Science.gov

Sample records for aegolius funer eus

  1. Planning Your Own Funeral

    MedlinePlus

    ... payments are available to pay for the funeral products and services when they're needed. But protections vary widely ... a Cemetery Site Choosing a Funeral Provider Comparing Products Online Extended Warranties and Service Contracts Finding a Locksmith Funeral Costs and Pricing ...

  2. Shopping for Funeral Services

    MedlinePlus

    ... homes to give you written price lists for products and services. Resist pressure to buy goods and services you ... a Cemetery Site Choosing a Funeral Provider Comparing Products Online Extended Warranties and Service Contracts Finding a Locksmith Funeral Costs and Pricing ...

  3. Funeral Honors Support

    DTIC Science & Technology

    1999-04-01

    Pentagram , 27 November, 1998. 2 Jim Halvorson, HQ USAF/ILVX, Bullet Background Paper on Base Honor Guard Support for Military Funerals. 23 September 1998. 3...general and funerals in specific have crucial roles in the military. Ceremony reinforces the truth that no one is alone in battle. At war, a unit’s

  4. 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

  5. Alternative Funerals: An Exploratory Study.

    ERIC Educational Resources Information Center

    Bergen, M. Betsy; Williams, Robert R.

    1981-01-01

    Studied attitudes and beliefs related to death and funeral preferences in a small midwestern Protestant congregation. While most respondents felt a ceremony or funeral was important, 75 percent preferred an alternative to the conventional funeral. Alternatives considered building a simple coffin with private burial and later public ceremony.…

  6. Clergy Attitudes toward Funeral Directors.

    ERIC Educational Resources Information Center

    Kalish, Richard A.; Goldberg, Helene

    1978-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  8. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Arrangements, requesting that funeral and burial services for the deceased be procured. (b) The contracting officer will enter into negotiations with local funeral directors to procure a complete funeral and burial...) accompanies the casket to the place of burial. (c) An additional allowance for transportation of the body...

  9. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Arrangements, requesting that funeral and burial services for the deceased be procured. (b) The contracting officer will enter into negotiations with local funeral directors to procure a complete funeral and burial...) accompanies the casket to the place of burial. (c) An additional allowance for transportation of the body...

  10. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Arrangements, requesting that funeral and burial services for the deceased be procured. (b) The contracting officer will enter into negotiations with local funeral directors to procure a complete funeral and burial...) accompanies the casket to the place of burial. (c) An additional allowance for transportation of the body...

  11. 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

  12. EUS-Guided Ethanol Ablation of Insulinomas

    PubMed Central

    Qin, Shan-yu; Lu, Xiu-ping; Jiang, Hai-xing

    2014-01-01

    Abstract Surgical resection is a standard treatment for insulinomas; however, it is associated with a high risk of complications and limited to specific suitable candidates. In recent years, endoscopic ultrasound (EUS)-guided ethanol ablation of insulinomas has emerged as a new therapeutic option, especially for elderly patients and candidates unfit for surgery. We aimed to evaluate the feasibility and safety of this technique for insulinomas. Four patients diagnosed with insulinomas based on EUS–fine-needle aspiration and immunohistochemistry results underwent EUS-guided 95% ethanol ablation. A comprehensive literature review was performed to understand the current status of the feasibility, safety, and effects of EUS-guided ethanol ablation of insulinomas. EUS-guided ethanol ablation of insulinomas was successfully completed in all the 4 patients. There were no perioperative or postoperative complications. The patients were discharged at 3 days after the procedure. No recurrence of hypoglycemia or tumors was noted during follow-up (range, 3–6 months). Literature review showed 8 patients with insulinomas who underwent EUS-guided ethanol ablation. All the procedures were successful, with no need for further surgical treatment. Among these reviewed cases, 6 patients had no post-procedural complications, while other 2 patients showed a mild increase in the serum levels of lipase and/or pancreatic enzymes within 48 h post-procedure; furthermore, 1 of these 2 patients presented at a later date with medically controllable hematoma and ulceration. During follow-up, 6 patients remained asymptomatic and normoglycemic, while the 2 patients who presented post-procedural complications developed occasional mild confusion. EUS-guided ethanol ablation of insulinomas is an effective and safe modality, with an acceptable level of post-procedural complications. However, the long-term effects of this new therapeutic option need to be validated in a large randomized controlled

  13. Does ampullary adenoma size predict invasion on EUS? Does invasion on EUS predict presence of malignancy?

    PubMed Central

    Patel, Vaishali; Jowell, Paul; Obando, Jorge; Guy, Cynthia D.; Burbridge, Rebecca A.

    2016-01-01

    Background and study aims: It is common practice to perform ampullectomy without endoscopic ultrasound (EUS) for ampullary lesions < 1 cm but no data exists to support it. No studies have explored whether EUS findings of invasion correlate with malignancy or high-grade dysplasia (HGD) on pathology. We explored the association between adenoma size, pathology results, and invasion on EUS.  Patients and methods: This was a single-center retrospective cohort study at a large tertiary care academic hospital. Chart review was performed for 161 patients with benign ampullary lesions on endoscopic biopsy (identified by pathology records). The primary outcomes were mean size (mm) of adenomas and pathology findings with and without intraductal and/or duodenal wall invasion on EUS.  Results: Invasion was identified by EUS in 41 (34.1 %) of 120 patients who underwent EUS. The mean size of the lesion in these patients was 20.9 mm (± 11.6 mm) compared to 13.9 mm (± 11.3 mm, P = 0.0001) in patients without invasion. A receiver operating characteristic (ROC) curve (AUC 0.73, 95 % CI 0.63 – 0.83) revealed 100 % sensitivity for absence of invasion on EUS in lesions less than 6.5 mm. Invasion on EUS had sensitivity of 63.0 % (95 % CI 47.0 % – 77.0 %) and specificity 88.0 % (95 % CI 78.0 % – 95.0 %) for presence of malignancy, HGD or invasion on pathology. Conclusions: EUS should be considered for ampullary lesions > 6.5 mm. This study provides evidence to support the practice of ampullectomy without EUS for smaller adenomas. EUS evidence of invasion is highly specific for pathologic malignancy, HGD, or invasion (which preclude endoscopic ampullectomy). PMID:27995195

  14. 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…

  15. Funerals, Family, and Forefathers: A View of Italian-American Funeral Practices.

    ERIC Educational Resources Information Center

    Cowell, Daniel David

    1986-01-01

    Traces the evolution of Italian-American funeral practices from the preimmigrant culture of southern Italy to contemporary funeral practices of Italian-Americans. The author describes his family experience of death as rooted in Old World traditions, modified by American social patterns, and shaped by psychosocial family dynamics. (NRB)

  16. 48 CFR 837.7002 - List of qualified funeral directors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    ERIC Educational Resources Information Center

    Mackin, Jim

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

  18. The birth of a multicultural funeral home.

    PubMed

    van der Pijl, Yvon

    2017-01-01

    In 2014, the Dutch Funeral Organization Yarden started with the participatory preparations for a multicultural funeral home. The project aims at a 24/7 service for the super-diverse population of Amsterdam and beyond. This article gives an ethnographic account of Yarden's efforts to capture cultural diversity. It explores how a multicultural gaze creates a power/knowledge dynamic producing new discourses and shaping new layers of significance. The study then turns into arguing that the birth of the multicultural home is, above all, a cultural, collaborative search leaving (counter-discursive) space for creativity, change, and cultural renewal of all actors involved.

  19. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  20. 48 CFR 837.7003 - Funeral authorization.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  1. Large magnetocaloric effect in sintered ferromagnetic EuS

    NASA Astrophysics Data System (ADS)

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

    2016-10-01

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

  2. EUS-Guided Antitumor Therapy for Pancreatic Tumors

    PubMed Central

    2010-01-01

    Endoscopic ultrasound (EUS) is a very useful modality for the diagnosis and staging of pancreatic masses. With the advent of EUS-guided fine-needle aspiration technology, this modality has made a tremendous leap from imaging modality to histologic diagnosis and therapeutic intervention. EUS offers high-resolution images of and unparalleled access to the pancreas. After locating the tip of the echoendoscope in the duodenum or stomach, several drugs or local treatment modalities can be delivered directly into the pancreas. EUS-guided ethanol lavage with/without paclitaxel injection has been tested for the treatment of cystic tumors of the pancreas, with complete resolution of cystic tumor being observed in up to 70-80% of patients. Ethanol injection is also performed for the management of solid neuroendocrine tumors of the pancreas. Various type of EUS-guided injection have also been investigated for the treatment of pancreatic cancer. An activated allogenic mixed lymphocyte culture (Cytoimplant) was injected in patients with advanced pancreatic cancer. A replication-deficient adenovirus vector carrying the tumor necrosis factor-alpha gene was also delivered intratumorally by EUS. ONYX-015 is an oncolytic attenuated adenovirus that exhibits replication preferentially in malignant cells, causing cell death, and this has also been injected into pancreatic cancers under EUS guidance. EUS-guided local ablation therapies such as radiofrequency ablation, photodynamic therapy, and brachytherapy are also under investigation. EUS-guided fine-needle injection for various solid or cystic lesions is a rapidly expanding field. This article reviews the various applications of EUS for the treatment of pancreatic tumors. PMID:21103299

  3. 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.

  4. Beyond words: some uses of music in the funeral setting.

    PubMed

    Caswell, Glenys

    Music is a common feature of funerals, both in terms of sacred music and also secular music when a funeral is personalized to the individual who has died. Drawing on data from research exploring Scottish funeral practices, this article examines some of the ways in which music can be used during a funeral. It suggests five specific uses of music in the funeral context: the use of music as a means of control; the use of music as a means of inclusion and exclusion; music as a source of collective activity; music as a means of creating or shifting emotion; and music as a means of evoking the memory of the deceased person. These uses of music are described and discussed, and suggestions made for further research exploring the use of music in funerals.

  5. 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.…

  6. 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.

  7. 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.

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of the burial expenses files an application authorizing payment to the funeral home. Usually, the... to the funeral home to be the person who has assumed responsibility for the burial expenses. (b) An... assumed responsibility for the payment of the burial expenses. (Approved by the Office of Management...

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... of the burial expenses files an application authorizing payment to the funeral home. Usually, the... to the funeral home to be the person who has assumed responsibility for the burial expenses. (b) An... assumed responsibility for the payment of the burial expenses. (Approved by the Office of Management...

  15. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... of the burial expenses files an application authorizing payment to the funeral home. Usually, the... to the funeral home to be the person who has assumed responsibility for the burial expenses. (b) An... assumed responsibility for the payment of the burial expenses. (Approved by the Office of Management...

  16. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... of the burial expenses files an application authorizing payment to the funeral home. Usually, the... to the funeral home to be the person who has assumed responsibility for the burial expenses. (b) An... assumed responsibility for the payment of the burial expenses. (Approved by the Office of Management...

  17. 20 CFR 234.13 - Payment to a funeral home.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... of the burial expenses files an application authorizing payment to the funeral home. Usually, the... to the funeral home to be the person who has assumed responsibility for the burial expenses. (b) An... assumed responsibility for the payment of the burial expenses. (Approved by the Office of Management...

  18. 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…

  19. Homecoming rituals: weaving multicultural funeral narratives.

    PubMed

    Kwon, Soo-Young

    2003-01-01

    Using the personal experience of "homecoming" funcrary journey from the U.S. to Korea the author of this article probes the cultural construction of familial bond in Korean and biblical (Genesis) tuneral narratives. He highlights the cultural differences between American and Korean funeral traditions--(1) dying at hospital vs. dying at home, (2) embalming vs sup/yom (washing/binding of the corpse), (3) metal casket vs. wooden coffin, (4) committal vs. banhon (returning of the spirit)--to explore the religious and practical implications of the multicultural grieving process for pastoral care and grief ministry in which death is conceived as returning to the familial, cultural, and spiritual homes.

  20. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) of § 20.2053-1. A reasonable expenditure for a tombstone, monument, or mausoleum, or for a burial lot... funeral expenses is the cost of transportation of the person bringing the body to the place of burial....

  1. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) of § 20.2053-1. A reasonable expenditure for a tombstone, monument, or mausoleum, or for a burial lot... funeral expenses is the cost of transportation of the person bringing the body to the place of burial....

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) of § 20.2053-1. A reasonable expenditure for a tombstone, monument, or mausoleum, or for a burial lot... funeral expenses is the cost of transportation of the person bringing the body to the place of burial....

  3. 26 CFR 20.2053-2 - Deduction for funeral expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) of § 20.2053-1. A reasonable expenditure for a tombstone, monument, or mausoleum, or for a burial lot... funeral expenses is the cost of transportation of the person bringing the body to the place of burial....

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) of § 20.2053-1. A reasonable expenditure for a tombstone, monument, or mausoleum, or for a burial lot... funeral expenses is the cost of transportation of the person bringing the body to the place of burial....

  5. Differential diagnosis of solid pancreatic masses: contrast-enhanced harmonic (CEH-EUS), quantitative-elastography (QE-EUS), or both?

    PubMed Central

    Lindkvist, Björn; Lariño-Noia, Jose; Abdulkader-Nallib, Ihab; Dominguez-Muñoz, J Enrique

    2016-01-01

    Background Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and quantitative-elastography endoscopic ultrasound (QE-EUS) are considered useful tools for the evaluation of solid pancreatic tumors (SPT). The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS, QE-EUS, and the combination of both for the differential diagnosis of SPT. Methods Sixty-two consecutive patients (mean age 64.3 years, range 32–89 years, 44 male) who underwent EUS for the evaluation of SPT were prospectively included. EUS was performed with a linear Pentax-EUS and a Hitachi-Preirus processor. The mass (area A) and a reference area B were selected during QE-EUS, and results expressed as B/A (strain ratio). A strain histogram of the mass was also evaluated. Microvascularization of the tumor was evaluated over 2 min during CEH-EUS after intravenous injection of 4.8 mL SonoVue. Final diagnosis was based on histopathology of surgical specimens or EUS-guided tissue acquisition and clinical follow-up in non-operated cases. Diagnostic accuracy of CEH-EUS, QE-EUS, and their combination was calculated. Results Median size of the masses was 32 mm (range 12-111). Final diagnosis was pancreatic adenocarcinoma (n = 45), neuroendocrine tumor (n = 3), inflammatory mass (n = 10), pancreatic metastasis (n = 2), autoimmune pancreatitis (n = 1), and a mucinous cystadenocarcinoma (n = 1). Overall accuracies for determination of malignancy using QE-EUS, CEH-EUS, their combination, and EUS-guided tissue acquisition were 98.4% (95% confidence interval (CI): 91.4–99.7), 85.5% (95% CI: 74.7–92.2), 91.9% (95% CI: 82.5–96.5), and 91.5% (95% CI: 83.6–99.5), respectively. Conclusion The combination of QE-EUS and CEH-EUS is a useful tool for the differential diagnosis of SPT, giving complementary information. However, this combination does not significantly increase the diagnostic accuracy of either of the techniques performed alone. PMID:28344791

  6. Reinterpreting funerals and pastoral care: a pastoral theology response to Tom Long's Accompany Them with Singing.

    PubMed

    Fowler, Gene

    2012-03-01

    This article addresses Tom Long's (2009) criticism that a traditional pastoral care approach to funerals is responsible for significant distortions in contemporary Christian funeral practices in the United States. The article will show that his criticism should be affirmed but that his solution for a contemporary understanding of pastoral care and funerals is not adequate. A critique and reinterpretation of pastoral care and funerals will show that Long's reform of Christian funerals needs to incorporate a contemporary understanding of caring for the bereaved in funerals.

  7. Degree of Closeness: Does it Affect the Bereaved's Attitudes toward Selected Funeral Practices?

    ERIC Educational Resources Information Center

    Swanson, Elizabeth A.; Bennett, Teresa F.

    1982-01-01

    Investigated attitudes of bereaved individuals toward selected funeral practices. Correlated sex, closeness to deceased, and religious preference to timing of the death, viewing at funeral home and location of funeral service. Found closeness of relationship to deceased emerged as a significant variable in assessing attitudes toward certain…

  8. 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…

  9. Vascular involvement in periampullary tumors: MDCT, EUS, and CDU.

    PubMed

    Gusmini, S; Nicoletti, R; Martinenghi, C; Del Maschio, A

    2009-07-01

    In patients affected by periampullary tumors, surgical resection represents the only treatment with curative intent. Preoperative evaluation of vascular involvement is necessary to avoid surgical treatments unable of curative intent resection. The aim of our update article is to assess the performance of multidetector computed tomography (MDCT), endoscopic ultrasonography (EUS), and color Doppler ultrasonography (CDU) in the evaluation of vascular involvement of major peripancreatic vessels, in periampullary tumors, analyzing the current and past literature.

  10. Funeral directors and bereaved children: beliefs and experiences.

    PubMed

    Mahon, Margaret M

    2009-09-01

    As one component of an ongoing project to develop resources for bereaved children and families, funeral directors were surveyed about their experiences and practices with bereaved children. About one-third of respondents reported that they provided services specifically for bereaved children. Of these, some were proactive (reaching out to provide services) whereas others were reactive (responding only when information or services were requested). Many of the participant funeral directors found that families mediated children's involvement or experiences. Often, the parents were perceived as an impediment to optimal experiences for the child. Many funeral directors who did not provide services described being encumbered by a lack of resources, or they perceived that other individuals or organizations in the community were filling that need.

  11. Attending patient funerals: Practices and attitudes of Australian medical practitioners.

    PubMed

    Zambrano, Sofía C; Chur-Hansen, Anna; Crawford, Gregory B

    2017-02-01

    The appropriateness of attending a patient's funeral is a medical dilemma. This article focuses on 437 doctors who participated in an online survey. Seventy-one percent of general practitioners, 67% of oncologists, 67% of psychiatrists, 63% of palliative medicine specialists, 52% of surgeons, and 22% of intensive care specialists had attended patient funerals. Significant differences in demographics and between specialties were identified in terms of barriers and benefits associated with attendance. Although attendance is a personal decision, there is a need for open discussions in medical education and professional development concerning death and the role of doctors after a patient dies.

  12. Funeral Directors and Bereaved Children: Beliefs and Experiences

    ERIC Educational Resources Information Center

    Mahon, Margaret M.

    2009-01-01

    As one component of an ongoing project to develop resources for bereaved children and families, funeral directors were surveyed about their experiences and practices with bereaved children. About one-third of respondents reported that they provided services specifically for bereaved children. Of these, some were proactive (reaching out to provide…

  13. Situational Correlates of Death Anxiety: Reactions to Funeral Practices

    ERIC Educational Resources Information Center

    Selby, James W., III

    1977-01-01

    Death anxiety did not appear to be related to any of a number of demographic and personal variables which might have been expected to be correlates. It was, however, found to be associated with reports of personal reactions and preferences in a situation directly related to death--funerals. (Author)

  14. 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

  15. Historiographies of the Tradition of Rhetoric: A Brief History of Classical Funeral Orations.

    ERIC Educational Resources Information Center

    Poulakos, Takis

    1990-01-01

    Argues that the surviving funeral orations from the classical Greek period are instances of laudatory discourse designed to fulfill the institutional function of glorifying the Athenian state. Examines changes this discourse underwent as the state changed, and reveals incompleteness in current explanations of funeral orations as essentially…

  16. 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…

  17. Consumer Preparedness, Knowledge, and Opinions about Practices and Regulations of the Funeral Industry.

    ERIC Educational Resources Information Center

    Garman, E. Thomas; Kidd, Charlotte A.

    1983-01-01

    Focuses on consumers' knowledge and opinions concerning the funeral industry. Questionnaires showed university faculty and staff (N=293) rejected the status quo. Almost 9 out of 10 of the respondents were quite unprepared for their own funerals. Relationships existed between knowledge scores and the age, education, and sex of respondents.…

  18. 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,…

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-04-01

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

  1. 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.

  2. Fluorescence-Magnetism Functional EuS Nanocrystals with Controllable Morphologies for Dual Bioimaging.

    PubMed

    Sun, Yuanqing; Wang, Dandan; Zhao, Tianxin; Jiang, Yingnan; Zhao, Yueqi; Wang, Chuanxi; Sun, Hongchen; Yang, Bai; Lin, Quan

    2016-12-14

    Multiple functions incorporated in one single component material offer important applications in biosystems. Here we prepared a divalent state of rare earth EuS nanocrystals (NCs), which provides luminescent and magnetic properties, using both 1-Dodecanethiol (DT) and oleylamine (OLA) as reducing agents. The resultant EuS NCs exhibit controllable shapes, uniform size, and bright luminescence with a quantum yield as high as 3.5%. OLA as a surface ligand plays an important role in tunable morphologies, such as nanowires, nanorods, nanospheres et al. Another attractive nature of the EuS NCs is their paramagnetism at room temperature. In order to expand the biological applications, the resultant EuS NCs were modified with amphiphilic block copolymer F127 and transferred from oil to water phase. The excellent biocompatibility of EuS NCs is demonstrated as well as preservation of their luminescence and paramagnetic properties. The EuS NCs offer multifunction and great advantages of bright luminescence, paramagnetic, controllable morphologies, and good biocompatibility promising applications in the field of simultaneous magnetic resonance and fluorescence bioimaging.

  3. 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…

  4. Mortality of U.S. embalmers and funeral directors.

    PubMed

    Hayes, R B; Blair, A; Stewart, P A; Herrick, R F; Mahar, H

    1990-01-01

    The causes of mortality of 3,649 white and 397 non-white male U.S. embalmers and funeral directors, who had died between 1975 and 1985, were examined in a proportional mortality study. Non-significant excesses were found for malignancies of the buccal cavity and pharynx (PMR = 120) and for nasopharyngeal cancer (PMR = 216). No sinonasal cancers were observed, while 1.7 were expected. A statistically significant excess of colon cancer (PMR = 127) was found and a non-significant excess of brain and other CNS cancer was noted among whites only (PMR = 123). Statistically significant excesses of malignancies of the lymphatic and hematopoietic systems were found in whites (PMR = 131) and non-whites (PMR = 241). Myeloid leukemia (PMR = 157) and leukemia of other and unspecified cell types (PMR = 228) were in excess, while no excess of lymphatic leukemia was noted. Elevations in risk were also found for non-Hodgkin's lymphoma, polycythemia vera, and myelofibrosis. Non-whites showed a marked excess of multiple myeloma (PMR = 369). Chronic nephritis was in excess among whites (PMR = 215) and non-whites (PMR = 257). No excess of cirrhosis of the liver was found. Excesses of malignancies of the lymphatic and hematopoietic systems could not be directly related to job held in the funeral industry. Further case-control studies are planned to rule out the possibility that the observed associations are artifactual, by assessing the association between specific work practices and disease risk.

  5. Is Endoscopic Ultrasound (EUS) necessary in the pre-therapeutic assessment of Barrett’s esophagus with early neoplasia?

    PubMed Central

    Fernández-Sordo, Jacobo Ortiz; Konda, Vani J.A.; Chennat, Jennifer; Madrigal-Hoyos, Erika; Posner, Mitchell C.; Ferguson, Mark K.

    2012-01-01

    Endoscopic ultrasound (EUS) is considered the most accurate tool for the TNM staging of esophageal cancer, but its role in early Barrett’s neoplasia is still debatable. The aim was to evaluate the utility of EUS in Barrett’s patients prior to therapy. Retrospective review of 109 patients enrolled in a treatment protocol for Barrett’s neoplasia in our institution. EUS assessment was classified as suspicious for invasion in 19 patients; 84% of them had no evidence of invasion in final pathology. The assessment of depth of invasion of Barrett’s neoplasia based solely on EUS findings leads to overstaging in most patients. PMID:23205307

  6. Personal reflections of funeral rituals and spirituality in a Kentucky African American family.

    PubMed

    Collins, Wanda Lott; Doolittle, Amy

    2006-12-01

    This article introduces the authors' experiences and observations as grief/bereavement counselors participating in urban and rural funerals. A vignette illustrates the use of rituals and spirituality of one African American family, living in a rural area of Kentucky, and their efforts to cope with their own grief and loss of a loved one. The article describes why it is important for professional practitioners to have awareness about a range of diverse funeral events and traditions that can take place in the African American community. Funeral practices and customs are discussed as well as suggestions for culturally competent practice in working with those who have experienced loss and grief.

  7. Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA) of the Pancreas in a Porcine Model

    PubMed Central

    Gaidhane, Monica; Smith, Ioana; Ellen, Kristi; Gatesman, Jeremy; Habib, Nagy; Foley, Patricia; Moskaluk, Christopher; Kahaleh, Michel

    2012-01-01

    Backgrounds. Limited effective palliative treatments exist for pancreatic cancer which includes surgery or chemotherapy. Radiofrequency ablation (RFA) uses high frequency alternating current to ablate diseased tissue and has been used to treat various tumors. In this study, we evaluated a prototype probe adjusted to the EUS-needle to perform EUS-RFA to permit coagulative necrosis in the pancreas. Methods. Five Yucatan pigs underwent EUS-guided radiofrequency ablation of the head of their pancreas. Using an EUS-needle, RFA was applied with 6 mm and then 10 mm of the probe exposed at specific wattage for preset durations. Results. Only one pig showed moderate levels of pancreatitis (20% proximal pancreatitis). The other animals showed much lower areas of tissue damage. In 3 of the 5 pigs, the proximal pancreas showed greater levels of tissue injury than the distal pancreas, consistent with the proximity of the tissue to the procedure site. In 1 pig, both proximal and distal pancreas showed minimal pancreatitis (1%). There was minimal evidence of fat necrosis in intra-pancreatic and/or extra-pancreatic adipose tissue. Conclusion. EUS-guided RFA of the pancreatic head with the monopolar probe through a 19-gauge needle was well tolerated in 5 Yucatan pigs and with minimal amount of pancreatitis. PMID:23049547

  8. Funeral rituals following the death of a child in Taiwan.

    PubMed

    Gudmundsdottir, M; Martinson, P V; Martinson, I M

    1996-01-01

    This study explores the practices of 25 Taiwanese families following the death of a child from cancer. Detailed description of the families' post-death practices was obtained through semi-structured interviews with at least one family member. Through content analysis of the data, 10 categories were identified. These were: caring for the body, funeral arrangements, mourning clothes, ashes, spirit tablets, child's belongings, child's room, visits to the grave or the temple, dreams, and talking about the dead child. The findings show that although the rituals performed following the death of a child are simpler than those traditionally performed for an adult, they are still an important part of the families' lives during the post-death period.

  9. "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.

  10. Paying the Piper: The High Cost of Funerals in South Africa1

    PubMed Central

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

    2013-01-01

    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

  11. 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.

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

    PubMed Central

    Kouba, Marek; Bartoš, Luděk; Zárybnická, Markéta

    2014-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. consumer preparedness, knowledge, and opinions about practices and regulations of the funeral industry.

    PubMed

    Garman, E T; Kidd, C A

    1983-01-01

    This study focuses on consumers' level of knowledge, opinions, and degree of preparedness concerning selected practices and regulations of the funeral industry. Questionnaires were returned by 75 percent of the sample of faculty and staff at a large university. Opinions of respondents rejected the status quo concerning various practices and regulations of the funeral industry, indicating a desire to support newly suggested changes in the industry. Preparedness scores indicated that almost 9 out of 10 of the respondents were quite unprepared for their own funerals. The mean achievement score regarding knowledge as measured by the Consumer Funeral Test, which was developed for this study, was 4.0, representing 57 percent correct. Significant statistical relationships existed between knowledge scores and the age, education, and sex of the respondents; those who were older and had more education scored higher, and men scored higher than women. No relationships existed, however, among knowledge, opinion, and preparedness scores and the demographic variables of age, education, income, sex, and religion, raising the fundamental question of the value of funeral information programs for consumers.

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

    PubMed

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

    2009-10-01

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

  17. Arterial bleeding during EUS-guided pseudocyst drainage stopped by placement of a covered self-expandable metal stent

    PubMed Central

    2013-01-01

    Background Hemorrhagic complications during EUS-guided pseudocyst drainage can occur, because the vessels on the internal wall of the pseudocyst might be compressed by the fluid and thus not visible on color Doppler or even power Doppler EUS. Case presentation We report a case of an immediate internal spurting arterial bleeding precipitated during EUS-guided pseudocyst drainage which stopped instantaneously by placement of a double flanged covered self-expandable metal stent through mechanical hemostasis. Conclusion In an unusual situation of bleeding from collateral circulation near the pseudocyst wall during pseudocyst drainage, the placement of an expandable metal stent proved to be useful. PMID:23706101

  18. 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

  19. Factors Affecting Vocalization in Tengmalm’s Owl (Aegolius funereus) Fledglings during Post-Fledging Dependence Period: Scramble Competition or Honest Signalling of Need?

    PubMed Central

    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

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

    PubMed

    Kouba, Marek; Bartoš, Luděk; Štastný, Karel

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  2. 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.

  3. Effective optical Faraday rotations of semiconductor EuS nanocrystals with paramagnetic transition-metal ions.

    PubMed

    Hasegawa, Yasuchika; Maeda, Masashi; Nakanishi, Takayuki; Doi, Yoshihiro; Hinatsu, Yukio; Fujita, Koji; Tanaka, Katsuhisa; Koizumi, Hitoshi; Fushimi, Koji

    2013-02-20

    Novel EuS nanocrystals containing paramagnetic Mn(II), Co(II), or Fe(II) ions have been reported as advanced semiconductor materials with effective optical rotation under a magnetic field, Faraday rotation. EuS nanocrystals with transition-metal ions, EuS:M nanocrystals, were prepared by the reduction of the Eu(III) dithiocarbamate complex tetraphenylphosphonium tetrakis(diethyldithiocarbamate)europium(III) with transition-metal complexes at 300 °C. The EuS:M nanocrystals thus prepared were characterized using X-ray diffraction (XRD), transmission electron microscopy (TEM), inductively coupled plasma atomic emission spectroanalysis (ICP-AES), and a superconducting quantum interference device (SQUID) magnetometer. Enhanced Faraday rotations of the EuS:M nanocrystals were observed around 550 nm, and their enhanced spin polarization was estimated using electron paramagnetic resonance (EPR) measurements. In this report, the magneto-optical relationship between the Faraday rotation efficiency and spin polarization is discussed.

  4. Steroid-Induced Psychosis after EUS-Guided Celiac Plexus Blockade

    PubMed Central

    Lewis, Jason J.

    2017-01-01

    A 46-year-old female with no previous personal or family psychiatric history underwent endoscopic ultrasound (EUS)-guided celiac plexus blockade (CPB) to treat pain related to cystic fibrosis transmembrane conductance regulator-associated chronic pancreatitis. She had excellent response to her first three CPBs using bupivacaine and triamcinolone. The patient’s subsequent CPBs were complicated by symptoms of racing thoughts, delusional thinking, and insomnia. She was diagnosed with acute psychosis secondary to triamcinolone. This is the first reported case of steroid-induced psychosis caused by EUS-guided CPB. Optimal treatment for steroid-induced psychiatric symptoms include dose reduction or discontinuation of steroids and administration of lithium, valproic acid, or atypical antipsychotics. PMID:28144616

  5. The incremental benefit of EUS for identifying unresectable disease among adults with pancreatic adenocarcinoma: A meta-analysis

    PubMed Central

    James, Paul D.; Zhang, Mei; Belletrutti, Paul J.; Mohamed, Rachid; Ghali, William; Roberts, Derek J.; Martel, Guillaume; Heitman, Steven J.

    2017-01-01

    Background and study aims It is unclear to what extent EUS influences the surgical management of patients with pancreatic adenocarcinoma. This systematic review sought to determine if EUS evaluation improves the identification of unresectable disease among adults with pancreatic adenocarcinoma. Patients and methods We searched MEDLINE, EMBASE, bibliographies of included articles and conference proceedings for studies reporting original data regarding surgical management and/or survival among patients with pancreatic adenocarcinoma, from inception to January 7th 2017. Our main outcome was the incremental benefit of EUS for the identification of unresectable disease (IBEUS). The pooled IBEUS were calculated using random effects models. Heterogeneity was explored using stratified meta-analysis and meta-regression. Results Among 4,903 citations identified, we included 8 cohort studies (study periods from 1992 to 2007) that examined the identification of unresectable disease (n = 795). Random effects meta-analysis suggested that EUS alone identified unresectable disease in 19% of patients (95% confidence interval [CI], 10–33%). Among those studies that considered portal or mesenteric vein invasion as potentially resectable, EUS alone was able to identify unresectable disease in 14% of patients (95% CI 8–24%) after a CT scan was performed. Limitations The majority of the included studies were retrospective. Conclusions EUS evaluation is associated with increased identification of unresectable disease among adults with pancreatic adenocarcinoma. PMID:28319148

  6. Evaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts

    PubMed Central

    Lee, Alexander; Kadiyala, Vivek; Lee, Linda S.

