Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a...Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. Aims: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. Methods: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, > 5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity< 100% ),were compared. Results: Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive ofmalignancy; sensitivity and specificity reached 100% when a cutoff value of > 1 and > 6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42% ). Conclusions: Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies.展开更多
Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearan ce of metastatic TCBC to the GI tract. In addition to descr...Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearan ce of metastatic TCBC to the GI tract. In addition to describing the EUS feature s of recurrent metastatic TCBC, this study determined the number of patients ref erred for evaluation of a primary GI luminal cancer in which EUS instead establi shed the diagnosis of metastatic recurrent TCBC. Methods: Patients referred from July 2000 through April 2004 for EUS evaluation of a suspected primary GI lumin al cancer were retrospectively reviewed. For patients with an established diagno sis of recurrent metastatic TCBC, EUS images were retrospectively reviewed to id entify characteristic features. Results: Of 2216 patients undergoing EUS to eval uate a suspected primary GI luminal cancer, 3 men (0.14% : 95% confidence int erval [0.02% , 0.29% ]) (mean age 67 years, range 54- 74 years) were found in stead to have recurrent metastatic TCBC involving the duodenum (n = 1) or rectum (n = 2). The patients presented a mean of 32 months after diagnosis of the prim ary TCBC with change in bowel habit (n = 1) and symptoms of bowel obstruction (n = 2). In each patient, initial endoscopy revealed circumferential luminal steno sis and mucosal erythema, but mucosal biopsy specimens revealed normal tissue. E US demonstrated hypoechoic, symmetric, circumferential wall thickening, loss of deep wall layers, and pseudopodia- like extensions into the peri- intestinal t issues. In the two patients with rectal involvement, no evidence of direct infil tration from the bladder bed was seen. EUS- guided FNA was diagnostic of metast atic TCBC in all patients. Conclusions: Although most cases of hypoechoic bowel - wall thickening and stenosis are from primary GI neoplasia, recurrent TCBC sh ould be considered in patients with a history of this tumor. Correct diagnosis i s important, because this allows selection of appropriate therapeutic interventi ons. Although firm EUS criteria for TCBC cannot be established based on findings in 3 patients, certain features may prove useful. EUS- guided FNA can confirm the diagnosis.展开更多
The aim of this study was to determine whether subcutaneous octreotide is effective for the treatment of acute migraine. Patients with migraine with and without aura as classified by the International Headache Society...The aim of this study was to determine whether subcutaneous octreotide is effective for the treatment of acute migraine. Patients with migraine with and without aura as classified by the International Headache Society were recruited to a double- blind placebo- controlled crossover study. Patients were instructed to treat two attacks of at least moderate pain severity, with at least a 7 day interval, using subcutaneous 100 μ g octreotide or matching placebo. The primary endpoint was the headache response defined as: severe or moderate pain becomes mild or nil, at 2 h. The primary endpoint was analysed using a Multilevel Analysis approach. Secondary end- points included associated symptoms and a four- point functional disability score. The study was powered to detect a 30% difference at an α of 0.05 and a β of 0.8. A total of 51 patients were recruited, of whom 42 provided efficacy data on an attack treated with octreotide and 41 with placebo. Modelling the headache response as a binomial determined by treatment, using the patient as the level 2 variable, and considering a possible period effect, and sex and migraine type as other variables of interest, subcutaneous octreotide was not significantly superior to placebo. The two hour headache response rates were 20% for placebo and 14% for octreotide, whilst the two hour pain free rates were 7% and 2% , respectively. Subcutaneous octreotide 100 μ g is not effective in the acute treatment of migraine when compared to placebo.展开更多
文摘Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. Aims: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. Methods: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, > 5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity< 100% ),were compared. Results: Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive ofmalignancy; sensitivity and specificity reached 100% when a cutoff value of > 1 and > 6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42% ). Conclusions: Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies.
文摘Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearan ce of metastatic TCBC to the GI tract. In addition to describing the EUS feature s of recurrent metastatic TCBC, this study determined the number of patients ref erred for evaluation of a primary GI luminal cancer in which EUS instead establi shed the diagnosis of metastatic recurrent TCBC. Methods: Patients referred from July 2000 through April 2004 for EUS evaluation of a suspected primary GI lumin al cancer were retrospectively reviewed. For patients with an established diagno sis of recurrent metastatic TCBC, EUS images were retrospectively reviewed to id entify characteristic features. Results: Of 2216 patients undergoing EUS to eval uate a suspected primary GI luminal cancer, 3 men (0.14% : 95% confidence int erval [0.02% , 0.29% ]) (mean age 67 years, range 54- 74 years) were found in stead to have recurrent metastatic TCBC involving the duodenum (n = 1) or rectum (n = 2). The patients presented a mean of 32 months after diagnosis of the prim ary TCBC with change in bowel habit (n = 1) and symptoms of bowel obstruction (n = 2). In each patient, initial endoscopy revealed circumferential luminal steno sis and mucosal erythema, but mucosal biopsy specimens revealed normal tissue. E US demonstrated hypoechoic, symmetric, circumferential wall thickening, loss of deep wall layers, and pseudopodia- like extensions into the peri- intestinal t issues. In the two patients with rectal involvement, no evidence of direct infil tration from the bladder bed was seen. EUS- guided FNA was diagnostic of metast atic TCBC in all patients. Conclusions: Although most cases of hypoechoic bowel - wall thickening and stenosis are from primary GI neoplasia, recurrent TCBC sh ould be considered in patients with a history of this tumor. Correct diagnosis i s important, because this allows selection of appropriate therapeutic interventi ons. Although firm EUS criteria for TCBC cannot be established based on findings in 3 patients, certain features may prove useful. EUS- guided FNA can confirm the diagnosis.
文摘The aim of this study was to determine whether subcutaneous octreotide is effective for the treatment of acute migraine. Patients with migraine with and without aura as classified by the International Headache Society were recruited to a double- blind placebo- controlled crossover study. Patients were instructed to treat two attacks of at least moderate pain severity, with at least a 7 day interval, using subcutaneous 100 μ g octreotide or matching placebo. The primary endpoint was the headache response defined as: severe or moderate pain becomes mild or nil, at 2 h. The primary endpoint was analysed using a Multilevel Analysis approach. Secondary end- points included associated symptoms and a four- point functional disability score. The study was powered to detect a 30% difference at an α of 0.05 and a β of 0.8. A total of 51 patients were recruited, of whom 42 provided efficacy data on an attack treated with octreotide and 41 with placebo. Modelling the headache response as a binomial determined by treatment, using the patient as the level 2 variable, and considering a possible period effect, and sex and migraine type as other variables of interest, subcutaneous octreotide was not significantly superior to placebo. The two hour headache response rates were 20% for placebo and 14% for octreotide, whilst the two hour pain free rates were 7% and 2% , respectively. Subcutaneous octreotide 100 μ g is not effective in the acute treatment of migraine when compared to placebo.
