration appears to be a safe and reliable technique to obtain tissue from pancreatic masses with a low risk of complications. EUS became also a therapeutic procedure, especially applied for celiac plexus neurolysis, pseudocyst drainage, and pancreaticogastrostomy. Further developments are expected by improvement of needle devices such as pancreatic pseudocyst drainage kits. In the future, EUS might be also a support for local application of new treatments of pancreatic tumors, such as gene or cellular therapy products. In this review, we discuss the current clinical applications of interventional EUS and the future development for diagnosis and management of pancreatic diseases. PMID:16327280

  20. Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Percutaneous Ultrasound-Guided Fine Needle Aspiration in Diagnosis of Focal Pancreatic Masses

    PubMed Central

    Okasha, Hussein Hassan; Naga, Mazen Ibrahim; Esmat, Serag; Naguib, Mohamed; Hassanein, Mohamed; Hassani, Mohamed; El-Kassas, Mohamed; Mahdy, Reem Ezzat; El-Gemeie, Emad; Farag, Ali Hassan; Foda, Ayman Mohamed

    2013-01-01

    Objective: Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer. Patients and Methods: A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2). Results: EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%). Conclusion: EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate. PMID:24949394

  1. 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

  2. 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

  3. 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

  4. Serotonergic drugs and spinal cord transections indicate that different spinal circuits are involved in external urethral sphincter activity in rats

    PubMed Central

    Chang, Hui-Yi; Cheng, Chen-Li; Chen, Jia-Jin J.; de Groat, William C.

    2011-01-01

    Lower urinary tract function is regulated by spinal and supraspinal reflexes that coordinate the activity of the urinary bladder and external urethral sphincter (EUS). Two types of EUS activity (tonic and bursting) have been identified in rats. This study in urethane-anesthetized female rats used cystometry, EUS electromyography, spinal cord transection (SCT) at different segmental levels, and analysis of the effects of 5-HT1A receptor agonist (8-OH-DPAT) and antagonist (WAY100635) drugs to examine the origin of tonic and bursting EUS activity. EUS activity was elicited by bladder distension or electrical stimulation of afferent axons in the pelvic nerve (pelvic-EUS reflex). Tonic activity evoked by bladder distension was detected in spinal cord-intact rats and after acute and chronic T8–9 or L3–4 SCT but was abolished after L6–S1 SCT. Bursting activity was abolished by all types of SCT except chronic T8–9 transection. 8-OH-DPAT enhanced tonic activity, and WAY100635 reversed the effect of 8-OH-DPAT. The pelvic-EUS reflex consisted of an early response (ER) and late response (LR) when the bladder was distended in spinal cord-intact rats. ER remained after acute or chronic T8–9 and L3–4 SCT, but was absent after L6–S1 SCT. LR occurred only in chronic T8–9 SCT rats where it was enhanced or unmasked by 8-OH-DPAT. The results indicate that spinal serotonergic mechanisms facilitate tonic and bursting EUS activity. The circuitry for generating different patterns of EUS activity appears to be located in different segments of the spinal cord: tonic activity at L6–S1 and bursting activity between T8–9 and L3–4. PMID:17047164

  5. The Therapeutic Use of Endoscopic Ultrasonography in Pediatric Patients is Safe: A Case Series

    PubMed Central

    Jia, Yi; Maspons, Aldo; Othman, Mohammed O.

    2015-01-01

    Background/Aim: Despite the safety and high diagnostic yield of endoscopic ultrasound guided fine needle aspiration (EUS FNA) for the evaluation of gastrointestinal diseases in adults, literature discussing the therapeutic use of EUS FNA in pediatrics remains limited. This study reports our experience with the use of EUS in children with pancreaticobiliary disorders. Patients and Methods: A retrospective study was conducted to evaluate safety, clinical utility, and impact of therapeutic EUS on the management of children (<18 years) at a tertiary referral center. Data were collected from January 1, 2011, to April 30, 2014. Patient demographics, clinical characteristics, and EUS procedure data were reviewed. Continuous variables were described using the mean and standard deviation. Categorical variables were described using frequencies and percentages. Results: A total of 6 therapeutic EUS procedures were performed in 5 children (3 F/2 M). The mean age was 13 years (range 6–17) with a mean body mass index of 28.2 (range 18.5–38.8). The indications for EUS procedures were abdominal pain with chronic pancreatitis (3) and management of symptomatic pancreaticobiliary cysts/pseudocysts observed on previous imaging (3). All procedures were performed under general anesthesia. The 6 therapeutic procedures performed were celiac plexus block (3), cyst gastrostomy with stents placement (2), and cyst aspiration using EUS FNA (1). A celiac plexus block effectively relieved abdominal pain in 2 patients with chronic pancreatitis. Cyst gastrostomy successfully resulted in pseudocyst resolution in the follow up imaging of 2 patients (up to 6 months after the procedure). Cyst aspiration with EUS guided FNA resulted in cyst resolution and confirmation of the benign nature of the cyst in 1 patient. All the procedures were successfully completed with no reported complications. Conclusion: The therapeutic use of endoscopic ultrasound in the pediatric population is safe and has a high

  6. Characterization of bladder and external urethral activity in mice with or without spinal cord injury-a comparison study with rats.

    PubMed

    Kadekawa, Katsumi; Yoshimura, Naoki; Majima, Tsuyoshi; Wada, Naoki; Shimizu, Takahiro; Birder, Lori A; Kanai, Anthony J; de Groat, William C; Sugaya, Kimio; Yoshiyama, Mitsuharu

    2016-04-15

    To clarify the lower urinary tract function in mice, we compared bladder and urethral activity between rats and mice with or without spinal cord injury (SCI). Female Sprague-Dawley rats and C57BL/6N mice were divided into five groups:1) spinal intact (SI) rats,2) SI mice,3) pudendal nerve transection (PNT) SI mice,4) spinal cord injury (SCI) rats, and5) SCI mice. Continuous cystometry (CMG) and external urethral sphincter (EUS)-electromyogram (EMG) analyses were conducted under an awake, restrained condition. During voiding bladder contractions, SI animals exhibited EUS bursting with alternating active and silent periods, which, in rats but not mice, coincided with small-amplitude intravesical pressure oscillations in CMG recordings. In SI mice with bursting-like EUS activity, the duration of active periods was significantly shorter by 46% (32 ± 5 ms) compared with SI rats (59 ± 9 ms). In PNT-SI mice, there were no significant differences in any of cystometric parameters compared with SI mice. In SCI rats, fluid elimination from the urethra and the EUS bursting occurred during small-amplitude intravesical pressure oscillations. However, SCI mice did not exhibit clear EUS bursting activity or intravesical pressure oscillations but rather exhibited intermittent voiding with slow large-amplitude reductions in intravesical pressure, which occurred during periods of reduced EUS activity. These results indicate that EUS pumping activity is essential for generating efficient voiding in rats with or without spinal cord injury. However, EUS bursting activity is not required for efficient voiding in SI mice and does not reemerge in SCI mice in which inefficient voiding occurs during periods of reduced tonic EUS activity. PMID:26818058

  7. 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

  8. 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

  9. Endoscopic ultrasound-guided biliary intervention in patients with surgically altered anatomy

    PubMed Central

    Siripun, Aroon; Sripongpun, Pimsiri; Ovartlarnporn, Bancha

    2015-01-01

    AIM: To evaluate the efficacy of endoscopic ultrasound guided biliary drainage (EUS-BD) in patients with surgically altered anatomies. METHODS: We performed a search of the MEDLINE database for studies published between 2001 to July 2014 reporting on EUS-BD in patients with surgically altered anatomy using the terms “EUS drainage” and “altered anatomy”. All relevant articles were accessed in full text. A manual search of the reference lists of relevant retrieved articles was also performed. Only full-text English papers were included. Data regarding age, gender, diagnosis, method of EUS-BD and intervention, type of altered anatomy, technical success, clinical success, and complications were extracted and collected. Anatomic alterations were categorized as: group 1, Billroth I; group 2, Billroth II; group 4, Roux-en-Y with gastric bypass; and group 3, all other types. RESULTS: Twenty three articles identified in the literature search, three reports were from the same group with different numbers of cases. In total, 101 cases of EUS-BD in patients with altered anatomy were identified. Twenty-seven cases had no information and were excluded. Seventy four cases were included for analysis. Data of EUS-BD in patients categorized as group 1, 2 and 4 were limited with 2, 3 and 6 cases with EUS-BD done respectively. Thirty four cases with EUS-BD were reported in group 3. The pooled technical success, clinical success, and complication rates of all reports with available data were 89.18%, 91.07% and 17.5%, respectively. The results are similar to the reported outcomes of EUS-BD in general, however, with limited data of EUS-BD in patients with altered anatomy rendered it difficult to draw a firm conclusion. CONCLUSION: EUS-BD may be an option for patients with altered anatomy after a failed endoscopic-retrograde-cholangiography in centers with expertise in EUS-BD procedures in a research setting. PMID:25789101

  10. 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

  11. 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

  12. [Endoscopic ultrasound-guided choledocho-duodenostomy in advanced pancreatic cancer with duodenal obstruction].

    PubMed

    Mella, José Manuel; Guidi, Martín; De María, Julio; Hwang, Hui-Jer; Curvale, Cecilia R; Matano, Raúl

    2015-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first-approach for biliary drainage. In cases of ERCP failure, patients are usually referred for percutaneous transhepatic biliary drainage or surgical biliary bypass. In the last decade, the indications of endoscopic ultrasound (EUS) in the management of patients with pancreatic cancer have increased, and numerous cases of EUS-guided biliary drainage have been reported in patients with failures during the ERCP. Our goal is to report a patient with locally advanced pancreatic cancer who presented with painless jaundice and cholestasis with biliary and duodenal obstruction. A EUS-guided choledochoduodenostomy was performed by placement of a self-expanding metal stent. PMID:26502467

  13. Review of current and evolving clinical indications for endoscopic ultrasound

    PubMed Central

    Luthra, Anjuli K; Evans, John A

    2016-01-01

    For the first several years after its development, endoscopic ultrasound (EUS) was primarily limited to identification of pancreatic malignancies. Since this time, the field of EUS has advanced at a tremendous speed in terms of additional clinical diagnostic and therapeutic uses. The combination of ultrasound with endoscopy provides a unique interventional modality that is a minimally invasive alternative to various surgical interventions. Given the expanding recommended indications for EUS, this article will serve to review the most common uses with supporting evidence, while also exploring innovative endeavors that may soon become common clinical practice. PMID:26862365

  14. Advances in endoscopic ultrasound imaging of colorectal diseases

    PubMed Central

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

    2016-01-01

    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

  15. 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

  16. 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

  17. Endoscopic ultrasound-guided pancreaticobiliary intervention in patients with surgically altered anatomy and inaccessible papillae: A review of current literature

    PubMed Central

    Martin, Aaron; Kistler, Charles Andrew; Wrobel, Piotr; Yang, Juliana F.; Siddiqui, Ali A.

    2016-01-01

    The management of pancreaticobiliary disease in patients with surgically altered anatomy is a growing problem for gastroenterologists today. Over the years, endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the treatment of pancreaticobiliary disease. Patient anatomy has become increasingly complex due to advances in surgical resection of pancreaticobiliary disease and EUS has emerged as the therapy of choice when endoscopic retrograde cholangiopancreatography failed cannulation or when the papilla is inaccessible such as in gastric obstruction or duodenal obstruction. The current article gives a comprehensive review of the current literature for EUS-guided intervention of the pancreaticobiliary tract in patients with altered surgical anatomy. PMID:27386471

  18. 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

  19. 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

  20. 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

  1. 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

  2. Endoscopic Ultrasound-Guided Treatment of Pancreatic Cystic and Solid Masses

    PubMed Central

    2015-01-01

    Pancreatic tumor is one of the most difficult diseases to diagnose and treat because of its anatomical location and characteristics. Recently, there have been several innovative trials on the treatment of pancreatic tumors using endoscopic ultrasound (EUS) because it allows selective access to the difficult to reach target organ along the gastrointestinal tract and can differentiate vessels by color Doppler. Among these trials, several have investigated EUS-guided ethanol lavage with or without paclitaxel for pancreatic cystic tumors. These studies show a 33% to 79% complete resolution rate with a favorable safety profile. Compared to EUS-guided ethanol lavage for pancreatic cystic tumors, EUS-guided radiofrequency ablation is considered a less invasive treatment method for pancreatic cancer. Although there are still several difficulties and concerns about complications, one clinical study reported 72.8% feasibility with favorable safety, and therefore, we anticipate the results of ongoing studies with these new less invasive techniques. PMID:26240804

  3. 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

  4. Endoscopic ultrasound fine needle aspiration: Technique and applications in clinical practice

    PubMed Central

    Tharian, Benjamin; Tsiopoulos, Fotios; George, Nayana; Pietro, Salvatore Di; Attili, Fabia; Larghi, Alberto

    2012-01-01

    Since its initial report in 1992, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of adjacent organs. Its introduction constitutes a major breakthrough in the endoscopic field and has gradually transformed EUS from a pure imaging modality into a more interventional procedure. In addition, the possibility of collecting samples, providing a definitive cytological and/or histological evidence of the presence of malignancy, has strongly contributed to changing EUS from a subjective, highly operator dependant procedure into a more objective one. This article will review the instrumentation, technique and the most important clinical applications of EUS-FNA. PMID:23293723

  5. 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

  6. 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

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

    PubMed Central

    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

  8. Endoscopic Ultrasonograpy for Choledocholithiasis and Biliary Malignancy.

    PubMed

    Moparty, Bhavani; Bhutani, Manoop S

    2005-04-01

    Endoscopic ultrasound (EUS) is a valuable tool in gastrointestinal endoscopy, with various applications such as diagnosis, staging, and evaluation of the pancreaticobiliary system. EUS has comparable sensitivity to magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) for detection of choledocholithiasis. EUS may be considered for evaluation for choledocholithiasis as prelude to ERCP when there is a low to intermediate suspicion for common bile duct stones or when there is an increased risk for complications from ERCP. Endosonography may also be useful in the evaluation of cholangiocarcinoma. Intraductal ultrasound within the bile duct may help differentiate malignant from benign strictures. EUS-guided fine needle aspiration can be helpful in the diagnosis of cholangiocarcinoma, especially in the region of the hilum. PMID:15769435

  9. 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

  10. Effect of the time of day and queue position in the endoscopic schedule on the performance characteristics of endoscopic ultrasound-guided fine-needle aspiration for diagnosing pancreatic malignancies

    PubMed Central

    Korenblit, Jason; Tholey, Danielle M.; Tolin, Joanna; Loren, David; Kowalski, Thomas; Adler, Douglas G.; Davolos, Julie; Siddiqui, Ali A.

    2016-01-01

    Background and Objectives: Recent reports have indicated that the time of day may impact the detection rate of abnormal cytology on gynecologic cytology samples. The aim of this study was to determine if procedure time or queue position affected the performance characteristics of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosing solid pancreatic malignancies. Patients and Methods: We conducted a retrospective study evaluating patients with solid pancreatic lesions in whom EUS-FNA was performed. Three timing variables were evaluated as surrogate markers for endoscopist fatigue: Procedure start times, morning versus afternoon procedures, and endoscopy queue position. Statistical analyses were performed to determine whether the timing variables predicted performance characteristics of EUS-FNA. Results: We identified 609 patients (mean age: 65.8 years, 52.1% males) with solid pancreatic lesions who underwent EUS-FNA. The sensitivity of EUS-FNA was 100% for procedures that started at 7 AM while cases that started at 4 PM had a sensitivity of 81%. Using start time on a continuous scale, each elapsed hour was associated with a 1.9% decrease in EUS-FNA sensitivity (P = 0.003). Similarly, a 10% reduction in EUS-FNA sensitivity was detected between morning and afternoon procedures (92% vs. 82% respectively, P = 0.0006). A linear regression comparing the procedure start time and diagnostic accuracy revealed a decrease of approximately 1.7% in procedure accuracy for every hour later a procedure was started. A 16% reduction in EUS-FNA accuracy was detected between morning and afternoon procedures (100% vs. 84% respectively, P = 0.0009). When the queue position was assessed, a 2.4% reduction in accuracy was noted for each increase in the queue position (P = 0.013). Conclusion: Sensitivity and diagnostic accuracy of EUS-FNA for solid pancreatic lesions decline with progressively later EUS starting times and increasing numbers of procedures before a

  11. 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

  12. 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.