    2017-01-01

    Objectives Management of asymptomatic pancreatic cysts is challenging. Guidelines by the American Gastroenterological Association (AGA) and International Association of Pancreatology (Fukuoka) seek to identify high-risk patients. We assessed performance of these guidelines in selecting patients for endoscopic ultrasound (EUS) and/or surgery. Methods PART I – We retrospectively studied 143 asymptomatic cysts with magnetic resonance imaging (MRI) followed by EUS. Appropriate selection for EUS was defined as: malignant cytology or surgical pathology, or development of concerning features on MRI as defined by the guidelines. PART II – We retrospectively studied 152 resected cysts to assess the performance of guidelines in selecting cysts for surgery using malignant histology as the outcome. Results PART I – Of 143 EUS, 43 (30.1 %) were male with median age 65.0 years (interquartile range [IQR] 58.0 – 73.0). AGA guideline demonstrated lower sensitivity (17.6 % versus 35.3 %, P = 0.03), higher specificity (94.5 % versus 66.1 %, p < 0.001), and higher accuracy (76.2 % versus 58.7 %, P = 0.002) than Fukuoka. There was no difference in positive predictive value (50.0 % versus 24.5 %, P = 0.15) and negative predictive value (78.6 % versus 76.6 %, p=0.75). PART II – Of 152 resected cysts, 45 (29.8 %) were male with median age 59.0 years (IQR 47.3 – 66.7). There was no difference in performance characteristics of the guidelines in selecting cysts for surgery. AGA and Fukuoka guidelines missed 25.0 % and 18.8 % of malignant cysts, respectively (P = 1.00). Conclusions For referral to EUS, the AGA guideline was highly specific compared to Fukuoka; both suffered from poor sensitivity, although the Fukuoka guideline was relatively more sensitive than AGA. For referral to surgery, both guidelines have modest sensitivity and specificity and miss a similar percentage of malignant lesions. PMID:28210708

  7. 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...

  8. 38 CFR 3.1611 - Official Department of Veterans Affairs representation at funeral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 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...

  9. 38 CFR 3.1611 - Official Department of Veterans Affairs representation at funeral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 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...

  10. 38 CFR 3.1611 - Official Department of Veterans Affairs representation at funeral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 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...

  11. 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...

  12. Personal Reflections of Funeral Rituals and Spirituality in a Kentucky African American Family

    ERIC Educational Resources Information Center

    Collins, Wanda Lott; Doolittle, Amy

    2006-01-01

    This article introduces the authors' experiences and observations as grief/bereavement counselors participating in urban and rural funerals. A vignette illustrates the use of rituals and spirituality of one African American family, living in a rural area of Kentucky, and their efforts to cope with their own grief and loss of a loved one. The…

  13. 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

  14. Hegemony and cost-effectiveness of endoscopic ultrasound (EUS) in the field of gastroenteropancreatic-neuroendocrine tumors (GEP-NETs).

    PubMed

    De Angelis, C; Manfrè, S F; Bruno, M; Pellicano, R

    2014-10-01

    Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a group of neoplasms arising from the diffuse neuroendocrine system of the gastrointestinal (GI) tract. They often represent a diagnostic challenge because of their little dimensions, the deep localization into the retroperitoneum or in extramucosal sites, the possibility to be multilocated and the heterogeneous patterns of presentation. Endoscopic ultrasound (EUS) is a cost-effective technique that enables to look very definitely at a suspicious mass and at the surrounding area both within the GI wall and in the pancreas, allowing to precisely assess T and N stage. Under EUS-guidance it is possible to obtain tissue samples in order to reach a definitive diagnosis and to establish the tumor grade. In the therapeutic field, EUS is crucial to assess the safety and the feasibility of resective endoscopic techniques for the GI-wall NETs and it can guide local ablative techniques for pancreatic NETs. After treatment, EUS can be successfully useful to assess complete endoscopic resection and to follow-up resected or ablated patients. It is so evident that EUS has a role in the whole route of NETs management, from diagnosis, evaluation, grading and staging assessment, to therapy and consequent follow-up.

  15. Pancreatic Metastasis from Rectal Cancer that was Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Aspiration (EUS-FNA)

    PubMed Central

    Sano, Itsuki; Katanuma, Akio; Yane, Kei; Kin, Toshifumi; Nagai, Kazumasa; Yamazaki, Hajime; Koga, Hideaki; Kitagawa, Koh; Yokoyama, Kensuke; Ikarashi, Satoshi; Takahashi, Kuniyuki; Maguchi, Hiroyuki; Omori, Yuko; Shinohara, Toshiya

    2017-01-01

    Pancreatic metastasis from colorectal cancer is rare, and there have been only a few reports of its preoperative diagnosis by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with immunohistochemical staining. We herein describe the case of a 77-year-old woman in whom a solitary mass in the pancreatic tail was detected 11 years after rectal cancer resection. The patient also had a history of pulmonary tumor resection. We performed EUS-FNA and a histopathological examination showed adenocarcinoma with CD20+, CD7-, and CDX2+ (similar to her rectal cancer). EUS-FNA enabled a histopathological examination, including immunohistochemical staining, which helped to confirm the diagnosis of pancreatic and pulmonary metastasis from rectal cancer. PMID:28154274

  16. 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.

  17. 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.

  18. Survivor's motives for extravagant funerals among the Yorubas of Western Nigeria.

    PubMed

    Adamolekun, K

    2001-10-01

    This article highlights the rationale participants provided for what some observers describe as elaborate and extravagant funeral practices in Western Nigeria. This includes the need to achieve psychological, social, and emotional fulfillment and contentment. This underlines the desire of survivors to take care of themselves. The article concludes that professionals in the death, dying, and bereavement field should accept the survivors as they are as long as they are not hurt by their actions. This is the bedrock of whatever help is offered.

  19. Balanced Propofol Sedation in Patients Undergoing EUS-FNA: A Pilot Study to Assess Feasibility and Safety

    PubMed Central

    Pagano, N.; Arosio, M.; Romeo, F.; Rando, G.; Del Conte, G.; Carlino, A.; Strangio, G.; Vitetta, E.; Malesci, A.; Repici, A.

    2011-01-01

    Introduction and aims. Balanced propofol sedation (BPS) administered by gastroenterologists has gained popularity in endoscopic procedures. Few studies exist about the safety of this approach during endosonography with fine needle aspiration (EUS-FNA). We assessed the safety of BPS in EUS-FNA. Materials and methods. 112 consecutive patients, referred to our unit to perform EUS-FNA, from February 2008 to December 2009, were sedated with BPS. A second gastroenterologist administered the drugs and monitorized the patient. Results. All the 112 patients (62 males, mean age 58.35) completed the examination. The mean dose of midazolam and propofol was, respectively, of 2.1 mg (range 1–4 mg) and 350 mg (range 180–400). All patients received oxygen with a mean flux of 4 liter/minute (range 2–6 liters/minute). The mean recovery time after procedure was 25 minutes (range 18–45 minutes). No major complications related to sedation were registered during all procedures. The oxygen saturation of all patients never reduced to less than 85%. Blood systolic pressure during and after the procedure never reduced to less than 100 mmHg. Conclusions. In our experience BPS administered by non-anaesthesiologists provided safe and successful sedation in patients undergoing EUS-FNA. PMID:21785561

  20. 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.

  1. 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

  2. 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…

  3. Metastatic renal cell carcinoma from a native kidney of a renal transplant patient diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy

    PubMed Central

    Alastal, Yaseen; Hammad, Tariq A; Rafiq, Ehsan; Nawras, Mohamad; Alaradi, Osama

    2015-01-01

    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy sampling of enlarged lymph nodes is increasingly used to diagnose metastatic tumors, especially of the gastrointestinal tract and the lungs. Herein, we describe the diagnosis of metastatic renal cell carcinoma from a native kidney of a 54 year-old male patient, who had a 5-years history of renal transplant, by EUS-FNA of mediastinal and celiac lymph nodes. Histological and immunohistochemical findings confirmed the origin of metastatic tumor. EUS-FNA with proper cytological evaluation can be useful in the diagnosis of metastatic renal cell carcinoma in renal transplant patients. PMID:28326261

  4. 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

    2016-03-04

    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.

  5. Enhanced magneto-optical properties of semiconductor EuS nanocrystals assisted by surface plasmon resonance of gold nanoparticles.

    PubMed

    Kawashima, Akira; Nakanishi, Takayuki; Shibayama, Tamaki; Watanabe, Seiichi; Fujita, Koji; Tanaka, Katsuhisa; Koizumi, Hitoshi; Fushimi, Koji; Hasegawa, Yasuchika

    2013-10-18

    Remarkable magneto-optical properties of a new isolator material, that is, europium sulfide nanocrystals with gold (EuS-Au nanosystem), has been demonstrated for a future photo-information technology. Attachment of gold particles that exhibit surface plasmon resonance leads to amplification of the magneto-optical properties of the EuS nanocrystals. To construct the EuS-Au nanosystems, cubic EuS and spherical Au nanocrystals have been joined by a variety of organic linkers, that is, 1,2-ethanedithiol (EDT), 1,6-hexanedithiol (HDT), 1,10-decanedithiol (DDT), 1,4-bisethanethionaphthalene (NpEDT), or 1,4-bisdecanethionaphthalene (NpDDT) . Formation of these systems was observed by XRD, TEM, and absorption spectra measurements. The magneto-optical properties of the EuS-Au nanosystem have been characterized by using Faraday rotation spectroscopy. The Faraday rotation angle of the EuS-Au nanosystem is dependent on the Au particle size and interparticle distance between EuS and Au nanocrystals. Enhancement of the Faraday rotation of EuS-Au nanosystems was observed. The spin configuration in the excited state of the EuS-Au nanosystem was also investigated using photo-assisted electron paramagnetic resonance.

  6. 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.

  7. 20 CFR 1002.55 - Is all funeral honors duty considered “service in the uniformed services?”

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Is all funeral honors duty considered âservice in the uniformed services?â 1002.55 Section 1002.55 Employees' Benefits OFFICE OF THE ASSISTANT SECRETARY FOR VETERANS' EMPLOYMENT AND TRAINING SERVICE, DEPARTMENT OF LABOR REGULATIONS UNDER THE UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT...

  8. An outbreak of El Tor cholera associated with a tribal funeral in Irian Jaya, Indonesia.

    PubMed

    Korthuis, P T; Jones, T R; Lesmana, M; Clark, S M; Okoseray, M; Ingkokusumo, G; Wignall, F S

    1998-09-01

    An outbreak of El Tor biotype cholera occurring in a rural village in Irian Jaya, Indonesia was evaluated for risk factors associated with death from cholera. Among those dying in the village during the epidemic, a significant association between membership in one of the five tribal groups in the village complex was associated with an elevated risk of suffering a cholera death (odds ratio = 5.9). Interviews with members of the decedents' families revealed a very strong association (odds ratio = 11.6) between risk of cholera death and having attended the two day funeral of a woman who died of a cholera-like illness a few days prior to an outbreak of cholera-like diarrheal disease in the village complex. Recent flooding may have contributed to the creation of an environment conducive to cholera transmission.

  9. 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

  10. Sensitivity of EUS and ERCP Endoscopic Procedures in the Detection of Pancreatic Cancer During Preoperative Staging Correlated with CT and CT Angiography Imaging Methods

    PubMed Central

    Vukobrat-Bijedic, Zora; Husic-Selimovic, Azra; Bijedic, Nina; Gornjakovic, Srdjan; Sofic, Amela; Gogov, Bisera; Bjelogrlic, Ivana; Mehmedovic, Amila; Glavas, Sanjin

    2014-01-01

    The goal: The goal of this work was to give advantage to EUS as endoscopic method in diagnosis and following therapeutic treatment of pancreatic cancer in relation to radiological methods of CT and CTA. Material and Methods: The study included 49 patients, 20 women and 29 men hospitalized at the Clinic for gastroenterohepatology, due to suspicion on pancreatic cancer during observed 2 years period. All cancers were histologically and cytologically confirmed. The patients underwent ERCP as a mandatory part of staging and all patients underwent endoscopic ultrasound as well as CT or CT angiography. Results: Testing of differences was carried out using Fisher’s exact test in open-source software R. The following characteristics were tested: involvement of the blood vessels, lymph nodes, metastases, tumor size and duodenum infiltration. Results showed statistically significant difference at the 0.05 level for EUS, CT and CT angiography. Risk ratio showed that EUS is less effective in detecting infiltration of blood vessels within a malignant process then CTA where RR=0.52, CI 0.2–1.38, p-value=0.33. EUS and CTA are equal in the diagnosis of enlarged lymph nodes affected by malignancy where RR=1.3, CI 0.75–1.42, p-value=0.09. Comparison according to distant metastases showed that EUS is less effective compared to CT in approximately 30% of cases. In the diagnosis of duodenal infiltration EUS is in 5% of cases less accurate than the CT with the RR=0.95, CI 0.27–3.32, p-value=0.76, but the CTA method is more efficient because the comparison of EUS and CTA showed RR=12.52, CI 0.2–1.38, p-value=0.33. EUS as a diagnostic method is dominant in determining the size of malignant lesions located in the pancreas as compared to CT and CTA. Conclusion: EUS as endoscopic method compared to CT and CTA is one of the more invasive methods of examination but due to its ability to be performed immediately, to locate a changes smaller than 5 mm and the target biopsy option, to

  11. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes: experience from region with high prevalence of tuberculosis.

    PubMed

    Manucha, Varsha; Kaur, Gagandeep; Verma, Kusum

    2013-12-01

    Utility of EUS-FNA in diagnosing granulomatous lesions of mediastinum in regions with high prevalence of tuberculosis has not yet been evaluated. In the present study, utility and limitations of EUS-FNA of mediastinal lesions from a tertiary care center with high prevalence of tuberculosis were studied. All cases where EUS-FNA had been performed to diagnose mediastinal lymphadenopathy from January 2006 to December 2008 were retrieved from the files of cytopathology laboratory. These were reviewed by the cytopathologist. Two hundred and eighty one EUS-FNA aspirates from 269 patients were evaluated. Satisfactory aspirates were available in 259 cases. A cytological diagnosis of granulomatous lymphadenitis was rendered in 206 cases. Of these, tuberculosis could be established as an etiology in 76 cases and sarcoidosis in 7 cases only. In remaining 123 cases the etiology of granulomatous lymphadenitis could not be established and clinical correlation was suggested. Malignancies were diagnosed or suspected in 24 and 5 cases, respectively. The study highlights that the dilemma of tuberculosis versus sarcoidosis persists in regions with high prevalence of tuberculosis. However, EUS-FNA is useful in diagnosing unsuspected malignancies and confirming the presence of granulomatous lymphadenitis.

  12. 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

  13. Exposure to and precautions for blood and body fluids among workers in the funeral home franchises of Fort Worth, Texas.

    PubMed

    Nwanyanwu, O C; Tabasuri, T H; Harris, G R

    1989-08-01

    In 1982 the Centers for Disease Control published a set of recommendations and measures to protect persons working in health care settings or performing mortician services from possible exposure to the human immunodeficiency virus. This study of a number of funeral homes in the Fort Worth area was designed to determine the level of exposure of funeral home workers to blood and other body fluids and also to assess existing protective measures and practices in the industry. Workers in 22 funeral home franchises were surveyed with a predesigned questionnaire. Eighty-five responses from 20 of the 22 establishments were received. All 85 respondents admitted exposure of varying degrees to blood and body fluids. Sixty persons (70%) admitted heavy exposure, that is, frequent splashes. Analysis of the responses showed that 81 of 85 (95.3%) persons consistently wore gloves while performing tasks that might expose them to blood or other body fluids. Of the 60 persons who were heavily exposed, 43 wore long-sleeved gowns, 27 wore waterproof aprons, 17 surgical masks, and 15 goggles. The study further revealed that 52.9% (45/85) of the respondents had sustained accidental cuts or puncture wounds on the job. In light of these findings it is important to target educational efforts to persons in this industry to help them minimize their risks of infection with blood and body fluid borne infections.

  14. EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study

    PubMed Central

    Khashab, Mouen A.; El Zein, Mohamad H.; Sharzehi, Kaveh; Marson, Fernando P.; Haluszka, Oleh; Small, Aaron J.; Nakai, Yousuke; Park, Do Hyun; Kunda, Rastislav; Teoh, Anthony Y.; Peñas, Irene; Perez-Miranda, Manuel; Kumbhari, Vivek; Van der Merwe, Schalk; Artifon, Everson L.; Ross, Andrew S.

    2016-01-01

    Background and study aims: How enteroscopy-assisted ERCP (e-ERCP) and endoscopic ultrasound-guided biliary drainage (EUS-BD) compare in patients with surgically altered upper gastrointestinal anatomy is currently unknown. The aims of this study were to compare efficacy and safety of both techniques and study predictors of these outcomes. Patients and methods: This was an international, multicenter comparative cohort study at 10 tertiary centers. Outcomes data included technical success (biliary access with cholangiography and stent placement [when indicated]), clinical success (resolution of biliary obstruction) and adverse events (AEs) (graded according to the ASGE lexicon). Results: A total of 98 patients underwent EUS-BD (n = 49) or e-ERCP (n = 49). Technical success was achieved in 48 (98 %) patients in the EUS-BD group as compared to 32 (65.3 %) patients in the e-ERCP group (OR 12.48, P = 0.001). Clinical success was attained in 88 % of patients in EUS-BD group as compared to 59.1 % in the e-ERCP group (OR 2.83, P = 0.03). Procedural time was significantly shorter in the EUS-BD group (55 min vs 95 min, P < 0.0001). AEs occurred more commonly in the EUS-BD group (20 % vs. 4 %, P = 0.01). However, the majority (90 %) of AEs were mild/moderate. Length of stay was significantly longer in the EUS-BD group (6.6 d vs. 2.4 d, P < 0.0001). Conclusions: EUS-BD can be performed with a higher degree of clinical efficacy and shorter procedure time than e-ERCP in patients with surgically-altered upper gastrointestinal anatomy. Whether or not this approach should be first-line therapy in this patient population is highly dependent on the indication for the procedure, the patient’s anatomy, and local practice and expertise. PMID:27995197

  15. Mucin (MUC) expression in EUS-FNA specimens is a useful prognostic factor in pancreatic ductal adenocarcinoma

    PubMed Central

    Higashi, Michiyo; Yokoyama, Seiya; Yamamoto, Takafumi; Goto, Yuko; Kitazono, Ikumi; Hiraki, Tsubasa; Taguchi, Hiroki; Hashimoto, Shinichi; Fukukura, Yoshihiko; Koriyama, Chihaya; Mataki, Yuko; Maemura, Kosei; Shinchi, Hiroyuki; Jain, Maneesh; Batra, Surinder K.; Yonezawa, Suguru

    2015-01-01

    Objectives The aim of this study was to further examine the utility of mucin expression profiles as prognostic factors in PDAC. Methods Mucin (MUC) expression was examined by immunohistochemistry (IHC) analysis in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) specimens obtained from 114 patients with PDAC. The rate of expression of each mucin was compared with clinicopathologic features. Results The expression rates of mucins in cancer lesions were MUC1, 87.7%; MUC2, 0.8%; MUC4, 93.0%; MUC5AC, 78.9%; MUC6, 24.6%; and MUC16, 67.5%. MUC1 and MUC4 were positive and MUC2 was negative in most PDACs. Patients with advanced stage of PDAC with MUC5AC expression had a significantly better outcome than those who were MUC5AC-negative (P=0.002).With increasing clinical stage, total MUC6 expression decreased (P for trend=0.001) and MUC16 cytoplasmic expression increased (P for trend=0.02). The prognosis of patients with MUC16 cytoplasmic expression was significantly poorer than those without this expression. Multivariate survival analysis revealed that MUC16 cytoplasmic expression was a significant independent predictor of a poor prognosis after adjusting for the effects of other prognostic factors (P=0.002). Conclusion Mucin expression profiles in EUS-FNA specimens have excellent diagnostic utility and are useful predictors of outcome in patients with PDAC. PMID:25906442

  16. 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.

  17. 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.

  18. Clinical outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts: a large multicenter study

    PubMed Central

    Yang, Dennis; Amin, Sunil; Gonzalez, Susana; Mullady, Daniel; Edmundowicz, Steven A.; DeWitt, John M.; Khashab, Mouen A.; Wang, Andrew Y.; Nagula, Satish; Buscaglia, Jonathan M.; Bucobo, Juan Carlos; Wagh, Mihir S.; Draganov, Peter V.; Stevens, Tyler; Vargo, John J.; Khara, Harshit S.; Diehl, David L.; Keswani, Rajesh N.; Komanduri, Srinadh; Yachimski, Patrick S.; Prabhu, Anoop; Kwon, Richard S.; Watson, Rabindra R.; Goodman, Adam J.; Benias, Petros; Carr-Locke, David L.; DiMaio, Christopher J.

    2017-01-01

    Background and study aims Data on clinical outcomes of endoscopic drainage of debris-free pseudocysts (PDF) versus pseudocysts containing solid debris (PSD) are very limited. The aims of this study were to compare treatment outcomes between patients with PDF vs. PSD undergoing endoscopic ultrasound (EUS)-guided drainage via transmural stents. Patients and methods Retrospective review of 142 consecutive patients with pseudocysts who underwent EUS-guided transmural drainage (TM) from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM technical success, treatment outcomes (symptomatic and radiologic resolution), need for endoscopic re-intervention at follow-up, and adverse events (AEs). Results TM was performed in 90 patients with PDF and 52 with PSD. Technical success: PDF 87 (96.7 %) vs. PSD 51 (98.1 %). There was no difference in the rates for endoscopic re-intervention (5.5 % in PDF vs. 11.5 % in PSD; P = 0.33) or AEs (12.2 % in PDF vs. 19.2 % in PSD; P = 0.33). Median long-term follow-up after stent removal was 297 days (interquartile range [IQR]: 59 – 424 days) for PDF and 326 days (IQR: 180 – 448 days) for PSD (P = 0.88). There was a higher rate of short-term radiologic resolution of PDF (45; 66.2 %) vs. PSD (21; 51.2 %) (OR = 0.30; 95 % CI: 0.13 – 0.72; P = 0.009). There was no difference in long-term symptomatic resolution (PDF: 70.4 % vs. PSD: 66.7 %; P = 0.72) or radiologic resolution (PDF: 68.9 % vs. PSD: 78.6 %; P = 0.72) Conclusions There was no difference in need for endoscopic re-intervention, AEs or long-term treatment outcomes in patients with PDF vs. PSD undergoing EUS-guided drainage with transmural stents. Based on these results, the presence of solid debris in pancreatic fluid collections does not appear to be associated with a poorer outcome. PMID:28210709

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

    PubMed Central

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

    2016-01-01

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

  20. 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.

  1. 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.

  2. CoopEUS Case Study: Tsunami Modelling and Early Warning Systems for Near Source Areas (Mediterranean, Juan de Fuca).

    NASA Astrophysics Data System (ADS)

    Beranzoli, Laura; Best, Mairi; Chierici, Francesco; Embriaco, Davide; Galbraith, Nan; Heeseman, Martin; Kelley, Deborah; Pirenne, Benoit; Scofield, Oscar; Weller, Robert

    2015-04-01

    There is a need for tsunami modeling and early warning systems for near-source areas. For example this is a common public safety threat in the Mediterranean and Juan de Fuca/NE Pacific Coast of N.A.; Regions covered by the EMSO, OOI, and ONC ocean observatories. Through the CoopEUS international cooperation project, a number of environmental research infrastructures have come together to coordinate efforts on environmental challenges; this tsunami case study tackles one such challenge. There is a mutual need of tsunami event field data and modeling to deepen our experience in testing methodology and developing real-time data processing. Tsunami field data are already available for past events, part of this use case compares these for compatibility, gap analysis, and model groundtruthing. It also reviews sensors needed and harmonizes instrument settings. Sensor metadata and registries are compared, harmonized, and aligned. Data policies and access are also compared and assessed for gap analysis. Modelling algorithms are compared and tested against archived and real-time data. This case study will then be extended to other related tsunami data and model sources globally with similar geographic and seismic scenarios.

  3. Learning curve for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions in a novel ex-vivo simulation model

    PubMed Central

    Gonzalez, J. M.; Cohen, J.; Gromski, M. A.; Saito, K.; Loundou, A.; Matthes, K.

    2016-01-01

    Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is essential in the management of digestive cancers. However, teaching and learning this technique remain challenging due to the lack of cost-effective models. Material and methods: This was a prospective experimental study using a complete porcine upper gastrointestinal ex-vivo organ package, placed in an Erlangen Active Simulator for Interventional Endoscopy (EASIE-R), and prepared with one cyst and two solid masses (2 cm). Five fellows inexperienced in EUS-FNA were enrolled, performing 10 procedures on each lesion, alternatively. The total time, number of attempts for success, of needle view losses, and of scope handling were recorded, associated with an independent skills rating by procedure. We compared the first 15 procedures with the last 15 for each fellow. Results: The fellows successfully performed all procedures in 2 to 40 minutes, requiring 1 to 6 attempts. All (5/5) improved their total time taken (P < 0.001), number of times when the EUS view of the needle was lost (P < 0.05), scope handling (P < 0.005), and skills rating (P < 0.001), whereas 4/5 (80 %) improved their number of attempts. The overall evaluation showed a significant decrease (P < 0.001) in the total time taken (11.2 ± 7.8 vs 4.3 ± 2.2 minutes), number of attempts (2.6 ± 1.2 vs 1.2 ± 0.7), number of times when the EUS view of the needle was lost (2.3 ± 2 vs 0.5 ± 0.7), and need for scope handling (1.1 ± 1.7 vs 0.1 ± 0.2). We also observed an improvement in skills rating (5 ± 1.9 vs. 7.7 ± 1.1). Conclusion: This newly designed ex-vivo model seems to be an effective way to improve the initial learning of EUS-FNA, by performing 30 procedures. PMID:27995190

  4. 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.

  5. Mortality Reduction Associated with HIV/AIDS Care and Antiretroviral Treatment in Rural Malawi: Evidence from Registers, Coffin Sales and Funerals

    PubMed Central

    Mwagomba, Beatrice; Zachariah, Rony; Massaquoi, Moses; Misindi, Dalitso; Manzi, Marcel; Mandere, Bester C.; Bemelmans, Marielle; Philips, Mit; Kamoto, Kelita; Schouten, Eric J.; Harries, Anthony D.

    2010-01-01

    Background To report on the trend in all-cause mortality in a rural district of Malawi that has successfully scaled-up HIV/AIDS care including antiretroviral treatment (ART) to its population, through corroborative evidence from a) registered deaths at traditional authorities (TAs), b) coffin sales and c) church funerals. Methods and Findings Retrospective study in 5 of 12 TAs (covering approximately 50% of the population) during the period 2000–2007. A total of 210 villages, 24 coffin workshops and 23 churches were included. There were a total of 18,473 registered deaths at TAs, 15781 coffins sold, and 2762 church funerals. Between 2000 and 2007, there was a highly significant linear downward trend in death rates, sale of coffins and church funerals (X2 for linear trend: 338.4 P<0.0001, 989 P<0.0001 and 197, P<0.0001 respectively). Using data from TAs as the most reliable source of data on deaths, overall death rate reduction was 37% (95% CI:33–40) for the period. The mean annual incremental death rate reduction was 0.52/1000/year. Death rates decreased over time as the percentage of people living with HIV/AIDS enrolled into care and ART increased. Extrapolating these data to the entire district population, an estimated 10,156 (95% CI: 9786–10259) deaths would have been averted during the 8-year period. Conclusions Registered deaths at traditional authorities, the sale of coffins and church funerals showed a significant downward trend over a 8-year period which we believe was associated with the scaling up HIV/AIDS care and ART. PMID:20454611

  6. Photoionization thresholds of rare-earth impurity ions. EuS :CaF2, CeT :YAG, and SmS :CaF2

    SciTech Connect

    Pedrini, C.; Rogemond, F.; McClure, D.S.

    1986-02-15

    The spectral dependence of the photoionization energy of EuS :CaF2, CeT :YAG, and SmS :CaF2 systems have been measured and thresholds experimentally determined and compared with theoretical values calculated from electrostatic models. It is shown that the excited state absorption transitions or the persistent hole burning observed by other authors occur above the threshold energy of photoionization of the impurities and that the states of the crystal which form the bottom of the conduction band may play an important role in the strong probability of these processes. A review of thresholds now known is also given.

  7. First chemical evidence of royal purple as a material used for funeral treatment discovered in a Gallo-Roman burial (Naintré, France, third century AD).

    PubMed

    Devièse, Thibaut; Ribechini, Erika; Baraldi, Pietro; Farago-Szekeres, Bernard; Duday, Henri; Regert, Martine; Colombini, Maria Perla

    2011-10-01

    Violet-purple residues collected from a Gallo-Roman burial dated back to the second half of the third century A.D. and excavated at Naintré (France) were chemically investigated by multi-analytical methodology involving the use of Raman spectroscopy, direct exposure-mass spectrometry (DE-MS) and high-performance liquid chromatography (HPLC-UV-visible). Little is known about funeral treatment and rituals during Roman times. Retrieving valuable information on these by chemical analysis of organic residues was thus a key aspect of this work. Analyses demonstrated the presence of the very precious purple colorant obtained from shellfish glands commonly known as Tyrian or royal purple and its exceptional preservation. Chemical investigation and archaeological evidence have shown that purple was widely spread after the deposition of the body for burial. These results are the earliest chemical evidence of purple colorant used during funeral rituals (not as textile dye) and enabled us to highlight new aspects of funeral practices in Roman times.

  8. 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

  9. Understanding EUS (Endoscopic Ultrasonography)

    MedlinePlus

    ... Week ® GI Outlook (GO) Practice Management Conference Practice Management Quality & Safety STAR Certificate Programs Trifecta DDW Videos International ... Outlook 2017 (GO): The Practice Management Conference Practice Management Courses Quality & Safety ... Registry MACRA Resource Center Practice Accreditation ...

  10. 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.

  11. Silurian, Devonian, and Mississippian Formations of the Funeral Mountains in the Ryan Quadrangle, Death Valley Region, California

    USGS Publications Warehouse

    McAllister, James Franklin

    1974-01-01

    A composite section of the Silurian, Devonian, and Mississippian formations in the Funeral Mountains between Death Valley and Amargosa Valley is about 4,700 feet thick. The formations are in the top of a concordant, complexly faulted sequence that is about 25,000 feet thick from the highest part of the Precambrian to the Upper Mississippian. The Silurian and younger formations consist of marine dolomite and limestone that contain some regionally characteristic cherty and siliceous clastic beds as well as widely spaced fossiliferous zones. The Hidden Valley Dolomite, overlying the Ordovician Ely Springs Dolomite, is 1,440 feet thick except in the southeast end of the area where it is 870 feet thick. Cherty dark dolomite in the lower part of the Hidden Valley contains Silurian (possibly Llandovery, clearly Wenlock, and probably Ludlow) fossils; dolomite in a somewhat argillaceous and silty uppermost part contains Lower Devonian (upper Emsian) fossils. The Lost Burro Formation, 2,640 feet thick, has Middle Devonian (Givetian) fossils stratigraphically high in the lower part of the formation, which consists of dolomite above the basal Lippincott Member. It has Upper Devonian (Frasnian) fossils midway in the upper part, which consists predominantly of limestone. The Tin Mountain Limestone, 315 feet thick, contains abundant Lower Mississippian (Kinderhookian and Osagean) fossils. The Perdido Formation, which is incomplete and no more than 500 feet thick under unconformable Cenozoic continental rocks, consists mostly of limestone, chert, and siltstone. Fossils, which are scarce, include Upper Mississippian (Meramecian) microfossils 205 feet above the base of the Perdido.

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

    USGS Publications Warehouse

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

    2008-01-01

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

  13. Characterization of epitaxial EuS(111) thin films on BaF2(111) and SrF2(111) substrates grown by molecular beam epitaxy

    NASA Astrophysics Data System (ADS)

    Senba, Shinya; Matsumoto, Naoki; Jomura, Mitsuhiro; Asada, Hironori; Koyanagi, Tsuyoshi; Kishimoto, Kengo; Fukuma, Yasuhiro

    2013-06-01

    We have successfully grown EuS (111) epitaxial films on BaF2 (111) and SrF2 (111) substrates by using molecular beam epitaxy at substrate temperatures ( T S 's) between 100 and 500 °C. Pole figures of X-ray diffraction indicate a high degree of in-plane orientation, and all of the samplesshow very high resistivity. The surface roughness for 10-nm-thick EuS films on BaF2 (111) and SrF2 (111) substrates measured by using atomic force microscopy (AFM) are 0.122 and 0.092 nm, respectively. The Curie temperature of the EuS films increases up to ˜16 K with increasing T S . We also try to manipulate the coercive force, which is an important magnetic property, by Te-doping to achieve an anti-parallel magnetization state between two ferromagnetic layers in spin devices. The obtained coercive force for the Te-doped film (110 Oe) is large compared with that for the undoped one (20 Oe).

