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Vlăduț C, Stan-Ilie M, Săftoiu A, Țuțuian R, Constantinescu G. Recombinant Tissue Plasminogen Activator: The New Concept for Dissolving Septae in Loculated Peri-pancreatic Fluid Collection prior to Endoscopic Drainage. A Case Report. J Gastrointestin Liver Dis 2023; 32:554-557. [PMID: 38147601 DOI: 10.15403/jgld-4798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/16/2023] [Indexed: 12/28/2023]
Abstract
Peri-pancreatic fluid collections are late complications of acute pancreatitis. Loculated peri-pancreatic fluid collections, even rare, remain the "black sheep" in terms of drainage, due to difficulty to puncture all compartments, thus prohibiting proper drainage of all compartments. Recombined tissue plasminogen activator (r-tPA) has been advocated as treatment of the loculated collections, due to its ability to dissolve the fibrinous strands and thus facilitate proper drainage. We report the case of a 58 years-old male presenting with a painful loculated peri-pancreatic fluid collection secondary to acute pancreatitis. We performed Alteplase injection, followed by successful endosonographic drainage with lumen apposing metal stent of the collection after 48 hours. Our observation suggests that r-tPA could be a new strategy for loculated collections management, ensuring better drainage and limiting the indication for surgical treatment.
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Affiliation(s)
| | - Mădălina Stan-Ilie
- Department of Gastroenterology, Clinical Emergency Hospital Bucharest, Romania. .
| | - Adrian Săftoiu
- Department of Gastroenterology, Clinical Emergency Hospital Elias, Bucharest, Romania.
| | - Radu Țuțuian
- Department of Gastroenterology, Bürgerspital Solothurn, Solothurn, Switzerland.
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Badiu SM, Gheorghe EC, Nicolau C, Săftoiu A. Quantitative time intensity curve analysis of contrast-enhanced ultrasound (CEUS) examinations for the assessment of focal liver lesions. Med Ultrason 2023. [PMID: 37931012 DOI: 10.11152/mu-4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Contrast enhanced ultrasound (CEUS) is well-established for the characterization of focal liver lesions (FLLs). By using intravenous ultrasound contrast agents, followed by specific low mechanical index examinations, CEUS enables a high spatial and temporal resolution as well as a dynamic assessment of macro- and microvascularization down to the capillaries. Nevertheless, CEUS has the disadvantage of being examiner-dependent, so quantitative analysis of time-intensity curves in dynamic CEUS (D-CEUS) could provide further information. The aim of this article is to provide a general review of the current literature regarding the usefulness of D-CEUS in the assessment of FLLs.
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Affiliation(s)
- Simona Maria Badiu
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Carol Davila Bucharest, 050474, Romania.
| | - Elena Codruța Gheorghe
- Department of Family Medicine, University of Medicine and Pharmacy Craiova, 200349, Romania.
| | - Carmen Nicolau
- Lotus Image Medical Center, ActaMedica SRL Târgu Mureș, 540084, Romania.
| | - Adrian Săftoiu
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Carol Davila Bucharest, 050474, Romania.
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Dietrich CF, Braden B, Burmeister S, Aabakken L, Arciadacono PG, Bhutani MS, Götzberger M, Healey AJ, Hocke M, Hollerbach S, Ignee A, Jenssen C, Jürgensen C, Larghi A, Moeller K, Napoléon B, Rimbas M, Săftoiu A, Sun S, Bun Teoh AY, Vanella G, Fusaroli P, Carrara S, Will U, Dong Y, Burmester E. How to perform EUS-guided biliary drainage. Endosc Ultrasound 2022; 11:342-354. [PMID: 36255022 PMCID: PMC9688140 DOI: 10.4103/eus-d-21-00188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
EUS-guided biliary drainage (EUS-BD) has recently gained widespread acceptance as a minimally invasive alternative method for biliary drainage. Even in experienced endoscopy centers, ERCP may fail due to inaccessibility of the papillary region, altered anatomy (particularly postsurgical alterations), papillary obstruction, or neoplastic gastric outlet obstruction. Biliary cannulation fails at first attempt in 5%-10% of cases even in the absence of these factors. In such cases, alternative options for biliary drainage must be provided since biliary obstruction is responsible for poor quality of life and even reduced survival, particularly due to septic cholangitis. The standard of care in many centers remains percutaneous transhepatic biliary drainage (PTBD). However, despite the high technical success rate with experienced operators, the percutaneous approach is more invasive and associated with poor quality of life. PTBD may result in long-term external catheters for biliary drainage and carry the risk of serious adverse events (SAEs) in up to 10% of patients, including bile leaks, hemorrhage, and sepsis. PTBD following a failed ERCP also requires scheduling a second procedure, resulting in prolonged hospital stay and additional costs. EUS-BD may overcome many of these limitations and offer some distinct advantages in accessing the biliary tree. Current data suggest that EUS-BD is safe and effective when performed by experts, although SAEs have been also reported. Despite the high number of clinical reports and case series, high-quality comparative studies are still lacking. The purpose of this article is to report on the current status of this procedure and to discuss the tools and techniques for EUS-BD in different clinical scenarios.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Department of Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland,Address for correspondence Dr. Christoph F. Dietrich, Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland. E-mail:
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Sean Burmeister
- Hepato-Pancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Lars Aabakken
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Paolo Giorgio Arciadacono
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Manoop S. Bhutani
- Department of Gastroenterology Hepatology and Nutrition, UTMD Anderson Cancer Center, Houston, Texas, USA
| | - Manuela Götzberger
- Department of Gastroenterology and Hepatology, München Klinik Neuperlach und Harlaching, Munich, Germany
| | | | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - André Ignee
- Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Kathleen Moeller
- Department of Medical I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | | | - Mihai Rimbas
- Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Giuseppe Vanella
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, Imola, Italy
| | - Silvia Carrara
- Division of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Milan, Italy
| | - Uwe Will
- Department of Gastroenterology, SRH Klinikum Gera, Gera, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Eike Burmester
- Medizinische Klinik I, Sana Kliniken Luebeck, Luebeck, Germany
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Harbiyeli IFC, Burtea DE, Ivan ET, Streață I, Nicoli ER, Uscatu D, Șerbănescu MS, Ioana M, Vilmann P, Săftoiu A. Assessing Putative Markers of Colorectal Cancer Stem Cells: From Colonoscopy to Gene Expression Profiling. Diagnostics (Basel) 2022; 12:diagnostics12102280. [PMID: 36291969 PMCID: PMC9601164 DOI: 10.3390/diagnostics12102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Cancer stem cells (CSCs) are proposed to be involved in colorectal cancer (CRC) initiation, growth, and metastasis. The aim of our pilot study was to assess possible correlations between the clinicopathological characteristics of CRC patients and CSCs gene expression patterns, in order to provide insight into new methods for patient stratification and targeted therapeutic strategies. Our study involved 60 CRC patients, and the following three specific CSC genes were targeted: PROM1/CD133, ALCAM/CD166 and HCAM /CD44. Data are presented as relative mRNA expression of target genes to GAPDH. The expression of total CD133 and CD166 was assessed in paired samples of CRC tumors and adjacent tissue, while CD44 was assessed in similar samples. The qRT-PCR analysis detected all three targeted genes to different extents, in both normal and tumor tissue. In nine cases (15.69%), total CD133 had a higher expression in tumor tissue, whilst in 28 cases (47.06%) the expression was higher in non-malignant peritumor tissue. The total CD166 expression was increased in tumor tissue compared with paired non-invaded peritumor samples in eight cases (13.73%), whilst in eight cases (13.73%) the expression was higher in non-malignant peritumor tissue. Total CD44 expression was higher in tumor tissue compared with paired non-invaded peritumor samples in 47 cases (78.95%). In the remaining cases the difference between paired samples was biologically insignificant. In conclusion, our study suggests that qRT-PCR is feasible in assessing the gene expression profiles of CSCs from CRC, and a promising pathway to be followed for determining how often a person needs screening by colonoscopy and at which age to start. This could improve CRC diagnosis and early patient stratification, and open the way for new oncologic treatment development.
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Affiliation(s)
- Irina Florina Cherciu Harbiyeli
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Daniela Elena Burtea
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
- Correspondence:
| | - Elena Tatiana Ivan
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Ioana Streață
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Elena Raluca Nicoli
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniel Uscatu
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mircea-Sebastian Șerbănescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihai Ioana
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Peter Vilmann
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
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Liliac IM, Sacerdoțianu MV, Ungureanu BS, Mogoantă L, Mărgăritescu C, Pirici D, Săftoiu A, Crisan AE. Subtle Immunoreactivity Differences in the Fractal Patterns of Membrane E-Cadherin in Gastric Adenocarcinoma. Curr Health Sci J 2022; 48:303-310. [PMID: 36815089 PMCID: PMC9940928 DOI: 10.12865/chsj.48.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/22/2022] [Indexed: 02/24/2023]
Abstract
Gastric cancer continues to be a significant malignancy worldwide, accounting for approximately one million new cases in 2020. Scientists are focusing on the cancerous cells' plasma membrane (PM) as a potential therapeutic target in cancer because it functions as the cell's interface with its environment through a variety of mechanisms. The capacity of membrane shape and its structures to influence biological processes frequently occurs through the regulation of enzymes or preferential protein binding to membranes via membrane shape changes. We aimed here to assess the morphological irregularities of the cellular membranes in gastric adenocarcinoma tumors, and to find any putative differences from normal gastric mucosae epithelial cells. We analyzed the pattern of E-cadherin at the level of the cell membrane using the fractal dimension (FD) analysis on fluorescence immunohistochemistry samples labeled with E-cadherin in gastric well/moderate and solid gastric adenocarcinoma from patients without any associated chemotherapeutic treatment or radiotherapy. Images were binarized based on a fixed threshold of the E-cadherin fluorescence channel, and then the FD of the binarized image outlines has been calculated in order to assess the ruggedness of the cellular membranes. Overall assessment of the FD revealed that the subtle membrane variations were evident enough to deem a statistically significant difference and the complexity of the membrane roughness was clearly higher for adenocarcinoma cases. We intended to evaluate if separating adenocarcinoma cases as low grade (G1 and G2) and high grade (G3 and solid), FD analysis could still differentiate membrane patterns and check if the available clinical parameters like age, gender, tumor location, lymph ganglia involved might correlate with FD values for adenocarcinoma patients. Altogether, the morphological analysis of a simple marker for the cell membrane can identify and distinguish tumor cells. Although there was a limited correlation between this analysis and the main clinical and pathological indicators of the disease, it will be very useful in the future for automatic computer-assisted diagnosis on slides, as well as for evaluating cellular adhesion and inter-cellular trafficking in cancer cells.