  13. Application of Endobronchial Ultrasonography for the Preoperative Detecting Recurrent Laryngeal Nerve Lymph Node Metastasis of Esophageal Cancer

    PubMed Central

    Shan, Hong-Bo; Zhang, Rong; Li, Yin; Gao, Xiao-Yan; Lin, Shi-Yong; Luo, Guang-Yu; Li, Jian-Jun; Xu, Guo-Liang

    2015-01-01

    Background The preoperative detection of recurrent laryngeal nerve lymph node (RLN LN) metastasis provides important information for the treatment of esophageal cancer. We investigated the possibility of applying endobronchial ultrasonography (EBUS) with conventional preoperative endoscopic ultrasonography (EUS) and computerized tomography (CT) examination to evaluate RLN LN metastasis in patients with esophageal cancer. Methods A total of 115 patients with advanced thoracic esophageal cancer underwent EBUS examinations. Patients also underwent EUS and CT imaging as reference diagnostic methods. Positron emission tomography /computed tomography (PET/CT) was also introduced in partial patients as reference method. The preoperative evaluation of RLN LN metastasis was compared with the surgical and pathological staging in 94 patients who underwent radical surgery. Results The sensitivities of the preoperative evaluations of RLN LN metastasis by EBUS, EUS and CT were 67.6%, 32.4% and 29.4%, respectively. The sensitivity of EBUS was significantly different from that of EUS or CT, especially in the detection of right RLN LNs. In addition, according to the extra data from reference method, PET/CT was not superior to EBUS or EUS in detecting RLN LN metastasis. Among all 115 patients, 21 patients who were diagnosed with tracheal invasions by EUS or EBUS avoided radical surgery. Another 94 patients who were diagnosed as negative for tracheobronchial tree invasion by EUS and EBUS had no positive findings in radical surgery. Conclusions EBUS can enhance the preoperative sensitivity of the detection of RLN LN metastasis in cases of thoracic esophageal cancer and is a useful complementary examination to conventional preoperative EUS and CT, which can alert thoracic surgeons to the possibility of a greater range of preoperative lymph node dissection. EBUS may also indicate tracheal invasion in cases of esophageal stricture. PMID:26372339

  14. EUROPEAN SCIENCE: Research Behemoth Slated for Overhaul.

    PubMed

    Koenig, R

    2000-09-22

    Disaffection with the European Union's (E.U.'s) flagship research effort has found a sympathetic ear in the program's upper echelons. Last week, the E.U.'s top two research officials said they are pushing for big changes in the successor to Europe's 5-year, $17 billion Framework 5, including stronger efforts to coordinate research across the continent and to support innovative projects. PMID:17799385

  15. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts

    PubMed Central

    Săftoiu, Adrian; Vilmann, Andreas; Vilmann, Peter

    2015-01-01

    Pancreatic pseudocysts are fluid collections in the peripancreatic tissues associated with acute or chronic pancreatitis. Endoscopic ultrasound (EUS)-guided drainage has become an established indication, having better results as compared to percutaneous drainage, nonguided endoscopic drainage, or surgical drainage. The aim of this review is to assess critically the current literature concerning EUS-guided pseudocyst drainage and to review the place of the procedure in the clinical decision management algorithms of these patients. PMID:26643700

  16. Endoscopic Ultrasound in Endocrinology: Imaging of the Adrenals and the Endocrine Pancreas.

    PubMed

    Kann, Peter Herbert

    2016-01-01

    Endoscopic ultrasound (EUS) imaging of adrenal glands and its application to diagnostic procedures of adrenal diseases has been reported since 1998. It can be considered a relevant advantage in the field of adrenal diseases. Indeed, EUS allows the detection of adrenal lesions (even very small ones) and their characterization, the assessment of malignancy criteria, the early detection of neoplastic recurrences, the preoperative identification of morphologically healthy parts of the glands, the differentiation of extra-adrenal from adrenal tumors, and of the pathological entities associated with adrenal insufficiency, and the fine-needle aspiration biopsy (EUS-FNA) of suspicious lesions. At the same time, its clinical relevance depends on the experience of the endosonographer. Moreover, EUS is also by far the best and most sensitive imaging technique to detect and assess the follow-up of pancreatic manifestation of MEN1 disease. It furthermore enables the preoperatively localization of insulinomas and critical structures in their neighborhood, and may be relevant in planning surgical strategy. A positive EUS in a case of insulinoma furthermore confirms the endocrine diagnosis, especially considering the differential diagnosis of hypoglycemia factitia by oral antidiabetics. It can be supplemented by EUS-FNA. Again, it has to be considered that EUS may reveal false positive and false negative results, and the quality of the findings largely depends on the endosonographer's skills and experience. The most important technical details together with the advantages and limitations of EUS, and the pathognomonic characteristic of benign and malignant disorders of the adrenals and pancreas are presented here. PMID:27003412

  17. 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.

  18. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts.

    PubMed

    Saftoiu, Adrian; Vilmann, Andreas; Vilmann, Peter

    2015-01-01

    Pancreatic pseudocysts are fluid collections in the peripancreatic tissues associated with acute or chronic pancreatitis. Endoscopic ultrasound (EUS)-guided drainage has become an established indication, having better results as compared to percutaneous drainage, nonguided endoscopic drainage, or surgical drainage. The aim of this review is to assess critically the current literature concerning EUS-guided pseudocyst drainage and to review the place of the procedure in the clinical decision management algorithms of these patients. PMID:26643700

  19. Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle

    PubMed Central

    Barresi, Luca; Tarantino, Ilaria; Granata, Antonino; Curcio, Gabriele; Traina, Mario

    2012-01-01

    Cystic lesions of the pancreas are being diagnosed with increasing frequency, covering a vast spectrum from benign to malignant and invasive lesions. Numerous investigations can be done to discriminate between benign and non-evolutive lesions from those that require surgery. At the moment, there is no single test that will allow a correct diagnosis in all cases. Endoscopic ultrasound (EUS) morphology, cyst fluid analysis and cytohistology with EUS-guided fine needle aspiration can aid in this difficult diagnosis. PMID:22720127

  20. The diagnostic value of endoscopic ultrasonography and contrast-enhanced harmonic endoscopic ultrasonography in gastrointestinal stromal tumors

    PubMed Central

    Zhao, Yanchao; Qian, Linxue; Li, Peng; Zhang, Shutian

    2016-01-01

    Objective: To evaluate the diagnostic value of endoscopic ultrasonography (EUS) and contrast-enhanced harmonic (CEH) EUS in patients with gastrointestinal stromal tumors (GISTs). Patients and Methods: About 19 patients with suspected GISTs underwent EUS and CEH-EUS before tumor resection. The malignant potential was assessed according to the modified Fletcher classification system. Patients were divided into lower (Group I) and higher (Group II) malignant potential group. The clinical characteristics and EUS/CEH-EUS features were compared between two groups. Results: The tumor size in Group II was significantly larger than that in Group I (14.6 ± 5.8 mm vs. 32.1 ± 8.4 mm, P < 0.05). Heterogeneous echogenicity was observed in 4 (4/8) cases in Group II and none in Group I (P < 0.05). Irregular intratumoral vessels were detected in 6 cases in Group II and none in Group I (P < 0.05). The sensitivity and specificity of irregular vessel detection for discriminating higher from lower malignant potential GISTs were 75% and 100%, respectively. The positive predictive value and negative predictive value of detection of irregular vessels to high malignant potential GISTs were 33% and 100%, respectively. Conclusion: Detection of irregular intratumoral vessels can predict higher malignant potential before tumor resection. The tumor size and echogenicity are assistant factors for malignant potential assessment. Endoscopic resection is an efficacious treatment with good security for appropriate patients. PMID:27080610

  1. 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

  2. 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

  3. 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

  4. An overview of endoscopic ultrasound equipment.

    PubMed

    LeBlanc, J K

    2008-06-01

    Endoscopic ultrasound imaging technology has significantly improved over the last decade. Innovative design of equipment and devices has broadened the utility of EUS as diagnostic and therapeutic tools. Lesions as small as 3 mm can be imaged and targeted for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS imaging with the latest generation electronic radial and linear scopes is excellent and does not vary significantly between models. Miniprobes should not be used in place of routine EUS echoendoscopes when available and technically feasible. The drawbacks of ultrasound miniprobes are the inability to perform fine needle aspiration and the limited depth of imaging. Transpapillary intraductal ultrasound (IDUS) improves staging of biliary tumors and improves imaging of biliary and pancreatic duct strictures. Endoscopic ultrasound-guided celiac plexus neurolysis or block (EUS-CPN/CPB) can be performed with the EUS-FNA needle or a specially designed celiac plexus block needle which distributes the neurolytic agent into the celiac plexus in a radial fashion. Use of the core biopsy needle is safe and should be used with a therapeutic linear scope through the gastric wall. PMID:18319690

  5. Endoscopic approach to the diagnosis of pancreatic cystic tumor.

    PubMed

    Kawaguchi, Yoshiaki; Mine, Tetsuya

    2016-02-15

    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

  6. 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

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

    PubMed

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

    2016-04-10

    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

  8. Endosonography guided management of pancreatic fluid collections

    PubMed Central

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

    2015-01-01

    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. PMID:26557008

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

    PubMed

    Lee, Hang Lak

    2016-05-01

    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

  10. 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

  11. Morpho-anatomical characterization of mature embryo-derived callus of rice (Oryza sativa L.) suitable for transformation.

    PubMed

    Bevitori, R; Popielarska-Konieczna, M; dos Santos, E M; Grossi-de-Sá, M F; Petrofeza, S

    2014-05-01

    The objective of this study was to morpho-anatomically characterize embryogenic rice calli during early induction of somatic embryogenesis of three Brazilian rice cultivars. Herein, we explored embryogenic units (EUs) from 2-week-old cut proliferated calli to verify whether they were suitable for Agrobacterium tumefasciens-mediated transformation. Histological analysis and scanning electron microscopy (SEM) were used to analyze these types of calli during early rice callogenesis in the cultivars BRS Primavera, BRS Bonança, and BRS Caiapó. The characteristics of the embryogenic cells were preserved in the EUs, which showed a globular, compact structure that contained tightly packed cells and thus rendered the cells suitable for transformation. The EUs of BRS Caiapó also maintained the characteristics of the non-embryogenic callus, such as an elongated morphology and a lack of cellular organization. In general, the observations of the histological sections corresponded with those of the SEM images. The histological analysis suggested that all cultivars used in these experiments have morphogenic potential. The EUs from proliferated 2-week-old cut calli maintained their embryogenic features. The EUs were subjected to Agrobacterium-mediated transformation, which exhibited a regeneration frequency of 58 % for transformed hygromycin-resistant cell lines. These results show that EUs from proliferated 2-week-old cut calli are suitable for plant transformation. PMID:24085343

  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. 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.

  14. 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

  15. Endoscopic ultrasound-guided drainage of pancreatic fluid collections

    PubMed Central

    Fabbri, Carlo; Luigiano, Carmelo; Maimone, Antonella; Polifemo, Anna Maria; Tarantino, Ilaria; Cennamo, Vincenzo

    2012-01-01

    Pancreatic fluid collections (PFCs) develop secondary to either fluid leakage or liquefaction of pancreatic necrosis following acute pancreatitis, chronic pancreatitis, surgery or abdominal trauma. Pancreatic fluid collections include acute fluid collections, acute and chronic pancreatic pseudocysts, pancreatic abscesses and pancreatic necrosis. Before the introduction of linear endoscopic ultrasound (EUS) in the 1990s and the subsequent development of endoscopic ultrasound-guided drainage (EUS-GD) procedures, the available options for drainage in symptomatic PFCs included surgical drainage, percutaneous drainage using radiological guidance and conventional endoscopic transmural drainage. In recent years, it has gradually been recognized that, due to its lower morbidity rate compared to the surgical and percutaneous approaches, endoscopic treatment may be the preferred first-line approach for managing symptomatic PFCs. Endoscopic ultrasound-guided drainage has the following advantages, when compared to other alternatives such as surgical, percutaneous and non-EUS-guided endoscopic drainage. EUS-GD is less invasive than surgery and therefore does not require general anesthesia. The morbidity rate is lower, recovery is faster and the costs are lower. EUS-GD can avoid local complications related to percutaneous drainage. Because the endoscope is placed adjacent to the fluid collection, it can have direct access to the fluid cavity, unlike percutaneous drainage which traverses the abdominal wall. Complications such as bleeding, inadvertent puncture of adjacent viscera, secondary infection and prolonged periods of drainage with resultant pancreatico-cutaneous fistulae may be avoided. The only difference between EUS and non-EUS drainage is the initial step, namely, gaining access to the pancreatic fluid collection. All the subsequent steps are similar, i.e., insertion of guide-wires with fluoroscopic guidance, balloon dilatation of the cystogastrostomy and insertion of

  16. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography in suspected choledocholithiasis: A systematic review

    PubMed Central

    De Castro, Vinicius Leite; Moura, Eduardo G.H.; Chaves, Dalton M.; Bernardo, Wanderley M.; Matuguma, Sergio E.; Artifon, Everson L.A.

    2016-01-01

    Background and Objectives: There is a lack of consensus about the optimal noninvasive strategy for patients with suspected choledocholithiasis. Two previous systematic reviews used different methodologies not based on pretest probabilities that demonstrated no statistically significant difference between Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) for the detection of choledocholithiasis. In this article, we made a comparison of the diagnostic ability of EUS and MRCP to detect choledocholithiasis in suspected patients. Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations with all published randomized prospective trials. We performed the systemic review using MedLine, EMBASE, Cochrane, LILACS, and Scopus reviews through May 2015. We identified eight randomized, prospective, blinded trials comparing EUS and MRCP. All the patients were submitted to a gold standard method. We calculated the study-specific variables and performed analyses using aggregated variables such as sensitivity, specificity, prevalence, positive predictive value (PPV) and negative predictive value (NPV), and accuracy. Results: Five hundred and thirty eight patients were included in the analysis. The pretest probability for choledocholithiasis was 38.7. The mean sensitivity of EUS and MRCP for detection of choledocholithiasis was 93.7 and 83.5, respectively; the specificity was 88.5 and 91.5, respectively. Regarding EUS and MRCP, PPV was 89 and 87.8, respectively, and NPV was 96.9 and 87.8, respectively. The accuracy of EUS and MRCP was 93.3 and 89.7, respectively. Conclusions: For the same pretest probability of choledocholithiasis, EUS has higher posttest probability when the result is positive and a lower posttest probability when the result is negative compared with MRCP. PMID:27080611

  17. Endoscopic ultrasound-guided fine-needle aspiration with an echobronchoscope in undiagnosed mediastinal lymphadenopathy: First experience from India

    PubMed Central

    Dhooria, Sahajal; Aggarwal, Ashutosh Nath; Singh, Navneet; Gupta, Dheeraj; Behera, Digamber; Gupta, Nalini; Agarwal, Ritesh

    2015-01-01

    Background and Aim: Several studies have reported the performance of combining endoscopic ultrasound fine-needle aspiration with an echobronchoscope (EUS-B-FNA), with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), for the diagnosis of mediastinal lymphadenopathy. Herein we report our initial experience with this technique. Patients and Methods: In this retrospective study, we report the outcome of patients who underwent EUS-B-FNA with or without EBUS-TBNA during the same session. Details of the lymph nodes sampled, number of passes, duration of the procedure, results of the cytological examination, and the final diagnosis of all the patients are presented. Results: Eleven patients underwent EUS-B-FNA during the study period. EUS-B-FNA and EBUS-TBNA together yielded a sensitivity and specificity of 72.7 and 100%, respectively. The number of lymph nodes sampled per patient and the number of passes per lymph node were significantly higher with EBUS-TBNA compared to EUS-B-FNA. The mean duration of procedure was also significantly higher in the EBUS-TBNA group. The most common reason (five patients (45.5%)) for resorting to EUS-B-FNA was the patient being unfit for EBUS-TBNA or the inability of the operator to complete the procedure. Sarcoidosis was the most frequent final diagnosis in the study patients (four cases), followed by bronchogenic carcinoma (three cases). Conclusions: EUS-B-FNA is a useful additional tool for the diagnosis of mediastinal lymphadenopathy. In combination with EBUS-TBNA, it has a fairly good diagnostic yield and is a good alternative in situations where EBUS-TBNA is not feasible. PMID:25624588

  18. 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.

  19. Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage

    PubMed Central

    Kitamura, Katsuya; Yamamiya, Akira; Ishii, Yu; Nomoto, Tomohiro; Honma, Tadashi; Yoshida, Hitoshi

    2016-01-01

    AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography (EUS)-guided pancreatic fluid collection drainage. METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage (EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections (PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter (electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter (non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups. RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients (87%) in the electrocautery group and 10 patients (77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100% (15/15) and 100% (13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67% (10/15) and 69% (9/13) for the electrocautery and the non-electrocautery groups, respectively (P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group (mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment

  20. 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…

  1. 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... fail to furnish accurate price information disclosing the cost to the purchaser for each of...

  2. 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…

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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.…

  10. 78 FR 62643 - Agency Information Collection Activities: Submission for OMB Review; Comment Request; Disaster...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    .... The request will be processed under OMB's normal clearance procedures in accordance with the... clearance submissions to OMB, FEMA invites the general public to comment on the proposed collection of... addition to funeral, medical and dental expenses. FEMA's current registration application and script...

  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. 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…

  13. 36 CFR 12.6 - Disinterments and exhumations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) The next-of-kin is responsible for making all arrangements and incurring all financial obligations... following: (1) Compliance with State and local health laws and regulations; (2) Engaging a funeral director... order issued by a State or Federal court of competent jurisdiction. The superintendent shall...

  14. 36 CFR 12.6 - Disinterments and exhumations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) The next-of-kin is responsible for making all arrangements and incurring all financial obligations... following: (1) Compliance with State and local health laws and regulations; (2) Engaging a funeral director... order issued by a State or Federal court of competent jurisdiction. The superintendent shall...