  14. Types of Funerals

    MedlinePlus

    ... an additional fee for a graveside service. Direct Cremation The body is cremated shortly after death, without ... buried or scattered in a favorite spot. Direct cremation usually costs less than the "traditional" full-service ...

  15. CoopEUS EMSO-OOI Case Study: Tsunami Modelling and Early Warning Systems for Near Source Areas (Mediterranean, Juan de Fuca).

    NASA Astrophysics Data System (ADS)

    Best, M.; Beranzoli, L.; Chierici, F.; Delaney, J. R.; Embriaco, D.; Galbraith, N.; Huber, R.; Orcutt, J. A.; Weller, R. A.

    2014-12-01

    There is a need for tsunami modeling and early warning systems for near-source areas. For example this is a common public safety threat in the Mediterranean and Juan de Fuca/NE Pacific Coast of N.A.; Regions covered by the EMSO and OOI ocean observatories respectively. Through the CoopEUS EU-US cooperation project, a number of environmental research infrastructures have come together to coordinate efforts on environmental challenges; this tsunami case study tackles one such challenge. There is a mutual need of tsunami event field data and modeling to deepen our experience in testing methodology and developing real-time data processing. Tsunami field data are already available for past events, part of this use case compares these for compatibility, gap analysis, and model groundtruthing. It also reviews sensors needed and harmonizes instrument settings. Sensor metadata and registries are compared, harmonized, and aligned. Data policies and access are also compared and assessed for gap analysis. Modelling algorithms are compared and tested against archived and real-time data. This case study will then be extended to other related tsunami data and model sources globally with similar geographic and seismic scenarios (e.g. DONET, ONC).

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

    PubMed

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

    2013-04-01

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

  17. 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.

  18. 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

  19. Dynamic magnetic behaviour of some diluted EuS and EuSe compounds

    NASA Astrophysics Data System (ADS)

    Baalbergen, J. J.; Verstelle, J. C.; Van Duyneveldt, A. J.

    1990-09-01

    AC susceptibility measurements over a wide frequency range (1-10 8 Hz) on some EuxSr1- xS ( x = 0.40 and 0.55) and EuxSr- xSe ( x = 0.50 and 0.70) compounds are reported. The analysis of the experimental data is concerned on the complex 1/χ-plane which enables separate treatment of the influence of the demagnetizing effect on χ and on τ c. A satisfactory description of the results by a so-called Cole-Cole relaxation process, χac ∞(1 + jωτc) 1- h, is possible over the whole frequency range. This relaxation is detected below a temperature Th, well above the spin-glass freezing temperature Tf. The obtained relaxation time constant τc do not show any anomaly at or near T. The Cole-Cole description leads to an algebraic power-law-like behaviour in the time domain of the relaxation function.

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

    PubMed

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

    2015-01-01

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

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

    ClinicalTrials.gov

    2017-02-16

    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

  2. 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

  3. 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

  4. 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…

  5. Autoimmune Pancreatitis Diagnosed with Core Biopsy Obtained from a Novel Fork-Tip EUS Needle

    PubMed Central

    Saini, Sameer D.; Chamberlain, Priscilla R.; Prabhu, Anoop

    2017-01-01

    The endoscopic diagnosis of autoimmune pancreatitis from histologic criteria remains challenging as it requires adequate architectural details rather than cytology alone. A 67-year-old man presented with progressive abdominal pain and weight loss. Cross-sectional imaging showed inflammatory changes of the pancreatic body and tail and periaortitis on abdominal computed tomography, but normal serum immunoglobulin G4. A mass-like lesion of the pancreatic body and tail was identified on endoscopic ultrasonography. A histologic diagnosis of autoimmune pancreatitis was accomplished through needle biopsy using a novel fork-tip needle. PMID:28144612

  6. Materials Data on EuS (SG:225) by Materials Project

    SciTech Connect

    Kristin Persson

    2016-03-23

    Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

  7. Materials Data on EuSe (SG:221) by Materials Project

    SciTech Connect

    Kristin Persson

    2016-09-19

    Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

  8. Materials Data on EuSe (SG:225) by Materials Project

    SciTech Connect

    Kristin Persson

    2016-03-22

    Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

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

    ERIC Educational Resources Information Center

    Johnson, Gordon C., II

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

  10. "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…

  11. 29 CFR 779.369 - Funeral home establishments may qualify as exempt 13(a)(2) establishments.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... described in paragraph (e) below. (b) Burial insurance operations. There is no retail concept applicable to the insurance business (see § 779.317). Burial associations which enter into burial insurance... except any employees who perform any work in connection with burial insurance operations (see...

  12. 29 CFR 779.369 - Funeral home establishments may qualify as exempt 13(a)(2) establishments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... described in paragraph (e) below. (b) Burial insurance operations. There is no retail concept applicable to the insurance business (see § 779.317). Burial associations which enter into burial insurance... except any employees who perform any work in connection with burial insurance operations (see...

  13. 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.

  14. 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.

  15. "The Funeral": A Study of Children's Shared Meaning-Making and Its Developmental Significance

    ERIC Educational Resources Information Center

    Lofdahl, Annica

    2005-01-01

    This article argues the need to examine communication in joint play situations rather than individual assessments in solitary play situations when children's development is focused. Informed by Bakhtin's dialogical and Moscovici's interactionist perspectives, observations were made of the interaction between two girls, aged 3 1/2 and 4, playing at…

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... except any employees who perform any work in connection with burial insurance operations (see paragraph... described in paragraph (e) below. (b) Burial insurance operations. There is no retail concept applicable to the insurance business (see § 779.317). Burial associations which enter into burial...

  17. 29 CFR 779.369 - Funeral home establishments may qualify as exempt 13(a)(2) establishments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... except any employees who perform any work in connection with burial insurance operations (see paragraph... described in paragraph (e) below. (b) Burial insurance operations. There is no retail concept applicable to the insurance business (see § 779.317). Burial associations which enter into burial...

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... except any employees who perform any work in connection with burial insurance operations (see paragraph... described in paragraph (e) below. (b) Burial insurance operations. There is no retail concept applicable to the insurance business (see § 779.317). Burial associations which enter into burial...

  19. Flexible percutaneous endoscopic retroperitoneal necrosectomy (PEN) as rescue therapy for pancreatic necroses beyond the reach of EUS: A case series.

    PubMed

    Jürgensen, Christian; Brückner, Stefan; Reichel, Stephanie; Kilian, Maik; Pannach, Sven; Distler, Marius; Weitz, Jürgen; Neser, Frank; Hampe, Jochen; Will, Uwe

    2017-01-23

    Minimally invasive or endoscopic transluminal drainage and necrosectomy are the standard of care for infected pancreatic fluid collections and necroses after pancreatitis. In an endoscopic treatment algorithm, necroses beyond the reach of safe endoscopic access are typically treated by percutaneous drainage. We aimed to evaluate percutaneous minimally invasive necrosectomy using a purely endoscopic technique in patients with extensive necrosis. In patients with necroses beyond safe transluminal reach, the percutaneous drainage canal was used for flexible endoscopic access and dilatation of the tract to 20mm. Percutaneous endoscopic necrosectomy (PEN) was performed through this canal. We present a case series of 14 patients in whom between 1 and 4 necrosectomy (median 2) sessions were performed to remove solid necroses successfully in 13 out of 14 patients. There were no major complications apart from one patient with abdominal compartment syndrome secondary to delayed arrosion of the splenic artery. Percutaneous flexible necrosectomy might evolove to an alternative to surgical minimally invasive necrosectomy in anatomic sites beyond transluminal endoscopic reach. This article is protected by copyright. All rights reserved.

  20. Differences in structure and changes in gene regulation of murrel molecular chaperone HSP family during epizootic ulcerative syndrome (EUS) infection.

    PubMed

    Sathyamoorthy, Akila; Chaurasia, Mukesh Kumar; Arasu, Mariadhas Valan; Al-Dhabi, Naif Abdullah; Harikrishnan, Ramasamy; Arockiaraj, Jesu

    2017-01-01

    Heat shock proteins (HSPs) are immunogenic, ubiquitous class of molecular chaperones, which are induced in response to various environmental and microbial stressful conditions. It plays a vital role in maintaining cellular protein homeostasis in eukaryotic cells. In this study, we described a comprehensive comparative data by bioinformatics approach on three different full length cDNA sequences of HSP family at molecular level. The cDNA sequences of three HSPs were identified from constructed cDNA library of Channa striatus and named as CsCPN60, CsHSP60 and CsHSP70. We have conducted various physicochemical study, which showed that CsHSP70 (666 amino acid) possessed a larger polypeptides followed by CsCPN60 (575) and CsCPN60 (542). Three dimensional structural analysis of these HSPs showed maximum residues in α-helices and least in β-sheets; also CsHSP60 lacks β-sheet and formed helix-turn-helix structure. Further analysis indicated that each HSP carried distinct domains and gene specific signature motif, which showed that each HSP are structurally diverse. Homology and phylogenetic study showed that the sequences taken for analysis shared maximum identity with fish HSP family. Tissue specific mRNA expression analysis revealed that all the HSPs showed maximum expression in one of the major immune organ such as CsCPN60 in kidney, CsHSP60 in spleen and CsHSP70 in head kidney. To understand the function of HSPs in murrel immune system, the elevation in mRNA expression level was analyzed against microbial oxidative stressors such as fungal (Aphanomyces invadans) and bacterial (Aeromonas hydrophila). It is interesting to note that all the HSP showed a different expression pattern and reached maximum up-regulation at 48 h post-infection (p.i) during fungal stress, whereas in bacterial stress only CsCPN60 showed maximum up-regulation at 48 h p.i, but CsHSP60 and CsHSP70 showed maximum up-regulation at 24 h p.i. The differential expression pattern showed that each HSP is diverse in function. Overall, the elevation in expression levels showed that HSPs might have potential involvement in murrel immune protection thus, protecting the organism against various external stimuli including environmental and microbial stress.

  1. Endoscopic ultrasound in the diagnosis of mediastinal diseases

    PubMed Central

    Wang, Zhiguo; Jiang, Chunmeng

    2015-01-01

    EUS is a useful tool for diagnosis of mediastinal diseases. EUS-FNA plays an important role in staging of lung cancer and in tissue acquisition in patients with mediastinal masses. In this review, the following issues will be addressed: EUS-FNA and EBUS-TBNA, metastatic mediastinal lymph nodes diagnosed by EUS, EUS in assessment of mediastinal lymph node status for staging of lung cancer, mediastinal lymphoma diagnosed by EUS, sarcoidosis and tuberculosis diagnosed by EUS. PMID:28352755

  2. 25 CFR 15.301 - May I receive funds from the decedent's IIM account for funeral services?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... burial; and (3) The decedent's IIM account contains more than $2,500 on the date of death. (b) You must... approve reasonable costs of no more than $1,000 that are necessary for the burial services, taking...

  3. 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

    ... burial; and (3) The decedent's IIM account contains more than $2,500 on the date of death. (b) You must... approve reasonable costs of no more than $1,000 that are necessary for the burial services, taking...

  4. 25 CFR 15.301 - May I receive funds from the decedent's IIM account for funeral services?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... burial; and (3) The decedent's IIM account contains more than $2,500 on the date of death. (b) You must... approve reasonable costs of no more than $1,000 that are necessary for the burial services, taking...

  5. 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.

  6. Two coffins and a funeral: early or late caspase activation determines two types of apoptosis induced by DNA damaging agents.

    PubMed

    Oropesa-Ávila, Manuel; de la Cruz-Ojeda, Patricia; Porcuna, Jesús; Villanueva-Paz, Marina; Fernández-Vega, Alejandro; de la Mata, Mario; de Lavera, Isabel; Rivero, Juan Miguel Suarez; Luzón-Hidalgo, Raquel; Álvarez-Córdoba, Mónica; Cotán, David; Zaderenko, Ana Paula; Cordero, Mario D; Sánchez-Alcázar, José A

    2017-03-01

    Cell cytoskeleton makes profound changes during apoptosis including the organization of an Apoptotic Microtubule Network (AMN). AMN forms a cortical structure which plays an important role in preserving plasma membrane integrity during apoptosis. Here, we examined the cytoskeleton rearrangements during apoptosis induced by camptothecin (CPT), a topoisomerase I inhibitor, in human H460 and porcine LLCPK-1α cells. Using fixed and living cell imaging, we showed that CPT induced two dose- and cell cycle-dependent types of apoptosis characterized by different cytoskeleton reorganizations, time-dependent caspase activation and final apoptotic cell morphology. In the one referred as "slow" (~h) or round-shaped, apoptosis was characterized by a slow contraction of the actinomyosin ring and late caspase activation. In "slow" apoptosis the γ-tubulin complexes were not disorganized and microtubules were not depolymerized at early stages. In contrast, "fast" (~min) or irregular-shaped apoptosis was characterized by early caspase activation followed by full contraction of the actinomyosin ring. In fast apoptosis γ-tubulin complexes were disorganized and microtubules were initially depolymerized. However, after actinomyosin contraction, microtubules were reformed adopting a cortical but irregular disposition near plasma membrane. In addition to distinctive cytoskeleton reorganization kinetics, round and irregular-shaped apoptosis showed different biological properties with respect to AMN maintenance, plasma membrane integrity and phagocytes response. Our results suggest that the knowledge and modulation of the type of apoptosis promoted by genotoxic agents may be important for deciding a better therapeutic option and predicting the immune response in cancer treatment.

  7. 76 FR 47183 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Extension

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-04

    ... for information collection requirements contained in its Funeral Industry Practice Rule (``Funeral... INFORMATION: Title: Funeral Industry Practices Rule. OMB Control Number: 3084-0025. Type of Review: Extension.... Write ``Funeral Rule Paperwork Comment: FTC File No. P084401'' on your comment, and file your...

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

    PubMed

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

    2012-09-14

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-25

    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.

  11. Endoscopic ultrasound for chronic abdominal pain and gallbladder disease.

    PubMed

    Dill, B; Dill, J E; Berkhouse, L; Palmer, S T

    1999-01-01

    Endoscopic ultrasound (EUS) is a major advance in gastrointestinal endoscopy. EUS, which is invaluable in the diagnosis and staging of gastrointestinal cancer, is now being used in the diagnosis of chronic upper abdominal pain. EUS combined with stimulated biliary drainage (EUS/SBD) aids in the diagnosis of choledocholithiasis, cholecystitis, microlithiasis, and various conditions of the upper gastrointestinal tract. This article describes the EUS/SBD procedure and nursing care. Two case histories illustrating potential benefits to patients are presented.

  12. Applications of endoscopic ultrasound in pancreatic cancer.

    PubMed

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

    2014-06-28

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

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

    PubMed

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

    2016-08-01

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

  14. Complications of endoscopic ultrasonography.

    PubMed

    Fabbri, C; Luigiano, C; Cennamo, V; Ferrara, F; Pellicano, R; Polifemo, A M; Tarantino, I; Barresi, L; Morace, C; Consolo, P; D'Imperio, N

    2011-06-01

    Since its development in the 1980s, endoscopic ultrasonography (EUS) has undergone a great deal of technological modifications. EUS has become an important tool in the evaluation of patients with various clinical disorders and is increasingly being utilized in many centers. EUS has been evolving over the years; EUS-guided fine needle aspiration (FNA) for cytological and/or histological diagnosis has become standard practice and a wide array of interventional and therapeutic procedures are performed under EUS guidance for diseases which otherwise would have needed surgery, with its associated morbidities. EUS shares the risks and complications of other endoscopic procedures. This article addresses the specific adverse effects and risks associated with EUS, EUS-FNA and interventional EUS, namely perforation, bleeding, pancreatitis and infection. Measures to help minimizing these risks will also be discussed.

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  17. Forward-viewing endoscopic ultrasound-guided NOTES interventions: A study on peritoneoscopic potential

    PubMed Central

    Jeong, Seung Uk; Aizan, Hassanuddin; Song, Tae Jun; Seo, Dong Wan; Kim, Su-Hui; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

    2013-01-01

    AIM: To evaluate the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions with a forward-viewing endoscopic ultrasound (FV-EUS). METHODS: This prospective endoscopic experimental study used an animal model. Combined TG peritoneoscopic interventions and EUS examination of the intra-abdominal organs were performed using an FV-EUS on 10 animal models (1 porcine and 9 canine). The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC) for hemostatic control. The animals were kept alive for 7 d, and then necropsy was performed to evaluate results and complications. RESULTS: In all 10 animals, TG peritoneoscopy, followed by endoscopic biopsy for the liver, spleen, abdominal wall, and omentum, was performed successfully. APC helped control minor bleeding. Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease. Intraperitoneal EUS-FNA was successfully performed on the liver, spleen, and kidney. Similarly, a successful outcome was achieved with EUS-RFA of the hepatic parenchyma. No adverse events were recorded during the study. CONCLUSION: Peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures. It promises potential as a platform for future EUS-based NOTES. PMID:24222961

  18. 76 FR 26297 - Agency Information Collection Activities; Proposed Collection; Comment Request; Extension

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-06

    ... collection requirements contained in its Funeral Industry Practice Rule (``Funeral Rule'' or ``Rule''). That... requirements for the Funeral Rule should be addressed to Craig Tregillus, Attorney, Division of Marketing Practices, Bureau of Consumer Protection, Federal Trade Commission, Room H-288, 600 Pennsylvania Ave.,...

  19. 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.

  20. Solid Pseudopapillary Neoplasm of the Pancreas in Young Male Patients: Three Case Reports

    PubMed Central

    Aso, Akira; Nakamura, Kazuhiko; Sudovykh, Irina; Ito, Tetsuhide; Nakamura, Masafumi; Ikeda, Tetsuo; Takizawa, Nobuyoshi; Oda, Yoshinao; Shimizu, Shuji

    2017-01-01

    A preoperative diagnosis of solid pseudopapillary neoplasms (SPNs) in young male patients is difficult to achieve using radiological images. We herein present three cases of young male patients with relatively small SPNs. Endoscopic ultrasound (EUS) showed well-encapsulated, smooth-surfaced, heterogeneous solid lesions in all patients, and all preoperative diagnoses were achieved by EUS-guided fine needle aspiration (EUS-FNA). The final pathological diagnosis after surgery was an SPN with a Ki-67 labeling index of <2%. SPNs should be considered even in young male patients. EUS with EUS-FNA could be a useful diagnostic modality for SPNs even in young male patients. PMID:28255475

  1. 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.

  2. Intrapancreatic Accessory Spleen: A Diagnosis Not to Forget!

    PubMed Central

    Marques, Susana; Bispo, Miguel; Noia, Lariño

    2016-01-01

    A 69-year-old male patient was incidentally diagnosed with a 5-mm lesion in the pancreatic tail by endoscopic ultrasound (EUS). After contrast-enhanced EUS and EUS-elastography, all imaging features were highly suggestive of a benign pancreatic solid lesion such as an intrapancreatic accessory spleen (IPAS) or a benign neuroendocrine tumor. Interposition of the splenic artery precluded EUS-guided fine-needle aspiration (FNA). When an asymptomatic pancreatic mass is detected, IPAS diagnosis should be considered, and, if EUS-FNA is infeasible, contrast-enhanced EUS and EUS-elastography are useful tools to differentiate a pancreatic benign lesion as IPAS from a malignancy, with avoidance of unnecessary surgery. PMID:28100996

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

    PubMed Central

    Saxena, Payal; Lakhtakia, Sundeep

    2015-01-01

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

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

    PubMed

    Segal, Nancy L

    2008-12-01

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

  5. 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…

  6. 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:

  7. 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

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

    PubMed

    Alvarez-Sánchez, María-Victoria; Napoléon, Bertrand

    2014-11-14

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

  9. Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting

    PubMed Central

    Oh, Dongwook; Park, Do Hyun; Song, Tae Jun; Lee, Sang Soo; Seo, Dong-Wan; Lee, Sung Koo; Kim, Myung-Hwan

    2016-01-01

    Background: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with transmural stenting has increased for biliary decompression in patients with an inaccessible papilla, the optimal biliary access point and the learning curve of EUS-HGS have not been studied. We evaluated the optimal biliary access point and learning curve for technically successful EUS-HGS. Methods: 129 consecutive patients (male n = 81, 62.3%; malignant n = 113, 87.6%) who underwent EUS-HGS due to an inaccessible papilla were enrolled. EUS finding and procedure times according to each needle puncture attempt in EUS-HGS were prospectively measured. Learning curves of EUS-HGS were calculated for two main outcome measurements (procedure time and adverse events) by using the moving average method and cumulative sum (CUSUM) analysis, respectively. Results: A total of 174 EUS-HGS attempts were performed in 129 patients. The mean number of needle punctures was 1.35 ± 0.57. Using the logistic regression model, bile duct diameter of the puncture site ⩽ 5 mm [odds ratio (OR) 3.7, 95% confidence interval (CI): 1.71–8.1, p < 0.01] and hepatic portion length [linear distance from the mural wall to the punctured bile duct wall on EUS; mean hepatic portion length was 27 mm (range 10–47 mm)] > 3 cm (OR 5.7, 95% CI: 2.7–12, p < 0.01) were associated with low technical success. Procedure time and adverse events were shorter after 24 cases, and stabilized at 33 cases of EUS-HGS, respectively. Conclusions: Our data suggest that a bile duct diameter > 5 mm and hepatic portion length 1 cm to ⩽ 3 cm on EUS may be suitable for successful EUS-HGS. In our learning curve analysis, over 33 cases might be required to achieve the plateau phase for successful EUS-HGS. PMID:28286558

  10. Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease

    PubMed Central

    Teshima, Christopher W; Sandha, Gurpal S

    2014-01-01

    Endoscopic ultrasound (EUS) is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic diseases. Furthermore, as EUS technology has advanced, it has increasingly become a therapeutic procedure, and the prospect of multiple applications of interventional EUS for the pancreas is truly on the near horizon. However, this review focuses on the established diagnostic and therapeutic roles of EUS that are used in current clinical practice. In particular, the diagnostic evaluation of acute pancreatitis, chronic pancreatitis, cystic pancreatic lesions and solid masses of the pancreas are discussed. The newer enhanced imaging modalities of elastography and contrast enhancement are evaluated in this context. The main therapeutic aspects of pancreatic EUS are then considered, namely celiac plexus block and celiac plexus neurolysis for pain control in chronic pancreatitis and pancreas cancer, and EUS-guided drainage of pancreatic fluid collections. PMID:25110426

  11. 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

  12. Ultrasound contrast agents

    PubMed Central

    Ignee, Andre; Atkinson, Nathan S. S.; Schuessler, Gudrun; Dietrich, Christoph F.

    2016-01-01

    Endoscopic ultrasound (EUS) plays an important role in imaging of the mediastinum and abdominal organs. Since the introduction of US contrast agents (UCA) for transabdominal US, attempts have been made to apply contrast-enhanced US techniques also to EUS. Since 2003, specific contrast-enhanced imaging was possible using EUS. Important studies have been published regarding contrast-enhanced EUS and the characterization of focal pancreatic lesions, lymph nodes, and subepithelial tumors. In this manuscript, we describe the relevant UCA, their application, and specific image acquisition as well as the principles of image tissue characterization using contrast-enhanced EUS. Safety issues, potential future developments, and EUS-specific issues are reviewed. PMID:27824024

  13. The Expanding Role of Contrast-Enhanced Endoscopic Ultrasound in Pancreatobiliary Disease

    PubMed Central

    Choi, Jun-Ho; Seo, Dong Wan

    2015-01-01

    Since its introduction into clinical practice in the 1980s, endoscopic ultrasound (EUS) has been described as a good imaging modality for the diagnosis of pancreatobiliary diseases. However, differential diagnosis of certain lesions based only on B-mode ultrasound images can be challenging. Clinical use of ultrasound contrast agents has expanded the utility of EUS from that of detection to characterization of pancreatobiliary lesions based on the enhancement features of contrast-enhanced EUS (CE-EUS). Current low mechanical index techniques for CE-EUS using second-generation contrast agents have a number of distinct advantages over conventional diagnostic modalities in evaluating pancreatobiliary lesions, including real-time assessment of perfusion pattern, availability, and the absence of exposure to radiation. This article describes the technical aspects of CE-EUS and reviews the expanding indications in pancreatobiliary diseases and further development of this technique. PMID:26503571

  14. Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound.

    PubMed

    Liu, Roy; Adler, Douglas G

    2014-07-01

    Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts. Endoscopic ultrasound (EUS) has been widely used as a modality for the evaluation and diagnosis of duplication cysts. EUS is the diagnostic tool of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. The question of whether or not to perform EUS-fine needle aspiration (EUS-FNA) on a lesion suspected of being a duplication cyst is controversial as these lesions can become infected with significant consequences, although EUS-FNA is often required to obtain a definitive diagnosis and to rule out more ominous lesions. This manuscript will review the literature on duplication cysts throughout the body and will also focus on the role of EUS and FNA with regards to these lesions.

  15. When trainees reach competency in performing endoscopic ultrasound: a systematic review.

    PubMed

    Shahidi, Neal; Ou, George; Lam, Eric; Enns, Robert; Telford, Jennifer

    2017-04-01

    Background/Study aim The American Society for Gastrointestinal Endoscopy (ASGE) recommends that trainees complete 150 endoscopic ultrasound (EUS) procedures before assessing competency. However, this recommendation is largely based on limited evidence and expert opinion. With new evidence suggesting that this historical threshold is underestimating training requirements, we evaluated the learning curve for achieving competency in EUS. Patients/Materials and methods Two investigators independently searched MEDLINE for full-text citations assessing the learning curve for achieving competency in EUS in the period 1946 to 25 March 2016. A learning curve was defined as either a tabulated or graphic representation of competency as a function of increasing EUS experience. Results Eight studies assessing 28 trainees and 7051 EUS procedures were included. When stratifying studies based on procedural indication: three studies assessed competency in evaluating mucosal lesions, three studies assessed competency in EUS fine-needle aspiration (EUS-FNA), and two studies assessed comprehensive competency. Among studies assessing mucosal lesion T-staging accuracy, competency was achieved by 65 to 231 procedures. Among studies assessing EUS-FNA, competency was achieved by 30 to 40 procedures. Among the two studies assessing comprehensive competency in EUS, competency was not achieved in either study across all trainees. Only four of 17 trainees reached competency by 225 to 295 EUS procedures. Conclusion As EUS competency assessment has evolved to more closely reflect independent clinical practice, the number of procedures required to achieve competency has risen well above ASGE recommendations. Advanced endoscopy training programs and specialty societies need to re-assess the structure of EUS training.

  16. When trainees reach competency in performing endoscopic ultrasound: a systematic review

    PubMed Central

    Shahidi, Neal; Ou, George; Lam, Eric; Enns, Robert; Telford, Jennifer

    2017-01-01

    Background/Study aim The American Society for Gastrointestinal Endoscopy (ASGE) recommends that trainees complete 150 endoscopic ultrasound (EUS) procedures before assessing competency. However, this recommendation is largely based on limited evidence and expert opinion. With new evidence suggesting that this historical threshold is underestimating training requirements, we evaluated the learning curve for achieving competency in EUS. Patients/Materials and methods Two investigators independently searched MEDLINE for full-text citations assessing the learning curve for achieving competency in EUS in the period 1946 to 25 March 2016. A learning curve was defined as either a tabulated or graphic representation of competency as a function of increasing EUS experience. Results Eight studies assessing 28 trainees and 7051 EUS procedures were included. When stratifying studies based on procedural indication: three studies assessed competency in evaluating mucosal lesions, three studies assessed competency in EUS fine-needle aspiration (EUS-FNA), and two studies assessed comprehensive competency. Among studies assessing mucosal lesion T-staging accuracy, competency was achieved by 65 to 231 procedures. Among studies assessing EUS-FNA, competency was achieved by 30 to 40 procedures. Among the two studies assessing comprehensive competency in EUS, competency was not achieved in either study across all trainees. Only four of 17 trainees reached competency by 225 to 295 EUS procedures. Conclusion As EUS competency assessment has evolved to more closely reflect independent clinical practice, the number of procedures required to achieve competency has risen well above ASGE recommendations. Advanced endoscopy training programs and specialty societies need to re-assess the structure of EUS training. PMID:28367496

  17. Spinal stimulation of the upper lumbar spinal cord modulates urethral sphincter activity in rats after spinal cord injury.

    PubMed

    Abud, Edsel M; Ichiyama, Ronaldo M; Havton, Leif A; Chang, Huiyi H

    2015-05-01

    After spinal cord injury (SCI), the neurogenic bladder is observed to develop asynchronous bladder and external urethral sphincter (EUS) contractions in a condition known as detrusor-sphincter dyssnergia (DSD). Activation of the EUS spinal controlling center located at the upper lumbar spinal cord may contribute to reduce EUS dyssynergic contractions and decrease urethral resistance during voiding. However, this mechanism has not been well studied. This study aimed at evaluating the effects of epidural stimulation (EpS) over the spinal EUS controlling center (L3) in combination with a serotonergic receptor agonist on EUS relaxation in naive rats and chronic (6-8 wk) T8 SCI rats. Cystometrogram and EUS electromyography (EMG) were obtained before and after the intravenous administration of 5HT-1A receptor agonist and antagonist. The latency, duration, frequency, amplitude, and area under curve of EpS-evoked EUS EMG responses were analyzed. EpS on L3 evoked an inhibition of EUS tonic contraction and an excitation of EUS intermittent bursting/relaxation correlating with urine expulsion in intact rats. Combined with a 5HT-1A receptor agonist, EpS on L3 evoked a similar effect in chronic T8 SCI rats to reduce urethral contraction (resistance). This study examined the effect of facilitating the EUS spinal controlling center to switch between urine storage and voiding phases by using EpS and a serotonergic receptor agonist. This novel approach of applying EpS on the EUS controlling center modulates EUS contraction and relaxation as well as reduces urethral resistance during voiding in chronic SCI rats with DSD.

  18. 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

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

    PubMed Central

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

    2016-01-01

    Abstract 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

  20. 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

  1. Current Status of Interventional Endoscopic Ultrasound.

    PubMed

    Ryozawa, Shomei; Fujita, Naotaka; Irisawa, Atsushi; Hirooka, Yoshiki; Mine, Tetsuya

    2017-03-20

    Endoscopic ultrasound (EUS) is being used increasingly in the management of pancreatic fluid collection, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of the gallbladder, and other conditions. The role of interventional EUS is rapidly expanding and new interventions are continuously emerging. The development of devices could be a major breakthrough in the field of interventional EUS. New devices would enable the expansion of its role even further and prompt its widespread use in clinical practice. This review focuses on the current status of interventional EUS, especially highlighting the topics that are drawing endoscopists' interest at present. This article is protected by copyright. All rights reserved.

  2. Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Clinical Assessment of Pancreatic Neoplasms.

    PubMed

    Varadarajulu, Shyam; Bang, Ji Young

    2016-04-01

    Accurate diagnosis and staging of pancreatic neoplasms is essential for surgical planning and identification of locally advanced and metastatic disease that is incurable by surgery. The ability to position the endoscopic ultrasonography (EUS) transducer close to the pancreas combined with the use of fine-needle aspiration enables the accurate diagnosis of pancreatic cysts and solid masses. EUS is also increasingly being used to procure core tissue for molecular analysis that facilitates personalized treatment of pancreatic cancer. Various therapeutic interventions can be undertaken under EUS guidance. This article focuses on the applications of EUS and endoscopic retrograde cholangiopancreatography in pancreatic neoplasms.

  3. 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

  4. Endoscopic ultrasound in pancreatic cancer: innovative applications beyond the basics

    PubMed Central

    Yoo, Joseph; Kistler, C. Andrew; Yan, Linda; Dargan, Andrew

    2016-01-01

    Endoscopic ultrasound (EUS) has become a mainstay in assisting in the diagnosis and staging of pancreatic cancer. In addition, EUS provides a modality to treat chronic pain through celiac plexus neurolysis. Currently, there is growing data and utilization of EUS in more diverse and innovative applications aimed at providing more sophisticated diagnostic, prognostic and therapeutic options for patients with pancreatic cancer. EUS delivery of chemotherapy, viral and biological vectors and fiducial markers may eventually revolutionize the way clinicians approach the care of a patient with pancreatic cancer. PMID:28078128

  5. 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

  6. Science With The Extreme Ultraviolet Spectrometer For Solar Orbiter

    NASA Astrophysics Data System (ADS)

    Young, P. R.; EUS Science Working Group

    2007-01-01

    The CCLRC Rutherford Appleton Laboratory (UK) is leading a consortium that proposes to build an ultraviolet spectrometer for Solar Orbiter provisionally called the Extreme Ultraviolet Spectrometer (EUS). The selection of wavelength bands for EUS has been re-assessed by the EUS Science Working Group in recent months and the final decision calls for three wavelength bands covering 700-800 Å, 970-1040 Å, and 1163-1265 Å. The key features of these bands are summarised here, and particular science topics that can be addressed by EUS are discussed.