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Affiliation(s)
- Ilona Mihaela Liliac
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| | | | | | - Laurențiu Mogoantă
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| | - Claudiu Mărgăritescu
- Department of Pathology, University of Medicine and Pharmacy of Craiova, Romania
| | - Daniel Pirici
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| | - Adrian Săftoiu
- Department of Research Methodology, University of Medicine and Pharmacy of Craiova, Romania
| | - Anda Elena Crisan
- Department of Oncology, University of Medicine and Pharmacy of Craiova, Romania
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Sacerdoțianu VM, Ungureanu BS, Iordache S, Cazacu SM, Pirici D, Liliac IM, Burtea DE, Șurlin V, Stroescu C, Gheonea DI, Săftoiu A. Gastric Cancer Angiogenesis Assessment by Dynamic Contrast Harmonic Imaging Endoscopic Ultrasound (CHI-EUS) and Immunohistochemical Analysis-A Feasibility Study. J Pers Med 2022; 12:jpm12071020. [PMID: 35887515 PMCID: PMC9324362 DOI: 10.3390/jpm12071020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/16/2022] Open
Abstract
Tumor vascular perfusion pattern in gastric cancer (GC) may be an important prognostic factor with therapeutic implications. Non-invasive methods such as dynamic contrast harmonic imaging endoscopic ultrasound (CHI-EUS) may provide details about tumor perfusion and could also lay out another perspective for angiogenesis assessment. Methods: We included 34 patients with GC, adenocarcinoma, with CHI-EUS examinations that were performed before any treatment decision. We analyzed eighty video sequences with a dedicated software for quantitative analysis of the vascular patterns of specific regions of interest (ROI). As a result, time-intensity curve (TIC) along with other derived parameters were automatically generated: peak enhancement (PE), rise time (RT), time to peak (TTP), wash-in perfusion index (WiPI), ROI area, and others. We performed CD105 and CD31 immunostaining to calculate the vascular diameter (vd) and the microvascular density (MVD), and the results were compared with CHI-EUS parameters. Results: High statistical correlations (p < 0.05) were observed between TIC analysis parameters MVD and vd CD31. Strong correlations were also found between tumor grade and 7 CHI-EUS parameters, p < 0.005. Conclusions: GC angiogenesis assessment by CHI-EUS is feasible and may be considered for future studies based on TIC analysis.
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Affiliation(s)
- Victor Mihai Sacerdoțianu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
- Correspondence: ; Tel.: +40-723-178-763
| | - Sevastiţa Iordache
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Sergiu Marian Cazacu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Daniel Pirici
- Histology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.P.); (I.M.L.)
| | - Ilona Mihaela Liliac
- Histology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.P.); (I.M.L.)
| | - Daniela Elena Burtea
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Valeriu Șurlin
- Surgical Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cezar Stroescu
- Surgical Department II, St. Mary Hospital Bucharest, 011172 București, Romania;
| | - Dan Ionuț Gheonea
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
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Liliac IM, Ungureanu BS, Mărgăritescu C, Sacerdoțianu VM, Săftoiu A, Mogoantă L, Moraru E, Pirici D. E-Cadherin Modulation and Inter-Cellular Trafficking in Tubular Gastric Adenocarcinoma: A High-Resolution Microscopy Pilot Study. Biomedicines 2022; 10:biomedicines10020349. [PMID: 35203558 PMCID: PMC8961786 DOI: 10.3390/biomedicines10020349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023] Open
Abstract
Despite the numerous advances in tumor molecular biology and chemotherapy options, gastric adenocarcinoma is still the most frequent form of gastric cancer. One of the core proteins that regulates inter-cellular adhesion, E-cadherin plays important roles in tumorigenesis as well as in tumor progression; however, the exact expression changes and modulation that occur in gastric cancer are not yet fully understood. In an attempt to estimate if the synthesis/degradation balance matches the final membrane expression of this adhesion molecule in cancer tissue, we assessed the proportion of E-cadherin that is found in the Golgi vesicles as well as in the lysosomal pathway We utilized archived tissue fragments from 18 patients with well and poorly differentiated intestinal types of gastric cancer and 5 samples of normal gastric mucosa, by using high-magnification multispectral microscopy and high-resolution fluorescence deconvolution microscopy. Our data showed that E-cadherin is not only expressed in the membrane, but also in the cytoplasm of normal and tumor gastric epithelia. E-cadherin colocalization with the Golgian vesicles seemed to be increasing with less differentiated tumors, while co-localization with the lysosomal system decreased in tumor tissue; however, the membrane expression of the adhesion molecule clearly dropped from well to poorly differentiated tumors. Thus E-cadherin seems to be more abundantly synthetized than eliminated via lysosomes/exosomes in less differentiated tumors, suggesting that post-translational modifications, such as cleavage, conformational inactivation, or exocytosis, are responsible for the net drop of E-cadherin at the level of the membrane in more anaplastic tumors. This behavior is in perfect accordance with the concept of partial epithelial-to-mesenchymal transition (P-EMT), when the E-cadherin expression of tumor cells is in fact not downregulated but redistributed away from the membrane in recycling vesicles. Moreover, our high-resolution deconvolution microscopy study showed for the first time, at the tissue level, the presence of Lysosome-associated membrane glycoprotein 1 (LAMP1)-positive exosomes/multivesicular bodies being trafficked across the membranes of tumor epithelial cells. Altogether, a myriad of putative modulatory pathways is available as a treatment turning point, even if we are to only consider the metabolism of membrane E-cadherin regulation. Future super-resolution microscopy studies are needed to clarify the extent of lysosome/exosome exchange between tumor cells and with the surrounding stroma, in histopathology samples or even in vivo.
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Affiliation(s)
- Ilona Mihaela Liliac
- PhD Student, Doctoral School, Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Bogdan Silviu Ungureanu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (B.S.U.); (V.M.S.)
| | - Claudiu Mărgăritescu
- Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (C.M.); (D.P.)
| | - Victor Mihai Sacerdoțianu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (B.S.U.); (V.M.S.)
| | - Adrian Săftoiu
- Department of Research Methodology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Laurențiu Mogoantă
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Emil Moraru
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Daniel Pirici
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Correspondence: (C.M.); (D.P.)
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Cazacu SM, Săftoiu A, Iordache S, Ghiluşi MC, Georgescu CV, Iovănescu VF, Neagoe CD, Streba L, Caliţa M, Burtea ED, Cârţu D, Leru PM. Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy. Rom J Morphol Embryol 2021; 62:917-928. [PMID: 35673811 PMCID: PMC9289694 DOI: 10.47162/rjme.62.4.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Colorectal carcinoma represents a major cause of mortality and 0.2–12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.
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Affiliation(s)
- Sergiu Marian Cazacu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania; ,
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Anastasiou J, Coronel E, Cazacu I, Săftoiu A, Berzin T. Artificial Intelligence-Assisted Diagnostic Approaches for Pancreatic Disease. Pancreas 2021; 50:e69-e70. [PMID: 34714294 DOI: 10.1097/mpa.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Udriștoiu AL, Cazacu IM, Gruionu LG, Gruionu G, Iacob AV, Burtea DE, Ungureanu BS, Costache MI, Constantin A, Popescu CF, Udriștoiu Ș, Săftoiu A. Real-time computer-aided diagnosis of focal pancreatic masses from endoscopic ultrasound imaging based on a hybrid convolutional and long short-term memory neural network model. PLoS One 2021; 16:e0251701. [PMID: 34181680 PMCID: PMC8238220 DOI: 10.1371/journal.pone.0251701] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 04/25/2021] [Indexed: 12/24/2022] Open
Abstract
Differential diagnosis of focal pancreatic masses is based on endoscopic ultrasound (EUS) guided fine needle aspiration biopsy (EUS-FNA/FNB). Several imaging techniques (i.e. gray-scale, color Doppler, contrast-enhancement and elastography) are used for differential diagnosis. However, diagnosis remains highly operator dependent. To address this problem, machine learning algorithms (MLA) can generate an automatic computer-aided diagnosis (CAD) by analyzing a large number of clinical images in real-time. We aimed to develop a MLA to characterize focal pancreatic masses during the EUS procedure. The study included 65 patients with focal pancreatic masses, with 20 EUS images selected from each patient (grayscale, color Doppler, arterial and venous phase contrast-enhancement and elastography). Images were classified based on cytopathology exam as: chronic pseudotumoral pancreatitis (CPP), neuroendocrine tumor (PNET) and ductal adenocarcinoma (PDAC). The MLA is based on a deep learning method which combines convolutional (CNN) and long short-term memory (LSTM) neural networks. 2688 images were used for training and 672 images for testing the deep learning models. The CNN was developed to identify the discriminative features of images, while a LSTM neural network was used to extract the dependencies between images. The model predicted the clinical diagnosis with an area under curve index of 0.98 and an overall accuracy of 98.26%. The negative (NPV) and positive (PPV) predictive values and the corresponding 95% confidential intervals (CI) are 96.7%, [94.5, 98.9] and 98.1%, [96.81, 99.4] for PDAC, 96.5%, [94.1, 98.8], and 99.7%, [99.3, 100] for CPP, and 98.9%, [97.5, 100] and 98.3%, [97.1, 99.4] for PNET. Following further validation on a independent test cohort, this method could become an efficient CAD tool to differentiate focal pancreatic masses in real-time.
