Background: We evaluated the utility of peroral cholangioscopy (POCS) for distinguishing malignant from benign biliary disease to cover low sensitivity of tissue sampling. Methods: From February 1992 to April 2004, al...Background: We evaluated the utility of peroral cholangioscopy (POCS) for distinguishing malignant from benign biliary disease to cover low sensitivity of tissue sampling. Methods: From February 1992 to April 2004, all consecutive patients who underwent POCS to confirm the etiology of biliary disorders were included in this study. Brushing cytology or endobiliary forceps biopsy also was performed. We analyzed the diagnostic accuracy of tissue sampling with or without POCS diagnosis. Results: A total of 97 patients (66 men, 31 women; mean age 64.2 years) were included. The final diagnosis was confirmed by surgical resection in 44, clinical follow-up in 52, and cytologic study of ascitic fluid in one. On the basis of ERCP findings, there were 76 strictures and 21 filling defects. Forceps biopsy was performed in 25 patients, and brush cytology was performed in 68 patients. In the remaining 4 patients (4 filling defects, which were identified as stones by POCS), tissue samplings were not carried out. ERCP/tissue sampling correctly identified 22 of 38 malignant strictures and all 35 benign lesions except in 3 patients with inadequate samples (accuracy, 78.0% ; sensitivity, 57.9% ; specificity, 100% ). The addition of POCS correctly identified all 38 malignant strictures and 33 of 38 benign lesions (accuracy, 93.4% ; sensitivity, 100% ; specificity, 86.8% ). For the 21 filling defects observed by ERCP, POCS correctly diagnosed all 8 malignant diseases and 13 benign lesions. Conclusions: The addition of POCS to tissue sampling improves the diagnostic ability and covers for insufficient sensitivity. POCS is especially useful for diagnosing a filling defect.展开更多
A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central ...A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central facial palsy on the same side. Individual differences in supranuclear control of the pharyngeal muscles may explain this rare occurrence. The combination of these signs is described as a syndrome of upper medial medullary lesion.展开更多
文摘Background: We evaluated the utility of peroral cholangioscopy (POCS) for distinguishing malignant from benign biliary disease to cover low sensitivity of tissue sampling. Methods: From February 1992 to April 2004, all consecutive patients who underwent POCS to confirm the etiology of biliary disorders were included in this study. Brushing cytology or endobiliary forceps biopsy also was performed. We analyzed the diagnostic accuracy of tissue sampling with or without POCS diagnosis. Results: A total of 97 patients (66 men, 31 women; mean age 64.2 years) were included. The final diagnosis was confirmed by surgical resection in 44, clinical follow-up in 52, and cytologic study of ascitic fluid in one. On the basis of ERCP findings, there were 76 strictures and 21 filling defects. Forceps biopsy was performed in 25 patients, and brush cytology was performed in 68 patients. In the remaining 4 patients (4 filling defects, which were identified as stones by POCS), tissue samplings were not carried out. ERCP/tissue sampling correctly identified 22 of 38 malignant strictures and all 35 benign lesions except in 3 patients with inadequate samples (accuracy, 78.0% ; sensitivity, 57.9% ; specificity, 100% ). The addition of POCS correctly identified all 38 malignant strictures and 33 of 38 benign lesions (accuracy, 93.4% ; sensitivity, 100% ; specificity, 86.8% ). For the 21 filling defects observed by ERCP, POCS correctly diagnosed all 8 malignant diseases and 13 benign lesions. Conclusions: The addition of POCS to tissue sampling improves the diagnostic ability and covers for insufficient sensitivity. POCS is especially useful for diagnosing a filling defect.
文摘A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central facial palsy on the same side. Individual differences in supranuclear control of the pharyngeal muscles may explain this rare occurrence. The combination of these signs is described as a syndrome of upper medial medullary lesion.