  7. 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

  8. Endoscopic Ultrasound-Guided Oncologic Therapy for Pancreatic Cancer

    PubMed Central

    Suzuki, Rei; Irisawa, Atsushi; Bhutani, Manoop S.

    2013-01-01

    Since the development of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the early 1990s, its application has been extended to various diseases. For pancreatic cancer, EUS-FNA can obtain specimens from the tumor itself with fewer complications than other methods. Interventional EUS enables various therapeutic options: local ablation, brachytherapy, placement of fiducial markers for radiotherapy, and direct injection of antitumor agents into cancer. This paper will focus on EUS-guided oncologic therapy for pancreatic cancer. PMID:23533319

  9. 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

  10. Basic technique in endoscopic ultrasound-guided fine needle aspiration for solid lesions: What needle is the best?

    PubMed Central

    Lachter, Jesse

    2014-01-01

    Basic technique for endoscopic ultrasound (EUS) of solid lesions has developed during 30 years of EUS, as endoscopes and accessory equipment, particularly needles, have been developed. Systematic high-quality examinations require understanding and planning. Needles used for EUS-guided fine needle aspiration (FNA) have gone through many improvements; some 18 characteristics of any needle are presented and these come under consideration whenever choosing the best needle for each procedure. The bright future of EUS and FNA for solid lesions currently still leaves much room for continued developments. PMID:24949410

  11. Training in endoscopic ultrasonography: An Asian perspective.

    PubMed

    Wong, Jennie Y Y; Kongkam, Pradermchai; Ho, Khek Yu

    2017-01-09

    Training of endoscopic ultrasonography (EUS) in Asia faces two major challenges: (i) the ever-increasing demand for skills to handle a growing range of interventional EUS procedures; and (ii) a continual shortage of EUS training programs. As the therapeutic application of EUS continues to expand, the need to train more new endosonographers and upgrade skills of existing ones has become more critical than ever before. A formal fellowship to acquire EUS knowledge and skills in an advanced endoscopy center has always been perceived as the best way of training novices, but such opportunities remain limited in most Asian countries. To keep up with the pace of development in EUS, more short-term EUS programs have been conducted across Asia in recent years. Such programs are generally intensive and may combine didactic lectures, live-case demonstrations, and hands-on training on phantoms, or live animal models for teaching. Although not as rigorous as conventional full-time EUS fellowships, such short-term programs are not necessarily inferior in quality. With courses offered from basic to advanced levels, and at regular intervals, busy practising endoscopists have the flexibility to attend the course that best matches their individual levels of experience, learn at their own pace and acquire EUS knowledge and skills over as many courses as desired. This open-ended progressive learning model is more agile than established fixed-term learning models and is expected to adapt better to future needs.

  12. The impact of endoscopic ultrasound findings on clinical decision making in Barrett's esophagus with high-grade dysplasia or early esophageal adenocarcinoma.

    PubMed

    Bulsiewicz, W J; Dellon, E S; Rogers, A J; Pasricha, S; Madanick, R D; Grimm, I S; Shaheen, N J

    2014-07-01

    The clinical utility of endoscopic ultrasound (EUS) for staging patients with Barrett's esophagus and high-grade dysplasia (HGD) or intramucosal carcinoma (IMC) prior to endoscopic therapy is unclear. We performed a retrospective analysis of patients with HGD or IMC referred to an American medical center for endoscopic treatment between 2004 and 2010. All patients had pretreatment staging by EUS. We examined the frequency that EUS findings consistent with advanced disease (tumor invasion into the submucosa, lymph node involvement, or regional metastasis) led to a change in management. The analysis was stratified by nodularity and pre-EUS histology. We identified one hundred thirty-five patients with HGD (n = 106, 79%) or IMC (n = 29, 21%) had staging by EUS (79 non-nodular, 56 nodular). Pathologic lymph nodes or metastases were not found by EUS. There were no endosonographic abnormalities noted in any patient with non-nodular mucosa (0/79). Abnormal EUS findings were present in 8/56 patients (14%) with nodular neoplasia (five IMC, three HGD). Endoscopic mucosal resection was performed in 44 patients with a nodule, with 13% (6/44) having invasive cancer. In nodular neoplasia, the EUS and endoscopic mucosal resection were abnormal in 24% (5/21) and 40% (6/15) of those with IMC and 9% (3/35) and 0% (0/29) of those with HGD, respectively. In this study we found that EUS did not alter management in patients with non-nodular HGD or IMC. Because the diagnostic utility of EUS in subjects with non-nodular Barrett's esophagus is low, the value of performing endoscopic mucosal resection in this setting is questionable. For patients with nodular neoplasia, resection of the nodule with histological examination had greater utility than staging by EUS.

  13. 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)

  14. A Generic Clarifying Function of Philosophy of Education.

    ERIC Educational Resources Information Center

    Sutton, Kenneth R.; Kofoid, Charles M.

    If there is to be a funeral for philosophy of education because of the conflict regarding its nature and functions, it will be a political funeral rather than a functional one. Diversity in philosophies suggests their generic function, which is a potent factor in the preparation and professional improvement of a teacher. A consideration of…

  15. 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)

  16. 26 CFR 31.3121(b)(8)-1 - Services performed by a minister of a church or a member of a religious order.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... old-age, survivors, and disability insurance system established by title II of the Social Security Act... although from time to time he performs marriages and conducts funerals for relatives and friends. N..., service performed by M in performing marriages and conducting funerals is in the exercise of his...

  17. 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

    ... 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, interment... transportation of the body to the place of burial in addition to the burial and plot or interment allowance...

  18. 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

    ... 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, interment... transportation of the body to the place of burial in addition to the burial and plot or interment allowance...

  19. Endoscopic ultrasound-guided celiac plexus block and neurolysis.

    PubMed

    Yasuda, Ichiro; Wang, Hsiu-Po

    2017-02-03

    Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is widely used for reducing pain originating from upper abdominal organs. It is mainly indicated to treat pancreatic cancer pain, but also to relieve pain as a result of chronic pancreatitis. Real-time guidance and color Doppler imaging by EUS made the procedure easier and safer, resulting in greater pain relief. Currently, two techniques are used for EUS-CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the celiac axis. In the bilateral technique, the neurolytic agent is injected on both sides of the celiac axis. In addition, EUS-guided direct celiac ganglia neurolysis (EUS-CGN) was introduced recently. Pain relief is achieved by EUS-CPN in 70-80% of patients with pancreatic cancer and in 50-60% of those with chronic pancreatitis. The bilateral technique may be more efficient than the central technique, although the central technique is easier and possibly safer. Moreover, EUS-CGN may provide greater pain relief than conventional EUS-CPN. Procedure-related complications include transient pain exacerbation, transient hypotension, transient diarrhea, and inebriation. Although most complications are not serious, major adverse events such as retroperitoneal bleeding, abscess, and ischemic complications occasionally occur.

  20. Diagnostic Value of Endoscopic Ultrasonography in Symptomatic Patients with High and Intermediate Probabilities of Common Bile Duct Stones and a Negative Computed Tomography Scan

    PubMed Central

    Jeon, Tae Joo; Cho, Jae Hee; Kim, Yeon Suk; Song, Si Young; Park, Ji Young

    2017-01-01

    Background/Aims When computed tomography (CT) does not indicate choledocholithiasis in highly suspicious patients, there is no definite consensus on the subsequent modality. Endoscopic ultrasonography (EUS) indicates fewer procedure-related complications than endoscopic retrograde cholangiopancreatography (ERCP) and has a lower cost than magnetic resonance cholangiopancreatography. Therefore, we aimed to investigate the diagnostic value of EUS in patients with suspected choledocholithiasis and negative CT findings. Methods Between March 2008 and November 2014, we retrospectively evaluated 200 patients with negative CT findings and high or intermediate probabilities of choledocholithiasis. All patients initially underwent EUS followed by ERCP as a confirmatory criterion standard. The primary outcome in these patients was the accuracy of EUS in the detection of choledocholithiasis. The secondary outcome was the clinical prediction of common bile duct (CBD) stones in this group. Results EUS indicated choledocholithiasis in 165 of the 200 patients, and ERCP confirmed choledocholithiasis in 161 patients (80.5%). The accuracy of EUS in the detection of choledocholithiasis was 94.0% (sensitivity, 97.5%; specificity, 79.5%; positive predictive value, 95.2%; negative predictive value, 88.6%). A multivariate analysis demonstrated that choledocholithiasis was strongly predicted by EUS detection of choledocholithiasis, an age >55 years and a clinical diagnosis of cholangitis. Conclusions An EUS-first approach is recommended for patients with suspected CBD stones and negative CT findings. PMID:27965473

  1. Role of endoscopic ultrasonography in the diagnosis of acute and chronic pancreatitis.

    PubMed

    Stevens, Tyler

    2013-10-01

    Endoscopic ultrasonography (EUS) can be a useful tool for detecting underlying causes of acute pancreatitis and establishing the severity of fibrosis in chronic pancreatitis. Ancillary techniques include fine needle aspiration and core biopsy, bile collection for crystal analysis, pancreatic function testing, and celiac plexus block. This review focuses on the role of EUS in the diagnosis of acute and chronic pancreatitis.

  2. Safety and Utility of Single-Session Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography for the Evaluation of Pancreatobiliary Diseases

    PubMed Central

    Kawakubo, Kazumichi; Kuwatani, Masaki; Haba, Shin; Kudo, Taiki; Abe, Yoko; Kawahata, Shuhei; Onodera, Manabu; Ehira, Nobuyuki; Yamato, Hiroaki; Eto, Kazunori; Sakamoto, Naoya

    2014-01-01

    Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis, which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate. PMID:24827632

  3. 78 FR 52929 - Scientific Information Request on Imaging Tests for the Diagnosis and Staging of Pancreatic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-27

    ..., PET-CT, MRI) for diagnosis of pancreatic adenocarcinoma in adults with suspicious symptoms? a. What is... effectiveness of imaging techniques (e.g., MDCT angiography 3D reconstruction, other MDCT, EUS-FNA, PET-CT, MRI..., EUS-FNA, PET- CT, MRI) when used to diagnose and/or stage pancreatic adenocarcinoma? a. How...

  4. 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

  5. Pediatric emergency medicine fellow training in ultrasound: consensus educational guidelines.

    PubMed

    Vieira, Rebecca L; Hsu, Deborah; Nagler, Joshua; Chen, Lei; Gallagher, Rachel; Levy, Jason A

    2013-03-01

    The importance of point-of-care emergency ultrasound (EUS) to the practice of emergency medicine (EM) is well established, and mounting research continues to demonstrate how EUS can benefit pediatric emergency department (ED) patients. As members of the EM community, pediatric EM (PEM) physicians should understand the potential value of EUS and seek opportunities to incorporate EUS into their daily practice. Currently, EUS education and training is at an early developmental stage for PEM fellows and varies greatly between programs. The goal of this article is to provide consensus education guidelines and to describe a sample curriculum that can be used by PEM fellowship programs when developing or revising their US training curricula. The authors recognize that programs may be at different stages of EUS development and will consequently need to tailor curricula to individual institutional needs and capabilities. This guideline was developed through a collaborative process between EUS educators and members of the American Academy of Pediatrics Section of EM Fellowship Directors Subcommittee. The guideline includes the following topics: important considerations regarding EUS in PEM, PEM US program framework, PEM US curriculum, PEM US education program, and competency assessment.

  6. Therapeutic endoscopic ultrasound

    PubMed Central

    Venkatachalapathy, Suresh; Nayar, Manu K

    2017-01-01

    Endoscopic ultrasound (EUS) is now firmly established as one of the essential tools for diagnosis in most gastrointestinal MDTs across the UK. However, the ability to provide therapy with EUS has resulted in a significant impact on the management of the patients. These include drainage of peripancreatic collections, EUS-guided endoscopic retrograde cholangiopancreatogram, EUS-guided coeliac plexus blocks, etc. The rapid development of this area in endoscopy is a combination of newer tools and increasing expertise by endosonographers to push the boundaries of intervention with EUS. However, the indications are limited and we are at the start of the learning curve for these high-risk procedures. These therapies should, therefore, be confined to centres with a robust multidisciplinary team, including interventional endoscopists, radiologists and surgeons. PMID:28261439

  7. 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.

  8. 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

  9. 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

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

    PubMed

    LaPallo, Brandon K; Wolpaw, Jonathan R; Chen, Xiang Yang; Carp, Jonathan S

    2014-08-15

    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.

  11. 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

  12. 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.

  13. Impact of endoscopic ultrasonography and physician specialty on the management of patients with esophagus cancer.

    PubMed

    Gines, A; Cassivi, S D; Martenson, J A; Schleck, C; Deschamps, C; Sinicrope, F A; Alberts, S R; Murray, J A; Zinsmeister, Alan R; Vazquez-Sequeiros, Enrique; Nichols, F C; Miller, R C; Quevedo, J F; Allen, M S; Alexander, J A; Zais, T; Haddock, M G; Romero, Y

    2008-01-01

    While endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are the most accurate techniques for locoregional staging of esophageal cancer, little evidence exists that these innovations impact on clinical care. The objective on this study was to determine the frequency with which EUS and EUS-FNA alter the management of patients with localized esophageal cancer, and assess practice variation among specialists at a tertiary care center. Three gastroenterologists, three medical oncologists, three radiation oncologists and four thoracic surgeons were asked to independently report their management recommendations as the anonymized staging information of 50 prospectively enrolled patients from another study were sequentially disclosed on-line. Compared to initial management recommendations, that were based upon history, physical examination, upper endoscopy and CT scan results, EUS prompted a change in management 24% (95% CI: 12-36%) of the time; usually to a more resource-intensive approach (71%), for example from recommending palliation to recommending neoadjuvant chemoradiation therapy. EUS-FNA plus cytology results altered management an additional 8% (95% CI: 6-15%) of the time. Agreement between specialists ranged from fair (intraclass correlation [ICC=0.32) to substantial (ICC=0.65); improving with additional information. Among specialists, agreement was greatest for patients with stage I disease. EUS and EUS-FNA changed patient management the most for patients with stages IIA, IIB or III disease. EUS, with or without FNA, significantly impacts the management of patients with localized esophageal cancer. With respect to the optimal treatment for each patient, agreement among physicians incrementally increases with endoscopic ultrasound results. Specialty training appears to influence therapeutic decision-making behavior.

  14. 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

  15. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction

    PubMed Central

    Khashab, Mouen A.; Bukhari, Majidah; Baron, Todd H.; Nieto, Jose; El Zein, Mohamad; Chen, Yen-I; Chavez, Yamile Haito; Ngamruengphong, Saowanee; Alawad, Ahmad S.; Kumbhari, Vivek; Itoi, Takao

    2017-01-01

    Background and study aims EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers long-lasting luminal patency without the risk of tumor ingrowth/overgrowth. This study compared the clinical success, technical success, adverse events (AEs), length of hospital stay (LOHS) and symptom recurrence in EUS-GE versus SGJ. Methods This was a multicenter international retrospective comparative study of EUS-GE and SGJ in patients with malignant gastric outlet obstruction (GOO) who underwent either EUS-GE or SGJ. EUS-GE was performed using lumen apposing metal stents. Results A total of 93 patients with malignant GOO treated with either EUS-GE (n = 30) or SGJ (n = 63) were identified. Peritoneal carcinomatosis was present in 13 (43 %) patients in the EUS-GE group and 7 (11 %) patients in the SGJ group (P < 0.001). Although the technical success rate was significantly higher in the SGJ group as compared to the EUS-GE group (100 % vs. 87 %, P = 0.009), the clinical success rate was not different (90 % vs. 87 %, P = 0.18, OR 0.8, 95 %CI 0.44 – 7.07). The rate of AEs was lower in the EUS-GE group, but the difference was not statistically significant (16 % vs 25 %, P = 0.3). The mean LOHS was similar in the EUS-GE group compared to SGJ (P = 0.35). The rate of recurrent GOO was not different between the two groups (3 % vs. 14 %, P = 0.08). Similarly, the mean time to reintervention was similar (88 days vs. 121 days, P = 0.83). Conclusions EUS-GE is associated with equivalent efficacy and safety as compared to surgical GJ. This is the first comparative trial between both techniques and suggests EUS-GE as a non-inferior but less invasive alter to surgery. PMID:28382326

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

    PubMed Central

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

    2016-01-01

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

  17. 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.

  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. Efficacy and safety of endoscopic ultrasonography-guided interventional treatment for refractory malignant left-sided liver tumors: a case series of 26 patients

    PubMed Central

    Jiang, Tian-an; Deng, Zhuang; Tian, Guo; Zhao, Qi-yu; Wang, Wei-lin

    2016-01-01

    This study aimed to compare the efficacy and safety of EUS-guided ethanol injection and 125I seed brachytherapy for malignant left-sided liver tumors which were difficult for trans-abdominal intervention. The study protocol was registered at Clinicaltrials.gov (NCT02816944). Twenty-six patients were consecutively and prospectively hospitalized for EUS-guided interventional treatment of refractory malignant left-sided liver tumors between June 2014 and June 2016. Liver masses were detected using EUS in 25 of 26 (96.2%) patients. EUS-guided interventional treatment was completed uneventfully in 23 of 26 (88.5%) patients using anhydrous ethanol injection (n = 10) or iodine-125 seed implantation (n = 13). Six months later, complete response was achieved in 15 of 23 (65.2%) patients and partial response in 8 of 23 (34.8%) patients. Patients with tumor residual have second-look EUS-guided interventional treatment (n = 5), radiotherapy (n = 2) or surgical resection (n = 1). Complete response was achieved after repeated interventional treatment in 3 of 5 patients who underwent second EUS-guided intervention; 2 patients required additional surgical resection but one succeed. No significant complications occurred. Therefore EUS-guided 125I seed brachytherapy is an effective and safe treatment modality for radical operation or promising palliative control of malignant left-sided liver tumors refractory to trans-abdominal intervention. PMID:27958384

  20. Role of contrast-enhanced harmonic endoscopic ultrasound in submucosal tumors

    PubMed Central

    Alvarez-Sanchez, Maria Victoria; Gincul, Rodica; Lefort, Christine; Napoleon, Bertrand

    2016-01-01

    With the widespread use of endoscopy, gastrointestinal submucosal lesions are now more commonly discovered. Although endoscopic ultrasound (EUS) is superior to all other imaging techniques for the diagnosis of submucosal tumors (SMTs), it is still suboptimal for differentiating hypoechoic lesions arising from the fourth sonographic gastrointestinal wall layer, which encompass tumors with very different prognosis. EUS tissue acquisition has provided with the unique opportunity to obtain histological confirmation, but it is not accurate enough to evaluate the malignant potential of gastrointestinal stromal tumors (GISTs). In the last years, contrast-enhanced harmonic EUS (CH-EUS) emerged as a powerful imaging modality to assess the microperfusion patterns of pancreatic tumors. Based on the distinct microvascularity of malignant SMTs, it was hypothesized that CH-EUS might also assist in the differential diagnosis of SMTs. Preliminary experience in this field is now available and suggests CH-EUS as a performant modality to distinguish between benign SMTs and GISTs and to evaluate the malignant potential of GISTs. High expectations are also relied on CH-EUS for the monitoring of antiangiogenic treatments of GISTs and the evaluation of gastrointestinal neuroendocrine tumors (NETs). PMID:28000626

  1. Role of contrast-enhanced harmonic endoscopic ultrasound in submucosal tumors.

    PubMed

    Alvarez-Sanchez, Maria Victoria; Gincul, Rodica; Lefort, Christine; Napoleon, Bertrand

    2016-01-01

    With the widespread use of endoscopy, gastrointestinal submucosal lesions are now more commonly discovered. Although endoscopic ultrasound (EUS) is superior to all other imaging techniques for the diagnosis of submucosal tumors (SMTs), it is still suboptimal for differentiating hypoechoic lesions arising from the fourth sonographic gastrointestinal wall layer, which encompass tumors with very different prognosis. EUS tissue acquisition has provided with the unique opportunity to obtain histological confirmation, but it is not accurate enough to evaluate the malignant potential of gastrointestinal stromal tumors (GISTs). In the last years, contrast-enhanced harmonic EUS (CH-EUS) emerged as a powerful imaging modality to assess the microperfusion patterns of pancreatic tumors. Based on the distinct microvascularity of malignant SMTs, it was hypothesized that CH-EUS might also assist in the differential diagnosis of SMTs. Preliminary experience in this field is now available and suggests CH-EUS as a performant modality to distinguish between benign SMTs and GISTs and to evaluate the malignant potential of GISTs. High expectations are also relied on CH-EUS for the monitoring of antiangiogenic treatments of GISTs and the evaluation of gastrointestinal neuroendocrine tumors (NETs).

  2. Performance and Clinical Role of Endoscopic Ultrasound Fine Needle Aspiration for Diagnosing Gastrointestinal Intramural Lesions

    PubMed Central

    Sung, Hea Jung; Park, Eun Young; Moon, Sung Jin; Lim, Chul Hyun; Kim, Jin Su; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Myung-Gyu; Choi, Kyu Yong

    2013-01-01

    Background/Aims We evaluated the performance, clinical role, and diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in gastrointestinal intramural lesions. Methods Procedural and pathologic data were reviewed from consecutive patients undergoing EUS-FNA for intramural lesions. Final diagnoses were determined by surgical histopathologic conformation and the diagnosis of malignancy, including clinical follow-up with repeat imaging. Results Forty-six patients (mean age, 47 years; 24 males) underwent EUS-FNA. Lesions were located in the stomach (n=31), esophagus (n=5), and duodenum (n=10). The median lesion size was 2 cm (range, 1 to 20.6). Final diagnoses were obtained in 22 patients (48%). EUS-FNA was diagnostic in 40 patients (87%). The diagnostic accuracy of cytology for differentiating between benign and malignant lesions was 82%; diagnostic error occurred in three patients (6%). The cytologic results influenced clinical judgment in 78% cases. The primary reasons for negative or no clinical impact were false-negative results, misdirected patient management, and inconclusive cytology. Conclusions EUS-FNA exhibited an 87% diagnostic yield for gastrointestinal intramural lesions; the accuracy of cytology for differentiating malignancy was 82%. The limitations of EUS-FNA were primarily because of nondiagnostic sampling (9%) and probable diagnostic error (6%); these factors may influence the clinical role of EUS-FNA. PMID:24340255

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

    PubMed Central

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

    2014-01-01

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

  4. 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

  5. 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.

  6. 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

  7. Endoscopic Ultrasound Guided Rendezvous Drainage of Biliary Obstruction Using a New Flexible 19-Gauge Fine Needle Aspiration Needle

    PubMed Central

    Tang, Zhouwen; Igbinomwanhia, Efehi; Elhanafi, Sherif

    2016-01-01

    Background and Aim. A successful endoscopic ultrasound guided rendezvous (EUS-RV) biliary drainage is dependent on accurate puncture of the bile duct and precise guide wire manipulation across the ampulla of Vater. We aim to study the feasibility of using a flexible 19-gauge fine aspiration needle in the performance of EUS-RV biliary drainage. Method. This is a retrospective case series of EUS-RV biliary drainage procedures at a single center. Patients who failed ERCP during the same session for benign or malignant biliary obstruction underwent EUS-RV using a flexible, nitinol covered, 19-gauge needle for biliary access and guide wire manipulation. Result. 24 patients underwent EUS-RV biliary drainage via extrahepatic access while 1 attempt was via intrahepatic access. The technical success rate was 80%, including 83.3% of cases via extrahepatic access. There was no significant difference in success rate of inpatient and outpatient procedures, benign or malignant indications, or type of guide wire used. Adverse events included mild pancreatitis (3 patients) and cholangitis (1 patient). Conclusion. A flexible 19-gauge needle for biliary access can be safe and effective when used to perform EUS-RV biliary drainage. Direct comparison between the nitinol needle and conventional metal needles in the performance of EUS guided biliary drainage is needed. PMID:27822005

  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.

  9. 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

  10. Can contrast-enhanced harmonic endosonography predict malignancy risk in gastrointestinal subepithelial tumors?

    PubMed Central

    Park, Hye Yoon; Jeon, Seong Woo; Lee, Hyun Seok; Cho, Chang Min; Bae, Han Ik; Seo, An Na; Kweon, Oh Kyung

    2016-01-01

    Background and Objectives: Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) is a novel technology that can identify subepithelial tumors (SETs) by detecting the degree of enhancement, but whether CEH-EUS can predict the malignancy risk of gastrointestinal stromal tumors (GISTs) remains unclear. The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS and its ability to discriminate among SETs and predict the malignancy risk of GISTs. Materials and Methods: We retrospectively included patients with suspected subepithelial lesions who underwent CEH-EUS preoperatively. Thirty-five patients with histologically proven GISTs and benign neoplasms were enrolled in the study. The images of CEH-EUS were categorized in accordance with microvasculature, parenchymal perfusion, and nonenhancing spots. The diagnostic performance of CEH-EUS was evaluated by comparing these findings with the histological diagnosis. Results: When we divided the enrolled patients into high- and low-grade malignancy and benign groups, nonenhancing spots on CEH-EUS were found more frequently in the high-grade malignancy group (63.6%), followed by the low-grade malignancy (46.7%) and benign groups (25.7%) (P = 0.022). However, based on the statistical validity of the CEH-EUS findings for the discrimination of SETs, the sensitivity was 53.8% for diagnostic performance and 63.6% for prediction of malignancy risk of GISTs. Conclusions: From our study results, it is unclear whether CEH-EUS alone has a diagnostic role in the discrimination of SETs and the prediction of malignancy risk of GISTs. Further studies with larger samples from multiple centers and use of other imaging analysis modalities are needed. PMID:28000630

  11. 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

  12. Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable?

    PubMed

    Campbell, Jennifer Anne; Irvine, Andrew James; Hopper, Andrew Derek

    2017-01-21

    There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability. We sought to prospectively determine the tolerability and safety of EUS with benzodiazepine and opiate sedation in single United Kingdom centre. Two hundred consecutive patients undergoing either EUS or oesophago-gastroduodenoscopy (OGD) with conscious sedation were prospectively recruited with a 1:1 enrolment ratio. Patients completed questionnaires pre and post procedure detailing anticipated and actual pain experienced on a 1-10 visual analogue scale. Demographics, procedure duration, sedation doses and willingness to repeat the procedure were also recorded. EUS procedures lasted significantly longer than OGDs (15 min vs 6 min, P < 0.0001), however, there was no difference in anticipated pain scores between the groups (EUS 3.37/10 vs OGD 3.47/10, P = 0.46). Pain scores indicated EUS was better tolerated than OGD (1.16/10 vs 1.88/10, P = 0.03) although higher doses of sedation were used for EUS procedures. There were no complications identified in either group. We feel our study demonstrates that the tolerability of EUS with opiate and benzodiazepine sedation is acceptable.

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

    SciTech Connect

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

    2011-10-01

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

  14. 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

  15. Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable?

    PubMed Central

    Campbell, Jennifer Anne; Irvine, Andrew James; Hopper, Andrew Derek

    2017-01-01

    There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability. We sought to prospectively determine the tolerability and safety of EUS with benzodiazepine and opiate sedation in single United Kingdom centre. Two hundred consecutive patients undergoing either EUS or oesophago-gastroduodenoscopy (OGD) with conscious sedation were prospectively recruited with a 1:1 enrolment ratio. Patients completed questionnaires pre and post procedure detailing anticipated and actual pain experienced on a 1-10 visual analogue scale. Demographics, procedure duration, sedation doses and willingness to repeat the procedure were also recorded. EUS procedures lasted significantly longer than OGDs (15 min vs 6 min, P < 0.0001), however, there was no difference in anticipated pain scores between the groups (EUS 3.37/10 vs OGD 3.47/10, P = 0.46). Pain scores indicated EUS was better tolerated than OGD (1.16/10 vs 1.88/10, P = 0.03) although higher doses of sedation were used for EUS procedures. There were no complications identified in either group. We feel our study demonstrates that the tolerability of EUS with opiate and benzodiazepine sedation is acceptable. PMID:28210094

  16. 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

  17. 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.

  18. Applications of contrast-enhanced harmonic endoscopic ultrasound on biliary, focal liver lesions and vascular diseases

    PubMed Central

    Choi, Jun-Ho; Seo, Dong-Wan

    2017-01-01

    Over the last decade, the clinical applications of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) have increased steadily. The development of second-generation ultrasound contrast agents has allowed superior visualization of the microvasculature and tissue perfusion of the target lesion. This methodology has proven useful in the differential diagnosis of solid pancreatic masses and lymph nodes. In addition, the applicability of CH-EUS has expanded to nonpancreas structures such as biliary, focal liver lesions, and vascular disease. This article focuses primarily on the novel applications of CH-EUS in biliary tract and visceral vascular diseases. PMID:28218196

  19. Albertina Sisulu 1918-2011 Nurse and South African anti-apartheid activist.

    PubMed

    Earl, Geoff

    2011-07-13

    Albertina Sisulu, nurse and political activist, has died at the age of 92. In a message read to mourners at her state funeral, former president Nelson Mandela paid tribute to her as 'one of the greatest South Africans'.

  20. 41 CFR 102-33.165 - What standards must we establish or require (contractually, where applicable) for operation of...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... family with information about rights and services, such as crisis intervention, counseling and emotional... costs, mental health counseling, funeral and burial costs, and lost wages or loss of support. The...

  1. 48 CFR 837.7004 - Administrative necessity.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... (a) VA may make arrangements and assume expenses for local burial under separate contractual... funeral and burial service as prescribed in 837.7003 within the statutory allowance, before taking...

  2. 48 CFR 837.7004 - Administrative necessity.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    .... (a) VA may make arrangements and assume expenses for local burial under separate contractual... funeral and burial service as prescribed in 837.7003 within the statutory allowance, before taking...

  3. 48 CFR 837.7004 - Administrative necessity.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... (a) VA may make arrangements and assume expenses for local burial under separate contractual... funeral and burial service as prescribed in 837.7003 within the statutory allowance, before taking...

  4. 48 CFR 837.7004 - Administrative necessity.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... (a) VA may make arrangements and assume expenses for local burial under separate contractual... funeral and burial service as prescribed in 837.7003 within the statutory allowance, before taking...

  5. 48 CFR 837.7004 - Administrative necessity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    .... (a) VA may make arrangements and assume expenses for local burial under separate contractual... funeral and burial service as prescribed in 837.7003 within the statutory allowance, before taking...

  6. 20 CFR 1002.150 - Which non-seniority rights and benefits is the employee entitled to during a period of service?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  8. 75 FR 8740 - Notice of Intent to Repatriate a Cultural Item: Peabody Museum of Archaeology and Ethnology...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-25

    ... funeral rite. The Peabody Museum is not in possession of the human remains. Museum documentation describes... as part of the death rite or ceremony and is believed, by a preponderance of the evidence, to...

  9. 20 CFR 234.15 - When an employee's estate is entitled.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... funeral home by the employee before death; (3) Money paid by the employee under a contract, plan, system or general practice where no beneficiary was named to receive the money; (4) Money found among...

  10. 78 FR 77710 - National Register of Historic Places; Notification of Pending Nominations and Related Actions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-24

    ... Wyandotte County Simmons Funeral Home, 1404 S. 37th St., Kansas City, 13001046 Kentucky Boyle County Goodall Building, (Boyle MPS) 470 Stanford Rd., Danville, 13001047 Fayette County Southeast Greyhound Line...

  11. 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...

  12. Veterans Benefits: Burial Benefits and National Cemeteries

    DTIC Science & Technology

    2010-10-18

    approved by the Secretary of Veterans Affairs.15 The VA does not provide cremation or funeral arrangement services, which must be made through private...funeral providers or cremation offices. The Department of Defense under the National Defense Authorization Act for FY2000 (P.L. 106-65) does provide...active duty whose remains are not recovered or are unidentified, have remains buried at sea, have remains donated to science, or whose cremated remains

  13. Veterans Benefits: Burial Benefits and National Cemeteries

    DTIC Science & Technology

    2010-08-30

    persons seeking interment in a national cemetery must be approved by the Secretary of Veterans Affairs.13 The VA does not provide cremation or funeral...arrangement services, which must be made through private funeral providers or cremation offices. The Department of Defense under the National Defense... cremated remains have been scattered. Spouses and dependents whose remains are unavailable for interment may also be furnished with memorial

  14. Career Planning: Individual and Organizational Perspectives.

    DTIC Science & Technology

    1981-07-01

    world that justifies and vindicates itself. Becker’s (1951) jazz musicians come to respect only the judgments, tastes, and perspectives of like-minded...particular lifestyle. Experience then becomes the common denominator and shared ways of interpretinq this experience develop. Funeral directors, for example...heightened personal reserve and social conservatism (Habenstein, 196Z). Moreover, the practices ofIproviding24-hour availability and l ving in the funeral

  15. Secularizing funerary culture in nineteenth-century Belgium: A product of political and religious controversy.

    PubMed

    De Spiegeleer, Christoph; Tyssens, Jeffrey

    2017-01-01

    Modern historiography of collective attitudes, practices, and conflicts surrounding death often focuses on the institutional history of cemeteries and nonreligious funerals in 19th-century France. Institutional and cultural discussions concerning funerals and cemeteries also divided nineteenth-century Belgium. This article explores emblematic civil burials and the secularization of cemeteries in major Belgian cities. The article distinguishes different dimensions of the secularization of death and highlights the particular nature of Belgian funerary conflicts and burial reform within a broader European context.