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Affiliation(s)
| | - Irina Mihaela Cazacu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | | | - Gabriel Gruionu
- Faculty of Mechanics, University of Craiova, Craiova, Romania
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | - Daniela Elena Burtea
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Mădălin Ionuț Costache
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Alina Constantin
- Gastroenterology Department, Ponderas Academic Hospital, Bucharest, Romania
| | | | - Ștefan Udriștoiu
- Faculty of Automation, Computers and Electronics, University of Craiova, Craiova, Romania
- INNES Worldwide LLC, Craiova, Romania
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
- Gastroenterology Department, Ponderas Academic Hospital, Bucharest, Romania
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Giucă A, Mihai C, Jurcuț C, Gheorghiu AM, Groșeanu L, Dima A, Săftoiu A, Coman IM, Popescu BA, Jurcuț R. Screening for Pulmonary Hypertension in Systemic Sclerosis-A Primer for Cardio-Rheumatology Clinics. Diagnostics (Basel) 2021; 11:diagnostics11061013. [PMID: 34206055 PMCID: PMC8229459 DOI: 10.3390/diagnostics11061013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/20/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare disease, with unfavorable clinical course and prognosis, characterized by progressive multisystemic involvement. SSc associated pulmonary hypertension (SSc-PAH) and interstitial lung disease (ILD) are the most important factors for morbi-mortality in these patients, being responsible for more than 60% of total deaths. Though pulmonary arterial hypertension (PAH) is the dominant subtype seen in SSc, PH secondary to ILD, left-heart pathology, and pulmonary veno-occlusive disease (PVOD) are also possible occurrences. Initial evaluation of a SSc case is complex and should be performed with a multidisciplinary approach. Early detection of SSc-PAH is imperative, given the fact that new and effective medications are available and early treatment was shown to improve outcomes. Therefore, screening algorithms must be used adequately and in a cost-effective manner. Sensitivity and negative predictive value (NPV) are the most important performance measures in a screening test. Several algorithms were developed in the last decade (e.g., DETECT and ASIG) and demonstrated higher efficiency when compared to older algorithms. The present manuscript details the risk factors for SSc-PAH and includes a critical description of current detection algorithms, as a primer for clinicians working in the field of cardio-rheumatology.
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Affiliation(s)
- Adrian Giucă
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
| | - Carina Mihai
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Department of Rheumatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Ciprian Jurcuț
- Department of Internal Medicine, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Ana Maria Gheorghiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Str.Ion Movilă nr 5-7, 020475 Bucharest, Romania
| | - Laura Groșeanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Department of Rheumatology, “Sf. Maria” Clinical Hospital, Bd Ion Mihalache nr 37-39, 011172 Bucharest, Romania
| | - Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Sos Stefan cel Mare nr 19-21, 020125 Bucharest, Romania;
| | - Adrian Săftoiu
- Department of Internal Medicine, Craiova University of Medicine and Pharmacy, Str Petru Rares nr 2, 200349 Craiova, Romania;
| | - Ioan Mircea Coman
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
| | - Bogdan A. Popescu
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
| | - Ruxandra Jurcuț
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Correspondence:
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Şirli R, Sporea I, Popescu A, Dănilă M, Săndulescu DL, Săftoiu A, Moga T, Spârchez Z, Cijevschi C, Mihai C, Ioanițescu S, Nedelcu D, Iacob N, Miclăuș G, Brisc C, Badea R. Contrast-enhanced ultrasound for the assessment of focal nodular hyperplasia - results of a multicentre study. Med Ultrason 2021; 23:140-146. [PMID: 33945596 DOI: 10.11152/mu-2912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM Contrast-enhanced ultrasound (CEUS) has become a relevant imaging method for the evaluation of focal liver le-sions (FLL). The aim of this study was to evaluate the performance of CEUS for the assessment of focal nodular hyperplasia (FNH) in a large study group. MATERIAL AND METHODS We performed a multicentre prospective observational study, which included successive CEUS examinations from fourteen Romanian centres. CEUS examinations were performed in de novo FLL, using low mechanical index ultrasound, following an intravenous bolus of 2.4 ml SonoVue. CEUS was considered conclusive for FNH if a typical pattern was present following contrast (rapid "spoke-wheel" enhancement during the arterial phase, hyperenhanced lesion during venous phase, hyper- or isoenhanced in the late phase). In all cases a reference method was available (contrast enhanced CT or MRI or biopsy). The trial was registered in clinicaltrials.gov (Identifier NCT01329458). RESULTS During the 6 years study, 2062 "de novo" FLL were evaluated by CEUS. From this cohort, 94/2062 (4.5%) had a typical enhancing pattern for FNH as described in the EFSUMB guidelines. Contrast enhanced CT/MRI and biopsy diagnosed additional 15 FNH. From the 94 cases diagnosed as FNH by CEUS, in nine the final diagnosis was different (five of them adenomas). CEUS had 85% sensitivity, 99.5% specificity, 90.4% positive predictive value, 99.2% negative predictive value and 98.8% diagnostic accuracy for the diagnosis of FNH. CONCLUSIONS CEUS is a sensitive and very specific method for the diagnosis of FNH.
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Affiliation(s)
- Roxana Şirli
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timișoara, Romania.
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timișoara, Romania.
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timișoara, Romania.
| | - Mirela Dănilă
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timișoara, Romania.
| | - Daniela Larisa Săndulescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania.
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania.
| | - Tudor Moga
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timișoara, Romania.
| | - Zeno Spârchez
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj Napoca, Cluj Napoca, Romania.
| | - Cristina Cijevschi
- Department of Gastroenterology, "Gr.T.Popa" University of Medicine and Pharmacy Iaşi, Iași, Romania.
| | - Cătălina Mihai
- Department of Gastroenterology, "Gr.T.Popa" University of Medicine and Pharmacy Iaşi, Iași, Romania.
| | - Simona Ioanițescu
- Center of Internal Medicine, Fundeni Clinical Institute, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Dana Nedelcu
- Ponderas and Neolife Hospitals, Bucharest, Romania.
| | - Nicoleta Iacob
- Department of Anatomy and Embryology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania.
| | - Grațian Miclăuș
- Department of Anatomy and Embryology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania.
| | - Ciprian Brisc
- Department of Medical Disciplines, Gastroenterology Clinic, University of Oradea, Oradea, Romania.
| | - Radu Badea
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj Napoca, Cluj Napoca, Romania.
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Constantinescu EC, Udriștoiu AL, Udriștoiu ȘC, Iacob AV, Gruionu LG, Gruionu G, Săndulescu L, Săftoiu A. Transfer learning with pre-trained deep convolutional neural networks for the automatic assessment of liver steatosis in ultrasound images. Med Ultrason 2021; 23:135-139. [PMID: 33626114 DOI: 10.11152/mu-2746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM In this paper we proposed different architectures of convolutional neural network (CNN) to classify fatty liver disease in images using only pixels and diagnosis labels as input. We trained and validated our models using a dataset of 629 images consisting of 2 types of liver images, normal and liver steatosis. MATERIAL AND METHODS We assessed two pre-trained models of convolutional neural networks, Inception-v3 and VGG-16 using fine-tuning. Both models were pre-trained on ImageNet dataset to extract features from B-mode ultrasound liver images. The results obtained through these methods were compared for selecting the predictive model with the best performance metrics. We trained the two models using a dataset of 262 images of liver steatosis and 234 images of normal liver. We assessed the models using a dataset of 70 liver steatosis im-ages and 63 normal liver images. RESULTS The proposed model that used Inception v3 obtained a 93.23% test accuracy with a sensitivity of 89.9%% and a precision of 96.6%, and areas under each receiver operating characteristic curves (ROC AUC) of 0.93. The other proposed model that used VGG-16, obtained a 90.77% test accuracy with a sensitivity of 88.9% and a precision of 92.85%, and areas under each receiver operating characteristic curves (ROC AUC) of 0.91. CONCLUSION The deep learning algorithms that we proposed to detect steatosis and classify the images in normal and fatty liver images, yields an excellent test performance of over 90%. However, future larger studies are required in order to establish how these algorithms can be implemented in a clinical setting.
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Affiliation(s)
| | | | | | | | | | - Gabriel Gruionu
- Faculty of Mechanics, University of Craiova, Craiova, Romania.
| | - Larisa Săndulescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania.
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania.
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Copăescu C, Bîrlog C, Turcu F, Săftoiu A. A Novel Indocyanine Green Fluorescence-Guided Laparoscopic Technique to Map the Site of Obscure Gastrointestinal Haemorrhage. Chirurgia (Bucur) 2021; 116:89-101. [PMID: 33638330 DOI: 10.21614/chirurgia.116.1.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
The aim of our study was to explore the feasibility of a novel fluorescence-guided laparoscopic technique to localize the obscure GI haemorrhage, using the vascular wash-out properties of indocyanine green (ICG). Method: The feasability study included patients with previous surgical modifications of the gut architecture, qualified as an overt obscure GI bleeding with an urgent need to be localized and controlled. Five mL of ICG was injected intravenously and laparoscopic infrared inspection was performed 30 minutes after the dye was eliminated from the bloodstream. The bleeding area mapping was demonstrated and the haemostasis was carefully performed using endoscopy or laparoscopic techniques. Results: A series of two cases were included in our fesability study so far. Case 1. A 43-year old male, who recently received a Laparoscopic Roux-en-Y gastric bypass (RYGB), developed a recurrent GI bleeding. Post dye wash-out intense signal was demonstrated at the level of duodenum and weaker at the gastric remnant. The laparoscopic trans-gastric exploration of the remnant identified an active bleeding source siding the stapled line and haemostasis was achieved with laparoscopic ligation using stitches. Case 2. A 66-year old male patient who underwent an open Whipple resection nine months before, was admitted for a repeated GI bleeding. The inspection of the biliopancreatic limb noticed an intense fluorescent signal toward the enteral proximal end. Upper digestive endoscopy confirmed the presence of an active bleeding source from ectopic jejunal varices siding the choledoco-jejunal anastomosis. Argon plasma coagulation was performed endoscopically and achieved hemostasis. Conclusions: A successful novel ICG fluorescence-guided laparoscopic mapping technique was used to localize the site of the obscure GI haemorrhage and to facilitate the prompt bleeding control. To the best of our knowledge these are the first published cases for which this technique was used.