  15. The Celebration of Death: Two Folk Tales about DEath. Mini-Module.

    ERIC Educational Resources Information Center

    African-American Inst., New York, NY. School Services Div.

    This module contains two African folk tales about death, two descriptions of African funerals, a lesson plan with 11 questions exploring the finality of and customs surrounding death, and a bibliography of five books which deal with African religious beliefs. The folk tales present concepts of death and immortality of the soul. The descriptions of…

  16. Teachers and Their Survivors.

    ERIC Educational Resources Information Center

    Robinson, Thomas E.; Brower, Walter A.

    1982-01-01

    The influence of a good teacher never ends; successful teachers build a kind of immortality through the lives and activities of their students. The authors illustrate these assertions with a personal account of memories voiced by former students at a revered teacher's funeral. (Author/WD)

  17. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... ceremony” is a service commemorating the deceased with the body present. (n) Outer burial container. An... remains by cremation, without formal viewing, visitation, or ceremony with the body present. (h) Funeral... ceremony with the body present, except for a graveside service. (l) Memorial service. A “memorial...

  18. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... ceremony” is a service commemorating the deceased with the body present. (n) Outer burial container. An... remains by cremation, without formal viewing, visitation, or ceremony with the body present. (h) Funeral... ceremony with the body present, except for a graveside service. (l) Memorial service. A “memorial...

  19. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... ceremony” is a service commemorating the deceased with the body present. (n) Outer burial container. An... remains by cremation, without formal viewing, visitation, or ceremony with the body present. (h) Funeral... ceremony with the body present, except for a graveside service. (l) Memorial service. A “memorial...

  20. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... ceremony” is a service commemorating the deceased with the body present. (n) Outer burial container. An... remains by cremation, without formal viewing, visitation, or ceremony with the body present. (h) Funeral... ceremony with the body present, except for a graveside service. (l) Memorial service. A “memorial...

  1. 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 or practices. In selling or offering to sell...

  2. What about the Children? Dealing with Death. Project Enlightenment.

    ERIC Educational Resources Information Center

    Helms, Rose; Blazer, Doris

    This pamphlet offers practical guidance to parents of young children who have experienced the death of a close relative or other loved one. It is intended to explain the child's emotional needs and assist the parent in planning for the child's involvement in the various stages of the death-funeral-mourning process. The text is presented as answers…

  3. Managing Personal Matters. Successful Living Skills.

    ERIC Educational Resources Information Center

    Oklahoma State Board of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This module on managing personal matters is one of a series of modules designed to help teach students to become more self-sufficient in their personal and professional lives. This module provides teacher and student materials that are planned to help students maintain personal records, obtain insurance, and deal with funerals and wills. Six units…

  4. 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…

  5. 75 FR 21280 - National Advisory Committee on Institutional Quality and Integrity (NACIQI) Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-23

    ... aid or service to participate in the meeting (e.g., interpreting service, assistive listening device... date, we may not be able to make available the requested auxiliary aid or service because of.... American Board of Funeral Service Education. 3. American Speech Language Hearing Association, Council...

  6. 76 FR 47183 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Extension

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-04

    ... Tregillus, Attorney, Division of Marketing Practices, Bureau of Consumer Protection, Federal Trade... Rule. 76 FR 26297. No comments were received. Pursuant to the OMB regulations, 5 CFR part 1320, that... Funeral Rule requirements and the basis for the calculations summarized below, see 76 FR 26297....

  7. 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. PMID:7572875

  8. 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…

  9. 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…

  10. 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…

  11. 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)

  12. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., outer burial containers, immediate burials, or direct cremations, to persons inquiring about the...) The price range for the direct cremations offered by the funeral provider, together with: (1) A separate price for a direct cremation where the purchaser provides the container; (2) Separate prices...

  13. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., outer burial containers, immediate burials, or direct cremations, to persons inquiring about the...) The price range for the direct cremations offered by the funeral provider, together with: (1) A separate price for a direct cremation where the purchaser provides the container; (2) Separate prices...

  14. 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…

  15. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., outer burial containers, immediate burials, or direct cremations, to persons inquiring about the...) The price range for the direct cremations offered by the funeral provider, together with: (1) A separate price for a direct cremation where the purchaser provides the container; (2) Separate prices...

  16. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...” refers to the Federal Trade Commission. (e) Cremation. “Cremation” is a heating process which incinerates... cremation and sells funeral goods. (g) Direct cremation. A “direct cremation” is a disposition of human remains by cremation, without formal viewing, visitation, or ceremony with the body present. (h)...

  17. 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…

  18. 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…

  19. 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…

  20. 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...

  1. 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....

  2. 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....

  3. 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...

  4. 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....

  5. 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...

  6. 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....

  7. 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....

  8. 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...

  9. 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...

  10. 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.…

  11. 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)

  12. 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…

  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. "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)

  15. Imaging of common bile duct by linear endoscopic ultrasound

    PubMed Central

    Sharma, Malay; Pathak, Amit; Shoukat, Abid; Rameshbabu, Chittapuram Srinivasan; Ajmera, Akash; Wani, Zeeshn Ahamad; Rai, Praveer

    2015-01-01

    Imaging of common bile duct (CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound (EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations: (1) the fundus of stomach; (2) body of stomach; (3) duodenal bulb; (4) descending duodenum; and (5) antrum. Following down the upper 1/3rd of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3rd of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS. PMID:26504506

  16. 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.

  17. Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

    PubMed Central

    De Angelis, Claudio; Marietti, Milena; Bruno, Mauro; Pellicano, Rinaldo; Rizzetto, Mario

    2015-01-01

    In recent years, the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms, probably due to the widespread use of high-resolution imaging techniques. However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic work up. When noninvasive imaging tests (transabdominal ultrasound, computed tomography or magnetic resonance cholangiopancreatography) fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent, the probability of having biliary disease is considered low. In this setting, using EUS, the presence of pathologic findings (choledocholithiasis, strictures, chronic pancreatitis, ampullary or pancreatic tumors, cholangiocarcinoma), not always with a benign course, has been observed. The aim of this review has been to evaluate the prevalence of disease among non-jaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield. Data point out to a promising role of EUS in the identification of a potential biliary pathology. EUS is a low invasive technique, with high accuracy, that could play a double cost-effective role: identifying pathologic conditions with dismal prognosis, in asymptomatic patients with negative prior imaging tests, and excluding pathologic conditions and further follow-up in healthy subjects. PMID:26191344

  18. Endoscopic Ultrasound-Guided Drainage without Fluoroscopic Guidance for Extraluminal Complicated Cysts

    PubMed Central

    Nam, Hyeong Seok; Kim, Hyung Wook; Kang, Dae Hwan; Choi, Cheol Woong; Park, Su Bum; Kim, Su Jin; Ryu, Dae Gon; Jeon, Joon Ho

    2016-01-01

    Background. Endoscopic ultrasound- (EUS-) guided drainage is generally performed under fluoroscopic guidance. However, improvements in endoscopic and EUS techniques and experience have led to questions regarding the usefulness of fluoroscopy. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance. Methods. Patients who had undergone nonfluoroscopic EUS-guided drainage of extraluminal complicated cysts were enrolled. Drainage was performed via a transgastric, transduodenal, or transrectal approach. Single or double 7 Fr double pigtail stents were inserted. Results. Seventeen procedures were performed in 15 patients in peripancreatic fluid collections (n = 13) and pelvic abscesses (n = 4). The median lesion size was 7.1 cm (range: 2.8–13.0 cm), and the mean time spent per procedure was 26.2 ± 9.8 minutes (range: 16–50 minutes). Endoscopic drainage was successful in 16 of 17 (94.1%) procedures. There were no complications. All patients experienced symptomatic improvement and revealed partial to complete resolution according to follow-up computed tomography findings. Two patients developed recurrent cysts that were drained during repeat procedures, with eventual complete resolution. Conclusion. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts. PMID:27313606

  19. 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

  20. Endoscopic ultrasound-guided fine needle core biopsy for the diagnosis of pancreatic malignant lesions: a systematic review and Meta-Analysis

    PubMed Central

    Yang, Yongtao; Li, Lianyong; Qu, Changmin; Liang, Shuwen; Zeng, Bolun; Luo, Zhiwen

    2016-01-01

    Endoscopic ultrasound-guided fine needle core biopsy (EUS-FNB) has been used as an effective method of diagnosing pancreatic malignant lesions. It has the advantage of providing well preserved tissue for histologic grading and subsequent molecular biological analysis. In order to estimate the diagnostic accuracy of EUS-FNB for pancreatic malignant lesions, studies assessing EUS-FNB to diagnose solid pancreatic masses were selected via Medline. Sixteen articles published between 2005 and 2015, covering 828 patients, met the inclusion criteria. The summary estimates for EUS-FNB differentiating malignant from benign solid pancreatic masses were: sensitivity 0.84 (95% confidence interval (CI), 0.82–0.87); specificity 0.98 (95% CI, 0.93–1.00); positive likelihood ratio 8.0 (95% CI 4.5–14.4); negative likelihood ratio 0.17 (95% CI 0.10–0.26); and DOR 64 (95% CI 30.4–134.8). The area under the sROC curve was 0.96. Subgroup analysis did not identify other factors that could substantially affect the diagnostic accuracy, such as the study design, location of study, number of centers, location of lesion, whether or not a cytopathologist was present, and so on. EUS-FNB is a reliable diagnostic tool for solid pancreatic masses and should be especially considered for pathology where histologic morphology is preferred for diagnosis. PMID:26960914

  1. A Prospective Blinded Study Evaluating the Role of Endoscopic Ultrasound before Endoscopic Retrograde Cholangiopancreatography in the Setting of "Positive" Intraoperative Cholangiogram during Cholecystectomy.

    PubMed

    Luthra, Anjuli K; Aggarwal, Vipul; Mishra, Girish; Conway, Jason; Evans, John A

    2016-04-01

    During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is used to identify common bile duct (CBD) stones. In patients whose IOC is suspicious for stones, endoscopic retrograde cholangiopancreatography (ERCP) is the modality of choice for stone removal. However, IOC has a false positive rate of 30 to 60 per cent, and ERCP adverse events may occur in 11 per cent of patients. Endoscopic ultrasound (EUS) may serve as a noninvasive means of diagnosing suspected CBD stones. This study sought to assess the role of EUS in predicting the likelihood of choledocholithiasis at ERCP in patients found to have a positive IOC. This was a prospective blinded study of EUS before ERCP in patients with a positive IOC. Recruited subjects who underwent cholecystectomy and had an IOC with suspicion for obstruction were referred for ERCP within one month of their procedure. In patients with a positive IOC, EUS had a positive predictive value of 95 per cent in detecting choledocholithiasis. IOC with single or multiple filling defects more often correlated to the presence of CBD stones. At ERCP, choledocholithiasis was present in 65 per cent of patients who had an IOC suspicious for CBD stones. EUS should be used as a noninvasive method to correctly identify retained CBD stones in low-to-moderate risk patients with a positive IOC. PMID:27097628

  2. Field observations of fish species susceptible to epizootic ulcerative syndrome in the Zambezi River basin in Sesheke District of Zambia.

    PubMed

    Songe, Mwansa M; Hang'ombe, Mudenda B; Phiri, Harris; Mwase, Maxwell; Choongo, Kennedy; Van der Waal, Ben; Kanchanakhan, Somkiat; Reantaso, Melba B; Subasinghe, Rohana P

    2012-01-01

    A field investigation was conducted in the Sesheke District of Zambia along the Zambezi River to determine the fish species susceptible to epizootic ulcerative syndrome (EUS), a newly confirmed disease in Southern Africa. A total of 2,132 fishes were inspected for gross EUS-like lesions, of which 188 (8.82%; 95% CI=7.67-10.1%) were found with typical characteristic lesions of EUS. Of these 188 samples, 156 were found to have mycotic granulomas on histopathological analysis, representing 83.0% (95% CI=76.7-87.9%) of the initially identified in the laboratory through gross examination. The following 16 species of fish were examined and found with EUS lesions; Clarias ngamensis, Clarias gariepinus, Barbus poechii, Tilapia sparrmanii, Serranochromis angusticeps, Brycinus lateralis, Micralestes acutidens, Sargochromis carlottae, Hydrocynus vittatus, Phryngochromis acuticeps, Schilbe intermedius, Hepsetus odoe, Labeo lunatus, Oreochromis andersonii, Barbus unitaeniatus, and Barbus paludinosus. T. sparrmanii did not show any lesions, while the Clarias species were found to be the most afflicted with EUS. These results could be useful to fish farmers and organizations interested in improving aquaculture in the area. PMID:21647772

  3. Tumors and new endoscopic ultrasound-guided therapies

    PubMed Central

    Carrara, Silvia; Petrone, Maria Chiara; Testoni, Pier Alberto; Arcidiacono, Paolo Giorgio

    2013-01-01

    With the advent of linear echoendoscopes, endoscopic ultrasound (EUS) has become more operative and a new field of oncological application has been opened up. From tumor staging to tissue acquisition under EUS-guided fine-needle aspiration, new operative procedures have been developed on the principle of the EUS-guided puncture. A hybrid probe combining radiofrequency with cryotechnology is now available, to be passed through the operative channel of the echoendoscope into the tumor to create an area of ablation. EUS-guided fine-needle injection is emerging as a method to deliver anti-tumoral agents inside the tumor. Ethanol lavage, with or without paclitaxel, has been proposed for the treatment of cystic tumors in non-resectable cases and complete resolution has been recorded in up to 70%-80%. Many other chemical or biological agents have been investigated for the treatment of pancreatic adenocarcinoma: activated allogenic lymphocyte culture (Cytoimplant), a replication-deficient adenovirus vector carrying the tumor necrosis factor-α gene, or an oncolytic attenuated adenovirus (ONYX-015). The potential advantage of treatment under EUS control is the real-time imaging guidance into a deep target like the pancreas which is extremely difficult to reach by a percutaneous approach. To date there are no randomized controlled trials to confirm the real clinical benefits of these treatments compared to standard therapy so it seems wise to reserve them only for experimental protocols approved by ethics committees. PMID:23596535

  4. 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

  5. Characteristic endoscopic ultrasound findings of ampullary lesions that predict the need for surgical excision or endoscopic ampullectomy

    PubMed Central

    Rejeski, Jared J.; Kundu, Sarba; Hauser, Matthew; Conway, Jason D.; Evans, John A.; Pawa, Rishi; Mishra, Girish

    2016-01-01

    Background and Objectives: The management of ampullary lesions has evolved to include endoscopic ampullectomy (EA) as a curative approach to cancers of the ampulla of Vater. With this change comes a need to risk-stratify patients at initial diagnosis. Materials and Methods: Patients with verified ampullary lesions (N = 50) were analyzed in a case-control design. We evaluated endoscopic ultrasound (EUS) data to define characteristics that yield a high sensitivity in selecting candidates for EA. Results: Using data from previously published studies yielded a sensitivity of 0.765 in appropriately identifying the 34 surgical cases. Expanding these characteristics increased the sensitivity of EUS to 0.971 in identifying surgical candidates. Additionally, of advanced disease cases, the expanded characteristics correctly identified these cases with a sensitivity of 1.0-improved over 0.708 using prior published data. Conclusion: EA should be strongly considered if ampullary lesions are found to fit the following characteristics after EUS evaluation: lesion size <2.5 cm, invasion ≤4 mm, pancreatic duct dilatation ≤3 mm, ≤T1 lesion, no lymph nodes present, and no ductal stent in place. Furthermore, EUS data can be used to identify all high-risk lesions. With these characteristics identified, clinicians are better able to risk-stratify patients using EUS as either appropriate for or too high-risk for endoscopic resection. PMID:27386476

  6. Current endoscopic ultrasound-guided approach to incidental subepithelial lesions: optimal or optional?

    PubMed Central

    Eckardt, Alexander J.; Jenssen, Christian

    2015-01-01

    Subepithelial lesions (SEL) are identified during endoscopic procedures on a regular basis. They can occur anywhere in the gastrointestinal (GI) tract and are located beneath the normal epithelial layer, which explains why a tissue diagnosis is difficult to obtain with routine biopsies. Endoscopic ultrasound (EUS) is used to further characterize these lesions. EUS can distinguish intramural lesion from extramural compression. Furthermore, it allows allocation of intramural lesions to a specific layer of the GI wall and offers additional information as to whether a lesion could be benign or malignant. EUS also assists in choosing the optimal means of tissue acquisition. The choice of tissue acquisition is based on a number of factors, such as tumor size, EUS features, and location within the GI tract or within a specific layer of the GI wall. Furthermore, local expertise and patient factors should be considered when deciding whether tissue acquisition, surgical intervention or follow up is recommended. In this review we offer an EUS-guided approach to the evaluation of incidental SEL based on current evidence and point out areas of uncertainty, which explain why the proposed algorithmic approach may be optional rather than optimal. PMID:25830949

  7. 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

  8. Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration

    PubMed Central

    TANIMOTO, AZUSA; TAKEUCHI, SHINJI; YAEGASHI, HIROSHI; KOTANI, HIROSHI; KITAI, HIDENORI; NANJO, SHIGEKI; EBI, HIROMICHI; YAMASHITA, KANAME; MOURI, HISATSUGU; OHTSUBO, KOUSHIRO; IKEDA, HIROKO; YANO, SEIJI