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

    PubMed

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

    2015-05-01

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

  17. In vivo synthesis of europium selenide nanoparticles and related cytotoxicity evaluation of human cells.

    PubMed

    Kim, Eun Bee; Seo, Ji Min; Kim, Gi Wook; Lee, Sang Yup; Park, Tae Jung

    2016-12-01

    Nanotechnology strives to combine new materials for development of noble nanoparticles. As the nanoparticles exhibit unique optical, electronic, and magnetic properties depending on their composition, developing safe, cost-effective and environmentally friendly technologies for the synthesis have become an important issue. In this study, in vivo synthesis of europium selenide (EuSe) nanoparticles was performed using recombinant Escherichia coli cells expressing heavy-metal binding proteins, phytochelatin synthase and metallothionein. The formation of EuSe nanoparticles was confirmed by using UV-vis spectroscopy, spectrofluorometry, X-ray diffraction, energy dispersive X-ray and transmission electron microscopy. The synthesized EuSe nanoparticles exhibited high fluorescence intensities as well as strong magnetic properties. Furthermore, anti-cancer effect of EuSe nanoparticles against cancer cell lines was investigated. This strategy for the biogenic synthesis of nanoparticles has a great potential as bioimaging tools and drug carrying agents in biomedical fields due to its simplicity and nontoxicity.

  18. Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

    PubMed Central

    Puri, Rajesh; Thandassery, Ragesh Babu; Alfadda, Abdulrahman A; Kaabi, Saad Al

    2015-01-01

    Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis. PMID:25901214

  19. Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature.

    PubMed

    Puri, Rajesh; Thandassery, Ragesh Babu; Alfadda, Abdulrahman A; Kaabi, Saad Al

    2015-04-16

    Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.

  20. The Role of Endoscopic Ultrasound in the Diagnosis and Management of Primary Gastric Lymphoma

    PubMed Central

    Schizas, Dimitrios; Ntanasis-Stathopoulos, Ioannis; Tsilimigras, Diamantis I.; Scotiniotis, Ilias

    2017-01-01

    Endoscopic ultrasound (EUS) is considered a valuable diagnostic tool during the workup of malignant gastric lesions, including primary gastric lymphomas (PGL). Although endoscopy combined with multiple biopsies remains essential in the establishment of PGL diagnosis, EUS utilization in locoregional disease staging has been well documented in the literature. Data also support the possible role of EUS in prediction of response to first-line treatment, that is, Helicobacter pylori eradication. However, its application in the posttreatment setting remains problematic, since concordance rates between endosonography and histology findings during follow-up seem to vary substantially. The aim of the present review is to summarize all available data regarding the role of EUS in the management of PGL.

  1. Role of contrast harmonic-endoscopic ultrasound in pancreatic cystic lesions

    PubMed Central

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

    2017-01-01

    Incidental pancreatic cysts (PCs) are frequently encountered in the general population often in asymptomatic patients who undergo imaging tests to investigate unrelated conditions. The detection of a PC poses a significant clinical dilemma, as the differential diagnosis is quite broad ranging from benign to malignant conditions. Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) has been reported to be an accurate tool in the differential diagnosis; however, its sensitivity is suboptimal and false negative results do occur. Contrast harmonic EUS (CH-EUS) was demonstrated to be a useful tool to investigate pancreatic solid lesions to differentiate between benign and malignant ones. In the setting of PCs, CH-EUS could help identify areas of malignant growth inside the cystic cavities. Several studies have reported promising results showing malignant areas in PCs as hyperenhanced lesions. Confirmation of malignancy can then be obtained by FNA, which should be precisely targeted according to the findings of the contrast harmonic study. PMID:28218197

  2. Endoscopic ultrasound in the diagnosis of acinar cell carcinoma of the pancreas: contrast-enhanced endoscopic ultrasound, endoscopic ultrasound elastography, and pathological correlation.

    PubMed

    Chantarojanasiri, Tanyaporn; Hirooka, Yoshiki; Kawashima, Hiroki; Ohno, Eizaburo; Yamamura, Takeshi; Funasaka, Kohei; Nakamura, Masanao; Miyahara, Ryoji; Ishigami, Masatoshi; Watanabe, Osamu; Nakaguro, Masato; Shimoyama, Yoshie; Nakamura, Shigeo; Goto, Hidemi

    2016-11-01

    We report a case series of five patients with pancreatic acinar cell carcinoma who received surgical treatment and compared the preoperative contrast-enhanced endoscopic ultrasound (EUS) and EUS elastography patterns with the surgical specimens. The contrast-enhanced EUS indicated vascular tumors with gradual enhancement in four patients and a hypovascular tumor in one patient. The elastography indicated an elastic score of 3 (hard lesion with softer border) in two patients and a score of 5 (hard lesion, which included the surrounding area) in two patients. In tumors with an elastic score of 5, the pathology exhibited abundant hyalinizing fibrous stroma or massive tumor invasion to the surrounding tissue. We concluded that acinar cell carcinoma of the pancreas has various patterns of EUS contrast-enhancement and elastography, depending on the pathologic phenotype.

  3. Endoscopic ultrasound in the diagnosis of acinar cell carcinoma of the pancreas: contrast-enhanced endoscopic ultrasound, endoscopic ultrasound elastography, and pathological correlation

    PubMed Central

    Chantarojanasiri, Tanyaporn; Hirooka, Yoshiki; Kawashima, Hiroki; Ohno, Eizaburo; Yamamura, Takeshi; Funasaka, Kohei; Nakamura, Masanao; Miyahara, Ryoji; Ishigami, Masatoshi; Watanabe, Osamu; Nakaguro, Masato; Shimoyama, Yoshie; Nakamura, Shigeo; Goto, Hidemi

    2016-01-01

    We report a case series of five patients with pancreatic acinar cell carcinoma who received surgical treatment and compared the preoperative contrast-enhanced endoscopic ultrasound (EUS) and EUS elastography patterns with the surgical specimens. The contrast-enhanced EUS indicated vascular tumors with gradual enhancement in four patients and a hypovascular tumor in one patient. The elastography indicated an elastic score of 3 (hard lesion with softer border) in two patients and a score of 5 (hard lesion, which included the surrounding area) in two patients. In tumors with an elastic score of 5, the pathology exhibited abundant hyalinizing fibrous stroma or massive tumor invasion to the surrounding tissue. We concluded that acinar cell carcinoma of the pancreas has various patterns of EUS contrast-enhancement and elastography, depending on the pathologic phenotype. PMID:27853750

  4. 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

  5. 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

  6. Diagnostic yield of endoscopic ultrasound in patients with hypoglicemia and insulinoma suspected

    PubMed Central

    Téllez-Ávila, Félix Ignacio; Acosta-Villavicencio, Gladys Yolanda; Chan, Carlos; Hernández-Calleros, Jorge; Uscanga, Luis; Valdovinos-Andraca, Francisco; Ramírez-Luna, Miguel Ángel

    2015-01-01

    Background and Objectives: Noninvasive imaging techniques have shown limitations to identify insulinomas. In few studies reported so far, endoscopic ultrasound (EUS) has proven to be able to locate lesions. The aim of this study was to compare the performance of computed tomography versus EUS for the detection of insulinomas. Materials and Methods: In a retrospective manner prospectively collected data were analyzed. Patients with hypoglucemia and hyperinsulinemia were included. Diagnostic yield was measured in relationship to sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Surgical specimens were considered the gold standard. Results: Sensitivity, positive predictive value, and accuracy of EUS was 100%, 95.4% and 95.4%, respectively. In the case of CT the sensitivity was 60%, specificity 100%, positive predictive value 100%, negative predictive value 7%, and accuracy were 68%. Conclusions: EUS is useful in the preoperative assessment of patients with hypoglycemia and serum hyperinsulinemia. PMID:25789285

  7. A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP

    PubMed Central

    Moole, Harsha; Bechtold, Matthew L.; Forcione, David; Puli, Srinivas R.

    2017-01-01

    Abstract Background: In patients with inoperable malignant biliary strictures, endoscopic retrograde cholangiopancreatography (ERCP) guided biliary stenting fails in 5% to 10% patients due to difficult anatomy/inability to cannulate the papilla. Recently, endoscopic ultrasound guided biliary drainage (EUS-BD) has been described. Primary outcomes were to evaluate the biliary drainage success rates with EUS and compare it to percutaneous transhepatic biliary drainage (PTBD). Secondary outcomes were to evaluate overall procedure related complications. Methods: Study selection criteria: Studies evaluating the efficacy of EUS-BD and comparing EUS-BD versus PTBD in inoperable malignant biliary stricture patients with a failed ERCP were included in this analysis. Data collection and extraction: Articles were searched in Medline, PubMed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Subgroup analyses of prospective studies and EUS-BD versus PTBD were performed. Statistical method: Pooled proportions were calculated using fixed and random effects model. I2 statistic was used to assess heterogeneity among studies. Results: Initial search identified 846 reference articles, of which 124 were selected and reviewed. Sixteen studies (N = 528) that met the inclusion criteria were included in this analysis. In the pooled patient population, the percentage of patients that had a successful biliary drainage with EUS was 90.91% (95% CI = 88.10–93.38). The proportion of patients that had overall procedure related complications with EUS-PD was 16.46% (95% CI = 13.20–20.01). The pooled odds ratio for successful biliary drainage in EUS-PD versus PTBD group was 3.06 (95% CI = 1.11–8.43). The risk difference for overall procedure related complications in EUS-PD versus PTBD group was −0.21 (95% CI = −0

  8. 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.

  9. Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

    PubMed Central

    Cheriyan, Danny G; Byrne, Michael F

    2014-01-01

    Compared to standard endoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are often lengthier and more complex, thus requiring higher doses of sedatives for patient comfort and compliance. The aim of this review is to provide the reader with information regarding the use, safety profile, and merits of propofol for sedation in advanced endoscopic procedures like ERCP and EUS, based on the current literature. PMID:24833847

  10. 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.

  11. Endoscopic Ultrasound Does Not Accurately Stage Early Adenocarcinoma or High-Grade Dysplasia of the Esophagus

    DTIC Science & Technology

    2010-01-01

    MeSH search terms: " endoscopic ultrasound," "Barrett’s esophagus ," "adeno· carcinoma," "Barrett’s esophagus and high grade dyspla.c;ia...adenocarcinoma of the esophagus ; EMR, endoscopic mucosal resection; EUS, endoscopic ul- trasound; HGD, high-grade dysplasia. <D 2010 by the AGA Institute... esophagus and early adenocarcinoma found EUS examination to have perfecr accuracy for differentiating Tl CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol

  12. Is endoscopic ultrasound examination necessary in the management of esophageal cancer?

    PubMed Central

    DaVee, Tomas; Ajani, Jaffer A; Lee, Jeffrey H

    2017-01-01

    Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented. PMID:28223720

  13. Regional Amplitude-Distance Relations, Discrimination and Detection

    DTIC Science & Technology

    1981-07-13

    etoi a o sa -54-b 0 0 9 0 00 o L4 dews ,. Samse as Figure 5a but for bodozn (BDN). w ir o Nap Shoving interpretation of selected paths to Soviet...LAKE 0 E(WUS) Bs C C 0 0T -GNOME (EUS) O SALMON (EUS) 0 * / ERULISON 2 00 a GNOME (WUS) GASBUGGY SHOAL 0 MONERO AHTMASS. MTN . HARDHAT EARTHOUAKE 1 YUBA

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

    PubMed Central

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

    2016-01-01

    Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89%) and the specificity was 99% (CI 98–100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS. PMID:27818796

  15. 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

  16. 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

  17. Using Forceps Biopsy after Small Submucosal Dissection in the Diagnosis of Gastric Subepithelial Tumors.

    PubMed

    Jung, Yoon Suk; Lee, Hyuk; Kim, Kyungeun; Sohn, Jin Hee; Kim, Hong Joo; Park, Jung Ho

    2016-11-01

    The current tissue sampling techniques for subepithelial tumors (SETs) of the gastrointestinal (GI) tract have limited diagnostic efficacy. We evaluated the diagnostic yield and safety of forceps biopsies after small endoscopic submucosal dissection (SESD biopsies) in the diagnosis of gastric SETs. A total of 42 patients with gastric SETs > 10 mm were prospectively enrolled between May 2013 and October 2014. A dual knife was used to incise the mucosa and submucosa and forceps biopsies were then introduced deep into the lesion. To compare SESD biopsies with EUS-FNA, we used the retrospective data of 30 EUS-FNA cases. The diagnostic yield of SESD biopsies was comparable to that of EUS-FNA (35/42, 83.3% vs. 24/30, 80.0%, P = 0.717). The mean procedure time of SESD biopsies was shorter than that of EUS-FNA (10 vs. 37 minutes, P < 0.001). There were no procedure-related adverse events in the both group. The pathological diagnoses in SESD biopsies group included 15 leiomyomas, 7 GISTs, 10 heterotopic pancreases, 2 lipomas, and one other lesion. SESD biopsies are an easy, effective and safe technique for the diagnosis of gastric SETs and its diagnostic yield is comparable to that of EUS-FNA. This technique may be a reliable alternative to conventional EUS-FNA (Clinical trial registration No. KCT0000730).

  18. Using Forceps Biopsy after Small Submucosal Dissection in the Diagnosis of Gastric Subepithelial Tumors

    PubMed Central

    2016-01-01

    The current tissue sampling techniques for subepithelial tumors (SETs) of the gastrointestinal (GI) tract have limited diagnostic efficacy. We evaluated the diagnostic yield and safety of forceps biopsies after small endoscopic submucosal dissection (SESD biopsies) in the diagnosis of gastric SETs. A total of 42 patients with gastric SETs > 10 mm were prospectively enrolled between May 2013 and October 2014. A dual knife was used to incise the mucosa and submucosa and forceps biopsies were then introduced deep into the lesion. To compare SESD biopsies with EUS-FNA, we used the retrospective data of 30 EUS-FNA cases. The diagnostic yield of SESD biopsies was comparable to that of EUS-FNA (35/42, 83.3% vs. 24/30, 80.0%, P = 0.717). The mean procedure time of SESD biopsies was shorter than that of EUS-FNA (10 vs. 37 minutes, P < 0.001). There were no procedure-related adverse events in the both group. The pathological diagnoses in SESD biopsies group included 15 leiomyomas, 7 GISTs, 10 heterotopic pancreases, 2 lipomas, and one other lesion. SESD biopsies are an easy, effective and safe technique for the diagnosis of gastric SETs and its diagnostic yield is comparable to that of EUS-FNA. This technique may be a reliable alternative to conventional EUS-FNA (Clinical trial registration No. KCT0000730). PMID:27709855

  19. Right adrenal gland prospective evaluation through transgastric endoscopic ultrasound: an alternative approach

    PubMed Central

    Figueiredo, Pedro C.; Pinto-Marques, Pedro; Almeida, Ines; Gomes, Pedro C.; Serra, David

    2016-01-01

    Background and aims: Endoscopic ultrasound (EUS) guided right adrenal gland (RAG) evaluation is frequently unsuccessful and, when feasible, requires a cumbersome maneuver through the duodenum. In our experience, the use of a recent ultrasound platform has enabled transgastric detection of the RAG with a simple maneuver. The aim of this study was to determine the RAG transgastric EUS detection rate and identify predictive factors for failure. Methods: Consecutive patients referred to EUS in a single center were prospectively included over a 6-month period. Success was defined as RAG transgastric EUS detection within 180 seconds. Logistic regression analysis was used to assess factors associated with failure. Results: Among 100 patients, the success rate for RAG transgastric EUS detection was 75 %, with a median maneuver duration of 45 seconds [interquartile range, 25 – 70 seconds]. Two incidental RAG lesions were detected. Of possible demographic and anthropometric predictive factors for failure, only age (OR 1.04; P = 0.04) was statistically significant on multivariate analysis. Conclusions: The transgastric EUS approach for RAG detection is simple, fast and effective. PMID:27853745

  20. 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

  1. N-losses and energy use in a scenario for conversion to organic farming.

    PubMed

    Dalgaard, T; Kjeldsen, C; Hutchings, N J; Hansen, J F

    2001-11-16

    The aims of organic farming include the recycling of nutrients and organic matter and the minimisation of the environmental impact of agriculture. Reduced nitrogen (N)-losses and energy (E)-use are therefore fundamental objectives of conversion to organic farming. However, the case is not straightforward, and different scenarios for conversion to organic farming might lead to reduced or increased N-losses and E-use. This paper presents a scenario tool that uses a Geographical Information System in association with models for crop rotations, fertilisation practices, N-losses, and E-uses. The scenario tool has been developed within the multidisciplinary research project Land Use and Landscape Development Illustrated with Scenarios (ARLAS). A pilot scenario was carried out, where predicted changes in N-losses and E-uses following conversion to organic farming in areas with special interests in clean groundwater were compared. The N-surplus and E-use were on average reduced by 10 and 54%, respectively. However, these reductions following the predicted changes in crop rotations, livestock densities, and fertilisation practices were not large enough to ensure a statistically significant reduction at the 95% level. We therefore recommend further research in how conversion to organic farming or other changes in the agricultural practice might help to reduce N-surpluses and E-uses. In that context, the presented scenario tool would be useful.

  2. A novel three-dimensional endoscopic ultrasound technique for the freehand examination of the oesophagus.

    PubMed

    Inglis, Scott; Christie, Derek; Plevris, John N

    2011-11-01

    This study details the development and evaluation of a freehand radial three-dimensional endoscopic ultrasound (3D-EUS) technique for use in the upper gastro-intestinal tract. It comprised of a commercial EUS system, a custom acquisition system to simultaneous acquire radial B-mode images and corresponding incremental changes in position of the scope as it was withdrawn and a custom 3D-EUS package written in Matlab™, to reconstruct and analyse the volume. This technique was evaluated using an EUS phantom with embedded objects of known dimensions and volumes and with clinical images acquired during routine cancer staging. For the phantom measurements, average Z-dimensional error was <1% and volume errors were 1.4% (volume(1) = 48930 mm(3)) and 4.5% (volume(2) = 5100 mm(3)). Application of this technique to EUS acquired clinical images produced excellent characterisation of oesophageal structures and accurate dimension and volume measurements. It also enabled the endoscopist to review "off-line" the EUS examination in case important information was missed.

  3. Endoscopic ultrasound-guided tissue sampling of small subepithelial tumors of the upper gastrointestinal tract with a 22-gauge core biopsy needle

    PubMed Central

    Schlag, Christoph; Menzel, Christoph; Götzberger, Manuela; Nennstiel, Simon; Klare, Peter; Wagenpfeil, Stefan; Schmid, Roland M.; Weirich, Gregor; von Delius, Stefan

    2017-01-01

    Background and study aims The optimal approach to small subepithelial tumors (SETs) of the upper gastrointestinal tract remains inconclusive. The aim of this study was to evaluate endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for less invasive tissue sampling of small SETs of the upper gastrointestinal tract. Patients and methods In this prospective observational study patients with small ( ≤ 3 cm) SETs of the upper gastrointestinal tract were eligible and underwent EUS-FNB with a 22-gauge core biopsy needle. The main outcome measure was the diagnostic yield. The number of obtained core biopsies was also assessed. Results Twenty patients were included. The mean SET size was 16 mm (range 10 – 27 mm). EUS-FNB was technically feasible in all cases and no complications were observed. The diagnostic yield was 75 %. Core biopsy specimens were obtained in only 25 % of cases. Conclusion EUS-FNB with a 22-gauge core biopsy needle of small SETs can achieve a definite diagnosis in the majority of cases. However, because core samples cannot regularly be obtained, EUS-FNB seems not to be convincingly superior to standard EUS-FNA in this setting PMID:28299351

  4. Effect of tumor characteristics and duplication of the muscularis mucosae on the endoscopic staging of superficial Barrett esophagus-related neoplasia.

    PubMed

    Mandal, Rajni V; Forcione, David G; Brugge, William R; Nishioka, Norman S; Mino-Kenudson, Mari; Lauwers, Gregory Y

    2009-04-01

    Endoscopic mucosal resection (EMR) is being advocated as a diagnostic, staging, and therapeutic technique for the management of Barrett esophagus (BE)-related neoplasia. With the emergence of new endoluminal therapy including EMR for the treatment of BE-related superficial adenocarcinomas, accurate staging has become crucial to select patients for different treatment arms. Intramucosal adenocarcinomas can be successfully treated by endoluminal techniques, whereas submucosal invasive tumors with a greater risk of lymph node metastasis are likely candidates for esophagectomy. Endoscopic ultrasound (EUS) is used to stage superficial BE-related neoplasms, yet endoscopic staging can be incongruent to that obtained after pathologic examination. In this study, we sought to determine morphologic factors, which may influence EUS staging in 35 cases with intramucosal adenocarcinoma diagnosed by subsequent EMR, focusing on tumor characteristics and structural changes associated with BE. Among the latter duplication of the muscularis mucosae, either fragmented or well-organized, was seen in 64% of 11 cases that were overstaged as having submucosal invasion by EUS, compared with 38% of those accurately staged. A greater vertical thickness of the tumor was also associated with overstaging by EUS (1.61+/-0.75 mm in the discordant vs. 1.16+/-0.67 mm in the concordant groups, P=0.028). The results illustrate how morphologic factors may affect EUS staging of superficial esophageal adenocarcinomas. EUS alone is not sufficient for staging these neoplasms precisely, and to accurately stratify patients into different treatment arms, EMR should play a role as a complementary staging modality.

  5. Endoscopic management of combined malignant biliary and gastric outlet obstruction.

    PubMed

    Nakai, Yousuke; Hamada, Tsuyoshi; Isayama, Hiroyuki; Itoi, Takao; Koike, Kazuhiko

    2017-01-01

    Patients with periampullary cancer or gastric cancer often develop malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), and combined MBO and GOO is not rare in these patients. Combined MBO and GOO is classified by its location and sequence, and treatment strategy can be affected by this classification. Historically, palliative surgery, hepaticojejunostomy and gastrojejunostomy were carried out, but the current standard treatment is combined transpapillary stent and duodenal stent placement. Although a high technical success rate is reported, the procedure can be technically difficult and duodenobiliary reflux with subsequent cholangitis is common after double stenting. Recent development of endoscopic ultrasound (EUS)-guided procedures enables the management of MBO as well as GOO under EUS guidance. EUS-guided biliary drainage is now increasingly reported as an alternative to percutaneous transhepatic biliary drainage in failed endoscopic retrograde cholangiopancreatography (ERCP), and GOO is one of the major reasons for failed ERCP. In addition to EUS-guided biliary drainage, the feasibility of EUS-guided double-balloon-occluded gastrojejunostomy bypass for MBO was recently reported, and EUS-guided double stenting can potentially become the treatment of choice in the future. However, as each procedure has its advantages and disadvantages, treatment strategy should be selected based on the type of obstruction and the prognosis and performance status of the patient.

  6. Maximizing the endosonography: The role of contrast harmonics, elastography and confocal endomicroscopy

    PubMed Central

    Seicean, Andrada; Mosteanu, Ofelia; Seicean, Radu

    2017-01-01

    New technologies in endoscopic ultrasound (EUS) evaluation have been developed because of the need to improve the EUS and EUS-fine needle aspiration (EUS-FNA) diagnostic rate. This paper reviews the principle, indications, main literature results, limitations and future expectations for each of the methods presented. Contrast-enhanced harmonic EUS uses a low mechanical index and highlights slow-flow vascularization. This technique is useful for differentiating solid and cystic pancreatic lesions and assessing biliary neoplasms, submucosal neoplasms and lymph nodes. It is also useful for the discrimination of pancreatic masses based on their qualitative patterns; however, the quantitative assessment needs to be improved. The detection of small solid lesions is better, and the EUS-FNA guidance needs further research. The differentiation of cystic lesions of the pancreas and the identification of the associated malignancy features represent the main indications. Elastography is used to assess tissue hardness based on the measurement of elasticity. Despite its low negative predictive value, elastography might rule out the diagnosis of malignancy for pancreatic masses. Needle confocal laser endomicroscopy offers useful information about cystic lesions of the pancreas and is still under evaluation for use with solid pancreatic lesions of lymph nodes. PMID:28104978

  7. Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions

    PubMed Central

    Fujita, Mitsuru; Itoi, Takao; Ikeuchi, Nobuhito; Sofuni, Atsushi; Tsuchiya, Takayoshi; Ishii, Kentaro; Kamada, Kentaro; Umeda, Junko; Tanaka, Reina; Tonozuka, Ryosuke; Honjo, Mitsuyoshi; Mukai, Shuntaro; Moriyasu, Fuminori

    2016-01-01

    Background and Objectives: There have been few studies to date evaluating the effectiveness of contrast-enhanced endoscopic ultrasound (CE-EUS) for detecting mural nodules in patients with branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas. We aim to evaluate the effectiveness of CE-EUS for detecting mural nodules in BD-IPMN. Patients and Methods: Of the 427 BD-IPMN patients, 21 patients (4.9%) in whom the presence of mural nodules was suggested by CE computed tomography (CT) or magnetic resonance imaging (MRI), or in whom the presence of nodule-like lesions as shown by fundamental EUS, were examined by CE-EUS. Results: The mean diameter of cystic lesions was 29.8 ± 12.8 mm. The mean diameter of mural nodules was 9.5 ± 5.7 mm. BD-IPMN was detected in the pancreatic head in 16 cases, pancreatic body in 2 cases, and pancreatic tail in 3 cases. The mean follow-up period was 17.2 ± 11.9 months. The detection rates of mural nodule-like lesions in BD-IPMN patients on CT, MRI, and fundamental EUS were 36.8%, 63.2%, and 100%, respectively. The detection rates of true mural nodules in BD-IPMN patients on CT, MRI, and fundamental EUS were 85.7%, 71.4%, and 100%, respectively. The echo levels of mural nodule-like lesions on fundamental EUS were hyperechoic in 6 patients, isoechoic in 9 patients, and hypoechoic in 6 patients. The final diagnosis was mucus lumps in 14 patients and mural nodules in 7 patients. The contrast patterns observed were avascular, isovascular, and hypervascular in 14, 3, and 4 patients, respectively. No patients showed a hypovascular pattern. Fourteen patients showing an avascular pattern were diagnosed as having mucus lumps, and they were able to avoid surgical resection. Of the 7 patients who were diagnosed as having mural nodules, 5 underwent surgical resection. The pathological findings were adenocarcinoma in 2 patients and adenoma in 3 patients. Of the 3 adenoma patients, fundamental EUS demonstrated a hypoechoic

  8. Endoscopic ultrasound-guided drainage of pancreatic fluid collections.

    PubMed

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

    2012-11-16

    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

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

    PubMed Central

    2013-01-01

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

  10. Digital image analysis of endoscopic ultrasonography is helpful in diagnosing gastric mesenchymal tumors

    PubMed Central

    2014-01-01

    Background Endoscopic ultrasonography (EUS) is a valuable imaging tool for evaluating subepithelial lesions in the stomach. However, there are few studies on differentiation between gastrointestinal stromal tumors (GISTs) and benign mesenchymal tumors, such as leiomyoma or schwannoma, with the use of EUS. In addition, there are limitations in the analysis of the characteristic features of such tumors due to poor interobserver agreement as a result of subjective interpretation of EUS images. Therefore, the aim of this study was to evaluate the role of digital image analysis in distinguishing the features of GISTs from those of benign mesenchymal tumors on EUS. Methods We enrolled 65 patients with histopathologically proven gastric GIST, leiomyoma or schwannoma on surgically resected specimens who underwent EUS examination at our endoscopic unit from January 2007 to September 2010. After standardization of the EUS images, brightness values including the mean (Tmean), indicative of echogenicity, and the standard deviation (TSD), indicative of heterogeneity, in the tumors were analyzed. Results The Tmean and TSD were significantly higher in GIST than in leiomyoma and schwannoma (p < 0.001). However, there was no significant difference in the Tmean or TSD between benign and malignant GISTs. The sensitivity and specificity were almost optimized for differentiating GIST from leiomyoma or schwannoma when the critical values of Tmean and TSD were 65 and 75, respectively. The presence of at least 1 of these 2 findings in a given tumor resulted in a sensitivity of 94%, specificity of 80%, positive predictive value of 94%, negative predictive value of 80%, and accuracy of 90.8% for predicting GIST. Conclusions Digital image analysis provides objective information on EUS images; thus, it can be useful in diagnosing gastric mesenchymal tumors. PMID:24400772

  11. 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

  12. Sampling of the adrenal glands by endoscopic ultrasound-guided fine-needle aspiration.

    PubMed

    Stelow, Edward B; Debol, Steven M; Stanley, Michael W; Mallery, Shawn; Lai, Rebecca; Bardales, Ricardo H

    2005-07-01

    Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has proven to be a valuable modality for the primary diagnosis and staging of gastrointestinal, and perigastrointestinal malignancy. Aside from assessing thoracic and abdominal lymph nodes and the liver for metastases, EUS can assess and sample the adrenal glands, which are frequently involved by metastatic disease, but can also harbor benign primary neoplasms. The cytology files at our institution were reviewed for all cases of EUS-guided FNA of the adrenal glands. Clinical histories, sonographic findings, and cytologic findings of all cases were reviewed. Results were compared with overall EUS-guided FNA performance and the performance of non-EUS-guided FNA of the adrenal. The utility of cell block immunohistochemistry (IHC) in these cases was reviewed. Between 1/1/00 and 5/15/04 there were 24 cases of EUS-guided FNA of the adrenal gland from 22 different patients (13 men; 9 women) at our institution. This represented 1.4% of overall EUS-guided FNA and 77% of adrenal gland FNA. Patient ages ranged from 37 to 86 yr (mean 69 +/- 11 yr). Most patients had other cancers or mass lesions and were being staged at the time of the procedure (19 of 22). Almost all FNAs were of the left adrenal gland (23 of 24). Lesion size ranged from 0.9 to 7.9 cm (mean 2.5 +/- 1.6 cm). Diagnostic material was present in all cases when compared with an overall EUS-guided FNA diagnostic rate of 88%. Material for cell block was present in 21 cases, and IHC was used in 3 cases. Final diagnoses were as follows: cortical tissue consistent with cortical adenoma (19), metastatic adenocarcinoma (3), pheochromocytoma (1), and adrenal cortical carcinoma (1). EUS-guided FNA of the adrenal gland is primarily used in the staging of other malignancies when lesions of the left adrenal are recognized sonographically. Diagnostic tissue is easily obtained, including material for cell block IHC, which allows definitive diagnosis in cases that

  13. High risk of acute pancreatitis after endoscopic ultrasound-guided fine needle aspiration of side branch intraductal papillary mucinous neoplasms

    PubMed Central

    Siddiqui, Ali A.; Shahid, Haroon; Shah, Apeksha; Khurana, Tanvi; Huntington, William; Ghumman, Saad S.; Loren, David E.; Kowalski, Thomas E.; Laique, Sobia; Hayat, Umar; Eloubeidi, Mohamad A.

    2015-01-01

    Background and Objectives: Data on the risk of acute pancreatitis following endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions are limited. The aim of our study was to evaluate the frequency of acute pancreatitis after EUS-FNA of pancreatic cysts and solid lesions, and determine whether there was a difference in pancreatitis risk in patients with side branch intraductal papillary mucinous neoplasms (SB-IPMN). Patients and Methods: A retrospective review of patients who underwent EUS-FNA of pancreatic cysts and solid lesions was performed. The primary outcome measure was development of acute pancreatitis after EUS-FNA. Factors associated with acute pancreatitis were examined by statistical analysis to determine independent predictors of acute pancreatitis. Statistical significance was determined at a P ≤ 0.05. Results: We identified 186 patients with pancreatic cystic lesions and 557 with solid lesions in which EUS-FNA was performed. The median size of the cysts was 19 mm (range: 10-66 mm). There were 37 IPMNs, 33 mucinous cystic neoplasms, 58 serous cysts and 46 pseudocysts and 12 solid-cystic ductal carcinomas. The majority of patients (75%) with solid lesions were diagnosed with adenocarcinoma. Patients with pancreatic cysts had a statistically greater frequency of developing pancreatitis after EUS-FNA when compared to those with solid lesions (2.6% vs. 0.36% respectively; P = 0.13). In patients with cysts, there were no statistically significant differences between the two groups (with and without pancreatitis) with regard to a cyst location, size of the cyst, and number of needle passes or trainee involvement. Patients with SB-IPMN had a statistically higher frequency of pancreatitis after EUS-FNA compared to those with other cyst types (8% vs. 1.3% respectively; odds ratio = 6.4, 95% confidence intervals = 1.0-40.3, P = 0.05). Discussion: Patients with SB-IPMN are at a higher risk of developing acute pancreatitis after

  14. 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.