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Constantin AL, Cazacu IM, Stroescu C, Copăescu C, Săftoiu A. Prognostic biomarkers related to tumoral microenvironment in pancreatic ductal adenocarcinoma: a systematic review. Rom J Morphol Embryol 2021; 62:671-678. [PMID: 35263394 PMCID: PMC9019618 DOI: 10.47162/rjme.62.3.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Over the past decades, pancreatic ductal adenocarcinoma (PDAC) has been coming into view due to increased mortality, the 5-year survival rate being the lowest of all cancers (around 6%). In PDAC, microenvironmental components possess prognostic relevance. The aim of this article is to perform a review of studies evaluating the composition of the tumor microenvironment to identify tumor microenvironment-related prognostic biomarkers in patients with PDAC. A literature search has been performed in three major databases PubMed®, Embase®, Web of Science® using the search terms: pancreatic adenocarcinoma in combination with one of the following: alpha-smooth muscle actin (α-SMA), collagen I, cluster of differentiation (CD)31, CD105, CD3–CD4–CD8, CD68 and CD206. Total number of articles identified through database searching was 1185. After title and abstract review, we have selected 92 articles in which the markers sought were studied. Tumor microenvironment-related biomarkers appear to also possess role in monitoring the response to treatment. Thus, CD105 angiogenetic immunomarker, stromal immunomarkers such as α-SMA and collagen I, immune cells markers represented by CD4/CD8 ratio, CD206 and CD68 were correlated with negative prognosis, while CD3+, CD8+ immune cells markers and CD31 angiogenetic immunomarker proved to be correlated with good prognosis. Furthermore, most studies were performed on resected specimens and culture cells, while only a few studies used specimens obtained through endoscopic ultrasound-guided fine-needle biopsy (EUS–FNB). To increase the therapeutic response and reduce toxicity, prognostic targets should be determined on a large scale, not only based on resected specimens. EUS–FNB represents a feasible method to provide sufficient tissue for diagnosis and additional immunohistochemistry analysis.
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Săftoiu A. Art in Endoscopy: "Interstellar wormhole". Endoscopy 2020; 52:823. [PMID: 32967012 DOI: 10.1055/a-1233-8612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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17
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Caliţa M, Florescu DN, Streba CT, Stănculescu AD, Florescu MM, Popa P, Gheonea DI, Oancea CN, Săftoiu A. The quality of colorectal polypectomy. Is it enough to have just a visual assessment of the site? Rom J Morphol Embryol 2020; 61:1301-1307. [PMID: 34171078 PMCID: PMC8343597 DOI: 10.47162/rjme.61.4.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Performing a colonoscopy allows the examination of the entire colon and the assessment of polyps. PATIENTS, MATERIALS AND METHODS We performed a retrospective analysis of prospectively collected data from January 2018 until February 2020 (two years), in which we enrolled a number of 210 patients performing colonoscopy in the Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania. We performed 326 polypectomies. RESULTS We classified the polyps into diminutive (n=169), small (n=103) and large polyps (n=54). Regarding the polypectomy technique, our results indicated that 40 out of 48 (83.3%) polypectomies with the biopsy forceps were complete, as well as 27 out of 31 (87.1%) cold snare polypectomies and 12 out of 14 (85.7%) hot snare polypectomies. The differences were not statistically significant (p=0.116). Regarding the number of incomplete polypectomies, our data suggests that the high expertise endoscopist had two incomplete resections (5.1% of total), the medium expertise endoscopist 1 had also two incomplete resections (11.1% of total), the medium expertise endoscopist 2 had three incomplete resections (15% of total), the limited expertise endoscopist 1 had three incomplete resections (27.27% of total) and the limited expertise endoscopist 2 had four incomplete resections (30.76% of total). Analyzing the data, the differences were statistically significant (p=0.006). CONCLUSIONS Our study is able to suggest that high-definition white-light endoscopy (HD-WLE) macroscopic visualization of the polyp resection site is not enough to assess complete polyp resection and follow-up colonoscopy should be performed for cases with incomplete margins of resection.
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Affiliation(s)
- Mihaela Caliţa
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania;
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Constantin A, Cazacu I, Ciocârlan M, Constantinescu C, Baltog G, Balahura C, Doraş I, Filip S, Filip G, Panazan I, Piţigoi D, Pirvu V, Turcu F, Copăescu C, Săftoiu A. Short Term Outcomes of Using Fecal Immunochemical Test for a Pilot Colorectal Cancer Screening Program. A Single Center Study on 3024 Consecutive Patients. Chirurgia (Bucur) 2020; 115:448-457. [PMID: 32876018 DOI: 10.21614/chirurgia.115.4.448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/23/2022]
Abstract
Background: In Romania, colorectal cancer does not benefit yet from a national screening program. In order to decrease the harm and burden of colorectal cancer (CRC), opportunistic programs relying on endoscopy has been adopted by each centre according to its capacity. A colorectal cancer (CRC) screening programme based on faecal immunochemical test (FIT) was launched at Ponderas Academic Hospital (PAH) in 2019. Aim: The present study analyses the outcomes after the first 1500 tests in the PAH-FIT-CRC Screening Program. We have also aimed to compare the efficiency of the FIT testing program with the screening colonoscopies performed in our Center, withing the same time interval (2019). Methods: The test was recommended in asymptomatic patients over 45 years, and it was followed by a colonoscopy when the test results were positive. Furthermore, we performed a retrospective observational study gathering data from all the consecutive patients prospectively included in the respective databases of our hospital, comparing the efficacy of the two colorectal cancer screening methods (FIT versus colonoscopy). Results: Between 01.01.2019 and 01.01.2020, 1524 screening colonoscopies were performed, and the resulting data were compared with those obtained in the FIT group (1500 FIT tests freely distributed). In the screening colonoscopy group, the polyp detection rate was 38.98% and 22 (1.44%) adenocarcinomas were identified. In the FIT group, the FIT uptake rate was 71% with a positivity rate of 21.7%. The colonoscopy compliance rate for positive FIT patients was 29.4%, with only 2 adenocarcinomas detected. Conclusions: Following data analysis, the need for improvement of uptake rate and colonoscopy compliance rate was suggested, due to the lower acceptance of FIT tests and colonoscopies, especially among men. Moreover, special efforts should be made in order to improve quality indicators for screening colonoscopies (especially adenoma detection rate) with the purpose of decreasing interval CRC.
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Săftoiu A, Tomulescu V, Tanţău M, Gheorghe C, Dumitru E, Mateescu B, Negreanu L, Jinga M, Seicean A, Ciocîrlan M, Drug V, Mănuc M, Popescu R, Tiu C, Binţinţan V, Calu V, Şurlin V, Turcu F, Zaharie F, Ulmeanu D, Brebu D, Nicolau A, Liţescu M, Diaconescu B, Duţă C, Copăescu C. SRED-ARCE Recommendations for Minimally Invasive Interventions During the COVID-19 Pandemic in Romania. Chirurgia (Bucur) 2020; 115:289-306. [PMID: 32614284 DOI: 10.21614/chirurgia.115.3.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
The Romanian Society of Digestive Endoscopy (SRED) and the Romanian Association of Endoscopic Surgery (ARCE) have decided to establish a joint working group to elaborate specific recommendations for organizing the diagnostic and the minimally invasive interventional procedures, in the context of the COVID-19 pandemic. The recommendations are based on the guidelines of the international societies of endoscopy and gastroenterology (ESGE / BSG / ASGE / ACG / AGA), respectively endoscopic surgery (EAES SAGES) (4-8), on the experience of countries severely affected by the pandemic (Italy, France, Spain, USA, Germany, etc.) and they will be applied within the limits of measures imposed at local and governmental level by the competent authorities. On the other hand, these recommendations should have a dynamic evolution, depending on the upward or downward trend of the COVID-19 pandemic at regional and local level, but also according to the findings of professional and academic societies, requiring regular reviews based on the publica tion of further recommendations or international clinical trials. The objectives of the SRED and ARCE recommendations target the endoscopic and laparoscopic surgery activities, to support their non discriminatory used for diagnostic or therapeutic purposes, pursuing the demonstrated benefits of these procedures, in safe conditions for patients and medical staff.
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Săftoiu A, Hassan C, Areia M, Bhutani MS, Bisschops R, Bories E, Cazacu IM, Dekker E, Deprez PH, Pereira SP, Senore C, Capocaccia R, Antonelli G, van Hooft J, Messmann H, Siersema PD, Dinis-Ribeiro M, Ponchon T. Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020; 52:293-304. [PMID: 32052404 DOI: 10.1055/a-1104-5245] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In Europe at present, but also in 2040, 1 in 3 cancer-related deaths are expected to be caused by digestive cancers. Endoscopic technologies enable diagnosis, with relatively low invasiveness, of precancerous conditions and early cancers, thereby improving patient survival. Overall, endoscopy capacity must be adjusted to facilitate both effective screening programs and rigorous control of the quality assurance and surveillance systems required. 1 : For average-risk populations, ESGE recommends the implementation of organized population-based screening programs FOR COLORECTAL CANCER: , based on fecal immunochemical testing (FIT), targeting individuals, irrespective of gender, aged between 50 and 75 years. Depending on local factors, namely the adherence of the target population and availability of endoscopy services, primary screening by colonoscopy or sigmoidoscopy may also be recommendable. 2 : In high-risk populations, endoscopic screening FOR GASTRIC CANCER: should be considered for individuals aged more than 40 years. Its use in countries/regions with intermediate risk may be considered on the basis of local settings and availability of endoscopic resources. 3 : For esophageal and pancreatic cancer, endoscopic screening may be considered only in high-risk individuals:- FOR SQUAMOUS CELL CARCINOMA: , in those with a personal history of head/neck cancer, achalasia, or previous caustic injury; - FOR BARRETT'S ESOPHAGUS (BE)-ASSOCIATED ADENOCARCINOMA: , in those with long-standing gastroesophageal reflux disease symptoms (i. e., > 5 years) and multiple risk factors (age ≥ 50 years, white race, male sex, obesity, first-degree relative with BE or esophageal adenocarcinoma [EAC]). - FOR PANCREATIC CANCER SCREENING: , endoscopic ultrasound may be used in selected high-risk patients such as those with a strong family history and/or genetic susceptibility.
