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At least 397 records · Page 22Linked to original sources
PubMed2001

Accuracy of provisional diagnoses of dyspepsia in patients undergoing first endoscopy.

BACKGROUND: This study assessed agreement between provisional and endoscopic diagnoses for patients with dyspepsia undergoing initial endoscopy, and examined variation between clinicians at 2 hospitals. METHODS: This was a retrospective review of 423 consecutive patients. RESULTS: Crude percentage agreement ranged from 55% to 97%. Kappa scores revealed poor agreement: peptic ulcers (0.11: 95% CI [0.05, 0.17]); gastroesophageal reflux disease (0.29: 95% CI [0.20, 0.38]); benign esophageal stricture (0.33: 95% CI [0.08, 0.58]); and cancer (0.12: 95% CI [-0.12, 0.36]). Positive and negative predictive values for cancer and benign esophageal stricture showed that agreement for a negative diagnosis was almost perfect, whereas agreement for a positive diagnosis was low. Only 17% of patients with cancer were given an accurate provisional diagnosis. Accuracy of diagnosis did not vary substantially between hospitals. CONCLUSIONS: Crude percentage agreement is misleading. Emphasis should be placed on better prediction of cancer, benign esophageal stricture, and peptic ulcer disease. Accuracy of provisional diagnosis in everyday practice is no worse than that found in prospective studies in which clinicians knew a priori that diagnoses would be scrutinized. The difficulty of predicting diagnoses supports increased reliance on endoscopy.

Confidence Intervals↗
PubMed2004

[Diagnostic imaging of cancer].

Rapid development of imaging techniques provided much more precise methodology of diagnosis, staging and dynamics of cancer. Nowadays the onco-radiodiagnostic units are able to select the optimal imaging technique based on established international protocols. These protocols provide the basis of cancer diagnosis, therapy control and clinical research. The onco-radiodiagnostic unit is essential part of the oncoteam managing the cancer patients. Follow-up protocols are now equally important compared to those of the diagnosis and staging, requiring a continuous interaction between radiologists and physicians. The comprehensive cancer centers with all the necessary imaging techniques are the optimal organizations where professional and economic priorities both can be considered for the benefit of cancer patients.

Algorithms↗
PubMed1999

Digestive endoscopy: relevance of negative findings.

In patients with digestive complaints, endoscopy is the gold standard and is often the primary exploration. Positive findings in upper gastrointestinal endoscopy occur in 30 to 40% in relation to a benign or malignant structural disease. Negative findings occur therefore in 60 to 70% of cases: dyspepsia and/or reflux are functional diseases. Colonoscopy aims essentially at screening of colorectal cancer. Digestive cancer is very rare under 50 years, and most cases detected with symptoms are advanced; asymptomatic early and curable cancer is detected in screening. A negative finding at endoscopy is reliable in the hands of an experienced endoscopist controlling the risk of false negative and false positive findings. A reliable negative endoscopy is beneficial for the quality of life when it relieves anxiousness of the patient. It may be cost effective if drugs and consultations are decreased. Overuse of negative endoscopy is not so much through large indications, that in repetition of negative procedures. The relevance of negative endoscopy in screening for cancer in the upper and lower digestive tract, is whether is should be repeated. There is tendency to increased intervals in surveillance protocols. In the very near future the first role of endoscopy in the primary diagnosis could be challenged by concurrent techniques. Future progress is based upon a Quality Assurance program for quality, experience of the operator a control of the cost and a research programme on tolerance with a trend to reduced sedation.

Cost-Benefit Analysis↗
PubMed1997

Endoscopic ultrasonography: a new diagnostic imaging modality.

Endoscopic ultrasonography uses high-frequency ultrasound to visualize the gut wall and the surrounding structures of the mediastinum, the abdomen and the pelvis. Echoendoscopes are available in two different designs. A radial scanning echoendoscope produces a 360 degree real-time view perpendicular to the shaft of the echoendoscope. A linear-array instrument produces a 100 degrees real-time view parallel to the shaft of the echoendoscope, permitting direct ultrasonographic guidance of fine needles exiting the biopsy channel. Endoscopic ultrasonography has been established as the preferred diagnostic tool for the evaluation of submucosal masses of the upper gastrointestinal tract and the rectosigmoid, for differentiating benign from pathologic thickened gastric folds and for locating pancreatic endocrine tumors. The widest application of endoscopic ultrasonography is in the diagnosis and staging of esophageal, gastric, rectal and pancreaticobiliary neoplasms. Endosonography is the most accurate modality available for determining the T and N stages of these tumors. The recent development of endoscopic ultrasound-guided fine-needle aspiration provides physicians with the ability to cytologically diagnose lesions visualized endosonographically and to confirm cancer staging with tissue.