    2016-01-01

    A 76-year-old female in whom a renal cell carcinoma (RCC) lesion was resected 19 years previously presented to our hospital with cognitive dysfunction. Magnetic resonance imaging and computed tomography revealed nodules in the brain, lung, adrenal gland and a pelvic osteolytic lesion. To identify the primary cancer site, the present study performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the left adrenal lesion. Consequently, the pathological findings of the tissue obtained by EUS-FNA were similar to those of the previous nephrectomy specimen, revealing that the adrenal lesion was the recurrence of RCC. The majority of the metastatic lesions in the patient were reduced in size by the multiple kinase inhibitor, pazopanib. Contralateral adrenal metastasis of RCC is rare and the use of EUS-FNA in the diagnosis of adrenal lesions remains to be elucidated. This is a rare case of adrenal lesion, diagnosed by EUS-FNA. Therefore, EUS-FNA is considered to be a useful diagnostic modality of adrenal metastases from unidentified primary tumor types. PMID:27073657

  9. Endoscopic Ultrasound-Guided Fine-Needle Aspiration of the Adrenal Glands: Analysis of 21 Patients

    PubMed Central

    Puri, Rajesh; Choudhary, Narendra S.; Kotecha, Hardik; Misra, Smruti Ranjan; Bhagat, Suraj; Paliwal, Manish; Madan, Kaushal; Saraf, Neeraj; Sarin, Haimanti; Guleria, Mridula; Sud, Randhir

    2015-01-01

    Background/Aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology of adrenal masses helps in etiological diagnosis. The aim of this study was to evaluate the diagnostic yield of EUS-FNA of adrenal masses in cases where other imaging methods failed and/or were not feasible. Methods Twenty-one consecutive patients with adrenal masses, in whom adrenal FNA was performed because conventional imaging modalities failed and/or were not feasible, were prospectively evaluated over a period of 3 years. Results Of the 21 patients (mean age, 56±12.2 years; male:female ratio, 2:1), 12 had pyrexia of unknown origin and the other nine underwent evaluation for metastasis. The median lesion size was 2.4×1.6 cm. Ten patients were diagnosed with tuberculosis (shown by the presence of caseating granulomas [n=10] and acid-fast bacilli [n=4]). Two patients had EUS-FNA results suggestive of histoplasmosis. The other patients had metastatic lung carcinoma (n=6), hepatocellular carcinoma (n=1), and adrenal lipoma (n=1) and adrenal myelolipoma (n=1). EUS results were not suggestive of any particular etiology. No procedure-related adverse events occurred. Conclusions EUS-FNA is a safe and effective method for evaluating adrenal masses, and it yields diagnosis in cases where tissue diagnosis is impossible or has failed using conventional imaging modalities. PMID:25844346

  10. 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

  11. How to improve the success of endoscopic ultrasound guided fine needle aspiration cytology in the diagnosis of pancreatic lesions.

    PubMed

    Gimeno-García, Antonio Z; Elwassief, Ahmed

    2012-01-01

    Endoscopic ultrasonography (EUS) is highly accurate for assessing the pancreatic parenchyma and ductal system. Currently, it is the most sensitive imaging procedure for detecting small solid pancreatic masses. EUS-guided fine needle aspiration cytology (EUS-FNA) is a safe and highly accurate tool for the diagnosis of pancreatic malignancy. Prior to perform an EUS-FNA one should wonder whether the benefits outweigh the potential risks of the procedure. Therefore, it is important to take into account whether the procedure will influence patient management. The diagnostic yield and success rate of EUS-FNA in pancreatic lesions varies greatly depending on many factors including: the characteristics of the lesion itself (location of the mass and consistency of the lesion), technical factors (type of needle size, use of stylet, use of suction and number of needle passes performed) and the availability of immediate cytological assessment of the specimen. The aim of this review is to analyze all these factors for optimizing specimen collection and diagnostic efficiency in dealing with solid pancreatic masses. PMID:22586548

  12. Tumors and new endoscopic ultrasound-guided therapies.

    PubMed

    Carrara, Silvia; Petrone, Maria Chiara; Testoni, Pier Alberto; Arcidiacono, Paolo Giorgio

    2013-04-16

    With the advent of linear echoendoscopes, endoscopic ultrasound (EUS) has become more operative and a new field of oncological application has been opened up. From tumor staging to tissue acquisition under EUS-guided fine-needle aspiration, new operative procedures have been developed on the principle of the EUS-guided puncture. A hybrid probe combining radiofrequency with cryotechnology is now available, to be passed through the operative channel of the echoendoscope into the tumor to create an area of ablation. EUS-guided fine-needle injection is emerging as a method to deliver anti-tumoral agents inside the tumor. Ethanol lavage, with or without paclitaxel, has been proposed for the treatment of cystic tumors in non-resectable cases and complete resolution has been recorded in up to 70%-80%. Many other chemical or biological agents have been investigated for the treatment of pancreatic adenocarcinoma: activated allogenic lymphocyte culture (Cytoimplant), a replication-deficient adenovirus vector carrying the tumor necrosis factor-α gene, or an oncolytic attenuated adenovirus (ONYX-015). The potential advantage of treatment under EUS control is the real-time imaging guidance into a deep target like the pancreas which is extremely difficult to reach by a percutaneous approach. To date there are no randomized controlled trials to confirm the real clinical benefits of these treatments compared to standard therapy so it seems wise to reserve them only for experimental protocols approved by ethics committees. PMID:23596535

  13. Endoscopic ultrasound in the papilla and the periampullary region.

    PubMed

    Castillo, Cecilia

    2010-08-16

    Endoscopic ultrasound (EUS) provides relevant information when an ampullary or periampullary tumor is suspected. Early detection, T and N staging and Fine Needle Aspiration plus cithologic confirmation, are some of the expected benefits. Exclusion of benign findings like choledocholithiasis or chronic pancreatitis is also important. A correct understanding of the complex ampullary and periampullary anatomy is needed. Knowledge of the individual clinical history and other previous diagnostic images all contribute to a successful EUS examination. Radial and lineal EUS images are uniquely detailed and, at the moment, it seems to be the best way to exclude or confirm malignant or benign findings. We propose a procedural algorithm, including EUS, for suspected ampullary or periampullary tumors. This review summarizes the vast amount of information to be found spread in the literature, and recognizes this small anatomic area as the origin for a clinical entity with proper clinical presentation, proper imaging and proper therapeutic resolutions. The benefits of performing EUS for its study are highlighted. PMID:21160627

  14. Endoscopic therapy in chronic pancreatitis: current perspectives.

    PubMed

    Seicean, Andrada; Vultur, Simona

    2015-01-01

    Endoscopic therapy in chronic pancreatitis (CP) aims to provide pain relief and to treat local complications, by using the decompression of the pancreatic duct and the drainage of pseudocysts and biliary strictures, respectively. This is the reason for using it as first-line therapy for painful uncomplicated CP. The clinical response has to be evaluated at 6-8 weeks, when surgery may be chosen. This article reviews the main possibilities of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) therapies. Endotherapy for pancreatic ductal stones uses ultrasound wave lithotripsy and sometimes additional stone extractions. The treatment of pancreatic duct strictures consists of a single large stenting for 1 year. If the stricture persists, simultaneous multiple stents are applied. In case of unsuccessful ERCP, the EUS-guided drainage of the main pancreatic duct (MPD) or a rendezvous technique can solve the ductal strictures. EUS-guided celiac plexus block has limited efficiency in CP. The drainage of symptomatic or complicated pancreatic pseudocysts can be performed transpapillarily or transgastrically/transduodenally, preferably by EUS guidance. When the biliary stricture is symptomatic or progressive, multiple plastic stents are indicated. In conclusion, as in many fields of symptomatic treatment, endoscopy remains the first choice, either by using ERCP or EUS-guided procedures, after consideration of a multidisciplinary team with endoscopists, surgeons, and radiologists. However, what is crucial is establishing the right timing for surgery. PMID:25565876

  15. 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

  16. Electrical Stimulation of Sacral Dermatomes Can Suppress Aberrant Urethral Reflexes in Felines with Chronic Spinal Cord Injury

    PubMed Central

    McCoin, Jaime L.; Bhadra, Narendra; Gustafson, Kenneth J.

    2012-01-01

    Aims Uncoordinated reflex contractions of the external urethral sphincter (EUS) are a major component of voiding dysfunction after neurologic injury. Patterned stimulation of sacral afferent pathways can reduce abnormal EUS reflexes after acute SCI; however, effectiveness following chronic SCI is unknown. Methods Four adult male cats were implanted with bilateral extradural sacral root electrodes to allow bladder activation and underwent subsequent spinal transection (T10–12). Nine weeks after SCI urethral and bladder pressures were recorded with and without sacral afferent stimulation. Surface electrodes were applied to sacral and lumbar dermatomes and stimulus amplitude set below the muscle fasciculation threshold. The stimulation pattern was varied by on/off times of fixed frequency at each location. Results Reflexive EUS contractions were observed in all animals after chronic SCI. Patterned sacral dermatome stimulation reduced EUS reflex rate and amplitude in 2 of 4 cats. Suppression was dependent on both the stimulus location and pattern. Sacral locations and a stimulation pattern of (0.75 seconds on, 0.25 seconds off, 20 Hz) were effective in both responder animals. Conclusions Patterned sacral dermatome stimulation can reduce urethral abnormal reflexes following chronic SCI. Reflex suppression is dependent on both the stimulation location and stimulus pattern. Reduction of reflexive EUS activity after chronic SCI with this non-destructive and non-invasive approach may provide an advance for the treatment of detrusor-sphincter-dyssynergia. PMID:22674730

  17. Basic techniques in endoscopic ultrasound-guided fine needle aspiration for solid lesions: Adverse events and avoiding them

    PubMed Central

    Fujii, Larissa L.; Levy, Michael J.

    2014-01-01

    Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is often the preferred technique for tissue acquisition in the diagnosis of suspected intrathoracic and intraabdominal pathology. Although EUS FNA is a safe and accurate procedure, it has been associated with a low risk of adverse events. The unique properties of the echoendoscope and its ability to acquire tissue outside of the gastrointestinal lumen impart risks that are not associated with routine endoscopic procedures. In this review, we discuss the risk of perforation related to the echoendoscope itself and adverse events related to FNA of solid masses including infections, bleeding, pancreatitis and pancreatic duct leak, bile duct leak and tumor seeding. We also provide tips on how to avoid the most common adverse events related to EUS-FNA. PMID:24949409

  18. Clinical Applicability of Various Treatment Approaches for Upper Gastrointestinal Submucosal Tumors

    PubMed Central

    Zhang, Jing; Huang, Kaili; Ding, Shigang; Wang, Ye; Nai, Te; Huang, Yonghui; Zhou, Liya

    2016-01-01

    Submucosal tumor (SMT) is a disease that is commonly discovered during endoscopic examination. With advances in endoscopic ultrasonography (EUS) technology, this technique has become the primary screening method for the diagnosis of upper gastrointestinal SMTs. The present study summarized the clinical data of patients who were examined and diagnosed with upper gastrointestinal SMTs by EUS, underwent endoscopic therapy or surgical treatment, and received final pathological results in our hospital between January 2011 and September 2014. Our results show that endoscopic therapy has become the main approach for the treatment of upper gastrointestinal SMTs with the development and maturation of endoscopic technology in recent years. Our conclusion suggests that the selection of endoscopic methods, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and peroral submucosal tunneling endoscopic resection (STER), under the guidance of EUS is safe and effective for the treatment of upper gastrointestinal SMTs. PMID:26933439

  19. A case of thrombus of the descending aorta successfully diagnosed on preoperative endoscopic ultrasonography.

    PubMed

    Iwai, Tomohisa; Kida, Mitsuhiro; Kaneko, Toru; Yamauchi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2016-07-01

    A 45-year-old woman presented with left lower abdominal pain. A plain CT scan showed a slightly high-density, cord-like structure extending from the level of the diaphragm of the descending aorta to the superior mesenteric artery. Transgastric endoscopic ultrasonography (EUS) revealed a floating mass, smoothly attaching to the aortic intima and depicted as a hyperechoic region containing a mixture of hyperechoic and hypoechoic areas. EUS elastography revealed that the body of the mass consisted of medium soft tissue, with hard tissue at its base. On histopathological examination after surgery, the mass was found to consist mainly of fibrin, with no atypical cells. EUS examination should be used for the differential diagnosis between thrombi and tumors in the aorta. PMID:27169628

  20. 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

  1. Diagnosis and fine needle aspiration of pancreatic pseudocysts: the role of endoscopic ultrasound.

    PubMed

    Breslin, Niall; Wallace, Michael B

    2002-10-01

    Pseudocysts are localized collections of pancreatic fluid surrounded by nonepithelialized granulation tissue that occur following an insult to the pancreas. High image resolution and the ability sample in real-time by fine needle aspiration permit accurate distinction between various cystic lesions in the pancreas by endoscopic ultrasound (EUS). Other cyst characteristics and background pancreatic changes detectable at EUS assist in the diagnostic process. The use of Doppler flow ultrasound allows diagnosis of important pseudocyst complications such as pseudoaneurysms and varices. Endoscopic approaches to the drainage of symptomatic lesions previously relied on the use of cross-sectional imaging studies such as computed tomography scanning in combination with stent placement using a duodenoscope in the presence of an endoscopically visible cyst bulge. EUS facilitates this process allowing accurate imaging of the lesion prior to stent placement via the echoendoscope and overcomes many of the drawbacks and pitfalls of other endoscopic techniques. PMID:12607787

  2. Technical advances in endoscopic ultrasound-guided fiducial placement for the treatment of pancreatic cancer

    PubMed Central

    Chavalitdhamrong, Disaya; DiMaio, Christopher J.; Siersema, Peter D.; Wagh, Mihir S.

    2015-01-01

    Radiation therapy has an important role in the treatment of locally advanced or metastatic pancreatic cancer and can be used alone or in conjunction with surgery and/or systemic chemotherapy. Because of the challenge of delivering an accurate and optimal radiation dose, image-guided radiation therapy can be used to improve targeting. Fiducial markers can be placed in the tumor and used for localization in patients undergoing image-guided radiation therapy. The safety and feasibility of endoscopic ultrasound (EUS)-guided placement of fiducials has been assessed and reported for the management of pancreatic cancer. We herein review the technique, efficacy, and safety profile of EUS-guided fiducial placement. In addition, we highlight recent advances and technological upgrades in EUS-guided fiducial delivery systems for pancreatic cancer most relevant to practicing gastroenterologists and interventional endoscopists. PMID:26355267

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

    PubMed

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

    2016-04-28

    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

  4. Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips.

    PubMed

    Ogura, Takeshi; Sano, Tatsushi; Onda, Saori; Imoto, Akira; Masuda, Daisuke; Yamamoto, Kazuhiro; Kitano, Masayuki; Takeuchi, Toshihisa; Inoue, Takuya; Higuchi, Kazuhide

    2015-01-01

    Endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) is not normally indicated for an obstructed right intrahepatic bile duct (IHBD). The technical feasibility and clinical efficacy of a novel technique of EUS-BD for right IHBD obstruction were evaluated. A total of 11 patients underwent drainage using either a left or a right biliary access route. The causes of obstructive jaundice were cholangiocarcinoma (n = 6), pancreatic cancer (n = 3), gastric cancer (n = 1), and colon cancer (n = 1). After placement of an uncovered metal stent to bridge the obstruction, a hepaticogastrostomy was completed using a covered stent. Mean procedure time was 33.9 ± 10.0 minutes. Technical and functional success were achieved in all patients, and no adverse events occurred. This novel method appears to be safe and effective for right IHBD obstruction. PMID:25264761

  5. Technical advances in endoscopic ultrasound-guided fiducial placement for the treatment of pancreatic cancer.

    PubMed

    Chavalitdhamrong, Disaya; DiMaio, Christopher J; Siersema, Peter D; Wagh, Mihir S

    2015-08-01

    Radiation therapy has an important role in the treatment of locally advanced or metastatic pancreatic cancer and can be used alone or in conjunction with surgery and/or systemic chemotherapy. Because of the challenge of delivering an accurate and optimal radiation dose, image-guided radiation therapy can be used to improve targeting. Fiducial markers can be placed in the tumor and used for localization in patients undergoing image-guided radiation therapy. The safety and feasibility of endoscopic ultrasound (EUS)-guided placement of fiducials has been assessed and reported for the management of pancreatic cancer. We herein review the technique, efficacy, and safety profile of EUS-guided fiducial placement. In addition, we highlight recent advances and technological upgrades in EUS-guided fiducial delivery systems for pancreatic cancer most relevant to practicing gastroenterologists and interventional endoscopists. PMID:26355267

  6. 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

  7. 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.