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Affiliation(s)
- Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania.,Gastroenterology Department, Regina Maria-Ponderas Academic Hospital, Bucharest, Romania
| | | | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, The University of Texas, Houston, USA
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospitals Leuven, Leuven, Belgium
| | | | - Irina M Cazacu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania.,Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, The University of Texas, Houston, USA
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam University Medical Centers, The Netherlands
| | - Pierre H Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, Royal Free Hospital Campus, University College London, UK
| | - Carlo Senore
- Epidemiology and Screening Unit-CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | | | | | - Jeanin van Hooft
- Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam University Medical Centers, The Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mario Dinis-Ribeiro
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
| | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
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21
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Rimbas M, Larghi A, Fusaroli P, Dong Y, Hollerbach S, Jenssen C, Săftoiu A, Sahai AV, Napoleon B, Arcidiacono PG, Braden B, Burmeister S, Carrara S, Cui XW, Hocke M, Iglesias-Garcia J, Kitano M, Oppong KW, Sun S, Di Leo M, Petrone MC, B Teoh AY, Dietrich CF. How to perform EUS-guided tattooing? Endosc Ultrasound 2020; 9:291-297. [PMID: 32883923 PMCID: PMC7811726 DOI: 10.4103/eus.eus_44_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Recently, we introduced a series of papers describing on how to perform certain techniques and controversies in EUS. In the first paper, "What should be known before performing EUS examinations, Part I," the authors discussed clinical information and whether other imaging modalities should be needed before embarking in EUS examination. In Part II, some technical controversies on how EUS is performed are discussed from different points of view by providing the relevant available evidence. Herewith, we describe on how to perform EUS-guided fine needle tattooing (FNT) in daily practice. The aim of this paper is to discuss pros and cons for several issues including historical remarks, injecting material, technical approach, and how to perform EUS-FNT including argues in favor and against.
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Affiliation(s)
- Mihai Rimbas
- Gastroenterology and Internal Medicine Departments, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania; Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS; CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus MärkischOderland, Strausberg and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Paolo Giorgio Arcidiacono
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Johann Wolfgang Goethe University, Frankfurt, Germany & Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Sean Burmeister
- Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Michael Hocke
- Medical Department, Helios Klinikum, Meiningen, Germany
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Siyu Sun
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Maria Chiara Petrone
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Anthony Y B Teoh
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
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22
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Berceanu M, Mirea O, Donoiu I, Militaru C, Săftoiu A, Istrătoaie O. Myocardial Function Assessed by Multi-Layered Two-Dimensional Speckle Tracking Analysis in Asymptomatic Young Subjects with Diabetes Mellitus Type 1. Cardiology 2019; 145:80-87. [PMID: 31825945 DOI: 10.1159/000504532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 11/02/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diabetes mellitus type 1 (DM1) is associated with a high risk for cardiovascular disease, and early detection of myocardial dysfunction is crucial for the prevention of cardiac complications. OBJECTIVES The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by using both conventional echocardiography as well as multi-layered speckle tracking echocardiography (STE) in young adults with DM1. METHODS We included 50 young asymptomatic adults diagnosed with DM1 (mean interval from diagnosis 9 ± 6 years) and 80 healthy controls. STE was acquired using the GE Vivid S60 equipment. The LV longitudinal strain (LS), layer-specific strains of the endocardium, myocardium, and epicardium (global longitudinal strain [GLS]endo, GLSmyo, GLSepi) as well as RV strain were obtained using the EchoPAC BT13 workstation. RESULTS No significant intergroup differences in LV ejection fraction were noted. GLSendo and GLSmyo were reduced in the DM1 group (-20.6 ± 2.7 vs. -22.0 ± 2.3 and -18.0 ± 2.4 vs. -19.1 ± 1.9, respectively, p < 0.05) compared to controls. Mechanical dispersion was higher in the diabetes group (34 ± 11 vs. 29 ± 7, p < 0.05). RV strain measurements showed no significant difference between the groups. CONCLUSIONS Young adults with DM1 and without known heart disease have subclinical myocardial dysfunction with lower LV endocardium and myocardium LS and higher mechanical dispersion demonstrated by multi-layered STE.
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Affiliation(s)
- Mihaela Berceanu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Oana Mirea
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania,
| | - Ionut Donoiu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Constantin Militaru
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Octavian Istrătoaie
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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23
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Dietrich CF, Hollerweger A, Dirks K, Higginson A, Serra C, Calabrese E, Dong Y, Hausken T, Maconi G, Mihmanli I, Nürnberg D, Nylund K, Pallotta N, Ripollés T, Romanini L, Săftoiu A, Sporea I, Wüstner M, Maaser C, Gilja OH. EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features. Med Ultrason 2019; 21:299-315. [PMID: 31476211 DOI: 10.11152/mu-2162] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Transabdominal gastrointestinal ultrasound (GIUS) is unique in its capacity to examine the bowel non-invasively and in its physiological condition, including extra-intestinal features such as the splanchnic vessels, mesentery, omentum and lymph nodes- even at the bedside. Despite this, and its extensive documentation for its usefulness, it has only been fully implemented in a few European countries and expert centres. Therefore, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) established a GIUS Task Force Group in 2014 consisting of international experts from 9 European countries with the objectives to standardize and promote the use of GIUS in a clinical setting. This is achieved by publishing clinical guidelines and recommendations on indications and use of GIUS and so far,4 guidelines have been published: first on "examination techniques and normal findings", second on "inflammatory bowel disease", third on "acute appendicitis and diverticulitis" and fourth on "transrectal and perineal ultrasound".This paper describes the ultrasound features of miscellaneous disorders such as celiac disease, cystic fibrosis, omental infarction, Meckel's diverticle, endometriosis, intestinal neoplasia, mucocele, amyloidosis, GVHD, foreign bodies, vasculitis, and pneumatosis cystoides intestinalis. Bowel ultrasound can be indicated in most of these conditions to investigate intestinal symptoms but in other cases the alterations of the bowel can be also an incidental finding that suggest other examinations which finally help to discover an unknown pathological condition.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany.
| | - Alois Hollerweger
- 2Department of Radiology, Hospital Barmherzige Brüder, Salzburg, Austria
| | - Klaus Dirks
- Department of Gastroenterology and General Internal Medicine, Rems-Murr-Klinikum, Winnenden, Germany
| | | | - Carla Serra
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy
| | - Emma Calabrese
- Gastroenterology Department of Systems Medicine. University of Rome Tor Vergata, Rome, Italy
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Trygve Hausken
- Department of Clinical Medicine, University of Bergen, and Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Ismail Mihmanli
- Istanbul University, Cerrahpasa Medical Faculty Department of Radiology, Istanbul, Turkey
| | - Dieter Nürnberg
- Medical School Brandenburg, Department for Internal Medicine and Gastroenterology, Neuruppin, Germany
| | - Kim Nylund
- Department of Medicine, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Nadia Pallotta
- Department of Internal Medicine and Medical Specialties, Policlinico "Umberto I" La Sapienza University, Rome, Italy
| | - Tomás Ripollés
- Department of Radiology, Hospital Universitario Dr Peset, Valencia, Spain.
| | - Laura Romanini
- Department of Radiology, Ospedale di Cremona, Cremona, Italy
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
| | - Matthias Wüstner
- 18Zentrale interdisziplinäre Sonografie, Brüderkrankenhaus, Trier, Germany
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
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24
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Săftoiu A, Gilja OH, Sidhu PS, Dietrich CF, Cantisani V, Amy D, Bachmann-Nielsen M, Bob F, Bojunga J, Brock M, Calliada F, Clevert DA, Correas JM, D'Onofrio M, Ewertsen C, Farrokh A, Fodor D, Fusaroli P, Havre RF, Hocke M, Ignee A, Jenssen C, Klauser AS, Kollmann C, Radzina M, Ramnarine KV, Sconfienza LM, Solomon C, Sporea I, Ștefănescu H, Tanter M, Vilmann P. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018. Ultraschall Med 2019; 40:425-453. [PMID: 31238377 DOI: 10.1055/a-0838-9937] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.