Algorithms↗
PubMed2004

Endoscopic ultrasonography.

Endoscopic ultrasound (EUS) was introduced in the early 1980s in an attempt to improve sonographic imaging of the pancreas. Its uses have been expanded to include examination of the upper and lower gastrointestinal tracts, hepatobiliary and portal systems,and the anal sphincter; diagnosis and staging of esophageal, gastric,and pancreaticobiliary tumors; and evaluation of mediastinal nodes in lung cancer. Although EUS has its limitations and is greatly dependent on operator skill, it has wide-ranging interventional and therapeutic applications that can be expected to increase in the future with technologic advances and greater educational opportunities for physicians.

Adenoma↗
PubMed2000

[The indications for autonomic nerve-sparing surgery in rectal cancer patients].

Although extended lymph node dissection was developed to improve the therapeutic result in advanced rectal cancer in the 1970s, postoperative dysfunction remained problematic. Informed consent of cancer is generalized at present. The balance between complete cure and functional preservation is important. Therefore the autonomic nerve-sparing surgical technique for rectal cancer was introduce din the 1980s. The success of nerve-sparing surgery depends on a thorough knowledge of pelvic anatomy, especially the anatomic relationship between the pelvic plexus and internal intestinal vessels. Further investigation is required to clarify the indications for autonomic nerve-sparing surgery in rectal cancer patients.

Autonomic Nervous System↗
PubMedDate not supplied

Ultrastructurally "invasive" microvilli in an aggressively metastasizing biphasic malignant mesothelioma.

The presence of long, slender, often branching microvilli on cell surfaces is a characteristic feature of malignant and benign mesothelial cells. However, these typical microvilli are seen only in better-differentiated lumens within epithelial areas of malignant mesotheliomas. Presented here are the clinical and ultrastructural findings in a biphasic malignant mesothelioma that lacked lumens, but possessed very long microvilli. These invaginated deeply into the cytoplasm of neighboring tumor cells, as well as into the surrounding stromal matrix. The tumor cells had well-formed intercellular desmosomal junctions. The primary tumor was localized to the pleura and invaded the chest wall, but only minimally the lung. Lobectomy demonstrated the presence of metastatic tumor in 2 peribronchial lymph nodes. The disease progressed rapidly and, within 6 months, killed the patient. An autopsy revealed widespread metastases in multiple systemic organs. The authors speculate that the unique ultrastructural features of this case may be a clue to the unusually aggressive course of the neoplasm.

Adrenal Gland Neoplasms↗
PubMed1983

[Recent progress in tumor markers of the digestive system].

Recent progress in our tumor marker study of the digestive system was described. Of carcinoembryonic antigen (CEA), we developed a new assay system for detecting the CEA derived from gastrointestinal tumor tissues selectively, and succeeded to diagnose 72% of colorectal cancer patients including Dukes' A and B classifications. Of mucus antigens, intestinal IMA and gastric GMA, both were fractionated and purified in our laboratory, were demonstrated to be useful markers in detecting carcinofetal-type GI epithelia. Finally, a pancreas cancer-associated antigen (PCAA) derived from normal colonic mucosa in our laboratory, was shown to be identical immunochemically with Gelder's POA. Our results of the combined assay of PCAA and a pancreas tissue antigen (PaA) levels in sera from pancreatic cancer patients were evaluated to be positive in 90% of cases.

Antigens, Neoplasm↗
PubMed1979

Direct selective catheterization of the portal venous system.

A short description is given of the techniques for percutaneous transhepatic (PTP) and transumbilical (TUP) portal Venous catheterization and their use for direct selective catheterization of the portal vein and its tributaries. PTP was successful in 181 of 184 attempts (98 per cent) and TUP in 283 of 301 attempts (96 per cent). The complications are discussed in details. Among the clinical implications of the methods is the diagnosis of hormone producing tumours.