  15. Survey of blood parasites in two forest owls, Northern Saw-whet Owls and Flammulated Owls, of western North America.

    PubMed

    Leppert, Lynda L; Dufty, Alfred M; Stock, Sarah; Oleyar, M David; Kaltenecker, Greg S

    2008-04-01

    Except for a few studies in the eastern United States, little has been published on hemoparasites in owls. We surveyed the blood parasites of 108 Northern Saw-whet Owls (Aegolius acadicus) and 24 Flammulated Owls (Otus flammeolus) in Idaho during autumn migration in 1999 and 2000. We also surveyed 15 Flammulated Owls (FLOW) during breeding season in Utah from 2000. Leucocytozoon ziemanni, Haemoproteus syrnii, Haemoproteus noctuae, and Trypanosoma avium were identified. The overall prevalence of infection was 53% (78/147) and for the combined species, prevalences of Haemoproteus, Leucocytozoon, and Trypanosoma species were 20%, 39%, and 4%, respectively. Northern Saw-whet Owls (NSWO) had an overall prevalence of 51% (55/108), with prevalences of 6%, 47%, and 4% by hemoparasite genus, respectively. Flammulated Owls had an overall prevalence of 59% (23/39), with prevalences of 56%, 18%, and 5% by genus, respectively. This study provides baseline hematozoa information for two boreal owl species.

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

    PubMed

    Kutzer, E; Frey, H; Nöbauer, H

    1982-11-01

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

  17. Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer

    PubMed Central

    Marone, Pietro; de Bellis, Mario; D’Angelo, Valentina; Delrio, Paolo; Passananti, Valentina; Di Girolamo, Elena; Rossi, Giovanni Battista; Rega, Daniela; Tracey, Maura Claire; Tempesta, Alfonso Mario

    2015-01-01

    The prognosis of rectal cancer (RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC (LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy (NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound (EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor (T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery. PMID:26140096

  18. The role of contrast-enhanced endoscopic ultrasound in pancreatic adenocarcinoma

    PubMed Central

    Săftoiu, Adrian; Vilmann, Peter; Bhutani, Manoop S.

    2016-01-01

    Contrast-enhanced endoscopic ultrasound (CE-EUS) allows characterization, differentiation, and staging of focal pancreatic masses. The method has a high sensitivity and specificity for the diagnosis of pancreatic adenocarcinoma which is visualized as hypo-enhanced as compared to the rest of the parenchyma while chronic pancreatitis and neuroendocrine tumors are generally either iso-enhanced or hyper-enhanced. The development of contrast-enhanced low mechanical index harmonic imaging techniques used in real time during endoscopic ultrasound (EUS) allowed perfusion imaging and the quantification of intensity of the contrast signal through time-intensity curve analysis. Thus, contrast harmonic imaging-EUS has been used to differentiate pancreatic adenocarcinoma based on lower values of the peak enhancement. Future applications of CE-EUS in pancreatic adenocarcinoma include not only use of targeted contrast agents for early detection, tridimensional and fusion techniques for enhanced staging and resectability assessment but also novel applications of perfusion imaging for monitoring ablative therapy, improved local detection through EUS-guided sampling of portal vein flow or enhanced drug delivery through sonoporation and ultrasound-induced release of the drugs locally. PMID:28000627

  19. Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions

    PubMed Central

    Arshad, Hafiz Muhammad Sharjeel; Bharmal, Sheila; Duman, Deniz Guney; Liangpunsakul, Suthat; Turner, Brian G

    2017-01-01

    Pancreatic cystic lesions can be benign, premalignant or malignant. The recent increase in detection and tremendous clinical variability of pancreatic cysts has presented a significant therapeutic challenge to physicians. Mucinous cystic neoplasms are of particular interest given their known malignant potential. This review article provides a brief but comprehensive review of premalignant pancreatic cystic lesions with advanced endoscopic ultrasound (EUS) management approaches. A comprehensive literature search was performed using PubMed, Cochrane, OVID and EMBASE databases. Preneoplastic pancreatic cystic lesions include mucinous cystadenoma and intraductal papillary mucinous neoplasm. The 2012 International Sendai Guidelines guide physicians in their management of pancreatic cystic lesions. Some of the advanced EUS management techniques include ethanol ablation, chemotherapeutic (paclitaxel) ablation, radiofrequency ablation and cryotherapy. In future, EUS-guided injections of drug-eluting beads and neodymium:yttrium aluminum agent laser ablation is predicted to be an integral part of EUS-guided management techniques. In summary, International Sendai Consensus Guidelines should be used to make a decision regarding management of pancreatic cystic lesions. Advanced EUS techniques are proving extremely beneficial in management, especially in those patients who are at high surgical risk. PMID:27574295

  20. Emergence of epizootic ulcerative syndrome in native fish of the Murray-Darling River System, Australia: hosts, distribution and possible vectors.

    PubMed

    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.

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

    PubMed Central

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

    2012-01-01

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

  2. Endoscopic Ultrasound 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.

  3. Endoscopic ultrasound-guided ethanol ablation therapy for tumors

    PubMed Central

    Zhang, Wen-Ying; Li, Zhao-Shen; Jin, Zhen-Dong

    2013-01-01

    Endoscopic ultrasonography (EUS) has evolved into a useful therapeutic tool for treating a broad range of tumors since being introduced into clinical practice as a diagnostic modality nearly three decades ago. In particular, EUS-guided fine-needle injection has proven a successful minimally invasive approach for treating benign lesions such as pancreatic cysts, relieving pancreatic pain through celiac plexus neurolysis, and controlling local tumor growth of unresectable malignancies by direct delivery of anti-tumor agents. One such ablative agent, ethanol, is capable of safely ablating solid or cystic lesions in hepatic tissues via percutaneous injection. Recent research and clinical interest has focused on the promise of EUS-guided ethanol ablation as a safe and effective method for treating pancreatic tumor patients with small lesions or who are poor operative candidates. Although it is not likely to replace radical resection of localized lesions or systemic treatment of metastatic tumors in all patients, EUS-guided ablation is an ideal method for patients who refuse or are not eligible for surgery. Moreover, this treatment modality may play an active role in the development of future pancreatic tumor treatments. This article reviews the most recent clinical applications of EUS-guided ethanol ablation in humans for treating pancreatic cystic tumors, pancreatic neuroendocrine tumors, and metastatic lesions. PMID:23801831

  4. Role of endoscopic ultrasound in the molecular diagnosis of pancreatic cancer

    PubMed Central

    Bournet, Barbara; Gayral, Marion; Torrisani, Jérôme; Selves, Janick; Cordelier, Pierre; Buscail, Louis

    2014-01-01

    Pancreatic ductal adenocarcinoma remains one of the most deadly types of tumor. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe, cost-effective, and accurate technique for evaluating and staging pancreatic tumors. However, EUS-FNA may be inconclusive or doubtful in up to 20% of cases. This review underlines the clinical interest of the molecular analysis of samples obtained by EUS-FNA in assessing diagnosis or prognosis of pancreatic cancer, especially in locally advanced tumors. On EUS-FNA materials DNA, mRNA and miRNA can be extracted, amplified, quantified and subjected to methylation assay. Kras mutation assay, improves diagnosis of pancreatic cancer. When facing to clinical and radiological presentations of pseudo-tumorous chronic pancreatitis, wild-type Kras is evocative of benignity. Conversely, in front of a pancreatic mass suspected of malignancy, a mutated Kras is highly evocative of pancreatic adenocarcinoma. This strategy can reduce false-negative diagnoses, avoids the delay of making decisions and reduces loss of surgical resectability. Similar approaches are conducted using analysis of miRNA expression as well as Mucin or markers of invasion (S100P, S100A6, PLAT or PLAU). Beyond the diagnosis approach, the prediction of response to treatment can be also investigated form biomarkers expression within EUS-FNA materials. PMID:25152579

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

    PubMed

    Cruz, Yolanda; Pastelín, César; Balog, Brian M; Zaszczurynski, Paul J; Damaser, Margot S

    2014-12-01

    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.

  6. Defining the diagnostic algorithm in pancreatic cancer.

    PubMed

    Horwhat, John David; Gress, Frank G

    2004-07-01

    Most patients with pancreatic cancer present with a mass on radiologic studies, however, not every pancreatic mass is cancer. Since radiological studies alone are insufficient to establish the diagnosis of a pancreatic mass and patient management depends on a definitive diagnosis; confirmatory cytology or histology is usually required. As a minimally invasive procedure, EUS and EUS FNA avoid the risk of cutaneous or peritoneal contamination that may occur with CT or US-guided investigations and is less invasive than surgical interventions. As a result, EUS FNA of pancreatic masses is becoming the standard for obtaining cytological diagnosis. This chapter presents an EUS-based diagnostic algorithm for the evaluation of pancreatic lesions and is based upon a review of the pertinent literature in the field of pancreatic endosonography that has been the most influential in helping to guide this evolving field. Realizing there is much overlap among the EUS characteristics of various pancreatic lesions, for the sake of simplicity we have structured our discussion in broad terms of solid versus cystic lesions and discuss various pancreatic lesions within this framework. The additional contributors to this round table discussion have been asked to provide a more dedicated, focused discussion of the various subcategories of pancreatic lesions in greater detail than we could hope to achieve here. We provide this final contribution to the round table as a means of bringing the discussion back to the big picture of pancreatic lesions, rather than trying to hone in on the fine details of any one subclass.

  7. 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

  8. 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

  9. Is endoscopic ultrasonography essential for endoscopic resection of small rectal neuroendocrine tumors?

    PubMed Central

    Park, Su Bum; Kim, Dong Jun; Kim, Hyung Wook; Choi, Cheol Woong; Kang, Dae Hwan; Kim, Su Jin; Nam, Hyeong Seok

    2017-01-01

    AIM To evaluate the importance of endoscopic ultrasonography (EUS) for small (≤ 10 mm) rectal neuroendocrine tumor (NET) treatment. METHODS Patients in whom rectal NETs were diagnosed by endoscopic resection (ER) at the Pusan National University Yangsan Hospital between 2008 and 2014 were included in this study. A total of 120 small rectal NETs in 118 patients were included in this study. Histologic features and clinical outcomes were analyzed, and the findings of endoscopy, EUS and histology were compared. RESULTS The size measured by endoscopy was not significantly different from that measured by EUS and histology (r = 0.914 and r = 0.727 respectively). Accuracy for the depth of invasion was 92.5% with EUS. No patients showed invasion of the muscularis propria or metastasis to the regional lymph nodes. All rectal NETs were classified as grade 1 and demonstrated an L-cell phenotype. Mean follow-up duration was 407.54 ± 374.16 d. No patients had local or distant metastasis during the follow-up periods. CONCLUSION EUS is not essential for ER in the patient with small rectal NETs because of the prominent morphology and benign behavior. PMID:28373770

  10. Endoscopic ultrasonography-guided transmural drainage of an infected hepatic cyst due to Edwardsiella tarda: a case report.

    PubMed

    Taguchi, Hiroki; Tamai, Tsutomu; Numata, Masatsugu; Maeda, Hitomi; Ohshige, Akihiko; Iwaya, Hiromichi; Hashimoto, Shinichi; Kanmura, Shuji; Funakawa, Keita; Fujita, Hiroshi; Ido, Akio; Tsubouchi, Hirohito

    2014-10-01

    Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 77-year-old man with an infected hepatic cyst in the lateral segment caused by Edwardsiella tarda, which has not been previously reported as a pathogenic organism associated with infected hepatic cysts. Percutaneous drainage was temporarily effective, but infection recurred after the drainage tube was removed. We then inserted two drainage tubes into the cyst using an endoscopic ultrasonography (EUS)-guided technique, which was developed from EUS-guided fine needle aspiration (EUS-FNA). The internal drainage tube was a 7 Fr double pigtail stent, and the external tube was a 6 Fr nasobiliary drainage tube. Lavage through the external drainage tube was carried out for one week. The external drainage tube was discontinued when the patient's condition improved significantly. Sixteen days after tube insertion, he was discharged with the internal tube draining the hepatic cyst into the stomach. Fifteen months after EUS-guided drainage, CT examination showed no recurrence of the hepatic cyst. EUS-guided drainage is an effective treatment for infected hepatic cysts.

  11. Mediator deathwork.

    PubMed

    Walter, Tony

    2005-06-01

    The most discussed and analyzed form of deathwork is the dyadic therapist--client relationship, but this far from exhausts the various types of professional work involving the dead. Mediator deathwork is where the professional gleans or constructs information about the dead, edits and polishes it, and publicly presents the edited version in a public rite; this entails a triadic flow of information: the dead--the mediator--public rite. Examples include pathologists, coroners, American funeral directors, funeral celebrants, obituary writers, spiritualist mediums, and museum curators. Other types include barrier deathwork (in which the professional insulates the living from the dead--the dead | the living--as in British funeral directing), and intercessory deathwork in which priests send prayers the other way, from the living to, or on behalf of, the dead: mourner--priest--the dead. The article focuses on mediator deathwork because, though it is the most widespread form of deathwork, it is the least discussed and analyzed.

  12. Bereavement: an incomplete rite of passage.

    PubMed

    Hunter, Jennifer

    A bereavement ritual observed during anthropological fieldwork in Peru gives basis to this article which asserts that bereavement has become an incomplete rite of passage. The article reviews the role of ritual and rites of passage, examines other anthropologic examples of death and bereavement rituals, and identifies the lack of post-funeral ritual for many bereaved individuals in the United States. While funerary rituals which end with the funeral and burial of the dead are helpful in providing immediate structure for the bereaved, they are not congruent with the long-term emotional needs and reconstruction of meaning within grief. The author acknowledges value of both private ritual and reunions of the community of mourners, and recommends that bereavement counselors and/or the funeral industry offer to help bereaved construct a "ritual of remembrance and new meaning" after time has allowed them to move along in meaning reconstruction processes of making sense, finding benefits, and identity change.

  13. Donors' attitudes towards body donation for dissection.

    PubMed

    Richardson, R; Hurwitz, B

    1995-07-29

    We report a survey in the UK of potential whole-body donors for dissection. 218 people (age range 19-97 years) answered a postal questionnaire, giving information about themselves, their reasons for donation, attitudes towards the dead body, funeral preferences and medical giving and receiving. In addition to altruism, motives included the wish to avoid funeral ceremonies, to avoid waste, and in a few cases, to evade the expense of a funeral. 44% understood that their bodies would be used as teaching material, 42% for experiments. Whilst 69% believed in one or more supernatural phenomena, only 39% said they were religious. 69% requested cremation after dissection; 2% wanted to be buried. The notion of money incentives to promote donation was overwhelmingly rejected.

  14. 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.

  15. [Cremation--biological source for gender research].

    PubMed

    Grosskopf, Birgit; Gramsch, Alexander

    2004-09-01

    This article presents a project designed for prehistoric gender research. It focuses on the late Bronze Age to early Iron Age urnfield in Cottbus "Alvensleben-Kaserne", Brandenburg. The cremation remains were emptied from the urns layer by layer. This provided excellent conditions for a critical reconstruction of the funeral rituals related to the cremation. Detailed recording of each bone fragment in each layer made possible the discovery of the ritual deposition of burnt bones according to the anatomical order. Cremated bones, a primarily biological source, are also a substantial resource for cultural historical research, e.g., on funeral practices as well as social structures.

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

    PubMed

    Ahmed, Furqaan

    2014-05-06

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

  17. 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.

  18. Role of contrast-enhanced endoscopic ultrasound in lymph nodes

    PubMed Central

    Hocke, Michael; Ignee, Andre; Dietrich, Christoph

    2017-01-01

    Diagnosing unclear lymph node (LN) enlargements in the mediastinum and abdomen is the most important indication of endoscopic ultrasound (EUS)-fine needle aspiration (FNA) after the diagnosis and treatment of pancreatic diseases. Investigating LNs in these areas can happen in different clinical settings. Mostly, it is the first modality in general LN diseases without any peripheral LN enlargements. On the other hand, it can be the question of LN involvement in a known or suspected primary tumor. Due to EUS-FNA cytology, those questions can be answered highly, accurately. However, a primary discrimination of LNs might be helpful to increase the diagnostic value of the FNA cytology, especially in cases with multiple LN enlargements and hard to reach enlarged LNs for example by vessel interposition. Because of the unreliability of B-mode criteria, further diagnostic improvements such as elastography and contrast-enhanced EUS are investigated to increase the accuracy of the initial diagnosis. PMID:28218194

  19. 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

  20. Endoscopic Ultrasound-Guided Pancreatobiliary Endoscopy in Surgically Altered Anatomy

    PubMed Central

    Jirapinyo, Pichamol; Lee, Linda S.

    2016-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed. PMID:27894187

  1. Pancreatic and Gastric Plasmacytoma Presenting with Obstructive Jaundice, Diagnosed with Endoscopic Ultrasound-Guided Fine Needle Aspiration.

    PubMed

    Padda, Manmeet S; Milless, Tiffani; Adeniran, Adebowale J; Mahooti, Sepi; Aslanian, Harry R

    2010-09-28

    Pancreatic plasmacytoma is a rare disorder which may present with obstructive jaundice. Only eighteen cases have been reported in the English language literature. We present the first case of pancreatic plasmacytoma and gastric plasmacytoma diagnosed with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 75-year-old male with a known history of multiple myeloma presented with obstructive jaundice and a pancreatic mass. A concomitant gastric mass due to gastric plasmacytoma was seen. The diagnosis was established via EUS-FNA of the pancreatic mass. Pancreatic plasmacytoma should be suspected in patients with a history of myeloma. EUS-FNA is a safe and effective modality in the diagnosis of pancreatic plasmacytoma. Radiation therapy should be the first-line of therapy in treating pancreatic plasmacytomas.

  2. Pancreatic and Gastric Plasmacytoma Presenting with Obstructive Jaundice, Diagnosed with Endoscopic Ultrasound-Guided Fine Needle Aspiration

    PubMed Central

    Padda, Manmeet S.; Milless, Tiffani; Adeniran, Adebowale J.; Mahooti, Sepi; Aslanian, Harry R.

    2010-01-01

    Pancreatic plasmacytoma is a rare disorder which may present with obstructive jaundice. Only eighteen cases have been reported in the English language literature. We present the first case of pancreatic plasmacytoma and gastric plasmacytoma diagnosed with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 75-year-old male with a known history of multiple myeloma presented with obstructive jaundice and a pancreatic mass. A concomitant gastric mass due to gastric plasmacytoma was seen. The diagnosis was established via EUS-FNA of the pancreatic mass. Pancreatic plasmacytoma should be suspected in patients with a history of myeloma. EUS-FNA is a safe and effective modality in the diagnosis of pancreatic plasmacytoma. Radiation therapy should be the first-line of therapy in treating pancreatic plasmacytomas. PMID:21060710

  3. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

    PubMed Central

    Kamata, Ken; Takenaka, Mamoru; Kitano, Masayuki; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hajime; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Kudo, Masatoshi

    2017-01-01

    AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction. PMID:28216973

  4. Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors

    PubMed Central

    Ignee, Andre; Jenssen, Christian; Hocke, Michael; Dong, Yi; Wang, Wen-Ping; Cui, Xin-Wu; Woenckhaus, Matthias; Iordache, Sevastita; Saftoiu, Adrian; Schuessler, Gudrun; Dietrich, Christoph F.

    2017-01-01

    Background and Objectives: Gastrointestinal stromal tumors (GISTs) represent the largest group of subepithelial tumors (SET) of the upper gastrointestinal (GI) tract. They may show malignant behavior, in contrast to other SET. Endoscopic ultrasound (EUS) is frequently used to characterize SET. With the introduction of contrast-enhanced ultrasound (CEUS) into EUS (CE-EUS), distinct enhancement patterns can be detected. In the presented study, the characteristic features of CE-EUS in GIST are analyzed and compared with those of other SET. Materials and Methods: Consecutive patients from four centers with SET of the upper and middle GI tract were included and received endoscopic or transcutaneous CEUS. The results were compared with EUS-guided tissue acquisition, forceps biopsy, or surgical resection. Results: Forty-two out of 62 (68%) patients had SET of the stomach, 17/62 (27%) of the small intestine, 2/62 (3%) of the esophagus, and 1/62 (2%) extraintestinal. Eighty-one percent underwent surgery. Leiomyoma was found in 5/62 (8%) and GIST in 57/62 patients (92%). Thirty-nine out of 57 (68%) patients had GIST lesions in the stomach, 17/57 (30%) had GIST of the small intestine, and 1/57 (2%) patients had extraintestinal GISTs. GIST size was 62.6 ± 42.1 (16–200) mm. Hyperenhancement had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 98%, 100%, 100%, 93%, and 98% for the diagnosis of GIST. Fifty out of 57 patients with GIST (88%) showed avascular areas in the center of the lesions. Conclusion: CE-EUS and CEUS show hyperenhancement and avascular areas in a high percentage of GIST but not in leiomyoma. Thus, GIST and leiomyoma can be discriminated accurately. PMID:28218202

  5. Intra-channel stent release technique for fluoroless endoscopic ultrasound-guided lumen-apposing metal stent placement: changing the paradigm

    PubMed Central

    Anderloni, Andrea; Attili, Fabia; Carrara, Silvia; Galasso, Domenico; Di Leo, Milena; Costamagna, Guido; Repici, Alessandro; Kunda, Rastislav; Larghi, Alberto

    2017-01-01

    Background Recently, a novel lumen-apposing fully covered self-expanding metal stent (LA-FCSEMS) mounted on an electrocautery-enhanced delivery system has been developed to perform endoscopic ultrasound (EUS)-guided transluminal drainage. From early experience, however, release of the proximal flange of the stent has mostly been done using endoscopic view guidance to ensure proper positioning. Aim We describe a new technique that we have named the Intra-Channel Stent Release Technique (ICSRT) to perform stent placement under complete EUS control, without the use of either fluoroscopic or endoscopic views. Material and methods Data on all consecutive patients who underwent EUS-guided drainage using the new ICSRT between June 2014 and April 2016 were retrospectively retrieved from two institution databases. All EUS procedures were performed by experienced endoscopists with the patient under conscious or deep sedation. The total procedure and stent deployment time, and adverse events related to stent positioning with the ICSRT were evaluated. Results One hundred consecutive patients (51 women; mean age ± SD, 66 ± 15.2 years, range 34 – 95) underwent EUS-guided transluminal drainage with the Hot AXIOS™ device using the new ICSRT. The procedure was technically successful in all but one patient (1 %). The mean total procedural time was 21.9 minutes (range 7 – 50), while the mean time for stent placement was 3.2 minutes (range 1 – 15). No major adverse events occurred. Discussion The ICSRT has been used to deploy the newly developed lumen-apposing FCSEMS under complete EUS guidance without fluoroscopic and/or endoscopic assistance. The technique appears to be safe and highly effective and should be learned by all interventional endosonographers in order to be able to perform drainage in all clinical scenarios.

  6. 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

  7. 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.

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

    PubMed

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

    2011-01-01

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

  9. 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.

  10. Contrast harmonic endoscopic ultrasound: Instrumentation, echoprocessors, and echoendoscopes

    PubMed Central

    Iglesias-Garcia, Julio; Lariño-Noia, Jose; Domínguez-Muñoz, J. Enrique

    2017-01-01

    Endoscopic ultrasound (EUS) has become as one the best diagnostic and therapeutic methods for the management of several intraintestinal and extraintestinal diseases, among them to highlight pancreaticobiliary indications, mediastinal evaluation, and the analysis of gastrointestinal lesions. Over the years, there has been an enormous evolution in the systems available to perform EUS. Newer processors and echoendoscopes are available nowadays, with the ability to perform new imaging analysis, such as elastography and contrast enhancement. In the present article, we will review which systems are available nowadays, focusing also in the technical advances associated. PMID:28218199

  11. Endoscopic features of submucosal deeply invasive colorectal cancer with NBI characteristics : S Saito et al. Endoscopic images of early colorectal cancer.

    PubMed

    Saito, Shoichi; Tajiri, Hisao; Ikegami, Masahiro

    2015-12-01

    In this review, we discuss the features of conventional endoscopy, magnified endoscopy involving image enhanced endoscopy and endoscopic ultrasonography (EUS) using illustrations for submucosal deeply invasive colorectal cancer (SM-Ca). First, the typical features of SM-Ca were observed, including fold convergence, stiffness, depression (ulceration) and elevated lesions in depressed areas. Magnified endoscopic findings using NBI showed dilated, irregularly shaped micro-capillary vessels. In addition, VI and VN pits were clearly visible using crystal violet staining. In contrast, using EUS, at the third layer we found a layer that was thin compared to the surrounding normal mucosa, which suggested the existence of SM-Ca.

  12. Efficacy of endoscopic ultrasonography-guided fine needle aspiration for pancreatic neuroendocrine tumor grading

    PubMed Central

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

    2015-01-01

    AIM: To evaluate the efficacy of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for grading pancreatic neuroendocrine tumors (PNETs). METHODS: A total of 22 patients were diagnosed with PNET by EUS-FNA between October 2001 and December 2013 at Fukushima Medical University Hospital. Among these cases, we targeted 10 PNET patients who were evaluated according to the World Health Organization (WHO) 2010 classification. Surgery was performed in eight patients, and chemotherapy was performed in two patients due to multiple liver metastases.Specimens obtained by EUS-FNA were first stained with hematoxylin and eosin and then stained with chromogranin, synaptophysin, CD56, and Ki-67. The specimens were graded by the Ki-67 index according to the WHO 2010 classification. Specimens obtained by surgery were graded by the Ki-67 index and mitotic count (WHO 2010 classification). For the eight specimens obtained by EUS-FNA, the Ki-67 index results were compared with those obtained by surgery. In the two cases treated with chemotherapy, the effects and prognoses were evaluated. RESULTS: The sampling rate for histological diagnosis by EUS-FNA was 100%. No adverse effects were observed. The concordance rate between specimens obtained by EUS-FNA and surgery was 87.5% (7/8). For the two cases treated with chemotherapy, case 1 received somatostatin analog therapy and transcatheter arterial infusion (TAI) targeting multiple liver metastases. Subsequent treatment consisted of everolimus. During chemotherapy, the primary tumor remained unconfirmed, although the multiple liver metastases diminished dramatically. Case 2 was classified as neuroendocrine carcinoma (NEC) according to the Ki-67 index of a specimen obtained by EUS-FNA; therefore, cisplatin and irinotecan therapy was started. However, severe adverse effects, including renal failure and diarrhea, were observed, and the therapy regimen was changed to cisplatin and etoposide. TAI targeting multiple liver

  13. Dynamic contrast-enhanced endoscopic ultrasound: A quantification method

    PubMed Central

    Dietrich, Christoph F.; Dong, Yi; Froehlich, Eckhart; Hocke, Michael

    2017-01-01

    Dynamic contrast-enhanced ultrasound (DCE-US) has been recently standardized by guidelines and recommendations. The European Federation of Societies for US in Medicine and Biology position paper describes the use for DCE-US. Comparatively, little is known about the use of contrast-enhanced endoscopic US (CE-EUS). This current paper reviews and discusses the clinical use of CE-EUS and DCE-US. The most important clinical use of DCE-US is the prediction of tumor response to new drugs against vascular angioneogenesis. PMID:28218195

  14. Endoscopic ultrasonography in the management of esophageal cancer

    NASA Astrophysics Data System (ADS)

    Trowers, Eugene A.

    2000-05-01

    Precise tumor-staging is critical in the management of early esophageal caner. Endoscopic ultrasound (EUS) allows the endoscopist a view beyond the esophageal wall which opens the door to a variety of new gastroenterologic techniques. Endoscopic mucosal resection, laser photoablation and photodynamic therapy may be successfully employed in early esophageal cancer management. Combination radiation therapy and chemotherapy have shown better responses in advanced cancer. Expandable metallic stents may also provide palliation with inoperable esophageal cancer. The efficacy of EUS in the management of esophageal cancer is critically reviewed.

  15. Pancreatic pseudocyst drainage performed with a new prototype forward-viewing linear echoendoscope.

    PubMed

    Fernández de Castro, Cristina; Cañete, Ángel; Sanz de Villalobos, Eduardo; Ferreiro, Reyes; Albillos Martínez, Agustín; Vázquez Sequeiros, Enrique

    2016-10-01

    Interventional endoscopy is a field that continues to grow rapidly. A novel prototype forward-viewing echoendoscope (FV-EUS) has been recently developed in an attempt to overcome some of the limitations of conventional curved linear-array echoendoscopes (OV-EUS). We present a case of a successful endoscopic ultrasound-guided drainage of a pancreatic pseudocyst using a forward-viewing echoendoscope. Although the utilization use of this newly developed echoendoscope has not yet become widespread, its unique characteristics can help to easily perform routine therapeutic procedures and contribute to the expansion of interventional endoscopic utrasoundultrasound.

  16. Efficacy of Endoscopic Ultrasonography in Evaluation of Undetermined Etiology of Common Bile Duct Dilatation on Abdominal Ultrasonography

    PubMed Central

    Sotoudehmanesh, Rasoul; Nejati, Naimeh; Farsinejad, Maryam; Kolahdoozan, Shadi

    2016-01-01

    BACKGROUND The cause of common bile duct (CBD) dilatation cannot be determined by imaging modalities in many patients. The aim of this study was to assess the value of endoscopic ultrasonography (EUS) in detecting the cause of CBD dilatation in patients in whom ultrasonography could not demonstrate the cause of dilation. METHODS Prospectively, 152 consecutive patients who were referred for evaluation of dilated CBD (diameter ≥7 mm) of undetermined origin by ultrasonography were included in this study. All the patients underwent EUS. Final diagnoses were determined by using endoscopic retrograde cholangiopancreatography (ERCP), EUS-guided fine needle aspiration (FNA), surgical exploration, or follow-up for at least 10 months. Patients with choledocholithiasis were referred for ERCP and sphincterotomy, and patients with operable tumors were referred for surgery.Patients with inoperable tumors underwent biliary stenting with or without tchemoradiotherapy. RESULTS 152 patients (54% female) with dilated CBD were included. Mean (±SD) age of the patients was 60.4 (±17.3) years. The mean CBD diameter for all study group in transabdominal ultrasonography and EUS were 11.7 millimeter and 10.1 millimeter, respectively. Most of the patients with dilated CBD and abnormal liver function test (LFT) had an important finding in EUS and follow-up diagnosis including peri-ampullary tumors. Mean diameter of CBD in patients with and without abnormal LFT were 10.5 IU/L and 12.1 IU/L, respectively. Final diagnoses included choledocholithiasis in 32 (21.1%),passed CBD stone in 35 (23%), opium-induced CBD dilation in 14 (9.2%), post-cholecystectomy states in 20 (13.1%), ampullary adenoma/carcinoma in 15 (15.8%), cholangiocarcinoma in 14 (9.2%), and pancreatic head cancer in9 (5.9%) patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS for patients with abnormal EUS were 89.5%, 100.0%, 100.0%, 91.2%, and 90.9%, respectively

  17. Defeating Insurgencies with Minimal Force Ratios

    DTIC Science & Technology

    2013-06-14

    Before his killing he penned an open letter to President Carter, asking for the US to stop supporting the JRG and call for peace.47 At his funeral...in an enemy-centric fashion. Others, most notably demonstrated by COL (ret.) Tunnell’s open letter to the Secretary of the Army, argue the US should

  18. 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...

  19. Handbook. Disaster Response Staff Officer’s Handbook: Observations, Insights, and Lessons

    DTIC Science & Technology

    2010-12-01

    military specialists trained in foreign animal disease diagnosis, epidemiology, microbiology, immunology, entomology , pathology, and public health... Forensic dental pathology. • Forensic anthropology methods. 93 DISASTER RESPONSE • Processing. • Preparation. • Disposition of remains. DMORTs are...OPEO). Teams are composed of funeral directors, medical examiners, coroners, pathologists, forensic anthropologists, medical records technicians and

  20. 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)

  1. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., 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...

  2. 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...

  3. 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…

  4. 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)...

  5. 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...

  6. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...” 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)...

  7. 16 CFR 453.2 - Price disclosures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., 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...

  8. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...” 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)...

  9. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...” 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)...

  10. 16 CFR 453.1 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...” 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)...

  11. 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...

  12. 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.…

  13. What To Say to Bereaved Parents.

    ERIC Educational Resources Information Center

    Armstrong, Coleen

    1997-01-01

    When a student or former student dies, the principal should offer more than condolences. Principals can avoid feeling awkward or tongue-tied at the child's funeral by doing some homework (recalling memorable moments with the child); asking teachers for shared memories; considering a home visit, personal note, or phone call; and talking about the…

  14. 20 CFR 219.59 - Evidence of responsibility for or payment of burial expenses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... burial expenses. 219.59 Section 219.59 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER... Evidence of responsibility for or payment of burial expenses. The Board will ask for the following evidence... funeral home expenses or paid some or all of these expenses or other burial expenses; or the name...