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Affiliation(s)
- Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Paul S Sidhu
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
| | | | - Vito Cantisani
- Radiological, Pathological and Oncological Sciences Department, University Sapienza, Rome, Italy
| | - Dominique Amy
- Radiology Department, Breast Center, Aix-en-Provence, France
| | | | - Flaviu Bob
- Nephrology Department, University of Medicine and Pharmacy "Victor Babeș" Timișoara, Romania
| | - Jörg Bojunga
- Med. Klinik I, Department of Endocrinology Universitätsklinikum, Frankfurt am Main, Germany
| | - Marko Brock
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Germany
| | - Fabrizio Calliada
- Department of Radiology, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Dirk André Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Jean-Michel Correas
- Service de Radiologie adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen-University-Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Daniela Fodor
- 2nd Medical Clinic, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Pietro Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | | | - André Ignee
- Medizinische Klinik 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | | | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University of Vienna, Austria
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, Medical faculty, University of Latvia, Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Kumar V Ramnarine
- Medical Physics Department, Guy's and St Thomas' NHS Foundation Trust, London, and University of Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy and Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Carolina Solomon
- Radiology Department, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeș" Timișoara, Romania
| | - Horia Ștefănescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mickael Tanter
- Physics for Medicine Paris Institute, INSERM, CNRS, ESPCI Paris, France
| | - Peter Vilmann
- Endoscopy Department, Copenhagen University Hospital Herlev, Denmark
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25
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Sporea I, Săndulescu DL, Şirli R, Popescu A, Danilă M, Spârchez Z, Mihai C, Ioanițescu S, Moga T, Timar B, Brisc C, Nedelcu D, Săftoiu A, Enăchescu V, Badea R. Contrast-Enhanced Ultrasound for the Characterization of Malignant versus Benign Focal Liver Lesions in a Prospective Multicenter Experience - The SRUMB Study. J Gastrointestin Liver Dis 2019; 28:191-196. [PMID: 31204417 DOI: 10.15403/jgld-180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 12/15/2022]
Abstract
AIM This study evaluated the accuracy of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of benign vs. malignant focal liver lesions (FLL) in a real-life, multicenter experience. METHODS This prospective study, including 14 Romanian centers, was performed over a 6 year period (February 2011- April 2017) and included 2062 FLLs assessed by CEUS. Inclusion criteria were: newly diagnosed FLL on B-mode ultrasound, less than three lesions/patient, all FLLs evaluated by CEUS and by a second-line imaging technique (contrast enhanced CT or contrast enhanced MRI) or histology, considered as reference. The trial was registered in clinicaltrials.gov (Identifier NCT01329458). RESULTS From the 2062 FLLs included in the study, 57.2% (1179) were malignant and 42.8% (883) were benign. CEUS had 83.9% sensitivity (Se), 97.8% specificity (Sp), 98.1% positive predictive value (PPV), 82.2% negative predictive value (NPV) and a diagnostic accuracy (Ac) of 89.9% for the positive diagnosis of malignant lesions. For the benign lesions, CEUS had 97.8% Se, 83.9% Sp, 82.2% PPV, 98.1% NPV 89.9% Ac. The diagnostic performance of CEUS for hepatocellular carcinoma was 76.6% Se, 98.4% Sp, and 91.2% Ac; for hemangioma: 89.2% Se, 99% Sp, and 96.9% Ac and for metastases: 90.9% Se, 98.4% Sp, and 96.9% Ac. CONCLUSIONS CEUS proved a high accuracy in differentiating the malignant vs. benign character of a FLL. It can be confidently used as a first line imaging method in daily practice.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Daniela Larisa Săndulescu
- Centre for Research in Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Roxana Şirli
- Department of Gastroenterology and Hepatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania.
| | - Mirela Danilă
- Department of Gastroenterology and Hepatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Zeno Spârchez
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, and Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cătălina Mihai
- Department of Gastroenterology, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Simona Ioanițescu
- Department of Internal Medicine, Fundeni Clinical Institute, and Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Tudor Moga
- Department of Gastroenterology and Hepatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Bogdan Timar
- Department of Diabetes and Metabolic Diseases, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Ciprian Brisc
- Department of Gastroenterology, University of Oradea, Romania
| | - Dana Nedelcu
- Ponderas and Neolife Hospitals, Bucharest, Romania
| | - Adrian Săftoiu
- Centre for Research in Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Viorela Enăchescu
- Clinical Hospital "Filantropia", University of Medicine and Pharmacy Craiova, Romania
| | - Radu Badea
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, and Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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26
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Berceanu M, Mirea O, Târtea GC, Donoiu I, Militaru C, Istrătoaie O, Săftoiu A. The Significance of Right Ventricle in Young Subjects with Diabetes Mellitus Type 1. An echocardiographyic study. Curr Health Sci J 2019; 45:174-178. [PMID: 31624644 PMCID: PMC6778298 DOI: 10.12865/chsj.45.02.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diabetes mellitus type 1 (DM1) is associated with high risk for cardiovascular disease and early detection of myocardial dysfunction is very important for the prevention of cardiac complications. Although the functionality of right ventricule is important in a lot of disease affecting long time prognosis and progression, in diabetic type 1 patients has not been studied in depth yet. OBJECTIVES To evaluate the right ventricular function by using both conventional echocardiography as well as speckle tracking echocardiography (STE) in young adults with diabetes mellitus type 1. METHODS We included 60 young asymptomatic adults diagnosed with diabetes mellitus type 1 (mean interval from diagnosis 9±6 years) and 90 healthy controls. Conventional and STE Echocardiography was acquired using the GE Vivid S60 equipment. The longitudinal right ventricular strain 6 segments (RV GLS global) and 3 segments (RVFW GLS) of right ventricle (RV GLSbazal, RV GLSmid, RV GLSapex) as well were obtained using the EchoPAC BT13 workstation. RESULTS No significant intergroup differences in EF were noted. Conventional echocardiographic parameters revealed lower tricuspid annular velocities Et, At and Et/At ratio compared to controls suggesting a diastolic disfunction in diabetes group. RV speckle tracking strain measurements showed no significant difference between the groups. CONCLUSIONS Young adults with type 1 diabetes mellitus and without known heart disease have diastolic right ventricular dysfunction. The subclinical myocardial systolic function is preserved in early stages.
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Affiliation(s)
- M Berceanu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - O Mirea
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - G C Târtea
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
- Department of Physiology, University of Medicine and Pharmacy of Craiova, Romania
| | - I Donoiu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - C Militaru
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - O Istrătoaie
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - A Săftoiu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania
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Văduva IA, Mărgăritescu C, Georgescu CV, Enache AO, Pădureanu R, Săftoiu A, Pirici D. SMAD4 and TGFβR2 expression in pancreatic ductal carcinoma. Rom J Morphol Embryol 2019; 60:803-809. [PMID: 31912090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pancreatic ductal carcinoma is the most common type of pancreatic cancer, and currently represents the fourth cause of death by cancer, worldwide. Among classical pancreatic markers that ascertain the histopathology, new emerging targets have been proposed for both diagnostic and prognostic purposes. In the present study, utilizing a group of 28 confirmed resected pancreatic ductal carcinomas, we have assessed the immunoexpression and correlation ratios of mothers against decapentaplegic homolog 4 (Drosophila) (SMAD4)∕transforming growth factor beta receptor 2 (TGFβR2), and vimentin∕cluster of differentiation 105 (CD105). SMAD4 showed an overall increase in tumors versus pancreatic control tissue, but a decrease from G1 towards poorly differentiated tumors, while TGFβR2, vimentin and CD105 showed higher expression values in the tumor areas. Vimentin-CD105 colocalization degree decreased in tumor tissues compared to controls, illustrating a desynchronization of these two markers, both of them being negative in the tumor epithelia. Altogether, it is highly plausible that all these key players revolve around the epithelial-to-mesenchymal transition phenomenon, and this itself modulates the clinical outcome of the patient.
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Affiliation(s)
- Ion Alexandru Văduva
- Department of Gastroenterology, Department of Research Methodology, University of Medicine and Pharmacy of Craiova, Romania; ,
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Cazacu SM, Ghiluşi MC, Ivan ET, Ungureanu BS, Ciurea T, Săftoiu A, Dumitrescu CI, Forţofoiu M, Văduva IA, Neagoe CD. An unusual onset of Crohn's disease with oral aphthosis, giant esophageal ulcers and serological markers of cytomegalovirus and herpes virus infection: a case report and review of the literature. Rom J Morphol Embryol 2019; 60:659-665. [PMID: 31658341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Isolated esophageal ulcerations in Crohn's disease pose a great challenge in diagnosing and providing the correct treatment. We present the case of a 23-year-old woman with recurrent episodes of oral aphthosis, dysphagia, odynophagia and heartburn. Upper digestive endoscopy revealed an irregular mucosa with multiple ulcerations with irregular margins within the mid-esophagus. Immunoglobulin G (IgG) for cytomegalovirus and herpes virus were both positive. Four years after, she presented with the same symptoms and the involvement of ileo-colonic lesions, with pathological findings helped establish the Crohn's disease diagnosis. Crohn's disease represents an idiopathic chronic inflammatory gut disease, which can affect any part of the digestive tract. The onset by esophageal disease and no intestinal involvement is rare and challenging for a proper diagnosis.
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Affiliation(s)
- Sergiu Marian Cazacu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania; ; Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Romania;
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Popa P, Gheonea DI, Săftoiu A, Calița M. No Interval Cancers in Endoscopic Practice. Curr Health Sci J 2019; 45:5-18. [PMID: 31297257 PMCID: PMC6592672 DOI: 10.12865/chsj.45.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/12/2019] [Indexed: 11/18/2022]
Abstract
Colonoscopy is long time the most preferred method for CRC screening along with diagnosis and treatment for a range of colon diseases. Based on its difficulty in visualizing precursor CRC lesions, mostly those located on the right colon, this method can be subject of improvement. The colonoscopy quality can be influenced by many factors such as colon preparation, retraction time, the colonoscopists medical training and knowledges as well as the performance of endoscopy equipment. The bad quality of colonoscopy will result in the emergence of interval cancers defined, based on the author, as cancers that appear at 3-5 years up to 10 years from the colonoscopy procedure. Interval cancers have predominantly incriminated both the colonoscopy quality and the clinician competences and less the tumor biology. Subsequently there were set quality indicators of colonoscopy in order to raise the quality of the exploration. Among the important indicators, proving their utility in studies, the ADR (adenoma detection rate) is most commonly used along with PDR (polyp detection rate) and APC (adenoma per colonoscopy). Following the purpose of obtaining a higher colonoscopy quality the medical units should keep in check all indicators. Furthermore, there should be an active involvement in an additional training of non-conforming medical personnel or even restrain of practice, given the medical legal actions that have interval cancers as a main cause.