  8. 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

  9. Endoscopic ultrasound-guided biliary drainage using a lumen-apposing self-expanding metal stent: a case series.

    PubMed

    Brückner, Stefan; Arlt, Alexander; Hampe, Jochen

    2015-09-01

    Endoscopic ultrasound-guided biliary drainage (EUS-BD) might be an alternative to percutaneous or transpapillary biliary drainage in unresectable pancreatic or biliary cancer. A lumen-apposing, fully covered, self-expanding metal stent, which creates a sealed transluminal conduit between the biliary and gastrointestinal tract may offer advantages over conventional plastic and metal stents. In this retrospective, observational, open-label case study, five patients underwent EUS-BD for obstructive jaundice in pancreatic cancer (n = 4) or distal cholangiocarcinoma (n = 1). Technical and functional success was achieved in all patients without complications. The development of specialized stent and delivery systems may render EUS-BD an effective and safe alternative to percutaneous or transpapillary approaches. PMID:26021309

  10. 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

  11. Interventional gastroenterology: esophageal and pancreatic cancers.

    PubMed

    Lee, Jeffrey H

    2005-12-01

    The development and refinement of endoscopic procedures have greatly improved the diagnosis and management of esophageal and pancreatic cancers. Endoscopic ultrasound (EUS) is a highly accurate technique for TNM staging in esophageal cancer, and allows a tissue diagnosis of lymph nodes via fine-needle aspiration with low risk of complications. Endoscopic mucosal resection is a treatment option in patients with early esophageal cancer who are poor surgical candidates. Similarly, EUS fine-needle aspiration is helpful in establishing a diagnosis in cystic lesions, exocrine tumors, neuroendocrine tumors, and other lesions in the pancreas. Endoscopic retrograde cholangiopancreatography provides diagnostic and therapeutic modalities for various pancreaticobiliary problems. A number of promising EUS-guided therapies for pancreatic cancers are under investigation. PMID:16360009

  12. 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

  13. 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

  14. Endoscopic ultrasonography guided biliary drainage: Summary of consortium meeting, May 7th, 2011, Chicago

    PubMed Central

    Kahaleh, Michel; Artifon, Everson LA; Perez-Miranda, Manuel; Gupta, Kapil; Itoi, Takao; Binmoeller, Kenneth F; Giovannini, Marc

    2013-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred procedure for biliary or pancreatic drainage in various pancreatico-biliary disorders. With a success rate of more than 90%, ERCP may not achieve biliary or pancreatic drainage in cases with altered anatomy or with tumors obstructing access to the duodenum. In the past those failures were typically managed exclusively by percutaneous approaches by interventional radiologists or surgical intervention. The morbidity associated was significant especially in those patients with advanced malignancy, seeking minimally invasive interventions and improved quality of life. With the advent of biliary drainage via endoscopic ultrasound (EUS) guidance, EUS guided biliary drainage has been used more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that encompasses various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS guided biliary and pancreatic drainage techniques. This diversity has resulted in variations and improvements in EUS Guided biliary and pancreatic drainage; and over the years has led to an extensive nomenclature. The diversity of techniques, nomenclature and recent progress in our intrumentation has led to a dedicated meeting on May 7th, 2011 during Digestive Disease Week 2011. More than 40 advanced endoscopists from United States, Brazil, Mexico, Venezuela, Colombia, Italy, France, Austria, Germany, Spain, Japan, China, South Korea and India attended this pivotal meeting. The meeting covered improved EUS guided biliary access and drainage procedures, terminology, nomenclature, training and credentialing; as well as emerging devices for EUS guided biliary drainage. This paper summarizes the meeting’s agenda and the conclusions generated by the creation of this consortium group. PMID:23538784

  15. 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

  16. The usefulness of S100P, mesothelin, fascin, prostate stem cell antigen, and 14-3-3 sigma in diagnosing pancreatic adenocarcinoma in cytological specimens obtained by endoscopic ultrasound guided fine-needle aspiration.

    PubMed

    Dim, Daniel C; Jiang, Feng; Qiu, Qi; Li, Ting; Darwin, Peter; Rodgers, William H; Peng, Hong Qi

    2014-03-01

    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the pancreas is an efficient and minimally invasive procedure for the diagnosis and staging of pancreatic adenocarcinoma. Because of some limitations of EUS-FNA in diagnosis of well-differentiated or early stage cancers, the purpose of this study is to assess the added benefit of immunohistochemistry. We studied five proteins overexpressed in pancreatic adenocarcinoma, namely, prostate stem cell antigen, fascin, 14-3-3 sigma, mesothelin and S100P utilizing immunohistochemistry on paraffin sections from cellblocks obtained by EUS-FNA. Sixty-two cases of EUS-FNA of the pancreas that had follow-up histological and/or clinical diagnosis and sufficient material in cell blocks were included. Using histological diagnosis and/or clinical outcome as the reference standard, EUS-FNA shows the highest sensitivity (95%) and specificity (91%) and is superior to any marker in this study. Among five antibodies, S100P reveals the best diagnostic characters showing 90% of sensitivity and 67% of specificity. Fascin shows high specificity (92%) but low sensitivity (38%). Mesothelin has a moderate sensitivity (74%) and low specificity (33%), PSCA and 14-3-3 show high sensitivity but zero specificity. S100P and mesothelin were useful in nine indeterminate cases. S100P correctly predicted six of seven cancers and one of one without cancer and mesothelin correctly diagnosed five of seven cancers and one of two noncancers in this group. EUS-FNA cytomorphology is superior to any of the immunohistochemical markers used in this study. Use of S100P and mesothelin in cytologically borderline cases can increase the diagnostic accuracy in this group. PMID:21538952

  17. Successful Endosonography-Guided Drainage of an Intra-Abdominal Abscess in a 1-Year-Old Infant.

    PubMed

    Ito, Yukiko; Isayama, Hiroyuki; Nakai, Yousuke; Umefune, Gyoutane; Sato, Tatsuya; Nakahara, Saori; Suwa, Junko; Kato, Keiichi; Nakata, Ryo

    2016-05-23

    Endoscopic ultrasound (EUS)-guided intervention has been established as a safe, effective and minimally invasive procedure for various diseases in adults, but there have been limited reports in pediatric patients. Herein, we report our experience with successful EUS-guided drainage of an intraabdominal abscess in a 1-year-old infant concomitant with disseminated intravascular coagulation. The abscess was punctured via the stomach using a standard, convex-type echoendoscope, and the patient's condition improved after naso-cystic catheter placement. Although the clinical course was complicated by delayed hemorrhage from the puncture site, the bleeding was successfully managed by endoscopic hemostasis using a standard forward-viewing endoscope. PMID:27114437

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

    PubMed Central

    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

  19. Endoscopic ultrasound: state-of-the-art GI tumor staging

    NASA Astrophysics Data System (ADS)

    Trowers, Eugene A.

    1999-06-01

    Videoendoscopy has truly enlarged the scope of diagnostic and therapeutic gastroenterology. However, videoendoscopic examinations are limited to the mucosal surface. Endoscopic ultrasound allows the endoscopist a view beyond the intestinal wall which opens the door to a variety of new gastroenterologic techniques. The evaluation of plain images in combination with contrast-enhanced imags has been found to be helpful when applied to CT and MRI. A similar advantage may be found for endoscopic ultrasound (EUS) studies. The efficacy of EUS with and without contrast enhancement is critically reviewed.

  20. 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

  1. Clinical impact of preoperative endoscopic ultrasound-guided fine-needle aspiration for pancreatic ductal adenocarcinoma

    PubMed Central

    Tsutsumi, Hideharu; Hara, Kazuo; Mizuno, Nobumasa; Hijioka, Susumu; Imaoka, Hiroshi; Tajika, Masahiro; Tanaka, Tsutomu; Ishihara, Makoto; Yoshimura, Kenichi; Shimizu, Yasuhiro; Niwa, Yasumasa; Sasaki, Yutaka; Yamao, Kenji

    2016-01-01

    Aim: To reveal the impact of preoperative endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: We retrospectively reviewed 242 patients who underwent surgery for PDAC at our institution between January 1996 and July 2012. Among them, there were three patients with R2 resection and 30 patients with a follow-up period of less than 1 year, who were excluded because they did not meet the conditions for evaluating recurrence. Consequently, 209 patients were enrolled in the present study. The patients were divided into two groups: 126 patients who underwent preoperative EUS-FNA (FNA group) and 83 patients who did not (non-FNA group) undergo preoperative EUS-FNA. Results: There were no significant differences in baseline characteristics between FNA and non-FNA groups except mean age (66.6 ± 8.9 years vs. 63.5 ± 8.9 years, respectively, P = 0.02) and the administration rate of gemcitabine as adjuvant chemotherapy (42.9% vs. 18.1%, P < 0.01). Sampling adequacy of preoperative EUS-FNA was 99.2% (125/126) and sensitivity for diagnosis was 92.9% (117/126). The rate of complications related to EUS-FNA was 1.6% (2/126); two patients experienced reduction in hemoglobin (≥2.0 g/dL). These two patients did not have any apparent bleeding and could be managed conservatively. No severe complications were seen. We evaluated long-term outcomes of preoperative EUS-FNA, especially disease-free survival, needle-track seeding and recurrence. Kaplan-Meier analysis indicated no significant difference in disease-free survival between the two groups (P = 0.12). The site of recurrence was not significantly different between groups. Needle-track seeding was not observed in this study. Multivariate analysis of recurrence factors showed that preoperative EUS-FNA did not affect postoperative recurrence. Conclusion: Preoperative EUS-FNA for PDAC was shown to be a safe procedure with high diagnostic ability, and not a risk

  2. Endoscopic ultrasound-guided drainage of an abdominal fluid collection following Whipple's resection.

    PubMed

    Jah, Asif; Jamieson, Neville; Huguet, Emmanuel; Griffiths, William; Carroll, Nicholas; Praseedom, Raaj

    2008-11-28

    Percutaneous aspiration and drainage of post-operative abdominal fluid collections is a well established standard technique. However, some fluid collections are not amenable to percutaneous drainage either due to location or the presence of surrounding visceral structures. Endoscopic Ultrasound (EUS) has been widely used for the drainage of pancreatitis-related abdominal fluid collections. However, there are no reports on the use of this technique in the post-operative setting. We report a case where the EUS-guided technique was used to drain a percutaneously inaccessible post-operative collection which had developed after Whipple's resection. PMID:19058316

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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

  8. A Case Report of Esophageal Bronchogenic Cyst and Review of the Literature With an Emphasis on Endoscopic Ultrasonography Appearance

    PubMed Central

    Han, Chaoqun; Lin, Rong; Yu, Jun; Zhang, Qin; Zhang, Yang; Liu, Jun; Ding, Zhen; Hou, Xiaohua

    2016-01-01

    Abstract 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

  9. CORD-AEUS: consensus document for the emergency ultrasound milestone project.

    PubMed

    Lewiss, Resa E; Pearl, Michelle; Nomura, Jason T; Baty, Gillian; Bengiamin, Rimon; Duprey, Kael; Stone, Michael; Theodoro, Daniel; Akhtar, Saadia

    2013-07-01

    In 2012, the Accreditation Council for Graduate Medical Education (ACGME) designated ultrasound (US) as one of 23 milestone competencies for emergency medicine (EM) residency graduates. With increasing scrutiny of medical educational programs and their effect on patient safety and health care delivery, it is imperative to ensure that US training and competency assessment is standardized. In 2011, a multiorganizational committee composed of representatives from the Council of Emergency Medicine Residency Directors (CORD), the Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine (SAEM), the Ultrasound Section of the American College of Emergency Physicians (ACEM), and the Emergency Medicine Residents' Association was formed to suggest standards for resident emergency ultrasound (EUS) competency assessment and to write a document that addresses the ACGME milestones. This article contains a historical perspective on resident training in EUS and a table of core skills deemed to be a minimum standard for the graduating EM resident. A survey summary of focused EUS education in EM residencies is described, as well as a suggestion for structuring education in residency. Finally, adjuncts to a quantitative measurement of resident competency for EUS are offered. PMID:23859589

  10. Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions

    PubMed Central

    Ramesh, Jayapal; Bang, Ji Young; Hebert-Magee, Shantel; Trevino, Jessica; Eltoum, Isam; Frost, Andra; Hasan, Muhammad K.; Logue, Amy; Hawes, Robert; Varadarajulu, Shyam

    2015-01-01

    Objectives Although a large gauge needle can procure more tissue at endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), its advantage over smaller needles is unclear. This study compared flexible 19G and 25G needles for EUS-FNA of solid pancreatic masses. Methods This was a randomized trial of patients undergoing EUS-FNA of pancreatic masses using flexible 19G or 25G needle. Main outcome measure was to compare median number of passes for on-site diagnosis. Secondary measures were to compare specimen bloodiness, complications, technical failures, and histological core tissue procurement. Results One hundred patients were randomized to EUS-FNA using flexible 19G or 25G needle. Median of 1 pass was required to achieve on-site diagnosis of 96% and 92% (P = 0.68) in 19G and 25G cohorts. There was no significant difference in technical failure (0% vs 2%, P = 0.99) or adverse events (2% vs 0%, P = 0.99) between 19G and 25G cohorts. Although histological core tissue procurement was significantly better with flexible 19G needle (88% vs 44%, P < 0.001), specimens were bloodier (severe bloodiness, 36% vs 4%; P < 0.001). Conclusions As there is no significant difference in the performance of flexible 19G and 25G needles, needle choice for sampling pancreatic masses should be based on endoscopist preference and need for histology. PMID:25232713

  11. 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

  12. Role of endoscopic ultrasound in pancreatic cancer.

    PubMed

    Chang, David K; Nguyen, Nam Q; Merrett, Neil D; Dixson, Hugh; Leong, Rupert W L; Biankin, Andrew V

    2009-06-01

    Pancreatic cancer (PC) is the fourth most common cause of cancer deaths in Western societies. It is an aggressive tumor with an overall 5-year survival rate of less than 5%. Surgical resection offers the only possibility of cure and long-term survival for patients suffering from PC; however, unfortunately, fewer than 20% of patients suffering from PC have disease that is amendable to surgical resection. Therefore, it is important to accurately diagnose and stage these patients to enable optimal treatment of their disease. The imaging modalities involved in the diagnosis and staging of PC include multidetector CT scanning, endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreaticography and MRI. The roles and relative importance of these imaging modalities have changed over the last few decades and continue to change owing to the rapid technological advances in medical imaging, but these investigations continue to be complementary. EUS was first introduced in the mid-1980s in Japan and Germany and has quickly gained acceptance. Its widespread use in the last decade has revolutionized the management of pancreatic disease as it simultaneously provides primary diagnostic and staging information, as well as enabling tissue biopsy. This article discusses the potential benefits and drawbacks of EUS in the primary diagnosis, staging and assessment of resectability, and EUS-guided fine-needle aspiration in PC. Difficult diagnostic scenarios and pitfalls are also discussed. A suggested management algorithm for patients with suspected PC is also presented. PMID:19485810

  13. 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.

  14. Endoscopic ultrasound-guided placement of the lumen-apposing self-expandable metallic stent for gallbladder drainage: a promising technique

    PubMed Central

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

    2016-01-01

    Acute cholecystitis and other clinical problems requiring gallbladder removal or drainage have conventionally been treated with surgery, endoscopic retrograde cholangiopancreatography or percutaneous transhepatic drainage of the gallbladder and/or extrahepatic bile duct. Patients unable to undergo these procedures due to functional status or anatomical anomalies are candidates for endoscopic ultrasound (EUS)-guided gallbladder drainage with stent placement. The aim of this review was to evaluate the technical feasibility and efficacy of EUS-guided placement of the recently developed lumen-apposing self-expandable metallic stent (LASEMS). 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 78 patients were included across all studies described thus far in the literature. Studies have reported near 100% technical and clinical success rates in selected cases. No major complications were reported. EUS-guided gallbladder drainage and LASEMS placement can be a safe and effective alternative approach in the management of selected patients. PMID:27065728

  15. 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

  16. 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

  17. Endoscopic ultrasound-guided placement of the lumen-apposing self-expandable metallic stent for gallbladder drainage: a promising technique.

    PubMed

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

    2016-01-01

    Acute cholecystitis and other clinical problems requiring gallbladder removal or drainage have conventionally been treated with surgery, endoscopic retrograde cholangiopancreatography or percutaneous transhepatic drainage of the gallbladder and/or extrahepatic bile duct. Patients unable to undergo these procedures due to functional status or anatomical anomalies are candidates for endoscopic ultrasound (EUS)-guided gallbladder drainage with stent placement. The aim of this review was to evaluate the technical feasibility and efficacy of EUS-guided placement of the recently developed lumen-apposing self-expandable metallic stent (LASEMS). 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 78 patients were included across all studies described thus far in the literature. Studies have reported near 100% technical and clinical success rates in selected cases. No major complications were reported. EUS-guided gallbladder drainage and LASEMS placement can be a safe and effective alternative approach in the management of selected patients. PMID:27065728

  18. WASH SOLVENT REUSE IN PAINT PRODUCTION

    EPA Science Inventory

    This project evaluated solvent used to clean paint manufacture equipment for its utility in production of subsequent batches of solvent-borne paint. eusing wash solvent would reduce the amount of solvent disposed of as waste. he evaluation of this wash-solvent recovery technology...