  15. 20 CFR 10.412 - Will OWCP pay the costs of burial and transportation of the remains?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Will OWCP pay the costs of burial and... the costs of burial and transportation of the remains? In a case accepted for death benefits, OWCP will pay up to $800 for funeral and burial expenses. When an employee's home is within the...

  16. 20 CFR 219.58 - When evidence regarding payment of burial expenses is required.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false When evidence regarding payment of burial... evidence regarding payment of burial expenses is required. If a person applies for the lump-sum death payment because he or she is responsible for paying the funeral home or burial expenses of the employee...

  17. 20 CFR 219.58 - When evidence regarding payment of burial expenses is required.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true When evidence regarding payment of burial... evidence regarding payment of burial expenses is required. If a person applies for the lump-sum death payment because he or she is responsible for paying the funeral home or burial expenses of the employee...

  18. 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

    ....1605 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Burial... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... Affairs. (See § 3.1600(c)). In addition, the cost of transporting the body to the place of burial may...

  19. 20 CFR 219.59 - Evidence of responsibility for or payment of burial expenses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... burial expenses. 219.59 Section 219.59 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER... Evidence of responsibility for or payment of burial expenses. The Board will ask for the following evidence... funeral home expenses or paid some or all of these expenses or other burial expenses; or the name...

  20. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... AFFAIRS ADJUDICATION Burial Benefits § 3.1602 Special conditions governing payments. (a) Two or more persons expended funds. If two or more persons have paid from their personal funds toward the burial, funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will...

  1. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Burial Benefits § 3.1601 Claims and evidence. (a) Claims. Claims for reimbursement or direct payment of burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be received by VA within 2 years after the permanent burial or cremation of the body. Where the...

  2. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... AFFAIRS ADJUDICATION Burial Benefits § 3.1602 Special conditions governing payments. (a) Two or more persons expended funds. If two or more persons have paid from their personal funds toward the burial, funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will...

  3. 20 CFR 10.412 - Will OWCP pay the costs of burial and transportation of the remains?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Will OWCP pay the costs of burial and... the costs of burial and transportation of the remains? In a case accepted for death benefits, OWCP will pay up to $800 for funeral and burial expenses. When an employee's home is within the...

  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

    ....1605 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Burial... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... Affairs. (See § 3.1600(c)). In addition, the cost of transporting the body to the place of burial may...

  5. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Burial Benefits § 3.1601 Claims and evidence. (a) Claims. Claims for reimbursement or direct payment of burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be received by VA within 2 years after the permanent burial or cremation of the body. Where the...

  6. 20 CFR 219.59 - Evidence of responsibility for or payment of burial expenses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... burial expenses. 219.59 Section 219.59 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER... Evidence of responsibility for or payment of burial expenses. The Board will ask for the following evidence... funeral home expenses or paid some or all of these expenses or other burial expenses; or the name...

  7. 38 CFR 3.1602 - Special conditions governing payments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... AFFAIRS ADJUDICATION Burial Benefits § 3.1602 Special conditions governing payments. (a) Two or more persons expended funds. If two or more persons have paid from their personal funds toward the burial, funeral, plot, interment and transportation expenses, the burial and plot or interment allowance will...

  8. 20 CFR 10.412 - Will OWCP pay the costs of burial and transportation of the remains?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Will OWCP pay the costs of burial and... the costs of burial and transportation of the remains? In a case accepted for death benefits, OWCP will pay up to $800 for funeral and burial expenses. When an employee's home is within the...

  9. 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

    ....1605 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Burial... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... Affairs. (See § 3.1600(c)). In addition, the cost of transporting the body to the place of burial may...

  10. 20 CFR 10.412 - Will OWCP pay the costs of burial and transportation of the remains?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Will OWCP pay the costs of burial and... the costs of burial and transportation of the remains? In a case accepted for death benefits, OWCP will pay up to $800 for funeral and burial expenses. When an employee's home is within the...

  11. 20 CFR 219.59 - Evidence of responsibility for or payment of burial expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... burial expenses. 219.59 Section 219.59 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER... Evidence of responsibility for or payment of burial expenses. The Board will ask for the following evidence... funeral home expenses or paid some or all of these expenses or other burial expenses; or the name...

  12. 20 CFR 219.58 - When evidence regarding payment of burial expenses is required.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false When evidence regarding payment of burial... evidence regarding payment of burial expenses is required. If a person applies for the lump-sum death payment because he or she is responsible for paying the funeral home or burial expenses of the employee...

  13. 38 CFR 3.1601 - Claims and evidence.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Burial Benefits § 3.1601 Claims and evidence. (a) Claims. Claims for reimbursement or direct payment of burial and funeral expenses under § 3.1600(b) and plot or interment allowance under § 3.1600(f) must be received by VA within 2 years after the permanent burial or cremation of the body. Where the...

  14. 20 CFR 10.412 - Will OWCP pay the costs of burial and transportation of the remains?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Will OWCP pay the costs of burial and... the costs of burial and transportation of the remains? In a case accepted for death benefits, OWCP will pay up to $800 for funeral and burial expenses. When an employee's home is within the...

  15. 20 CFR 219.58 - When evidence regarding payment of burial expenses is required.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false When evidence regarding payment of burial... evidence regarding payment of burial expenses is required. If a person applies for the lump-sum death payment because he or she is responsible for paying the funeral home or burial expenses of the employee...

  16. 20 CFR 219.59 - Evidence of responsibility for or payment of burial expenses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... burial expenses. 219.59 Section 219.59 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER... Evidence of responsibility for or payment of burial expenses. The Board will ask for the following evidence... funeral home expenses or paid some or all of these expenses or other burial expenses; or the name...

  17. 20 CFR 219.58 - When evidence regarding payment of burial expenses is required.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true When evidence regarding payment of burial... evidence regarding payment of burial expenses is required. If a person applies for the lump-sum death payment because he or she is responsible for paying the funeral home or burial expenses of the employee...

  18. E Pluribus Unum: Strengthening the Air Force Space Command Culture

    DTIC Science & Technology

    2011-02-21

    and funerals ) are artifacts that differentiate the military from other large organizations. Visible behavior patterns, such as technology and...systems and procedures  Rites and rituals of the organization  Design of physical space, facades, and buildings  Stories about important people

  19. Defining suicide: Importance and implications for Judaism.

    PubMed

    Kaplan, S J; Schoeneberg, L A

    1988-06-01

    One of the more problematic situations in the Jewish tradition is seeing to the psychological needs of the family of a suicide. This is due to the legal statements found within the tradition, placing some restrictions on the funeral rite. As a result of this, the criteria for the suicide are to be well examined and understood to ensure proper pastoral care.

  20. 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…

  1. Douglas MacArthur Upon Reflection

    DTIC Science & Technology

    1998-04-01

    father’s funeral .14 Arthur II was a vigorous, bellicose, pugnacious, relentless and heroic military leader.15 According to General Enoch Crowder...the devil may care 1920s, Douglas didn’t understand the stock market, didn’t care for jazz and would not sample bathtub gin. The junior Mrs

  2. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... engage in any unfair or deceptive acts or practices specified in this rule, or to fail to comply with...

  3. Social Networks and Mourning: A Comparative Approach.

    ERIC Educational Resources Information Center

    Rubin, Nissan

    1990-01-01

    Suggests using social network theory to explain varieties of mourning behavior in different societies. Compares participation in funeral ceremonies of members of different social circles in American society and Israeli kibbutz. Concludes that results demonstrated validity of concepts deriving from social network analysis in study of bereavement,…

  4. A Comparative Analysis of the Availability of Information Resources on Ibibio Culture in the University of Uyo and Akwa Ibom State Public Library

    ERIC Educational Resources Information Center

    Okon, Henry Itohowo; Simon, Jehu S.; Akai, Iniobong

    2015-01-01

    This study reports the results of a survey of the available holdings of information resources on Ibibio culture in the University of Uyo Library and Akwa Ibom State Library. The specific objectives of the study were to determine the different size of information resources on funeral, fattening (Mbobo), taboos, myths as well as dissemination in the…

  5. 16 CFR 453.6 - Retention of documents.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Retention of documents. 453.6 Section 453.6 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.6 Retention of documents. To prevent the unfair or deceptive acts or practices specified in §§ 453.2 and...

  6. 16 CFR 453.9 - State exemptions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false State exemptions. 453.9 Section 453.9 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.9 State exemptions. If, upon application to the Commission by an appropriate state agency, the Commission...

  7. 16 CFR 453.7 - Comprehension of disclosures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Comprehension of disclosures. 453.7 Section 453.7 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.7 Comprehension of disclosures. To prevent the unfair or deceptive acts or practices specified...

  8. 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…

  9. Conversations Before the Crisis: If Talking is So Important, Why Is it So Hard?

    MedlinePlus

    ... Newspaper articles about illness and funerals • Movies • Sermons • Television talk shows, dramas and comedies • Financial planning • Annual ... points for conversations. Here are some other possibilities. Television Programs “I know you saw that discussion last ...

  10. 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…

  11. 29 CFR Non - Mandatory Appendix A to Subpart B of Part 1904-Partially Exempt Industries

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Stores 731 Advertising Services. 546 Retail Bakeries 732 Credit Reporting and Collection Services. 549... Retail Stores, Not Elsewhere Classified 804 Offices Of Other Health Practitioners. 60 Depository... Hardware Stores 725 Shoe Repair and Shoeshine Parlors. 542 Meat and Fish Markets 726 Funeral Service...

  12. 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)

  13. 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…

  14. 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…

  15. 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…

  16. 78 FR 21008 - Proposed Information Collection (NCA Customer Satisfaction Surveys (Headstone/Marker) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... respondents, including through the use of automated collection techniques or the use of other forms of... Cemetery Administration Focus Groups a. Next of Kin (5 groups/10 participants per group/3 hours each session) = 150 hours. b. Funeral Directors (5 groups/10 participants per group/3 hours each session) =...

  17. 26 CFR 1.1402(c)-5 - Ministers and members of religious orders.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...(e)(1)-1, to have the Federal old-age, survivors, and disability insurance system established by... marriages and conducts funerals for relatives and friends. N University is neither a religious organization... University is not in the exercise of his ministry. However, service performed by M in performing...

  18. 75 FR 17407 - Service Corporation International and Keystone North America Inc.; Analysis of Agreement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-06

    ... promotion, marketing, sale, and provision of funeral services and goods, including, but not limited to... disposition of human remains. Cemetery services include all activities relating to the promotion, marketing... benefitted from the rivalry between SCI and KNA in the form of lower prices, improved products, and...

  19. 20 CFR 234.15 - When an employee's estate is entitled.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... consisted of: (1) Money in the employee's single-ownership bank account; (2) Money paid directly to the funeral home by the employee before death; (3) Money paid by the employee under a contract, plan, system or general practice where no beneficiary was named to receive the money; (4) Money found among...

  20. 20 CFR 234.14 - Payment to an equitably entitled person.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... own money; (2) Money in a joint account with the employee or another individual; (3) Money paid to an individual who was named beneficiary to receive the money; (4) A promissory note; or (5) Money which several... order: (1) The person who paid the funeral home expenses; (2) The person who paid the grave opening...

  1. "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)

  2. 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)

  3. 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…

  4. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... business of insurance or to acts in the conduct thereof....

  5. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... business of insurance or to acts in the conduct thereof....

  6. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... business of insurance or to acts in the conduct thereof....

  7. 16 CFR 453.8 - Declaration of intent.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Declaration of intent. 453.8 Section 453.8 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES FUNERAL INDUSTRY PRACTICES § 453.8... business of insurance or to acts in the conduct thereof....

  8. 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…

  9. 32 CFR 564.41 - Burial.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Accountability for clothing. (1) If in a serviceable condition, the uniform in possession of the deceased will be... Form 3078 or 3345, substantially as follows: The items of clothing enumerated above were issued to clothe the remains of _____ for funeral purposes. At the time of his/her death, the deceased was a...

  10. 32 CFR 564.41 - Burial.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Accountability for clothing. (1) If in a serviceable condition, the uniform in possession of the deceased will be... Form 3078 or 3345, substantially as follows: The items of clothing enumerated above were issued to clothe the remains of _____ for funeral purposes. At the time of his/her death, the deceased was a...

  11. 32 CFR 564.41 - Burial.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Accountability for clothing. (1) If in a serviceable condition, the uniform in possession of the deceased will be... Form 3078 or 3345, substantially as follows: The items of clothing enumerated above were issued to clothe the remains of _____ for funeral purposes. At the time of his/her death, the deceased was a...

  12. 32 CFR 564.41 - Burial.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Accountability for clothing. (1) If in a serviceable condition, the uniform in possession of the deceased will be... Form 3078 or 3345, substantially as follows: The items of clothing enumerated above were issued to clothe the remains of _____ for funeral purposes. At the time of his/her death, the deceased was a...

  13. 32 CFR 564.41 - Burial.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Accountability for clothing. (1) If in a serviceable condition, the uniform in possession of the deceased will be... Form 3078 or 3345, substantially as follows: The items of clothing enumerated above were issued to clothe the remains of _____ for funeral purposes. At the time of his/her death, the deceased was a...

  14. 75 FR 27237 - Regulatory Flexibility Act Review of the Bloodborne Pathogens Standard

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-14

    ..., dental workers, funeral home workers, law enforcement, emergency, fire, and rescue workers. The Standard was upheld in American Dental Assoc. v. Martin, 984 F. 2d 823 (7th Cir. 1993), cert. denied, 510 U.S... capillary tubes, and exposed ends of dental wires.) Significant requirements of the 1991 Standard are...

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

    DTIC Science & Technology

    1983-06-01

    thoughtful studies of police departments are explicitly semiotic, while the later writings of Erving Goffman (1974, 1981) can be viewed as semiotic...the two substantive interests. Readers interested in the relation of semiotics to symbolic interactionist research and the dramaturgy of funeral work...Qualitative Research. Chicago: Aldine. Goffman , E. (1981) Forms of Talk. Philadelphia: University of Philadelphia. Goffman , E. (1974) Frame Analysis

  16. 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....

  17. 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...

  18. 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....

  19. 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...

  20. "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)

  1. 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.…

  2. 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…

  3. [Cribra orbitalia (Porotic hyperostosis) in a prehistoric population of Parana Medio].

    PubMed

    Cornero, Silvia; Puche, Rodolfo C

    2002-01-01

    The observation of porotic hyperostosis in the orbits (criba orbitalia) in bone remains of a funeral site at the north of the Santa Fe province strongly suggests the occurrence of severe anemia among dwellers. Intestinal parasitosis (by Ancylostoma duodenalis or Necator americanus) is deemed the most likely cause of the anemia.

  4. Death Rituals Reported by White, Black, and Hispanic Parents Following the ICU Death of an Infant or Child

    PubMed Central

    Brooten, Dorothy; Youngblut, JoAnne M.; Charles, Donna; Roche, Rosa; Hidalgo, Ivette; Malkawi, Fatima

    2015-01-01

    Purpose To examine rituals (disposing remains, wakes, funerals/burials, celebrations) of White, Black, Hispanic parents post ICU infant/child death. Design and methods Qualitative design, 63 parents completed English or Spanish semi-structured interviews at 7 & 13 months after infant’s/child’s death. Interviews were audio-recorded, transcribed verbatim, and entered into Atlas.ti for analysis. An inductive approach to thematization was used to develop codes. Results Parents: mean age 35.1 years (SD = 9.03); 33% Black, 27% White, 40% Hispanic; from 17 countries. Three themes emerged: immediately after death - shock and stress, needing help with arrangements, decisions on burial or cremation (conflicts due to finances, religion, culture), when and where to hold wakes, funerals/burials. Wakes and funerals - who prepares child’s body, appropriate dress (deceased child, mourners), who can come (cultural restrictions),-variations by child age, parent choice, culture, religion, country. After burial/cremation - being with family, milestone celebrations. Conclusion Child death is devastating for parents, other children, grandparents, and family members. Practice Implications. Rituals after child death require decisions about the child’s remains, wakes, funerals/burials at time of great pain for parents. This is especially true for newly immigrated parents and those with language barriers where making arrangements is especially hard and often very isolating. Health professionals who provide support need to be cognizant of practice differences based on religion, culture, economics, family traditions, and individual preference and provide as much support and resource as possible. A list of religious leaders representing the community’s cultures and funeral service providers who may provide lower cost burials/cremations is helpful. PMID:26639773

  5. Clinical effects of eosinophilic esophagitis observed using endoscopic ultrasound.

    PubMed

    Yamabe, Akane; Irisawa, Atsushi; Shibukawa, Goro; Abe, Yoko; Saito, Akiko; Imbe, Koh; Hoshi, Koki; Igarashi, Ryo

    2014-08-01

    A 50-year-old woman was referred to our hospital for dysphagia and several episodes of esophageal food impaction during the prior three months. Complete blood count and basic biochemical tests were normal. No eosinophilia was found. Esophagogastroduodenoscopy (EGD) revealed the presence of concentric rings (esophageal "trachealization") and stenosis along the middle and distal esophagus. Endoscopic ultrasound (EUS) showed circumferential thickening of all layers in the same part. Cytopathologic evaluation of a specimen obtained by endoscopic biopsy of the thickened area in the distal esophagus showed eosinophilic infiltration (20 eosinophils per high-powered field). She was diagnosed as having eosinophilic esophagitis (EoE). Topical steroid therapy was started. A tendency of dysphagia for relief and improvement of characteristic EGD findings began early, but wall thickening in EUS remained. Past reports of the related literature have described that thickness of submucosa and muscularis propria remained after therapy, although significant reduction in the mucosal thickness was provided by short-term steroid therapy. One explanation for early relapse is insufficient reduction in the submucosa and muscularis propria. Consequently, our patient was given steroids until thickness on EUS improved. EUS is regarded as useful for evaluating the curative effect in patients with EoE.

  6. Eosinophilic esophageal myositis diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report.

    PubMed

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

    2016-10-01

    Eosinophilic esophagitis (EoE) is diagnosed by microscopic findings of eosinophilic infiltration into the squamous epithelium. In contrast, another disease concept termed "eosinophilic esophageal myositis (EoEM)" has been proposed, whereby there is eosinophilic infiltration into the muscularis propria instead. A 60-year-old man was referred to our hospital for chest pain, dysphagia, and several episodes of esophageal food impaction. Although EoE was suspected based on clinical features, biopsy specimens showed no mucosal eosinophilic infiltration. Endoscopic ultrasound (EUS) showed thickening of the muscularis propria layer and subsequent EUS-guided fine-needle aspiration biopsy (EUS-FNA) revealed eosinophilic infiltration into the muscularis propria. Although the patient's symptoms gradually improved after steroid administration, complete remission was not achieved after 1 year of treatment. This case may reflect a disorder distinct from typical EoE based on eosinophilic infiltration of the muscularis propria but not the squamous epithelium, and we, therefore, diagnosed it as EoEM using the EUS-FNA findings as reference.

  7. B-mode and contrast-enhancement characteristics of small nonincidental neuroendocrine pancreatic tumors

    PubMed Central

    Braden, Barbara; Jenssen, Christian; D’Onofrio, Mirko; Hocke, Michael; Will, Uwe; Möller, Kathleen; Ignee, Andre; Dong, Yi; Cui, Xin-Wu; Săftoiu, Adrian; Dietrich, Christoph F.

    2017-01-01

    Background and Objectives: Imaging of the pancreas for detection of neuroendocrine tumors is indicated as surveillance in multiple endocrine neoplasia type 1 (MEN1) or if typical clinical symptoms combined with hormone production raise the suspicion of a neuroendocrine tumor. Endoscopic ultrasound (EUS) is considered the best imaging modality to detect small pancreatic tumors. However, little is known about how small pancreatic neuroendocrine tumors (pNETs) present on EUS. Patients and Methods: In this multicenter study, we retrospectively analyzed the endosonographic characteristics of small pNETs which had been detected due to typical biochemistry and clinical symptoms or during surveillance of MEN 1. Only small pancreatic tumors ≤15 mm with histological confirmation as pNET were included. B-mode and contrast-enhanced ultrasound- and EUS patterns were analyzed. Results: Among 32 patients with histologically proven small pNETs, 7 patients had known MEN1. Among the pNETs, 20 were insulinoma, 2 gastrinoma, 3 glucagonoma, 6 nonfunctional in MEN1, and one PPoma. 94% of the pNET appeared hypoechogenic, only 1 isoechogenic and 1 hyperechogenic. After contrast injection, 90% of the pNETS showed hyperenhancement compared to the surrounding pancreatic parenchyma. Conclusion: The high spatial resolution of EUS allows detection and even cytological confirmation of pNET <7 mm diameter. Hypoechogenicity in B-mode and hyperenhancement after injection of contrast agents are endosonographic characteristics of small pNET and present in >90% of pNETs. PMID:28218201

  8. 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

  9. Effect of orchiectomy and testosterone replacement on lower urinary tract function in anesthetized rats.

    PubMed

    Cheng, Chen-Li; de Groat, William C

    2016-11-01

    Lower urinary tract (LUT) symptoms (LUTS), including frequency, urgency, incomplete voiding, and slow stream, are common in both men and women with advancing age. The most common cause for LUTS in aging men is benign prostatic hyperplasia. Some studies have also revealed an inverse association of serum testosterone levels with LUTS; however, the underlying mechanisms by which gonadal hormones affect the LUT have not been clarified. In the present study, we examined the effect of orchiectomy and testosterone replacement on LUT function in adult male Sprague-Dawley rats. Six weeks after bilateral orchiectomy or sham operations and 3 wk after injection of long-acting testosterone undecanoate (100 mg/kg im), transvesical cystometry and external urethral sphincter electromyogram (EUS EMG) recordings were performed under urethane anesthesia. The micturition reflex was elicited in both sham and orchiectomized animals. In orchiectomized rats, volume threshold for inducing micturition decreased by 47.6%; however, contraction amplitude, duration, and voiding efficiency were similar in sham and orchiectomized rats. The active period during EUS EMG bursting was lengthened during micturition in orchiectomized animals. Testosterone treatment, which normalized plasma testosterone levels, reversed these changes but also increased the duration of EUS EMG bursting. Orchiectomy also reduced mean voiding flow rate estimated from the duration of EUS EMG bursting, an effect that was not reversed by testosterone. The results indicate that orchiectomy affects both the active and passive properties of the bladder and urethra, and that many, but not all, of the changes can be reversed by testosterone.

  10. 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.

  11. 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.

  12. Toward optical guidance during endoscopic ultrasound-guided fine needle aspirations of pancreatic masses using single fiber reflectance spectroscopy: a feasibility study

    NASA Astrophysics Data System (ADS)

    Stegehuis, Paulien L.; Boogerd, Leonora S. F.; Inderson, Akin; Veenendaal, Roeland A.; van Gerven, P.; Bonsing, Bert A.; Sven Mieog, J.; Amelink, Arjen; Veselic, Maud; Morreau, Hans; van de Velde, Cornelis J. H.; Lelieveldt, Boudewijn P. F.; Dijkstra, Jouke; Robinson, Dominic J.; Vahrmeijer, Alexander L.

    2017-02-01

    Endoscopic ultrasound-guided fine needle aspirations (EUS-FNA) of pancreatic masses suffer from sample errors and low-negative predictive values. Fiber-optic spectroscopy in the visible to near-infrared wavelength spectrum can noninvasively extract physiological parameters from tissue and has the potential to guide the sampling process and reduce sample errors. We assessed the feasibility of single fiber (SF) reflectance spectroscopy measurements during EUS-FNA of pancreatic masses and its ability to distinguish benign from malignant pancreatic tissue. A single optical fiber was placed inside a 19-gauge biopsy needle during EUS-FNA and at least three reflectance measurements were taken prior to FNA. Spectroscopy measurements did not cause any related adverse events and prolonged procedure time with ˜5 min. An accurate correlation between spectroscopy measurements and cytology could be made in nine patients (three benign and six malignant). The oxygen saturation and bilirubin concentration were significantly higher in benign tissue compared with malignant tissue (55% versus 21%, p=0.038; 166 μmol/L versus 17 μmol/L, p=0.039, respectively). To conclude, incorporation of SF spectroscopy during EUS-FNA was feasible, safe, and relatively quick to perform. The optical properties of benign and malignant pancreatic tissue are different, implying that SF spectroscopy can potentially guide the FNA sampling.

  13. Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook.

    PubMed

    Signoretti, Marianna; Valente, Roberto; Repici, Alessandro; Delle Fave, Gianfranco; Capurso, Gabriele; Carrara, Silvia

    2017-02-16

    Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer (LAPC), pancreatic neuroendocrine tumours (PNETs), and pancreatic cystic lesions (PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as well as hybrid cryotherm probe combining radiofrequency with cryotechnology. To date, many reports and case series have confirmed the safety and feasibility of that kind of ablation technique in the pancreatic setting. Moreover, EUS-guided fine-needle injection is emerging as a method to deliver ablative and anti-tumoral agents inside the tumuor. Ethanol injection has been proposed mostly for the treatment of PCLs and for symptomatic functioning PNETs, and the use of gemcitabine and paclitaxel is also interesting in this setting. EUS-guided injection of chemical or biological agents including mixed lymphocyte culture, oncolytic viruses, and immature dendritic cells has been investigated for the treatment of LAPC. Data on the long-term efficacy of these approaches, and large prospective randomized studies are needed to confirm the real clinical benefits of these techniques for the management of pancreatic lesions.

  14. Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook

    PubMed Central

    Signoretti, Marianna; Valente, Roberto; Repici, Alessandro; Delle Fave, Gianfranco; Capurso, Gabriele; Carrara, Silvia

    2017-01-01

    Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer (LAPC), pancreatic neuroendocrine tumours (PNETs), and pancreatic cystic lesions (PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as well as hybrid cryotherm probe combining radiofrequency with cryotechnology. To date, many reports and case series have confirmed the safety and feasibility of that kind of ablation technique in the pancreatic setting. Moreover, EUS-guided fine-needle injection is emerging as a method to deliver ablative and anti-tumoral agents inside the tumuor. Ethanol injection has been proposed mostly for the treatment of PCLs and for symptomatic functioning PNETs, and the use of gemcitabine and paclitaxel is also interesting in this setting. EUS-guided injection of chemical or biological agents including mixed lymphocyte culture, oncolytic viruses, and immature dendritic cells has been investigated for the treatment of LAPC. Data on the long-term efficacy of these approaches, and large prospective randomized studies are needed to confirm the real clinical benefits of these techniques for the management of pancreatic lesions. PMID:28250896

  15. Gastrointestinal involvement by mantle cell lymphoma observed by endoscopy

    PubMed Central

    Li, De-Ming; Jiang, Yue-Ping

    2017-01-01

    Abstract Introduction: Mantle cell lymphoma (MCL) is a subtype of non-Hodgkin B-cell lymphoma, accounting for 6% of all non-Hodgkin lymphoma. The typical appearance of intestinal MCL is multiple lymphomatous polyposis, whereas presentation as protruding lesions is uncommon. We herein report the case of a 64-year-old male patient who was admitted to our hospital with epigastric pains. On endoscopy, submucosal neoplasma were identified in the gastric antrum, the duodenal bulb, and the rectum. On endoscopic ultrasonography (EUS) (OLYMPUS EUS EU-ME2, Miniprobe sonography), the lesions were homogeneously hypoechoic and originated from the submucous layer or muscularis mucosa. Pathological examination of biopsied specimens from the lesions of the rectum revealed diffuse lymphomatous proliferation and dense infiltration by monomorphic and small cleaved cells with irregularly shaped nuclei. On immunohistochemistry, the cells were positive for cyclin D1, CD20, CD21, SOX-11, and Bcl-2, but negative for CD3 and CD10; these findings were compatible with a diagnosis of MCL. Conclusion: The EUS characteristics initially led to the suspicion of digestive neuroendocrine tumors, since MCL presenting as submucosal tumors on EUS is rarely reported. We herein present this case to suggest clinician to include MCL in the differential diagnosis of submucosal intestinal lesions, as early diagnosis and timely treatment may improve patient prognosis. PMID:28296749

  16. A high resolution magneto-optical system for imaging of individual magnetic flux quanta.

    PubMed

    Golubchik, Daniel; Polturak, Emil; Koren, Gad; Lipson, Stephen G

    2009-08-31

    A high-resolution magneto-optical imaging system is described. In this system magneto-optical Kerr effect is utilized for resolving individual flux quanta in a type II superconductor. Using an ultra thin EuSe indicator a spatial resolution of 0.8 microm is achieved.

  17. 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

  18. 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

  19. Intraductal tubulopapillary neoplasm with expansile invasive carcinoma of the pancreas diagnosed by endoscopic ultrasonography-guided fine needle aspiration: a case report.

    PubMed

    Furuhata, Ayako; Minamiguchi, Sachiko; Mikami, Yoshiki; Kodama, Yuzo; Sumiyoshi, Shinji; Adachi, Souichi; Haga, Hironori

    2014-04-01

    Intraductal tubulopapillary neoplasm (ITPN) of the pancreas, a novel entity included in the World Health Organization 2010 classification, accounts for <1% of all pancreatic exocrine neoplasms and the number of reported cases is limited in the English literature. Herein we describe the cytologic features of ITPN with invasive carcinoma showing expansile growth on endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) cytology. A 74-year-old male patient is presented with a 6.2 cm irregular mass in the head of the pancreas. Microscopic examination of EUS-FNA material showed abundant branching clusters of cells, with some scattered discohesive cells. High power magnification revealed tubular and cribriform patterns with central lumina, containing mucinous or proteinaceous secretions. The constituent cells were relatively uniform and showed mild to intermediate nuclear atypia. Intracytoplasmic mucin was not identified. On cell-block preparation, luminal spaces of clusters contained wispy luminal mucin. Immunohistochemically, constituent cells were positive for MUC1 and MUC6, and were negative for MUC5AC. The large cribriform and tubular clusters with luminal spaces containing wispy mucin were considered to be diagnostic clues for the cytologic diagnosis of ITPN by EUS-FNA. MUC1, MUC6, and MUC5AC immunohistochemistry for cell-block preparation appears to be a useful adjunctive tool to confirm the diagnosis. On EUS-FNA, ITPN should be included in the differential diagnosis of a pancreatic mass lesion showing good circumscription.

  20. 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

  1. Restaging locally advanced rectal cancer by different imaging modalities after preoperative chemoradiation: a comparative study

    PubMed Central

    2013-01-01

    Background To compare the accuracy of different imaging modalities, alone and in combination in predicting findings at surgery after preoperative chemoradiation for locally advanced rectal cancer. Methods Following chemoradiation, tumors were reclassified on the basis of findings on pelvic computed tomography (CT) (94 patients), endorectal ultrasonography (EUS) (138 patients) alone or by both CT and EUS (80 patients). The ability of the imaging modalities, to predict the pathologic T status, N status, and TNM stage at surgery was evaluated and compared. Results Mean age of the patients was 64.5 years (range 28–88 years); 55% were male. CT and EUS combined had a positive predictive value of 20% for pathologic pT1 stage, 29% for pT1, 29% for pT2, and 58% for pT3. Predictive values for the operative TNM stage were 50% for stage I, 45% for stage II, and 31% for stage III. These values did not exceed those for each modality alone. Conclusion The performance of preoperative CT and EUS in predicting the T and TNM stage of rectal cancer at surgery is poor. Neither modality alone nor the two combined is sufficiently accurate to serve as the basis for decisions regarding treatment modification. PMID:24286200

  2. The Suitability of Propofol Compared with Urethane for Anesthesia during Urodynamic Studies in Rats.

    PubMed

    Moheban, Adam A; Chang, Huiyi H; Havton, Leif A

    2016-01-01

    Urethane anesthesia preserves many reflex functions and is often the preferred anesthetic for urodynamic studies in rats. Because of the toxicity profile of urethane, its use as an anesthetic typically is limited to acute and terminal investigations. Alternative anesthetic options are needed for longitudinal studies of micturition reflexes in rats. In this study, we evaluated propofol anesthesia administered at constant rate infusion at different planes of anesthesia in rats for combined cystometrography and external urethral sphincter (EUS) EMG in rats. No reflex micturition was noted after rats received 100%, 80%, or 60% of a previously reported anesthetic dose of propofol. At 40% of the standard propofol dose, a subset of rats showed reflex voiding, with bladder contractions and associated EUS EMG activity. In contrast, urethane anesthesia at a surgical plane allowed for reflex voiding with bladder contractions and EUS activation. Latency to leaking or voiding was longer in rats under propofol anesthesia than in those under urethane anesthesia. In a subset of rats with reflex voiding under propofol anesthesia, voiding efficiency was decreased compared with that of rats anesthetized with urethane. We conclude that propofol anesthesia suppresses micturition reflexes in rats more efficiently than did urethane. Propofol is a suitable anesthetic for longitudinal studies in rats, but its use for urodynamic evaluations is limited in these animals due to its marked suppression of both bladder contractions and EUS EMG activation.