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Affiliation(s)
- P Popa
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - D I Gheonea
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - A Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - M Calița
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Mirea O, Berceanu M, Donoiu I, Militaru C, Săftoiu A, Istrătoaie O. Variability of right ventricular global and segmental longitudinal strain measurements. Echocardiography 2018; 36:102-109. [DOI: 10.1111/echo.14218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Oana Mirea
- Department of Cardiology; Emergency County Hospital Craiova; University of Medicine and Pharmacy of Craiova; Craiova Romania
| | - Mihaela Berceanu
- Department of Cardiology; Emergency County Hospital Craiova; University of Medicine and Pharmacy of Craiova; Craiova Romania
| | - Ionuț Donoiu
- Department of Cardiology; Emergency County Hospital Craiova; University of Medicine and Pharmacy of Craiova; Craiova Romania
| | - Constantin Militaru
- Department of Cardiology; Emergency County Hospital Craiova; University of Medicine and Pharmacy of Craiova; Craiova Romania
| | - Adrian Săftoiu
- Department of Gastroenterology; University of Medicine and Pharmacy of Craiova; Craiova Romania
| | - Octavian Istrătoaie
- Department of Cardiology; Emergency County Hospital Craiova; University of Medicine and Pharmacy of Craiova; Craiova Romania
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Militaru S, Ginghină C, Popescu BA, Săftoiu A, Linhart A, Jurcuţ R. Multimodality imaging in Fabry cardiomyopathy: from early diagnosis to therapeutic targets. Eur Heart J Cardiovasc Imaging 2018; 19:1313-1322. [DOI: 10.1093/ehjci/jey132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/23/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebastian Militaru
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Carmen Ginghină
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy“Carol Davila”, Bucharest, Romania
| | - Bogdan A Popescu
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy“Carol Davila”, Bucharest, Romania
| | - Adrian Săftoiu
- University of Medicine and Pharmacy, Craiova, Romania
- Emergency County Hospital, Craiova, Romania
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ruxandra Jurcuţ
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
- University of Medicine and Pharmacy“Carol Davila”, Bucharest, Romania
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Malmstrøm ML, Săftoiu A, Riis LB, Hassan H, Klausen TW, Rahbek MS, Gögenur I, Vilmann P. Dynamic contrast-enhanced EUS for quantification of tumor perfusion in colonic cancer: a prospective cohort study. Gastrointest Endosc 2018; 87:1530-1538. [PMID: 29329991 DOI: 10.1016/j.gie.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/02/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Dynamic contrast-enhanced EUS (CE-EUS) for quantification of perfusion in colonic tumors has not previously been reported in the literature. The aim of this study was to investigate correlations between perfusion parameters and vessel density assessed by immunohistochemical staining with antibodies toward CD31 and CD105. METHODS We conducted a prospective clinical study of 28 patients with left-sided colonic adenocarcinoma who underwent CE-EUS and left-sided hemicolectomy within 2 weeks. CE-EUS recordings were analyzed in 2 regions of interest: the entire tumor and the most enhanced area. Immunohistochemical staining with CD31 and CD105 was performed on tumor tissue sections. The slides were manually scanned for highly vascularized areas, and counting of vessels was performed in hotspots within the tumor and invasive front. New vasculature was assessed by CD105. Associations between CE-EUS and CD31 and CD105 were investigated using Spearman correlation. RESULTS We found significant P values for the correlation between CD31 and rise time (rho = .603 [95% confidence interval (95% CI), .238-.816]; P = .001) in tumor tissue and for the correlation between CD31 and rise time (rho = .50 [95% CI, .201-.695]; P = .008) and fall time (rho = .52 [95% CI, .204-.723]; P = .006) corresponding to the invasive front. We found no correlations between perfusion values evaluated by CE-EUS and CD105. CONCLUSIONS Our results show a significant correlation for vessel density evaluated by CD31 and perfusion parameters evaluated by CE-EUS. This may be the first step toward using real-time CE-EUS for monitoring antiangiogenic therapies in colonic cancer. (Clinical trial registration number: NCT02324023.).
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Affiliation(s)
- Marie Louise Malmstrøm
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark; Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark
| | - Adrian Săftoiu
- University of Medicine and Pharmacy, Research Centre of Gastroenterology and Hepatology, Craiova, Romania
| | - Lene Buhl Riis
- Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Hazem Hassan
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | | | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark
| | - Peter Vilmann
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Cartana ET, Gheonea DI, Cherciu IF, Streaţa I, Uscatu CD, Nicoli ER, Ioana M, Pirici D, Georgescu CV, Alexandru DO, Şurlin V, Gruionu G, Săftoiu A. Assessing tumor angiogenesis in colorectal cancer by quantitative contrast-enhanced endoscopic ultrasound and molecular and immunohistochemical analysis. Endosc Ultrasound 2018; 7:175-183. [PMID: 28685747 PMCID: PMC6032701 DOI: 10.4103/eus.eus_7_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives Data on contrast-enhanced endoscopic ultrasound (CE-EUS) for colorectal cancer (CRC) evaluation are scarce. Therefore, we aimed to assess the vascular perfusion pattern in CRC by quantitative CE-EUS and compare it to immunohistochemical and genetic markers of angiogenesis. Patients and Methods We performed a retrospective analysis of CE-EUS examinations of 42 CRC patients, before any therapy. CE-EUS movies were processed using a dedicated software. Ten parameters were automatically generated from the time-intensity curve (TIC) analysis: peak enhancement (PE), rise time (RT), mean transit time, time to peak (TTP), wash-in area under the curve (WiAUC), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-out AUC (WoAUC), and wash-in and wash-out AUC (WiWoAUC). The expression levels of the vascular endothelial growth factor receptor 1 (VEGFR1) and VEGFR2 genes were assessed from biopsy samples harvested during colonoscopy. Microvascular density and vascular area were calculated after CD31 and CD105 immunostaining. Results Forty-two CE-EUS video sequences were analyzed. We found positive correlations between the parameters PE, WiAUC, WiR, WiPI, WoAUC, WiWoAUC, and N staging (Spearman r = 0.437, r = 0.336, r = 0.462, r = 0.437, r = 0.358, and r = 0.378, respectively, P < 0.05), and also between RT and TTP and CD31 vascular area (r = 0.415, and r = 0.421, respectively, P < 0.05). VEGFR1 and VEGFR2 expression did not correlate with any of the TIC parameters. Conclusions CE-EUS with TIC analysis enables minimally invasive assessment of CRC angiogenesis and may provide information regarding the lymph nodes invasion. However, further studies are needed for defining its role in the evaluation of CRC patients.
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Affiliation(s)
| | - Dan Ionuţ Gheonea
- Research Center of Gastroenterology and Hepatology, Craiova, Romania
| | | | | | | | | | | | - Daniel Pirici
- Department of Research Methodology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Dragoş-Ovidiu Alexandru
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Valeriu Şurlin
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gabriel Gruionu
- Research Center of Gastroenterology and Hepatology, Craiova, Romania; Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Clinical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology, Craiova, Romania; Department of Endoscopy, Copenhagen University Hospital Herlev, Denmark
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Bărbălan A, Nicolaescu AC, Măgăran AV, Mercuţ R, Bălăşoiu M, Băncescu G, Şerbănescu MS, Lazăr OF, Săftoiu A. Immunohistochemistry predictive markers for primary colorectal cancer tumors: where are we and where are we going? Rom J Morphol Embryol 2018; 59:29-42. [PMID: 29940609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of our study is to highlight and organize the recently published immunohistochemistry (IHC) predictive biomarkers of primary colorectal cancers (CRCs) that could lead to practical implementation. We reviewed articles that examined CRC samples with significant statistic correlation between the IHC marker expression and disease progression over time, relationships with the available clinical features and those who detect the prognosis of drug effects. Our analysis showed that nine markers could correlate with medical treatment response of CRCs in different stages. When using better overall survival (OS) and better disease-free survival (DFS) as a grouping factor, there were 14 markers that could be used in assessing CRC prognosis. By using poor prognostic for the OS and the DFS as a grouping factor, we found 43 markers. Subgroup analysis was also performed based on the 32 markers recently confirmed to predict metastasis evolution or the recurrence risks. Venous invasion could be predictable for tumors, statistically significant metastasis susceptibility was observed for markers and also the capacity to evaluate recurrence. CRCs integrate a variety of localizations and there are proofs that distinguish the sites of tumors. The studies reporting data specifically for rectal cancer separating it from colon cancer contained seven IHC markers. In order to be able to implement a predictive biomarker in clinical practice, it must comply with certain criteria as clinical value and analytical proof. Unique biological signature of CRC can be distinguished by identifying biomarkers expression. Several markers have shown potential, but the majority still need to render clinical utility.
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Affiliation(s)
- Alexandru Bărbălan
- Department of Plastic Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania; ; Department of Surgery, "Victor Babes" University of Medicine and Pharmacy, "Pius Brinzeu" Emergency County Hospital, Timisoara, Romania;
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Malmstrøm ML, Brisling S, Klausen TW, Săftoiu A, Perner T, Vilmann P, Gögenur I. Staging with computed tomography of patients with colon cancer. Int J Colorectal Dis 2018; 33:9-17. [PMID: 29116438 DOI: 10.1007/s00384-017-2932-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Accurate staging of colonic cancer is important for patient stratification. We aimed to correlate the diagnostic accuracy of preoperative computed tomography (CT) with final histopathology as reference standard. METHODS Data was collected retrospectively on 615 consecutive patients operated for colonic cancer. Evaluation was based upon T-stage. Patients were stratified into high-risk and low-risk groups, based on the extent of tumor invasion beyond the proper muscle layer of more or less than 5 mm. The Kendall tau correlation coefficient was used to calculate concordance between radiological (r)T-stage obtained at CT imaging and pathological (p)T-stage from the final pathology. RESULTS In total, 501 patients were included. We found no significant differences in the Kendall tau values for diagnostic measures between the groups at the 95% confidence interval (CI) level: 49% (95% CI, 43-55) for all individuals, 48% (95% CI, 40-56) for screened individuals, and 47% (95% CI, 37-56) for non-screened individuals. The overall sensitivity and specificity for all individuals in identifying high-risk tumors on CT was 65% (95% CI, 56-73) and 89% (95% CI, 85-92). The risk of ending up in the high-risk group due to overstaging among all individuals was calculated as the number needed to harm 11.7 (95% CI, 9-16). CONCLUSIONS There is basis for improvement of CT-based preoperative staging of patients with colorectal cancer. Supplementary modalities may be needed for correct staging of patients preoperatively, especially in relation to stratification of patients into neoadjuvant treatments or tailored therapy in patients with early cancers.