Adult↗
PubMed1999

Survival after photodynamic therapy to non-pulmonary metastatic endobronchial tumors.

BACKGROUND: For the past 15 years we have used photodynamic therapy (PDT) to treat endobronchial tumors. Unfortunately patients who have non-primary lung cancer metastatic to bronchi and who have failed other treatment regimens may not be offered endobronchial tumor management. Thirteen patients with endobronchial tumors metastatic from non-pulmonary primaries were treated with PDT. We: 1) evaluated the effects of PDT on the tumor, the quality of life, and the length of survival; and 2) compared their survival after PDT to that of 27 patients with stage IV primary endobronchial tumors treated with PDT after they failed all other treatment regimens. MATERIALS AND METHODS: Photodynamic therapy was performed using 630-nm light delivered through cylinder diffusing tip quartz fibers passed through the biopsy channel of a flexible bronchoscope after intravenous injection of the photosensitizer dihematoporphyrin ether. One to two days after PDT bronchoscopy was repeated and necrotic tissue was mechanically removed and, if necessary, that site or other new sites were treated. Two days after this another bronchoscopy was performed and the necrotic tissue was mechanically removed. Bronchoscopy was repeated one month after PDT and periodically thereafter as needed to re-treat symptomatic residual tumor. The percent obstruction of the bronchus due to tumor was estimated before and at the end of each bronchoscopy. Clinical effects were evaluated using Wilcoxon signed rank tests for scaled parameters of dyspnea, cough, hemoptysis, and Karnofsky Performance Status (KPS) before and one month after PDT. All patients were followed until their death. RESULTS: The mean percent obstruction due to metastatic non-pulmonary tumors at 38 different endobronchial treated sites decreased from 85% to 13% at discharge after PDT. The 72% mean decrease of obstruction was statistically significant using the Wilcoxon signed rank test (P < .0001). There was a statistically significant improvement in the level of dyspnea (P = .012), hemoptysis (P = .028), cough (P = .027), and KPS (P = .020). Kaplan-Meier survival curves and Mann-Whitney U rank tests showed the median survival of stage IV primary tumor patients (4 months) vs. metastatic tumor patients (14 months) was statistically significant (P = .008). CONCLUSION: PDT of endobronchial metastatic tumors effectively decreased the amount of endobronchial obstruction, and improved the quality of life.

Aged↗
PubMed1976

Carcinoembryonic antigen: clinical application.

Carcinoembryionic antigen (CEA) a glycoprotein extracted from colonic cancer tissue (beta-globulin electrophoretic mobility, sedimentation coefficient 7 to 8S, and mol wt approximately 200,000) can be detected and measured by radioimmunoassay. Clinical evaluations of CEA determination have given the following results: In health: (1) Serum CEA level is not influenced by sex, age, blood type, time of blood sampling, or family history of cancer; (2) serum CEA level is influenced by a history of smoking or inflammatory disease of the bowel, lung, pancreas, and other organs (occasionally, a CEA level as high as 10 ng/ml is noted); and (3) currently, CEA positivity is defined as greater than 2.5 ng/ml, however, 5 ng/ml may be more realistic. In cancer: (1) CEA level may be increased in primary cancer of the gastrointestinal (GI) tract as well as in non-GI neoplasia; (2) the CEA test is not recommended for screening to detect early cancer; (3) serum CEA level depends on the stage of the neoplasia and usually is not influenced by the grade of differentiation; and (4) markedly increased (greater than 25 ng/ml serum CEA values are highly suggestive of metastatic cancer, particularly hepatic metastasis. In biological fluid: The CEA or CEA-like activity can be measured in gastrointestinal secretions. Quantitative studies of CEA levels in such fluids may yield more information than is obtainable from studies of serum. However, this possibility needs more study at present. Therefore, the currently available CEA tests cannot replace any of the now standard diagnostic methods for cancer detection. This use for assessment of therapy in selected patients or for following those known to be a high risk for cancer appears promising in preliminary studies, but clinical value, if any, remains to be determined.

Body Fluids↗