  19. 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

  20. Colorectal Subepithelial Lesions

    PubMed Central

    2015-01-01

    Most of subepithelial lesion (SEL) being identified was accidentally discovered as small bulging lesion covered with normal mucosa from endoscopic screening. The type of treatment and prognosis vary depending on the type of tumor, it would be crucial to perform an accurate differential diagnosis. Since the differentiation of SEL relied on the indirect findings observed from the mucosal surface using an endoscopy only in the past, it was able to confirm the presence of lesion only but difficult to identify complex detailed nature of the lesion. However, after the endoscopic ultrasonography (EUS) was introduced, it became possible to identify extrinsic compression, and size of intramural tumors, internal properties and contour so that it gets possible to have differential diagnosis of lesions and prediction on the lesion whether it is malignant or benign. In addition, the use of EUS-guided fine needle aspiration and EUS-guided core biopsy made it possible to make histological differential diagnosis. This study intended to investigate endoscopic and EUS findings, histological diagnosis, treatment regimen and impression of colorectal SELs. PMID:26240803

  1. How good is fine needle aspiration? What results should you expect?

    PubMed

    Eisendrath, Pierre; Ibrahim, Mostafa

    2014-01-01

    Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids. PMID:24949404

  2. Endoscopic ultrasound-guided placement of AXIOS stent for drainage of pancreatic fluid collections.

    PubMed

    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

  3. Conversion of Percutaneous Cholecystostomy to Internal Transmural Gallbladder Drainage Using an Endoscopic Ultrasound-Guided, Lumen-Apposing Metal Stent.

    PubMed

    Law, Ryan; Grimm, Ian S; Stavas, Joseph M; Baron, Todd H

    2016-03-01

    Patients with acute cholecystitis sometimes require placement of percutaneous cholecystostomy catheters, either as a bridge to surgery or as primary therapy. In patients who cannot undergo surgery, subsequent removal of the catheter can lead to recurrence of cholecystitis, whereas leaving the drain in place can cause adverse events. We investigated internalization of percutaneous cholecystostomy drainage catheters, using endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMS) as an alternative treatment strategy. Seven patients (median age, 57 years; 6 men) underwent EUS-guided cholecystoenterostomy for internalization of gallbladder drainage with EUS-guided placement of a 10- or 15-mm LAMS. All had initially been treated with placement of a percutaneous cholecystostomy catheter for cholecystitis and were later deemed unfit for cholecystectomy. Technical success was achieved in all patients in 1 endoscopic session, with subsequent removal of all percutaneous drains. Two patients required placement of self-expandable metal stents within the LAMS to successfully bridge the gallbladder and gastrointestinal lumen. No adverse events occurred after a median follow-up of 2.5 months. EUS-guided cholecystoenterostomy using a LAMS is therefore a viable option for internal gallbladder drainage in patients who have a percutaneous cholecystostomy catheter and are poor candidates for cholecystectomy. PMID:26528802

  4. 75 FR 67970 - Notice of Inquiry; An Analysis of the European Union Repeal of the Liner Conference Block Exemption

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ... Notice of Inquiry; An Analysis of the European Union Repeal of the Liner Conference Block Exemption... Commission in its identification, analysis and evaluation of any consequences of the E.U.'s policy decision on U.S. trades, and will be incorporated into the Commission's research for An Analysis of the...

  5. Clinical evaluation of endoscopic ultrasonography-guided drainage using a novel flared-type biflanged metal stent for pancreatic fluid collection

    PubMed Central

    Mukai, Shuntaro; Itoi, Takao; Sofuni, Atsushi; Tsuchiya, Takayoshi; Gotoda, Takuji; Moriyasu, Fuminori

    2015-01-01

    Background and Objectives: Endoscopic ultrasonography (EUS)-guided transluminal drainage for pancreatic fluid collections (PFCs) has become the standard therapy worldwide as a minimally invasive therapy compared with surgical drainage. Recently, a novel flared-type biflanged metal stent (BFMS) designed specifically for the treatment of PFCs has been developed. The aim of this study was to retrospectively assess the feasibility and safety of EUS-guided drainage and direct endoscopic necrosectomy (DEN) for PFCs using the novel flared-type BFMS. Patients and Methods: Twenty-one patients were treated by EUS-guided drainage using a flared-type BFMS for PFCs (pancreatic pseudocyst, 2 patients; walled-off necrosis, 19 patients). Results: The present study showed a technical success rate of 100%, a final clinical success rate of 100%, a procedure-related adverse event (AE) rate of 0%, an early AE rate of 28.6% (moderate and severe AE rate of 9.5%), a mortality rate of 0%, and a recurrence rate of 9.5%. DEN (mean, 2.3 sessions) was required in 38% of the patients. Conclusion: The present study clarified that the EUS-guided drainage using the flared-type BFMS is an effective and safe treatment approach for PFCs. Further studies using randomized controlled multicenter trials are warranted. PMID:26020046

  6. Enhancing regional lymph nodes from endoscopic ultrasound images

    NASA Astrophysics Data System (ADS)

    Nwogu, Ifeoma; Chaudhary, Vipin

    2008-03-01

    Esophageal ultrasound (EUS) is particularly useful for isolating lymph nodes in the N-staging of esophageal cancer, a disease with very poor overall prognosis. Although EUS is relatively low-cost and real time, and it provides valuable information to the clinician, its usefulness to less trained "users" including opportunities for computer-aided diagnosis is still limited due to the strong presence of spatially correlated interference noise called speckles. To this end, in this paper, we present a technique for enhancing lymph nodes in EUS images by first reducing the spatial correlation of the specular noise and then using a modified structured tensor-based anisotropic filter to complete the speckle reduction process. We report on a measure of the enhancement and also on the extent of automatic processing possible, after the speckle reduction process has taken place. Also, we show the limitations of the enhancement process by extracting relevant lymph node features from the despeckled images. When tested on five representative classes of esophageal lymph nodes, we found the despeckling process to greatly reduce the specularity of the original EUS images, therefore proving very useful for visualization purposes. But it still requires additional work for the complete automation of the lymph node characterizing process.

  7. 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

  8. 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.

  9. Celiac plexus neurolysis in pancreatic cancer: The endoscopic ultrasound approach

    PubMed Central

    Seicean, Andrada

    2014-01-01

    Pain in pancreatic cancer is often a major problem of treatment. Administration of opioids is frequently limited by side effects or insufficient analgesia. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) represents an alternative for the palliative treatment of visceral pain in patients with pancreatic cancer. This review focuses on the indications, technique, outcomes of EUS-CPN and predictors of pain relief. EUS-CPN should be considered as the adjunct method to standard pain management. It moderately reduces pain in pancreatic cancer, without eliminating it. Nearly all patients need to continue opioid use, often at a constant dose. The effect on quality of life is controversial and survival is not influenced. The approach could be done in the central position of the celiac axis, which is easy to perform, or in the bilateral position of the celiac axis, with similar results in terms of pain alleviation. The EUS-CPN with multiple intraganglia injection approach seems to have better results, although extended studies are still needed. Further trials are required to enable more confident conclusions regarding timing, quantity of alcohol injected and the method of choice. Severe complications have rarely been reported, and great care should be taken in choosing the site of alcohol injection. PMID:24415863

  10. Squamous Cell Carcinoma of Pancreas: Mystery and Facts.

    PubMed

    Raghavapuram, Saikiran; Vaid, Arjun; Rego, Rayburn F

    2015-08-01

    Squamous cell carcinoma of the pancreas is very rare as pancreas does not have any squamous cells. Only a few cases have been reported in the literature so far. We describe such a case where in the patient presented with painless jaundice. CT and EUS confirmed the pancreatic mass biopsy of which showed squamous cell cancer. PMID:26376556

  11. 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

  12. [Endoscopic ultrasonography of the upper digestive tract].

    PubMed

    Mesihović, Rusmir; Vanis, Nenad; Tanović, Haris; Gornjaković, Srdan; Smajlović, Fahrudin; Borovac, Nada

    2003-01-01

    Endoscopic Ultrasonography, or EUS, has joined medical techniques of endoscopy with high frequency ultrasound technique, known as ultrasound. This removable achievement allows physician for microscopic tissue examination, not only in digestive system, but also in its surroundings by highly frequent technique. Endoscopic ultrasonography detects all kinds and nature of possible abnormalities, including and information, which are necessary for proper diagnosis and optimal treatment. In experience hands, EUS can detect abnormalities, which are undetectable during any other techniques of examination. EUS is applied from inside the body, near or even touching the examined surface, so the precise, highly frequent energy of showing the images can be used. The sonography, MRI, CT techniques must show the inner organs through outside surface of body, loosing the resolution during process. The superior resolution of EUS shows 5 layers of digestive tract, almost equally good as by microscope; none of other techniques allows showing of intestinal wall equally good as this one. By EUS liquid has been proved with 90% of precision in diagnosis of operative degrees of pancreas tumours. CT in this case has shows only 50% of precision. Highly skilled surgeons are aware of application of these diagnostics techniques in preoperative cases so the surgical removement of tumours is going to be more effective. The precision of EUS findings are of critical importance for the utilisation of maximum of new treatment having in mind that abnormalities could be diagnosed and characterised without operative intervention. To be able to focus on specific anatomic surfaces, there is need of great knowledge, skillfulness and praxis during the manipulation with EUS instrument. The years of experience are needed to be able to achieve high standard of expertise. The accuracy of results varies, depending on physicians diagnostic experience, sub-optimal results are not going to be a good guide during

  13. Strategies for containing Ebola in West Africa.

    PubMed

    Pandey, Abhishek; Atkins, Katherine E; Medlock, Jan; Wenzel, Natasha; Townsend, Jeffrey P; Childs, James E; Nyenswah, Tolbert G; Ndeffo-Mbah, Martial L; Galvani, Alison P

    2014-11-21

    The ongoing Ebola outbreak poses an alarming risk to the countries of West Africa and beyond. To assess the effectiveness of containment strategies, we developed a stochastic model of Ebola transmission between and within the general community, hospitals, and funerals, calibrated to incidence data from Liberia. We find that a combined approach of case isolation, contact-tracing with quarantine, and sanitary funeral practices must be implemented with utmost urgency in order to reverse the growth of the outbreak. As of 19 September, under status quo, our model predicts that the epidemic will continue to spread, generating a predicted 224 (134 to 358) daily cases by 1 December, 280 (184 to 441) by 15 December, and 348 (249 to 545) by 30 December. PMID:25414312

  14. 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

  15. 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.

  16. Japanese particle-physics leader dies

    NASA Astrophysics Data System (ADS)

    Durrani, Matin

    2008-08-01

    Yoji Totsuka, former director general of the KEK particle-physics lab in Japan, died on 10 July at the age of 66. Totsuka, whose research interests were in the field of neutrino physics, served as KEK boss for three years from April 2003. After retiring in 2006, Totsuka became a professor emeritus at KEK and the University of Tokyo. His funeral on 12 July was attended by more than 500 people.

  17. 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

  18. Performance of the forward-view echoendoscope for pancreaticobiliary examination in patients with status post-upper gastrointestinal surgery

    PubMed Central

    Fusaroli, Pietro; Serrani, Marta; Lisotti, Andrea; D’Ercole, Maria Cristina; Ceroni, Liza; Caletti, Giancarlo

    2015-01-01

    Background and Objectives: Failures of endoscopic ultrasound (EUS) imaging of the head of the pancreas (HOP) and the common bile duct (CBD) have been reported in up to 50% of patients with status postsurgery (e.g., Billroth II and Roux-en-Y). This is attributable to inability to intubate the afferent limb or the duodenum. Recently, a forward-view (FV) echoendoscope has become available. The frontal endoscopic and ultrasound field of view theoretically allow easier manipulation throughout the gastrointestinal tract compared to the traditional echoendoscopes. The aim of our study was to evaluate the safety and performance of the FV echoendoscope for the investigation of the biliary tree and the pancreas, including fine-needle aspiration (FNA), in patients with surgically altered upper gastrointestinal anatomy. Patients and Methods: This was a retrospective evaluation of a prospectively maintained database. All EUS procedures were performed at our institution by one experienced endosonographer from March to September 2009 under conscious sedation. The FV echoendoscope was used for all procedures. Results: Twenty-five (25) out of 37 presented status post-Billroth II and 12 out of 37 with status post-Roux-en-Y surgery. Overall, HOP and CBD were adequately visualized in 28 out of 37 (75.7%). All the failures occurred in the Roux-en-Y patients. EUS-FNA was successfully performed in 16 patients. No adverse events were observed. Conclusions: The FV echoendoscope proved to be safe and effective in reaching the periampullary area in patients with previous Billroth II, allowing complete exploration of the HOP and the CBD and performance of EUS-FNA. However, FV EUS was unsuccessful in the majority of patients with Roux-en-Y, which still remains a challenging condition. PMID:26643703

  19. ENDOSCOPIC HIGH-INTENSITY FOCUSED US: TECHNICAL ASPECTS AND STUDIES IN AN IN VIVO PORCINE MODEL

    PubMed Central

    Li, Tong; Khokhlova, Tatiana; Wang, Yak-Nam; Maloney, Ezekiel; D'Andrea, Samantha; Starr, Frank; Farr, Navid; Morrison, Kyle; Keilman, George; Hwang, Joo Ha

    2015-01-01

    Background High-intensity focused ultrasound (HIFU) is becoming more widely used for non-invasive and minimally invasive ablation of benign and malignant tumors. Recent studies suggest that HIFU can also enhance targeted drug delivery and stimulate an anti-tumor immune response in many tumors. However, targeting of pancreatic and liver tumors using an extracorporeal source is challenging due to the lack of an adequate acoustic window. The development of an endoscopic ultrasound (EUS)-guided HIFU transducer has many potential benefits including improved targeting, decreased energy requirements and decreased potential for injury to intervening structures. Objective To design, develop and test an EUS-guided HIFU transducer for endoscopic applications. Design A pre-clinical, pilot characterization and feasibility study. Setting Academic research center. Patients Studies were performed in an in vivo porcine model. Intervention Thermal ablation of in vivo porcine pancreas and liver was performed with EUS guided focused ultrasound through the gastric tract. Results The transducer successfully created lesions in gel phantoms and ex vivo bovine livers. In vivo studies demonstrated that targeting and creating lesions in the porcine pancreas and liver are feasible. Limitations This is a pre-clinical, single-center feasibility study with a limited number of subjects. Conclusion An EUS-guided HIFU transducer was successfully designed and developed with dimensions that are appropriate for endoscopic use. Feasibility of performing EUS-guided HIFU ablation in vivo has been demonstrated in an in vivo porcine model. Further development of this technology will allow endoscopists to perform precise therapeutic ablation of peri-lumenal lesions without breaching the wall of the gastric tract. PMID:25759124

  20. 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.

  1. Preoperative radiotherapy for rectal adenocarcinoma: Which are strong prognostic factors?

    SciTech Connect

    Chapet, Olivier . E-mail: ochapet@med.umich.edu; Romestaing, Pascale; Mornex, Francoise; Souquet, Jean-Christophe; Favrel, Veronique; Ardiet, Jean-Michel; D'Hombres, Anne; Gerard, Jean-Pierre

    2005-04-01

    Purpose: This retrospective 12-year study evaluated the prognostic value of initial and postoperative staging of rectal tumors. Methods and Materials: Between 1985 and 1996, 297 patients were treated with preoperative radiotherapy (39 Gy in 13 fractions) and surgery for Stage T2-T4N0-N1M0 rectal adenocarcinoma. Pretreatment staging included a clinical examination and endorectal ultrasonography (EUS) since 1988. Clinical staging was performed by digital rectal examination and rigid proctoscopy. EUS was performed in 236 patients. Postoperative staging was performed by examination of the pathologic specimen. Results: The median follow-up was 49 months. The overall 5-year survival rate was 67%, with a local failure rate of 9%. The rate of sphincter preservation was 65%. The clinical examination findings were strong prognostic factor for both cT stage (p < 0.001) and cN stage (p < 0.006) but had poor specificity for cN stage (only 25 lymph nodes detected). In both univariate and multivariate analyses, EUS had a statistically significant prognostic value for uT (p < 0.014) but not for uN (p < 0.47) stage. In contrast, pT and pN stages were strong prognostic factors (p < 0.001 and p < 0.001, respectively). Conclusion: Pretreatment staging, including clinical examination and EUS, seemed accurate enough to present a high prognostic value for the T stage. EUS was insufficient to stage lymph node involvement. Owing to its lack of specificity, uN stage was not a reliable prognostic factor. An improvement in N staging is necessary and essential. Despite downstaging, postoperative staging remained a very strong prognostic factor for both T and N stages.

  2. Evaluating the Minimal Specimens From Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Pancreatic Masses.

    PubMed

    Park, Joo Kyung; Kang, Ki Joo; Oh, Cho Rong; Lee, Jong Kyun; Lee, Kyu Taek; Jang, Kee Taek; Park, Sang-Mo; Lee, Kwang Hyuck

    2016-05-01

    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

  3. 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

  4. 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

  5. Endoscopic ultrasound-guided fine-needle aspiration with on-site cytopathology versus core biopsy: a comparison of both techniques performed at the same endoscopic session

    PubMed Central

    Lin, Michael; Hair, Clark D.; Green, Linda K.; Vela, Stacie A.; Patel, Kalpesh K.; Qureshi, Waqar A.; Shaib, Yasser H.