  3. 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.

  4. Interventional Therapy for Pancreatic Cancer

    PubMed Central

    Zhu, Jianwei; Jin, Zhendong

    2016-01-01

    Background Palliative therapy and primarily chemoradiotherapy are the mainstream treatments in patients with locally advanced or metastatic pancreatic cancer (PC). Conventional endoscopy and endoscopic ultrasound (EUS)-guided interventional therapy has emerged as an important procedure for PC management. In this review, the progress in conventional endoscopy and EUS for PC management is discussed. Summary For local palliative therapy against PC, EUS-guided fine needle injection (FNI) could deliver different kinds of agents, such as radioactive seeds and fiducials. Although their feasibility and safety have been proven, the long-term efficiency of EUS-FNI is still not established. For pain, EUS-celiac plexus neurolysis (CPN) is effective. However, CPN can only relieve the pain to a limited degree, with short duration. Endoscopy-guided stent placement is the preferred strategy for biliary and duodenal obstruction. Plastic and metal stents are equally effective for the relief of obstructive jaundice. The functional times of metal stents are longer than those of a plastic stent. Key Message For biliary obstruction, a metal stent is the first choice. The long-term efficiency of EUS-FNI still needs further study. Practical Implications Endoscopy and EUS-guided interventions have gradually become the mainstream method for local treatment of PC due to mini-invasiveness and real-time observation. PC is the second most common gastrointestinal malignancy and the sixth leading cause of cancer mortality in the United States, leading to about 4.0% of all cancer deaths [Siegel et al: CA Cancer J Clin 2014;64:9-29]. The only curative approach for patients with PC is surgical resection, but unfortunately 80-90% of patients have a surgically inoperable disease, with 53% having local metastases at the time of diagnosis [Weinberg et al: Oncology (Williston Park) 2015;29:809-820, 886]. Therefore, palliative therapy and primarily chemoradiotherapy are the mainstream of treatment in

  5. 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.

  6. Endoscopic ultrasound-guided fine-needle aspirate-derived preclinical pancreatic cancer models reveal panitumumab sensitivity in KRAS wild-type tumors.

    PubMed

    Berry, William; Algar, Elizabeth; Kumar, Beena; Desmond, Christopher; Swan, Michael; Jenkins, Brendan J; Croagh, Daniel

    2017-05-15

    Pancreatic cancer (PC) is largely refractory to existing therapies used in unselected patient trials, thus emphasizing the pressing need for new approaches for patient selection in personalized medicine. KRAS mutations occur in 90% of PC patients and confer resistance to epidermal growth factor receptor (EGFR) inhibitors (e.g., panitumumab), suggesting that KRAS wild-type PC patients may benefit from targeted panitumumab therapy. Here, we use tumor tissue procured by endoscopic ultrasound-guided fine-needle aspirate (EUS-FNA) to compare the in vivo sensitivity in patient-derived xenografts (PDXs) of KRAS wild-type and mutant PC tumors to panitumumab, and to profile the molecular signature of these tumors in patients with metastatic or localized disease. Specifically, RNASeq of EUS-FNA-derived tumor RNA from localized (n = 20) and metastatic (n = 20) PC cases revealed a comparable transcriptome profile. Screening the KRAS mutation status of tumor genomic DNA obtained from EUS-FNAs stratified PC patients into either KRAS wild-type or mutant cohorts, and the engraftment of representative KRAS wild-type and mutant EUS-FNA tumor samples into NOD/SCID mice revealed that the growth of KRAS wild-type, but not mutant, PDXs was selectively suppressed with panitumumab. Furthermore, in silico transcriptome interrogation of The Cancer Genome Atlas (TCGA)-derived KRAS wild-type (n = 38) and mutant (n = 132) PC tumors revealed 391 differentially expressed genes. Taken together, our study validates EUS-FNA for the application of a novel translational pipeline comprising KRAS mutation screening and PDXs, applicable to all PC patients, to evaluate personalized anti-EGFR therapy in patients with KRAS wild-type tumors.

  7. Endosonography‑guided fine‑needle aspiration in the diagnosis of sarcoidosis: a randomized study.

    PubMed

    Kocoń, Piotr; Szlubowski, Artur; Kużdżał, Jarosław; Rudnicka-Sosin, Lucyna; Ćmiel, Adam; Soja, Jerzy; Włodarczyk, Janusz R; Talar, Piotr; Smęder, Tomasz; Gil, Tomasz; Warmus, Janusz; Tomaszewska, Romana

    2017-03-31

    INTRODUCTION    There are no widely accepted standards for the diagnosis of sarcoidosis. OBJECTIVES    The aim of this study was to assess the relative diagnostic yield of endobronchial ultrasound fine-needle aspiration (EBUS -FNA) and endoscopic ultrasound fine needle aspiration (EUS -FNA), and to compare them with standard diagnostic techniques such as endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), and mediastinoscopy. PATIENTS AND METHODS    This was a prospective randomized study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. EBB, TBLB, and TBNA were performed at baseline in all patients. Subsequently, patients were randomized to group A (EBUS -FNA) or group B (EUS -FNA). Next, a crossover control test was performed: all patients with negative results in group A underwent EUS -FNA and all patients with negative results in group B underwent EBUS -FNA. If sarcoidosis was not confirmed, mediastinoscopy was performed. RESULTS    We enrolled 106 patients, of whom 100 were available for the final analysis. The overall sensitivity and accuracy of standard endoscopic methods were 64% each. When analyzing each of the standard endoscopic methods separately, the diagnosis was confirmed with EBB in 12 patients (12%), with TBLB in 42 patients (42%), and with TBNA in 44 patients (44%). The sensitivity and accuracy of each endosonographic technique were significantly higher than those of EBB+TBLB+TBNA (P = 0.0112 vs P = 0.0134). CONCLUSIONS    The sensitivity and accuracy of EBUS -FNA and EUS -FNA are significantly higher than those of standard endoscopic methods. Moreover, the sensitivity and accuracy of EUS -FNA tend to be higher than those of EBUS -FNA.

  8. 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

  9. Single-dose intra-procedural ceftriaxone during endoscopic ultrasound fine-needle aspiration of pancreatic cysts is safe and effective: results from a single tertiary center

    PubMed Central

    Klein, Amir; Qi, Rose; Nagubandi, Shyam; Lee, Eric; Kwan, Vu

    2017-01-01

    Background Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) is universally used for the investigation and diagnosis of pancreatic cystic lesions (PCL). Infectious complications following EUS-FNA of PCL are rare. Antibiotic prophylaxis to reduce the risk of infection is recommended; however, there is no consensus on the optimal regimen or route of administration. Potential advantages of a single-dose intravenous (IV) antibiotic over a prolonged oral regimen include simplicity, guaranteed delivery and fewer antibiotic related adverse events, but there are only limited data to support this. We aimed to investigate the safety and efficacy of a single 1 g dose of IV ceftriaxone in preventing infectious complications following EUS-FNA of PCL. Methods A retrospective analysis was conducted of EUS-FNA of PCL procedures performed at our center. We reviewed patient medical records for any presentation to a hospital in our district within 30 days of the procedure. An infectious complication was defined as fever/rigors, or bacteremia, or abdominal pain accompanied by imaging or laboratory results suggestive of infection, within 30 days of the procedure. Data collection included patient demographics, procedural data and outcome. Results EUS-FNA of 204 PCL (mean size 18.0 mm) was performed. Successful fluid aspiration was achieved in 94% of cases. Single-dose IV ceftriaxone was given in 146/204 (72%) cases. Four patients had a complication (pancreatitis n=1, post-procedural pain n=3). No infectious complications and no IV antibiotic-related adverse events were identified. Conclusion A single dose of IV ceftriaxone appears to be a safe, effective and convenient intervention for preventing infectious complications after FNA. PMID:28243046

  10. 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

  11. Validation of diagnostic characteristics of needle based confocal laser endomicroscopy in differentiation of pancreatic cystic lesions

    PubMed Central

    Krishna, Somashekar G.; Swanson, Benjamin; Hart, Phil A.; El-Dika, Samer; Walker, Jon P.; McCarthy, Sean T.; Malli, Ahmad; Shah, Zarine K.; Conwell, Darwin L.

    2016-01-01

    Background and aims: Endoscopic ultrasound (EUS)-guided needle-based Confocal Laser Endomicroscopy (nCLE) characteristics of pancreatic cystic lesions (PCLs) have been identified in studies where the gold standard surgical histopathology was available in a minority of patients. There are diverging reports of interobserver agreement (IOA) and paucity of intraobserver reliability (IOR). Thus, we sought to validate current EUS-nCLE criteria of PCLs in a larger consecutive series of surgical patients. Methods: A retrospective analysis of patients who underwent EUS-nCLE at a single center was performed. For calculation of IOA (Fleiss’ kappa) and IOR (Cohen’s kappa), blinded nCLE-naïve observers (n = 6) reviewed nCLE videos of PCLs in two phases separated by a 2-week washout period. Results: EUS-nCLE was performed in 49 subjects, and a definitive diagnosis was available in 26 patients. The overall sensitivity, specificity, and accuracy for diagnosing a mucinous PCL were 94 %, 82 %, and 89 %, respectively. The IOA for differentiating mucinous vs. non-mucinous PCL was “substantial” (κ = 0.67, 95 %CI 0.57, 0.77). The mean (± standard deviation) IOR was “substantial” (κ = 0.78 ± 0.13) for diagnosing mucinous PCLs. Both the IOAs and mean IORs were “substantial” for detection of known nCLE image patterns of papillae/epithelial bands of mucinous PCLs (IOA κ = 0.63; IOR κ = 0.76 ± 0.11), bright particles on a dark background of pseudocysts (IOA κ = 0.71; IOR κ = 0.78 ± 0.12), and fern-pattern or superficial vascular network of serous cystadenomas (IOA κ = 0.62; IOR κ = 0.68 ± 0.20). Three (6.1 % of 49) patients developed post-fine needle aspiration (FNA) pancreatitis. Conclusion: Characteristic EUS-nCLE patterns can be consistently identified and improve the diagnostic accuracy of PCLs. These results support further investigations to optimize EUS-nCLE while minimizing adverse events

  12. Effects of premedication with Pronase for endoscopic ultrasound of the stomach: A randomized controlled trial

    PubMed Central

    Wang, Guo-Xin; Liu, Xiang; Wang, Sheng; Ge, Nan; Guo, Jin-Tao; Sun, Si-Yu

    2016-01-01

    AIM To analyze the effects of premedication with Pronase for endoscopic ultrasound (EUS) examination of the stomach. METHODS This was a prospective, randomized and controlled clinical study. All patients were randomly assigned to either the Pronase group or placebo group. The pretreatment solution was a mixed solution of 20000 U of Pronase and 60 mL sodium bicarbonate solution in the Pronase group, while an equal amount of sodium bicarbonate solution was administered to the placebo group. All operators, image evaluators and experimental recorders in EUS did not participate in the preparation and allocation of pretreatment solution. Two blinded investigators assessed the obscurity scores for the EUS images according to the size of artifacts (including ultrasound images of the gastric cavity and the gastric wall). Differences in imaging quality, the duration of examination and the usage of physiological saline during the examination process between the Pronase group and the control group were compared. RESULTS No differences existed in patient demographics between the two groups. For the gastric cavity, the Pronase group had significantly lower mean obscurity scores than the placebo group (1.0476 ± 0.77 vs 1.6129 ± 0.96, respectively, P = 0.000). The mean obscurity scores for the gastric mucosal surface were significantly lower in the Pronase group than the placebo group (1.2063 ± 0.90 vs 1.7581 ± 0.84, respectively, P = 0.001). The average EUS procedure duration for the Pronase group was 11.60 ± 3.32 min, which was significantly shorter than that of the placebo group (13.13 ± 3.81 min, P = 0.007). Less saline was used in the Pronase group than the placebo group, and the difference was significant (417.94 ± 121.38 mL vs 467.42 ± 104.52 mL, respectively, P = 0.016). CONCLUSION The group that had Pronase premedication prior to the EUS examination had clearer images than the placebo group. With Pronase premedication, the examination time was shorter, and the

  13. A Case of Contested Cremains Analyzed Through Metric and Chemical Comparison.

    PubMed

    Bartelink, Eric J; Sholts, Sabrina B; Milligan, Colleen F; Van Deest, Traci L; Wärmländer, Sebastian K T S

    2015-07-01

    Since the 1980s, cremation has become the fastest growing area of the U.S. funeral industry. At the same time, the number of litigations against funeral homes and cremation facilities has increased. Forensic anthropologists are often asked to determine whether the contents of an urn are actually cremated bone, and to address questions regarding the identity of the remains. This study uses both metric and chemical analyses for resolving a case of contested cremains. A cremains weight of 2021.8 g was predicted based on the decedent's reported stature and weight. However, the urn contents weighed 4173.5 g. The urn contents also contained material inconsistent with cremains (e.g., moist sediment, stones, ferrous metal). Analysis using XRD and SEM demonstrated that the urn contained thermally altered bone as well as inorganic material consistent with glass fiber cement. Although forensically challenging, cremains cases such as this one can be resolved using a multidisciplinary approach.

  14. Testing an unconventional mortality information source in the canton of Geneva Switzerland.

    PubMed

    Kabengele Mpinga, Emmanuel; Delley, Véronique; Jeannot, Emilien; Cohen, Joachim; Chastonay, Philippe; Wilson, Donna M

    2013-09-26

    Mortality data are often unavailable, incomplete, and difficult to access for research and other purposes. Gaps in mortality data reports, particularly those detailing place of death, deprive healthcare professionals, decision-makers, and many others of the information that is needed to plan, implement, and evaluate interventions designed for purposes such as to assist people in achieving their preferred death place or reduce hospital utilization. Alternative methods of collecting reliable and valid data on death place may be needed. Our study primarily compared mortality data from a conventional information system (Federal Statistical Office) with mortality data collected using an unconventional system (funeral homes) over a 6-year period (2005-10) for the canton of Geneva Switzerland. Only a small average difference (4.8%) in death incidence was found. Death place data comparisons were also useful. This study suggests that the unconventional data from funeral homes provides reasonably reliable, valid, timely, and useful mortality data.

  15. 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.

  16. [Spiritual care of a terminal liver cancer patient: a nursing experience].

    PubMed

    Chien, Hui-Chi

    2010-04-01

    Death, an unavoidable event in the human experience, causes physical as well as mental and spiritual suffering. This paper reports on a nursing experience giving spiritual care to a terminal liver cancer patient between January 17 and February 9, 2009. Eleven nursing logs were used as the source of data for daily information. During the care period, patient religious needs featured prominently, including his desire to become a Christian and his eagerness to know about and help in the arrangement of his funeral. Taking the initiative, the nurse helped link him with religious resources, arranged a minister for his baptism ceremony, had the priest explain funeral proceedings, and assisted with the completion of his entrusted plans. The function of this nursing care intervention was to provide a personal touch to a patient who was in desperate need of warm spiritual care. It is hoped that this report can help caregivers increase their sensitivity toward patient spiritual needs and enhance routine nursing care quality.

  17. Inmate failed to demonstrate harm resulted from HIV disclosure.

    PubMed

    1998-04-17

    An inmate who claimed he was taunted by corrections officers about his HIV infection has no cause of action unless he alleges the statements did him measurable harm, according to a Federal judge in New York. [Name removed] claims to have been verbally harassed at Green Haven Correctional Facility in 1994 and 1995 while serving time for rape. The harassers were not identified. [Name removed] sought damages from Green Haven, the warden, and a supervisor, arguing that they should all be held liable for revealing his HIV status to guards. U.S. District Court Judge Denise Cote ruled against [name removed] since he could not prove they had access to his medical records. [Name removed] also complained that prison staff were indifferent and refused to allow him to attend his mother's funeral; the judge stated that inmates do not have a constitutional right to attend a family member's funeral.

  18. Exposure Patterns Driving Ebola Transmission in West Africa: A Retrospective Observational Study

    PubMed Central

    Agua-Agum, Junerlyn; Aylward, Bruce; Bawo, Luke; Blake, Isobel M.; Brennan, Richard J.; Cawthorne, Amy; Cleary, Eilish; Clement, Peter; Conteh, Roland; Cori, Anne; Dafae, Foday; Dahl, Benjamin; Dangou, Jean-Marie; Diallo, Boubacar; Donnelly, Christl A.; Dye, Christopher; Eckmanns, Tim; Fallah, Mosoka; Fiebig, Lena; Fraser, Christophe; Garske, Tini; Gonzalez, Lice; Hamblion, Esther; Hamid, Nuha; Hinsley, Wes; Jambei, Amara; Jombart, Thibaut; Kargbo, David; Keita, Sakoba; Kinzer, Michael; George, Fred Kuti; Godefroy, Beatrice; Gutierrez, Giovanna; Kannangarage, Niluka; Mills, Harriet L.; Moller, Thomas; Meijers, Sascha; Mohamed, Yasmine; Newton, Emily; Nouvellet, Pierre; Nyenswah, Tolbert; Perea, William; Perkins, Devin; Riley, Steven; Rondy, Marc; Sagrado, Maria; Savulescu, Camelia; Schafer, Ilana J.; Schumacher, Dirk; Seyler, Thomas; Shah, Anita; Van Kerkhove, Maria D.; Wesseh, C. Samford; Yoti, Zabulon

    2016-01-01

    Background The ongoing West African Ebola epidemic began in December 2013 in Guinea, probably from a single zoonotic introduction. As a result of ineffective initial control efforts, an Ebola outbreak of unprecedented scale emerged. As of 4 May 2015, it had resulted in more than 19,000 probable and confirmed Ebola cases, mainly in Guinea (3,529), Liberia (5,343), and Sierra Leone (10,746). Here, we present analyses of data collected during the outbreak identifying drivers of transmission and highlighting areas where control could be improved. Methods and Findings Over 19,000 confirmed and probable Ebola cases were reported in West Africa by 4 May 2015. Individuals with confirmed or probable Ebola (“cases”) were asked if they had exposure to other potential Ebola cases (“potential source contacts”) in a funeral or non-funeral context prior to becoming ill. We performed retrospective analyses of a case line-list, collated from national databases of case investigation forms that have been reported to WHO. These analyses were initially performed to assist WHO’s response during the epidemic, and have been updated for publication. We analysed data from 3,529 cases in Guinea, 5,343 in Liberia, and 10,746 in Sierra Leone; exposures were reported by 33% of cases. The proportion of cases reporting a funeral exposure decreased over time. We found a positive correlation (r = 0.35, p < 0.001) between this proportion in a given district for a given month and the within-district transmission intensity, quantified by the estimated reproduction number (R). We also found a negative correlation (r = −0.37, p < 0.001) between R and the district proportion of hospitalised cases admitted within ≤4 days of symptom onset. These two proportions were not correlated, suggesting that reduced funeral attendance and faster hospitalisation independently influenced local transmission intensity. We were able to identify 14% of potential source contacts as cases in the case line

  19. 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.

  20. Female offspring desertion and male-only care increase with natural and experimental increase in food abundance.

    PubMed

    Eldegard, Katrine; Sonerud, Geir A

    2009-05-07

    In species with biparental care, one parent may escape the costs of parental care by deserting and leaving the partner to care for the offspring alone. A number of theoretical papers have suggested a link between uniparental offspring desertion and ecological factors, but empirical evidence is scarce. We investigated the relationship between uniparental desertion and food abundance in a natural population of Tengmalm's owl Aegolius funereus, both by means of a 5-year observational study and a 1-year experimental study. Parents and offspring were fitted with radio-transmitters in order to reveal the parental care strategy (i.e. care or desert) of individual parents, and to keep track of the broods post-fledging. We found that 70 per cent of the females from non-experimental nests deserted, while their partner continued to care for their joint offspring alone. Desertion rate was positively related to natural prey population densities and body reserves of the male partner. In response to food supplementation, a larger proportion of the females deserted, and females deserted the offspring at an earlier age. Offspring survival during the post-fledging period tended to be lower in deserted than in non-deserted broods. We argue that the most important benefit of deserting may be remating (sequential polyandry).

  1. Why do territorial male Tengmalm's owls fail to obtain a mate?

    PubMed

    Hakkarainen, Harri; Korpimäki, Erkki

    1998-05-01

    Non-breeding may occur because non-breeders are immature or somehow physiologically incapable of breeding, or because of a lack of resources (e.g. food resources, mating partners) needed to breed. There is, however, a lack of experimental evidence on whether bachelor males possessing territories and nest-sites are able to breed when supplemented with extra food or provided with mating partners. In vole-eating Tengmalm's owl, Aegolius funereus, we provided supplementary food and transferred females in nest-boxes of non-breeding males. Bachelor males that we supplemented with food did not attract mates at a higher frequency than unfed control males, which suggests that a lack of food did not influence the ability to attract a mating partner. In contrast, bachelor males presented with a female seemed to breed more frequently than bachelor males in the control group without mate addition. This suggests that scarcity of females may be an important reason for the high proportion of non-breeding males in the population (c. 25%) and excludes the possibility that non-breeding males are physiologically unable to breed. The operational sex ratio of the owl population at the time of mating may be male-biased, and some males may thus remain unpaired. Habitat and nest-box quality also seemed to be lower among bachelors than among breeding males.

  2. Sex ratio and fledging success of supplementary-fed Tengmalm's owl broods.

    PubMed

    Hörnfeldt, B; Hipkiss, T; Fridolfsson, A K; Eklund, U; Ellegren, H

    2000-02-01

    A nest box population of Tengmalm's owls (Aegolius funereus) in northern Sweden was studied to investigate the effects of extra food on the sex ratio between hatching and fledging in this sexually size-dimorphic species. The brood size and brood sex ratio of supplementary-fed and control broods were compared. Newly hatched nestlings were blood sampled and sexed by polymerase chain reaction (PCR) amplification of the sex-linked CHD1Z and CHD1W genes. The brood sex ratio at hatching was strongly male biased (65%); this was also the case in broods where all eggs hatched (72%). There was no relationship between hatch order and sex ratio, and hatching sex ratio did not vary significantly with laying date. Brood size decreased between hatching and fledging, but did not differ between fed and control broods at either stage. Brood sex ratio did not differ between hatching and fledging, and fledging sex ratio did not differ between fed and control broods. It was concluded that, at least during the year in which the study was carried out, feeding had no effect on brood reduction, and that male and female nestlings did not show any differential mortality. The mechanisms behind the male-biased sex ratio at hatching, and any possible adaptive reasons for it, are not known.

  3. Lifetime reproduction of a forest-dwelling owl increases with age and area of forests.

    PubMed

    Laaksonen, Toni; Hakkarainen, Harri; Korpimäki, Erkki

    2004-12-07

    Loss and alteration of habitats by human actions are the largest worldwide hazard to biodiversity and viability of populations. In boreal forests of Eurasia and North America the natural habitat is changing, mainly because of forestry practices and agriculture. Although there is evidence that the diversity and abundance of animal species are lower in intensively managed than in natural forests, very little is known about how the changes in habitat composition affect reproduction and survival. The best available measure of individual performance in the wild is lifetime reproductive success (LRS), the number of offspring produced during a lifetime, because it combines both survival and reproductive success to a single measure. We show that the LRS of forest-dwelling Tengmalm's owls (Aegolius funereus) increases with the proportion of old forest in the territory because of a higher number of breeding attempts, whereas it decreases with the proportion of agricultural land because of declining fledging success in years when prey populations crashed during owl breeding. These unique results provide an interesting insight into how human influence on the landscape can affect life-history traits of animals through various pathways.

  4. 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

  5. Habitat selection as an antipredator behaviour in a multi-predator landscape: all enemies are not equal.

    PubMed

    Morosinotto, Chiara; Thomson, Robert L; Korpimäki, Erkki

    2010-03-01

    1. Breeding territory choice constitutes a crucial antipredator behaviour for animals that determines reproductive success and survival during the breeding season. On arrival to breeding grounds migrant prey face a multitude of 'waiting' predators already settled within the landscape. 2. We studied territory selection and reproductive investment of migrant pied flycatcher (Ficedula hypoleuca) relative to breeding pygmy owls (POs) (Glaucidium passerinum) and Tengmalm's owls (TOs) (Aegolius funereus). Diurnal POs present a greater predation threat to adult flycatchers (up to 80% songbirds in diet) compared with nocturnal TOs (up to 36%). 3. During territory selection, pied flycatchers strongly avoided POs (occupation: 42% in presence vs. 92% in absence of owl nest) but not TOs (80% vs. 75%). This suggests that flycatchers are able to distinguish between two potential predators, avoiding dangerous POs but not obviously responding to the less risky TOs. 4. Flycatchers responded to presence of PO nests with c. 4-day delay in the start of egg-laying. A significantly prolonged nest building period contributed to this potentially costly breeding delay. Flycatchers further significantly reduced initial reproductive investment in presence of POs by laying 8.2% smaller clutch sizes, even if laying date was controlled. No breeding delay and clutch size reduction was found relative to TO presence. 5. Our results highlight flexibility in breeding territory selection and reproductive strategies as antipredator responses to perceived risk in a multi-predator environment. This supports the idea that for prey, not all predators are equal.

  6. Regional Mass Fatality Management in Pandemic Surge

    DTIC Science & Technology

    2008-12-01

    cremations , and entombments conducted in an average year per funeral director was around 150, with the total number of statewide on-site storage...supplies or pre-identifying temporary mass burial sites and cremation arrangements for death surge, emergency management directors do not believe that...burial sites or alternate cremation operations and another 26% cannot say one way or the other whether this has occurred. Neither are they confident

  7. The Helsinki Process: Negotiating Security and Cooperation in Europe

    DTIC Science & Technology

    1993-12-01

    Jazz Section of the Musicians’ Union in Czechoslovakia, as well as threats to minority cultures, in particular the Turks in Bulgaria and non-Russian...and 169 THE HELSINKI PROCESS the Jazz Section-which have given new meaning to the struggle of the oppressed for freedom.242 Fourth, the Helsinki...within three working days upon applica- tions relating to visits to a seriously ill or dying family member, travel to attend the funeral of a family member

  8. Business Plan for the JABEZ Records

    DTIC Science & Technology

    2003-12-01

    Convention. Dorsey began writing Christian music, moving away from his impetuous lyrics but not the jazz rhythms and blues genres and rhythmic style. As to...last decades. Traditional Gospel uses rhythms and styles found in blues, jazz and soul music. In the long term, JABEZ Records plans to broaden its...gospel music is played during formal church services, weddings, funerals , memorial services, drama plays, or in the car on the way home. The rhythms

  9. Exercise Desert Rock Letter Orders. Army, Camp Desert Rock, Nevada.

    DTIC Science & Technology

    1957-08-01

    WILF.iED J MSGT A19032i3 HJ;,ŕWAY, ELLafGzJN 8FC Xf,37791267 INOZ W, P. 1. PVT2 US52401808 KELLEY, JESSIE J SFC R1� EVaS, LOUIS PFC .,53073109...Ord Co (HAM) Camo Desert Rock, Nevada You will preeeed to Reynolds Funeral Vome, Sigourney, Iowa 0/a 24 AU ist 1957 for apprx fourteen (14) days to

  10. 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.

  11. Development of a Prototype Self-Assessment Program in Support of Soldier Competency Assessment

    DTIC Science & Technology

    2005-10-01

    has just alerted you that your squad will be providing the Honor Guard at a funeral detail the day after tomorrow in Millville , a town 30 miles away...reconnaissance to Millville . C. Don’t take any action until the platoon sergeant gets you the complete information D. Start gathering information on...movement options, logistics, and times to begin a tentative plan on how you will get your squad to Millville . Correct answer: A. Reference: FM 7-8, Chapter 2

  12. Analysis of Camp Pendleton California Medical Treatment Facility Budget and Execution Process

    DTIC Science & Technology

    2008-12-01

    in Example 1 - lnlier DRG DRG 002, Craniotomy Age >17, without complications and comorbidities DRG Weight = 2.3684 TRICARE ASA = $4,265.70 Length of...Affairs, 2006). 31 Data for use in Example 3 – Transfer DRG DRG 002, Craniotomy Age >17, without complications and comorbidities DRG Weight = 2.3684...the recovery , preparation, encasement, transportation, escort service (when applicable), funeral, and memorial services when remains are non

  13. Universal precautions and mortuary practitioners: influence on practices and risk of occupationally acquired infection.

    PubMed

    Beck-Sagué, C M; Jarvis, W R; Fruehling, J A; Ott, C E; Higgins, M T; Bates, F L

    1991-08-01

    Embalming, the most common funeral practice in the United States, may expose the embalmer to infectious diseases and blood. We surveyed the 860 members of the National Selected Morticians in 1988 to estimate the incidence of self-reported occupational contact with blood and infectious disease, assess morticians' knowledge of acquired immunodeficiency syndrome (AIDS), determine their adherence to universal precautions, and identify predictors of practices designed to reduce risk of occupational exposure to infections. Of 539 (63%) respondents, 212 (39%) reported needle-stick injuries in the past 12 months, and 15 (3%) reported percutaneous exposures to the blood of a decedent with AIDS. Those rating the risk of occupationally acquired human immunodeficiency virus infection as very high or high (194/539 [36%]) were more likely to decline funerals of decedents with antemortem diagnosis of AIDS (59/194 [30%]) and/or to charge more for such funerals (133/194 [69%]) than those who rated the risk as low to moderate (31/345 [9%], 174/135 [51%]).

  14. 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

  15. 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

  16. Sudden disappearance of the blood flow in a case of pancreatic acinar cell carcinoma.

    PubMed

    Kanno, Atsushi; Masamune, Atsushi; Hamada, Shin; Kikuta, Kazuhiro; Kume, Kiyoshi; Hirota, Morihisa; Shima, Kentaro; Okada, Takaho; Motoi, Fuyuhiko; Fujishima, Fumiyoshi; Ishida, Kazuyuki; Unno, Michiaki; Shimosegawa, Tooru

    2014-01-01

    A 55-year-old man was referred to our hospital for a further examination of a pancreatic cystic tumor with a solid component exhibiting vascularity. A few days later, the patient was admitted with a complaint of sudden severe epigastric pain. Enhanced CT showed the loss of vascularity in the tumor. In particular, contrast-enhanced endoscopic ultrasonography (EUS) clearly demonstrated the disappearance of the blood flow, and a histological examination revealed acinar cell carcinoma with central necrosis. To our knowledge, this is the first case in the literature of acinar cell carcinoma associated with the sudden disappearance of vascularity. In this case, contrast-enhanced harmonic EUS was especially useful for assessing the degree of vascularity.

  17. CT and ultrasound of gastric and duodenal duplications

    SciTech Connect

    Guibaud, L.; Genin, G.; Fouque, P.

    1996-05-01

    We present the radiological findings of gastric and duodenal duplications in four adults, in whom abdominal ultrasound, endoscopic ultrasound (EUS), and CT were primarily used for diagnosis. The diagnosis was surgically confirmed in all cases. Preoperative diagnosis of duplications was possible with ultrasound in three patients, in whom CT showed a nonspecific cystic structure. Ultrasound demonstrated a pathognomonic multilayered wall appearance suggestive of a digestive origin, including an echogenic inner mucosal layer and a hypoechoic muscular layer, better appreciated using EUS in one patient. In one case, digestive origin was confirmed by direct visualization of a peristaltic activity within the cystic wall after water ingestion. In the last patient, a non-specific heterogeneous mainly solid mass of the esophagogastric junction was found to be an adenocarcinoma arising from a duplication on the histological analysis of the surgical specimen. 10 refs., 4 figs.

  18. New strategies for the early detection of pancreatic cancer.

    PubMed

    Petrone, Maria Chiara; Arcidiacono, Paolo Giorgio

    2016-01-01

    Pancreatic cancer (PC) remains a deadly disease and early detection through screening is likely to be our best hope to improve survival. Considering the low incidence of PC, population-based screening is not feasible, but is advisable for high-risk patients. Screening individuals at high risk for developing PC leads to the detection of premalignant lesions. High-grade pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm are the targets for early detection of PC. Endoscopic ultrasound (EUS) and magnetic resonance imaging are considered the most accurate techniques for pancreatic imaging; in particular EUS has emerged as a promising imaging test given its potential for tissue sampling to obtain diagnosis and to provide material for molecular profiling of PC. At the moment, screening should be performed within research protocols at experienced centers with a specific clinical and research interest, where a multidisciplinary team of specialists is available.

  19. Mixture model of pottery decorations from Lake Chad Basin archaeological sites reveals ancient segregation patterns

    PubMed Central

    O'Brien, John D.; Lin, Kathryn; MacEachern, Scott

    2016-01-01

    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

  20. Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

    PubMed Central

    Storm, Andrew C; Lee, Linda S

    2016-01-01

    The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings. Tools, in addition to radiologic imaging, currently employed in the initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS-FNA has grown to become the gold standard in tissue diagnosis of pancreatic lesions. PMID:27818584