    2014-01-01

    Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) with bedside cytopathology is the gold standard for assessment of pancreatic, subepithelial, and other lesions in close proximity to the gastrointestinal tract, but it is time-consuming, has certain diagnostic limitations, and bedside cytopathology is not widely available. Aims: The goal of this study is to compare the diagnostic yield of EUS-guided FNA with on-site cytopathology and EUS-guided core biopsy. Methods: Twenty-six patients with gastrointestinal mass lesions requiring biopsy at a tertiary medical center were included in this retrospective analysis of a prospective cohort. Two core biopsies were taken using a 22 gauge needle followed by FNA guided by a bedside cytopathologist at the same endoscopic session. The diagnostic yield and test characteristics of EUS core biopsy and EUS FNA with bedside cytopathology were examined. Results: The mean number of passes was 3.2 for FNA, and the mean procedure time was 39.4 minutes. The final diagnosis was malignant in 92.3 %. Sensitivity and specificity were 83 % and 100 %, respectively, for FNA, and 91.7 % and 100 %, respectively, for core biopsy. Diagnostic accuracy was 92.3 % for FNA and 84.6 % for core biopsy. The two approaches were in agreement in 88.4 % with a kappa statistic of 0.66 (95 % confidence interval 0.33 – 0.99). Conclusions: An approach using two passes with a core biopsy needle is comparable to the current gold standard of FNA with bedside cytopathology. The performance of two core biopsies is time-efficient and could represent a good alternative to FNA with bedside cytopathology. PMID:26135096

  6. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses

    PubMed Central

    Voss, M; Hammel, P; Molas, G; Palazzo, L; Dancour, A; O'Toole, D; Terris, B; Degott, C; Bernades, P; Ruszniewski, P

    2000-01-01

    AIM—To assess the feasibility and diagnostic accuracy of endoscopic ultrasound guided fine needle biopsy (EUS-FNAB) in patients with solid pancreatic masses.
METHODS—Ninety nine consecutive patients with pancreatic masses were studied. Histological findings obtained by EUS-FNAB were compared with the final diagnosis assessed by surgery, biopsy of other tumour site or at postmortem examination, or by using a combination of clinical course, imaging features, and tumour markers.
RESULTS—EUS-FNAB was feasible in 90 patients (adenocarcinomas, n = 59; neuroendocrine tumours, n = 15; various neoplasms, n = 6; pancreatitis, n = 10), and analysable material was obtained in 73. Tumour size (⩾ or < 25 mm in diameter) did not influence the ability to obtain informative biopsy samples. Diagnostic accuracy was 74.4% (adenocarcinomas, 81.4%; neuroendocrine tumours, 46.7%; other lesions, 75%; p<0.02). Overall, the diagnostic yield in all 99 patients was 68%. Successful biopsies were performed in six patients with portal hypertension. Minor complications (moderate bleeding or pain) occurred in 5% of cases.
CONCLUSIONS—EUS-FNAB is a useful and safe method for the investigation of pancreatic masses, with a high feasibility rate even when lesions are small. Overall diagnostic accuracy of EUS-FNAB seems to depend on the tumour type.


Keywords: pancreas; tumour; endoscopic ultrasound; fine needle aspiration biopsy PMID:10644320

  7. 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. PMID:23099413

  8. Endoscopic ultrasonography for surveillance of individuals at high risk for pancreatic cancer

    PubMed Central

    Lami, Gabriele; Biagini, Maria Rosa; Galli, Andrea

    2014-01-01

    Pancreatic cancer is a highly lethal disease with a genetic susceptibility and familial aggregation found in 3%-16% of patients. Early diagnosis remains the only hope for curative treatment and improvement of prognosis. This can be reached by the implementation of an intensive screening program, actually recommended for individuals at high-risk for pancreatic cancer development. The aim of this strategy is to identify pre-malignant precursors or asymptomatic pancreatic cancer lesions, curable by surgery. Endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA) seems to be the most promising technique for early detection of pancreatic cancer. It has been described as a highly sensitive and accurate tool, especially for small and cystic lesions. Pancreatic intraepithelial neoplasia, a precursor lesion which is highly represented in high-risk individuals, seems to have characteristics chronic pancreatitis-like changes well detected by EUS. Many screening protocols have demonstrated high diagnostic yields for pancreatic pre-malignant lesions, allowing prophylactic pancreatectomies. However, it shows a high interobserver variety even among experienced endosonographers and a low sensitivity in case of chronic pancreatitis. Some new techniques such as contrast-enhanced harmonic EUS, computer-aided diagnostic techniques, confocal laser endomicroscopy miniprobe and the detection of DNA abnormalities or protein markers by FNA, promise improvement of the diagnostic yield of EUS. As the resolution of imaging improves and as our knowledge of precursor lesions grows, we believe that EUS could become the most suitable method to detect curable pancreatic neoplasms in correctly identified asymptomatic at-risk patients. PMID:25031786

  9. 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

  10. Social pathways for Ebola virus disease in rural Sierra Leone, and some implications for containment.

    PubMed

    Richards, Paul; Amara, Joseph; Ferme, Mariane C; Kamara, Prince; Mokuwa, Esther; Sheriff, Amara Idara; Suluku, Roland; Voors, Maarten

    2015-04-01

    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

  11. 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

  12. 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

  13. 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.

  14. 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

  15. 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

  16. 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

  17. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors

    PubMed Central

    Pai, Madhava; Habib, Nagy; Senturk, Hakan; Lakhtakia, Sundeep; Reddy, Nageshwar; Cicinnati, Vito R; Kaba, Iyad; Beckebaum, Susanne; Drymousis, Panagiotis; Kahaleh, Michel; Brugge, William

    2015-01-01

    AIM: To outline the feasibility, safety, adverse events and early results of endoscopic ultrasound (EUS)-radiofrequency ablation (RFA) in pancreatic neoplasms using a novel probe. METHODS: This is a multi-center, pilot safety feasibility study. The intervention described was radiofrequency ablation (RF) which was applied with an innovative monopolar RF probe (1.2 mm Habib EUS-RFA catheter) placed through a 19 or 22 gauge fine needle aspiration (FNA) needle once FNA was performed in patients with a tumor in the head of the pancreas. The Habib™ EUS-RFA is a 1 Fr wire (0.33 mm, 0.013”) with a working length of 190 cm, which can be inserted through the biopsy channel of an echoendoscope. RF power is applied to the electrode at the end of the wire to coagulate tissue in the liver and pancreas. RESULTS: Eight patients [median age of 65 (range 27-82) years; 7 female and 1 male] were recruited in a prospective multicenter trial. Six had a pancreatic cystic neoplasm (four a mucinous cyst, one had intraductal papillary mucinous neoplasm and one a microcystic adenoma) and two had a neuroendocrine tumors (NET) in the head of pancreas. The mean size of the cystic neoplasm and NET were 36.5 mm (SD ± 17.9 mm) and 27.5 mm (SD ± 17.7 mm) respectively. The EUS-RFA was successfully completed in all cases. Among the 6 patients with a cystic neoplasm, post procedure imaging in 3-6 mo showed complete resolution of the cysts in 2 cases, whilst in three more there was a 48.4% reduction [mean pre RF 38.8 mm (SD ± 21.7 mm) vs mean post RF 20 mm (SD ± 17.1 mm)] in size. In regards to the NET patients, there was a change in vascularity and central necrosis after EUS-RFA. No major complications were observed within 48 h of the procedure. Two patients had mild abdominal pain that resolved within 3 d. CONCLUSION: EUS-RFA of pancreatic neoplasms with a novel monopolar RF probe was well tolerated in all cases. Our preliminary data suggest that the procedure is straightforward and safe. The

  18. 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

  19. Pancreatic metastases from ovarian carcinoma--diagnosis by endoscopic ultrasound-guided fine needle aspiration.

    PubMed

    Hadzri, M Hasmoni; Rosemi, Salleh

    2012-04-01

    Pancreatic metastases are very uncommon and originate most commonly from lung, colon, breast and kidney cancer. Ovarian adenocarcinoma has been reported as a primary site of pancreatic metastasis, but its diagnosis has rarely being reported by endoscopic ultrasound guided fine needle aspiration (EUS-FNA). We report a case of multiple metastases to the pancreas from ovarian carcinoma occurring four years after original resection of the primary tumour. Our patient presented with severe epigastric pain which was initially treated as acute pancreatitis. Further imaging modalities showed multiple large pseudocystic lesions in the pancreatic head and body. Subsequent EUS-FNA confirmed that the lesions were metastatic disease from an advanced ovarian carcinoma. She underwent palliative chemotherapy and the pancreatic lesion showed receding size. PMID:22822646

  20. Cavernous hemangioma of adult pancreas: A case report and literature review

    PubMed Central

    Mondal, Utpal; Henkes, Nichole; Henkes, David; Rosenkranz, Laura

    2015-01-01

    Pancreatic hemangioma is a rare type of benign vascular tumor. Low clinical suspicion and inability of current cross sectional imaging techniques to differentiate it from other pancreatic lesions, contribute to the difficulty in making the correct diagnosis. Without a definitive diagnosis, and due to concern for malignancy, in many instances, surgery is performed. We report a case of pancreas cavernous hemangioma in an 18-year-old female. The patient presented with three-month history of epigastric pain. Physical examination and routine blood tests were normal. Abdominal Computed Tomography scan revealed a 5 cm × 6 cm complex non-enhancing cystic mass in the head of pancreas. Magnetic resonance imaging, endoscopic ultrasonography (EUS) and EUS guided fine needle aspiration cytology were non-diagnostic. Because of uncontrolled symptoms, the patient underwent surgical resection. Histopathology and Immunohistochemical staining confirmed the diagnosis of cavernous hemangioma of pancreas. PMID:26361427

  1. New ultrasound techniques for lymph node evaluation

    PubMed Central

    Cui, Xin-Wu; Jenssen, Christian; Saftoiu, Adrian; Ignee, Andre; Dietrich, Christoph F

    2013-01-01

    Conventional ultrasound (US) is the recommended imaging method for lymph node (LN) diseases with the advantages of high resolution, real time evaluation and relative low costs. Current indications of transcutaneous ultrasound and endoscopic ultrasound include the detection and characterization of lymph nodes and the guidance for LN biopsy. Recent advances in US technology, such as contrast enhanced ultrasound (CEUS), contrast enhanced endoscopic ultrasound (CE-EUS), and real time elastography show potential to improve the accuracy of US for the differential diagnosis of benign and malignant lymph nodes. In addition, CEUS and CE-EUS have been also used for the guidance of fine needle aspiration and assessment of treatment response. Complementary to size criteria, CEUS could also be used to evaluate response of tumor angiogenesis to anti-angiogenic therapies. In this paper we review current literature regarding evaluation of lymphadenopathy by new and innovative US techniques. PMID:23946589

  2. 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

  3. Endoscopic resection of subepithelial tumors

    PubMed Central

    Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Caca, Karel

    2014-01-01

    Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods. PMID:25512768

  4. Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option

    PubMed Central

    Zhuo, Chang-Hua; Shi, De-Bing; Ying, Min-Gang; Cheng, Yu-Fan; Wang, Yu-Wei; Zhang, Wen-Ming; Cai, San-Jun; Li, Xin-Xiang

    2014-01-01

    Colonic lymphangioma is an unusual benign malformation. We herein describe two cases. A 36-year-old woman was admitted with one year of intermittent abdominal pain; colonoscopy, abdominopelvic computed tomography and endoscopic ultrasonography (EUS) revealed enlarged cystic masses at the ascending colon. In another 40-year-old man, colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon. Both patients underwent laparoscopic segmental colectomy. Both masses were histologically confirmed as cystic lymphangiomas, and the patients were discharged without complications. The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complication risks. Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive, minimally invasive intervention with a fast postoperative recovery. PMID:25024636

  5. Postbrushing and fine-needle aspiration biopsy follow-up and treatment options for patients with pancreatobiliary lesions: the Papanicolaou Society of Cytopathology guidelines.

    PubMed

    Kurtycz, Daniel; Tabatabai, Z Laura; Michaels, Claire; Young, Nancy; Schmidt, C Max; Farrell, James; Gopal, Deepak; Simeone, Diane; Merchant, Nipun B; Field, Andrew; Pitman, Martha Bishop

    2014-04-01

    The papanicolaou society of cytopathology (PSC) has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature for pancreatobiliary cytology, ancillary testing, and postprocedure management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings over an 18 month period and synthesis of online comments of the draft document on the PSC web site [www.papsociety.org]. This document selectively presents the results of these discussions and focuses on the follow-up and treatment options for patients after procedures performed for obtaining cytology samples for the evaluation of biliary strictures and solid and cystic masses in the pancreas. These recommendations follow the six-tiered terminology and nomenclature scheme proposed by Committee III. PMID:24639399

  6. Successful Endosonography-Guided Drainage of an Intra-Abdominal Abscess in a 1-Year-Old Infant

    PubMed Central

    Ito, Yukiko; Isayama, Hiroyuki; Nakai, Yousuke; Umefune, Gyoutane; Sato, Tatsuya; Nakahara, Saori; Suwa, Junko; Kato, Keiichi; Nakata, Ryo

    2016-01-01

    Endoscopic ultrasound (EUS)-guided intervention has been established as a safe, effective and minimally invasive procedure for various diseases in adults, but there have been limited reports in pediatric patients. Herein, we report our experience with successful EUS-guided drainage of an intra-abdominal abscess in a 1-year-old infant concomitant with disseminated intravascular coagulation. The abscess was punctured via the stomach using a standard, convex-type echoendoscope, and the patient’s condition improved after naso-cystic catheter placement. Although the clinical course was complicated by delayed hemorrhage from the puncture site, the bleeding was successfully managed by endoscopic hemostasis using a standard forward-viewing endoscope. PMID:27114437

  7. 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

  8. 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

  9. Cell-block procedure in endoscopic ultrasound-guided-fine-needle-aspiration of gastrointestinal solid neoplastic lesions

    PubMed Central

    Ieni, Antonio; Barresi, Valeria; Todaro, Paolo; Caruso, Rosario Alberto; Tuccari, Giovanni

    2015-01-01

    In the present review we have analyzed the clinical applications of endoscopic ultrasound-guided-fine-needle-aspiration (EUS-FNA) and the methodological aspects obtained by cell-block procedure (CBP) in the diagnostic approach to the gastrointestinal neoplastic pathology. CBP showed numerous advantages in comparison to the cytologic routine smears; in particular, better preservation of cell architecture, achievement of routine haematoxylin-eosin staining equivalent to histological slides and possibility to perform immunohistochemistry or molecular analyses represented the most evident reasons to choose this method. Moreover, by this approach, the differential diagnosis of solid gastrointestinal neoplasias may be more easily achieved and the background of contaminant non-neoplastic gastrointestinal avoided. Finally, biological samples collected by EUS-FNA CBP-assisted should be investigated in order to identify and quantify further potential molecular markers. PMID:26322154

  10. 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

  11. Removal of displaced double flanged metal stent in walled-off necrosis by endoscopic ultrasonography

    PubMed Central

    Guo, Jintao; Liu, Zhijun; Sun, Siyu; Liu, Xiang; Wang, Sheng

    2016-01-01

    Endoscopic ultrasonography (EUS)-guided walled-off necrosis drainage using a double flanged metal stent was reported for satisfactory drainage and endoscopic necrosectomy. High complication rates related to stent migration are reported. This is the first report of the removal of a displaced, double flanged metal stent in walled-off necrosis by EUS. The patient was a 62-year-old male who was suffering from mild midepigastric abdominal pain. A double flanged metal stent had been placed in our endoscopy center 8 weeks before presentation. Computed tomography demonstrated complete resolution of the walled-off necrosis; however, the stent migrated into the cyst. We dislodged the stent using forceps with real-time endosonography. In conclusion, Follow-up is important for patients with a double flanged metal stent, specifically with regards to postprocedural stent migration. PMID:27080613

  12. Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy.

    PubMed

    Yamada, Reiko; Inoue, Hiroyuki; Yoshizawa, Naohiko; Kitade, Takashi; Tano, Shunsuke; Sakuno, Takashi; Harada, Tetsuro; Nakamura, Misaki; Katsurahara, Masaki; Hamada, Yasuhiko; Tanaka, Kyosuke; Horiki, Noriyuki; Takei, Yoshiyuki

    2016-01-01

    A 57-year-old man with a history of tuberculosis (TB) was found to have a pancreatic head mass, accompanied by stenosis of the common bile duct. Due to the inherent difficulty in differentiating pancreatic carcinoma from an inflammatory mass, endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) was thus performed. The pathological findings confirmed granuloma with caseous necrosis, and the results of the QuantiFERON TB2G test were positive. Accordingly, the patient was diagnosed with peripancreatic TB and thereafter was successfully treated with anti-TB therapy. Based on the findings of this case, we conclude that EUS-FNAB is a useful modality for the diagnosis of pancreatic TB. PMID:27086805

  13. [Horizon 2020, new EU Framework programme for research and innovation, 2014-2020].

    PubMed

    Kinkorová, Judita

    2014-01-01

    Horizon 2020 is a financial instrument implementing the Innovation Union, a Europe 2020 flagship initiative aimed at securing Europes global competitiveness. Running from 2014 to 2020 with a budget of just over € 80 billion, the EUs new programme for research and innovation is part of the drive to create new growth and jobs in Europe. Societal challenge Health, demographic change and wellbeing is an important part of Horizon 2020. PMID:25370773

  14. 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.

  15. Human Equilibrative Nucleoside Transporter 1 Expression in Endoscopic Ultrasonography-Guided Fine-Needle Aspiration Biopsy Samples Is a Strong Predictor of Clinical Response and Survival in the Patients With Pancreatic Ductal Adenocarcinoma Undergoing Gemcitabine-Based Chemoradiotherapy

    PubMed Central

    Yamada, Reiko; Mizuno, Shugo; Uchida, Katsunori; Yoneda, Misao; Kanayama, Kazuki; Inoue, Hiroyuki; Murata, Yasuhiro; Kuriyama, Naohisa; Kishiwada, Masashi; Usui, Masanobu; Ii, Noriko; Tsuboi, Junya; Tano, Shunsuke; Hamada, Yasuhiko; Tanaka, Kyosuke; Horiki, Noriyuki; Ogura, Toru; Shiraishi, Taizo; Takei, Yoshiyuki; Katayama, Naoyuki; Isaji, Shuji

    2016-01-01

    Objectives This study aimed to clarify whether pretreatment human equilibrative nucleoside transporter (hENT1) expressions in endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) specimens obtained from resectable, borderline resectable, and locally advanced unresectable pancreatic ductal adenocarcinoma (PDAC) are concordant with those in the resected specimen after gemcitabine-based chemoradiotherapy (Gem-CRT) and to validate the utility of hENT1 expression using EUS-FNAB samples as a prognostic marker. Methods We evaluated the relationship between hENT1 expressions assessed by immunohistochemical staining and clinical outcomes in 51 of 76 patients with PDAC who were diagnosed by EUS-FNAB and received preoperative Gem-CRT. Results The concordance rate of hENT1 expressions was 89.2% (K = 0.681). Median survival time (month) in the 51 whole patients and 37 patients with resection was significantly longer in hENT1 positive than in hENT1 negative: 25.0 and 30.0 versus 9.0 and 9.0, respectively. A multivariate analysis confirmed that hENT1 expression was an independent prognostic factor in both whole patients and those with resection. Regardless of T3 and T4, hENT1-positive patients with resection had significantly better prognosis than hENT1-negative patients, whose prognosis was similar to those without resection. Conclusions The assessment of hENT1 expression using EUS-FNAB samples before Gem-CRT provides important information on patients with PDAC who can benefit from curative-intent resection. PMID:26784908

  16. 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.

  17. Diagnostic yield of secretin-enhanced magnetic resonance cholangiopancreatography in the investigation of patients with acalculous biliary pain

    PubMed Central

    Dronamraju, Shridhar; Scott, John; Oppong, Kofi; Nayar, Manu

    2016-01-01

    Background Secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) facilitates better visualization of the pancreaticobiliary ductal system but its role in patients with acalculous biliary pain (ABP) is yet to be established. The aim of this study was to assess the diagnostic yield and the role of S-MRCP in the investigation of ABP patients. Methods This is a retrospective analysis of patients who had S-MRCP to investigate ABP over a 5-year period from June 2008 to May 2013. The findings and diagnosis as reported in the S-MRCP were compared with the findings on MRCP. The primary endpoint was the diagnostic yield of S-MRCP in ABP patients. Results A total of 117 patients with ABP [28 (24%) male] had S-MRCP during the study period. The most common abnormality identified was obstruction at the level of ampulla or in the proximal pancreatic duct. S-MRCP was able to identify significant pathological findings in 8 of 34 (22%) patients in whom MRCP did not detect any abnormality. Endoscopic ultrasound (EUS) was performed in 67% of patients. S-MRCP identified abnormalities in 21 of 41 (54%) patients who had a normal EUS. Conclusions We conclude that the diagnostic yield of S-MRCP for recognizing anatomical variants of the pancreatic ductal system, in particular ampullary or proximal pancreatic duct stricture, is better than MRCP and EUS. These findings reflect the dynamic nature of S-MRCP and its complementary role alongside MRCP, EUS and endoscopic retrograde cholangiopancreatography in ABP patients. PMID:27366040

  18. Endoscopic diagnostic of chronic pancreatitis.

    PubMed

    Cubranić, Aleksandar; Dintinjana, Renata Dobrila; Vanis, Nenad

    2014-12-01

    Chronic pancreatitis is defined as a continuous inflammatory pancreatic disease, one characterized by irreversible morphological changes, often associates with pain and sometimes with the loss of endocrine and exocrine function. As a histological confirmation of chronic pancreatitis is often unavailable, the diagnosis is traditionally based on imaging methods such as computerized tomography (CT) or endoscopic retrograde cholangiopancreatography (ERCP), and recently magnetic resonance cholangiopancreatography (MRCP) as a noninvasive alternative to ERCP. Developments in the classification system of CP include the Marseille classification of 1963 which offered histopathologic criteria for CP, the Cambridge classification of 1984 which introduced imaging features of computed tomography (CT), transabdominal ultrasound (TUS) and endoscopic retrograde cholangiopancreatography (ERCP) for classification of CP as well as Rosemont classification system of 2007 which presented the endoscopic ultrasonography diagnosis of CP. Endoscopic ultra-sonography (EUS) was first introduced as a diagnostic method for evaluation of pancreatic disease in 1986. It has experienced significant improvements since then and allowed for an alternative approach in diagnosing patients with pancreatic diseases. In patients with suspected pancreatic masses EUS-guided fine needle aspiration (EUS-FNA) is the best method for obtaining tissue diagnosis and differentiating CP from pancreatic carcinoma. The recent studies indicate that EUS is the method of choice when compared with other imaging methods such as ERCP because it frequently provides more accurate diagnostics. The aim of this review is to discuss the findings in endoscopic diagnostics up to the present moment and to indicate advantages, limitations and possible complications along with the current recommendations in CP diagnostics. PMID:25842773

  19. 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

  20. Multifunctional murrel caspase 1, 2, 3, 8 and 9: Conservation, uniqueness and their pathogen-induced expression pattern.

    PubMed

    Kumaresan, Venkatesh; Ravichandran, Gayathri; Nizam, Faizal; Dhayanithi, Nagarajan Balachandran; Arasu, Mariadhas Valan; Al-Dhabi, Naif Abdullah; Harikrishnan, Ramasamy; Arockiaraj, Jesu

    2016-02-01

    Caspases are evolutionarily conserved proteases which play fundamental role in apoptosis. Invasion of pathogen triggers the activation of caspases-mediated pro-inflammatory and pro-apoptotic pathways, where multifunctional caspases are involved. In striped murrel Channa striatus, epizootic ulcerative syndrome (EUS) causes endemics resulting in huge economic loss. Aphanomyces invadans, an oomycete is the primary causative agent of EUS which further induces secondary bacterial infections especially Aeromonas hydrophila. In order to get insights into the caspase gene family in C. striatus during EUS infection, we performed various physicochemical and structural analyses on the cDNA and protein sequences of five different murrel caspases namely CsCasp 1, 2, 3, 8 and 9. Sequence analysis of murrel caspase proteins showed that in spite of the conserved CASC domain, each caspase embraces some unique features which made them functionally different. Tissue distribution analysis showed that all the murrel caspases are highly expressed in one of the immune organs such as liver, kidney, spleen and blood cells. Further, to understand the role of caspase during EUS infection, modulation in expression of each caspase gene was analysed after inducing fungal and bacterial infection in C. striatus. Pathogen-induced gene expression pattern revealed an interesting fact that the expression of all the caspase genes reached a maximum level at 24 h post-infection (p.i) in case of bacteria, whereas it was 48 h in fungus. However, the initiation of elevated expression differed between each caspase based on their role such as pro-inflammatory, initiator and executioner caspase. Overall, the results suggested that the caspases in murrel are diverse in their structure and function. Here, we discuss the similarities and differences of five different murrel caspases. PMID:26777895

  1. 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.

  2. 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).

  3. 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

  4. 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

  5. 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.

  6. Staging algorithm for diffuse malignant pleural mesothelioma.

    PubMed

    Zielinski, Marcin; Hauer, Jolanta; Hauer, Lukasz; Pankowski, Juliusz; Nabialek, Tomasz; Szlubowski, Artur

    2010-02-01

    An algorithm of preoperative mediastinal nodal staging with endobronchial/endoesophageal ultrasonography (EBUS/EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) combined with laparoscopy/peritoneal lavage and cytology was analyzed to establish the realistic criteria for radical multimodality treatment of malignant pleural mesothelioma (MPM). The algorithm included computed tomography (CT), thoracoscopy with multiple pleural biopsies and talc pleurodesis, EBUS/EUS and one-stage TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid. Forty-two patients were diagnosed from 1 January 2004 to 31 December 2008. There were 16 women and 26 men in ages ranging from 43 to 77 years (mean 57.8); 31 epithelioid, 2 sarcomatoid and 9 biphasic type MPM. 21/42 patients were considered possible candidates for multimodality treatment. Three patients who received neoadjuvant chemotherapy were excluded from this study. EBUS/EUS was performed to stage the mediastinal nodes. In 3/18 patients metastatic nodes were discovered. In the rest of the 15 patients simultaneous TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid were performed. In three patients TEMLA was positive, in six patients laparoscopy was positive and in two patients both TEMLA and laparoscopy were positive. Finally, 4/42 (9.5%) patients underwent thoracotomy with one exploration (chest wall infiltration) and three pleuropneumonectomies with the subsequent chemo- and radiotherapy. The proposed algorithm of preoperative staging spared the majority of MPM patients from futile surgery. PMID:19843550

  7. 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

  8. Endoscopic ultrasound-guided inoculation of transmissible venereal tumor in the colon: A large animal model for colon neoplasia

    PubMed Central

    Bhutani, Manoop S.; Uthamanthil, Rajesh; Suzuki, Rei; Shetty, Anil; Klumpp, Sherry A.; Nau, William; Stafford, Roger Jason

    2016-01-01

    Background: To develop and evaluate the feasibility of emerging interventions, animal models with accurate anatomical environment are required. Objectives: We aimed to establish a clinically relevant colorectal tumor model with canine transmissible venereal tumor (CTVT) utilizing endoscopic ultrasound (EUS) imaging guidance. Design: Survival study using a canine model. Setting: Endoscopic animal research laboratory at a tertiary cancer center. Materials and Methods: This study involved five canines. Interventions: A colorectal tumor model was established and evaluated in five canines under cyclosporine immune suppression. Under endoscopic imaging guidance, saline was injected into the submucosal layer forming a bleb. Subsequently, CTVT was inoculated into the bleb under EUS guidance. Endoscopy was the primary method of assessing tumor growth. Tumors developed in 60-130 days. Upon detection of lesions >1 cm, the animals were euthanized and the tumors were harvested for histopathological characterization. Main outcome measurements: Success rate of tumor growth. The presence or absence of vasculature inside tumors. Results: Colorectal tumor successfully developed in three out of the five animals (60%). Among the ones with tumor growth, average inoculated CTVT volume, incubation time, and tumor size was 1.8 cc, 65.7 days, and 2.0 cm, respectively. The two animals without tumor growth were observed for >100 days. In all the tumors, vascular structure was characterized with CD31 imunohistochemical stain. Limitations: Small number of animals. Conclusion: We succeeded in creating a new colorectal tumor canine model with CTVT utilizing EUS. PMID:27080606

  9. Direct detection of spin chemical potential shift through spin filtering effect

    NASA Astrophysics Data System (ADS)

    Miao, Guoxing; Moodera, Jagadeesh

    2010-03-01

    Spin filtering (SF) effect is a unique way to generate highly spin-polarized tunnel currents from nonmagnetic electrodes. Magnetic tunnel junctions based on pure SF effect have been realized recently [1] as a clear demonstration of principle for the spin manipulation through SF effect. The next challenge is the readout of spin information. In this work, we present the direct detection of the spin chemical potential shift in an Al nano cluster sandwiched between two SF EuS tunnel barriers. The spin channels are split by depositing Al directly onto EuS, and the indirect exchange interaction between the Al conduction electrons and the localized Eu 4f electrons gives rise to an effective Zeeman splitting with the strength of a few mV. EuS on the readout side is isolated from the Al clusters with a natural Al2O3 barrier. In a vertical measurement geometry with no transport current, we directly detected the spin dependent voltage levels by aligning the detection SF barrier parallel or antiparallel to the first SF barrier, corresponding to the equilibrium up- and down-spin chemical potentials. A simple analysis treating the barriers as a set of resistors revealed that the observed voltage difference is the actual chemical potential shift modulated by the SF efficiency.[4pt] [1] G.X. Miao, M. Muller, J.S. Moodera,PRL102,076601(2009)

  10. Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis

    PubMed Central

    Roseau, Gilles

    2014-01-01

    Recto-sigmoid endoscopic ultrasonography (RS-EUS) has first been used in the staging of pelvic deep infiltrating endometriosis in the early 1990's. Since then, although publications have been sparse, RS-EUS is routinely used for this indication in few centers. In this paper, we focus on technical aspects and operating method of rectal and sigmoid endo-sonography, and describe the most characteristic echographic presentations of endometriosis of the lower digestive tract. Through a literature review, results obtained with different types of endo-rectal probes, either flexible endoscopic, or blind rigid, are presented and compared with those of other close imaging techniques: magnetic resonance imaging and the more recent trans-vaginal sonography. As well as these two latter techniques, RS-EUS appears as an interesting method in the staging of pelvic deep infiltrating endometriosis particularly to evaluate rectal and sigmoid infiltrations. However, more prospective studies are required, to correctly define respective indications for each exam, in the light of recent advancements in treating this frequent disease. PMID:25400866

  11. A Case of Gastrointestinal Stromal Tumor That Underwent Endoscopic Ultrasound-Guided Aspiration with a 25-Gauge Biopsy Needle

    PubMed Central

    Tomizawa, Minoru; Shinozaki, Fuminobu; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2016-01-01

    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed to obtain specimens for pathological analysis. For this procedure, 19-gauge (19G), 22-guage (22G), and 25-guage (25G) needles are available. The needles are classified into aspiration type and biopsy type. A 56-year-old woman underwent upper gastrointestinal endoscopy that showed a 38-mm-diameter submucosal tumor. The elevated lesion was diagnosed as a submucosal tumor of the stomach. Contrast-enhanced computed tomography showed a low-density area on the luminal surface of the gastric wall, which was covered with a thin layer of gastric mucosa. EUS showed a hypoechoic lesion in the submucosal layer. Color Doppler image showed a pulsating vascular signal extending into the center of the hypoechoic lesion from the periphery. EUS-FNA was performed with a 25G biopsy needle. The specimen tissue consisted of spindle-shaped cells. The cells were positive for CD117 and CD34. The submucosal tumor was diagnosed as a gastrointestinal stromal tumor.

  12. Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent.

    PubMed

    Chang, Arunchai; Aswakul, Pitulak; Prachayakul, Varayu

    2016-04-16

    One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type pain. Obstruction of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches, ranging from pharmacologic, endoscopic and radiologic treatments to surgical interventions. When the conservative treatment approaches fail to resolve symptomatic cases, however, endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach, despite its well-recognized drawbacks. When the conventional transpapillary approach fails to achieve the necessary drainage, the patients may benefit from application of the less invasive endoscopic ultrasound (EUS)-guided pancreatic duct interventions. Here, we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 mo. Computed tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at genu. After conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms, EUS-guided pancreaticogastrostomy (PGS) was applied using a fully covered, self-expandable, 10-mm diameter metallic stent. The treatment resolved the case and the patient experienced no adverse events. EUS-guided PGS with a regular biliary fully covered, self-expandable metallic stent effectively and safely treated pancreatic-type pain in chronic pancreatitis. PMID:27099862

  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 Central

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian

    2015-01-01

    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. PMID:26623120

  14. Solid Pseudopapillary Neoplasm of Pancreas; A Case Series and Review Literature

    PubMed Central

    Mirminachi, Babak; Farrokhzad, Solmaz; Sharifi, Amir Houshang; Nikfam, Sepideh; Nikmanesh, Arash; Malekzadeh, Reza; Pourshams, Akram

    2016-01-01

    BACKGROUND Information regarding solid pseudopapillary neoplasm (SPN) of the pancreas is limited in Iran. We aimed to review the clinicocytopathological features and follow-up of patients with SPN of pancreas who were diagnosed in a single center in Iran. METHODS Seven patients with SPN of the pancreas were diagnosed during January 2010 to March 2015 at the Digestive Disease Research Institute of Tehran University of Medical Sciences. The patients were reviewed prospectively. RESULTS Six out of the 7 patients were female and the mean age of all the patients was 29.4 years ranging from 15 to 61 years. The most common clinical presentation was nonspecific abdominal pain (N=6). The tumors were located mostly in head and neck of the pancreas. SPN was diagnosed in all patients by fine needle aspiration through endosonography (EUS-FNA). All patients underwent surgery. Histological findings of surgical tissues were consistent with EUS-FNA. The postoperative follow-up period of about 14 months was uneventful. CONCLUSION SPN of the pancreas is a rare pancreatic tumor which affects primarily young women. EUS-guided FNA could play an important role in preoperative diagnosis of SPN of the pancreas. PMID:27252816

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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.

  20. 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