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Affiliation(s)
- M L Malmstrøm
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark.
| | - S Brisling
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - T W Klausen
- Department of Hematology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - A Săftoiu
- Research Centre of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - T Perner
- Department of Radiology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - P Vilmann
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark
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Karstensen JG, Cârţână T, Constantinescu C, Dumitrașcu S, Kovacevic B, Klausen P, Hassan H, Klausen TW, Bertani H, Bhutani MS, Săftoiu A, Vilmann P. Endoscopic ultrasound guided needle-based confocal laser endomicroscopy in solid pancreatic masses - a prospective validation study. Endosc Int Open 2018; 6:E78-E85. [PMID: 29344564 PMCID: PMC5770262 DOI: 10.1055/s-0043-121987] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is a keystone in diagnosing and staging of pancreatic masses. Recently, a microfiber that can pass through a 19-gauge needle has been introduced for confocal laser endomicroscopy (nCLE). The aims of this study were to evaluate the diagnostic value and the reproducibility of nCLE criteria for solid malignant lesions. PATIENTS AND METHODS This prospective dual-center study included patients with pancreatic masses suspicious of malignancy referred for EUS-FNA. Endomicroscopic imaging was performed under EUS-guidance until organ-specific structures were obtained. Afterwards, standard cytology was obtained and patients were followed for up to 12 months. All nCLE parameters included in former studies were correlated with the final diagnosis (dark lobular structures/normal acinar cells, dark cell aggregates > 40 µm, dilated irregular vessels with fluorescein leakage, fine white fibrous bands, small black cell movements, pseudoglandular structures). Finally, three CLE novices and three CLE experts assessed the unedited movies from all patients. RESULTS Twenty-eight patients were enrolled in the study. A final diagnosis was obtained in 24 patients (86 %). One patient (3 %) died before a diagnosis was obtained, while 3 were lost to follow-up (11 %). In 18/24 patients (74 %) the diagnosis was malignant. The mean sensitivity, specificity, and accuracy for the nCLE parameters ranged from 19 - 93 %, 0 - 56 %, 26 - 69 %, respectively. The inter-observer values ranged from κ = 0.20 - 0.41 for novices and κ = -0.02 - 0.38 for experts. CONCLUSIONS The diagnostic value of nCLE in solid pancreatic masses is questionable and the inter-observer agreement for both novices and CLE experts appears limited.
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Affiliation(s)
- John Gásdal Karstensen
- Department of Gastrointestinal Surgery, Slagelse Hospital, Slagelse, Denmark,Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark,Corresponding author John Gásdal Karstensen, MD, PhD Gastro Unit, Division of EndoscopyCopenhagen University Hospital HerlevHerlev Ringvej 752730 HerlevDenmark+45 38684009
| | - Tatiana Cârţână
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Codruţa Constantinescu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Silviu Dumitrașcu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Bojan Kovacevic
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Pia Klausen
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Hazem Hassan
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | | | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Modena, Italy
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, Texas, USA
| | - Adrian Săftoiu
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark,Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Peter Vilmann
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
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Ungureanu BS, Pătrașcu Ș, Drăgoescu A, Nicolau C, Copăescu C, Șurlin V, Săftoiu A. Comparative Study of NOTES Versus Endoscopic Ultrasound Gastrojejunostomy in Pigs: A Prospective Study. Surg Innov 2017; 25:16-21. [DOI: 10.1177/1553350617748278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Ștefan Pătrașcu
- University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Alice Drăgoescu
- University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Carmen Nicolau
- “Lotus Life” Gastroenterology Private Hospital, Targu Mures, Romania
| | | | - Valeriu Șurlin
- University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology of Craiova, Craiova, Romania
- Copenhagen University Herlev Hospital, Herlev, Denmark
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Sporea I, Badea R, Brisc C, Ioanițescu S, Moga T, Popescu A, Săftoiu A, Săndulescu L, Spârchez Z, Șirli R. Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice. Med Ultrason 2017; 19:401-415. [PMID: 29197917 DOI: 10.11152/mu-1349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) allows a real-time assessment of the vascular pattern of different types of lesions, as it has no renal or liver toxicity, it lacks radiation exposure and it is also cheaper than other imaging methods, having a diagnostic capability that matches contrast-enhanced CT or MRI. In Romania CEUS is used more and more, especially by clinicians, and since some centres have extensive experience in this domain, we felt the need to disseminate our expertise in order to implement this method in as many centres as possible. These Guidelines present the clinical applications of CEUS in the liver, spleen, pancreas, kidney, testis, bowel, intra-cavitary and endoscopic ultrasound, as well as other applications.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.
| | - Radu Badea
- Department of Ultrasound, 3rd Medical Clinic, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj Napoca, Romania
| | - Ciprian Brisc
- Department of Gastroenterology, University of Oradea, Romania
| | - Simona Ioanițescu
- Department of Internal Medicine, Fundeni Clinical Institute & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | - Tudor Moga
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Larisa Săndulescu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Zeno Spârchez
- 3rd Medical Deparment, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj Napoca, Romania
| | - Roxana Șirli
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
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Pădureanu V, Enescu AŞ, Siloşi I, Forţofoiu M, Enescu A, Bogdan M, Forţofoiu MC, Dumitrescu AG, Tudoraşcu DR, Mita A, Streata I, Ioana M, Petrescu F, Săftoiu A. The association between chronic pancreatitis and the iNOS-2087A>G polymorphism. ACTA ACUST UNITED AC 2017; 55:89-95. [PMID: 28125406 DOI: 10.1515/rjim-2017-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Chronic pancreatitis is morphologically characterized by ductal dysplasia, breeding grounds for the proliferation of the ductal cells, the degenerative changes in pancreatic acinar cells and fibrosis, and it is defined on the basis of the clinical, morphological and functional criteria. AIM The aim of our study is to examine the existence of a possible correlation between the iNOS-2087A>G polymorphism and chronic pancreatitis by means of the genetic analysis. MATERIAL AND METHOD We have conducted the study at the Gastroenterology Clinic and the Research Center of Gastroenterology and Hepatology of the University of Medicine and Pharmacy, Craiova, between March 2015 - September 2016. The study had a prospective character. Both for the 58 patients diagnosed with chronic pancreatitis and for the 132 patients in the witness group, the biological material was represented by blood, (around 2.5 - 5 milliliters of venous blood) let on EDTA and kept at 4°C up to the separation of the DNA molecule. All the patients were genotyped for the iNOS - 2087A>G polymorphism, by means of the Real Time PCR technique with TaqMan probes. RESULTS Analysing the prevalence of the iNOS genotypes within the study group and witness group, we have noticed that, statistically speaking, there are no significant differences between the two groups. CONCLUSION As a conclusion, in the study lot we can sustain that the risk of developing chronic pancreatitis is not increased by the presence of the iNOS-2087A>G polymorphism.
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Affiliation(s)
- Adrian Săftoiu
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Herlev, Denmark; Gastroenterology Department, Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Herlev, Denmark
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Seicean A, Badea R, Moldovan-Pop A, Vultur S, Botan EC, Zaharie T, Săftoiu A, Mocan T, Iancu C, Graur F, Sparchez Z, Seicean R. Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses. Ultraschall Med 2017; 38:174-182. [PMID: 26274382 DOI: 10.1055/s-0035-1553496] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Purpose The global accuracy of fine-needle aspiration guided by endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85 %. The use of contrast agents during EUS to highlight vessels and the necrotic parts of pancreatic masses may improve biopsy guidance. Our aim was to assess whether the guidance of FNA by harmonic contrast-enhanced endoscopic ultrasound (CH-EUS) would increase diagnostic accuracy relative to conventional EUS-FNA in the same pancreatic masses. Patients and Methods In a prospective study, EUS-FNA was performed in patients with pancreatic masses on CT scan, followed by harmonic CH-EUS using SonoVue. A second cluster of CH-EUS-FNA was performed on contrast-enhanced images. The final diagnosis was based on the results of EUS-FNA and surgery, or the findings after 12 months' follow-up. Results The final diagnosis was adenocarcinoma (n = 35), chronic pancreatitis (n = 10), or other (n = 6). The diagnostic accuracy based on core histology was 78.4 % for EUS-FNA and 86.5 % for CH-EUS-FNA (p = 0.35). The accuracy increased to 94 % when the two methods' results were combined. The two false-negative EUS-FNA cases were correctly appreciated by CH-EUS. Neither core histology size nor the presence of necrosis was significant for the true-positive diagnosis of malignancy. Conclusion CH-EUS-FNA had an insignificant incremental effect on diagnostic accuracy compared with conventional EUS-FNA in our small group. The presence of necrosis did not influence the results of CEUS-FNA. Qualitative assessment of the contrast uptake within the lesion was useful in false-negative EUS-FNA cases.
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Affiliation(s)
- Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Radu Badea
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Anca Moldovan-Pop
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Simona Vultur
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Emil Claudiu Botan
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Teodor Zaharie
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Adrian Săftoiu
- Research Centre of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Teodora Mocan
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Cornel Iancu
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Florin Graur
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Zeno Sparchez
- Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Radu Seicean
- First Surgical Clinic, University of Medicine and Pharmacy Cluj-Napoca, Romania
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver, ranking as the second most common cause of death from cancer worldwide. Magnetic nanoparticles (MNPs) have been used so far in tumor diagnosis and treatment, demonstrating great potential and promising results. In principle, three different approaches can be used in the treatment of tumors with superparamagnetic iron oxide nanoparticles: magnetically induced hyperthermia, drug targeting and selective suppression of tumor growth. This review focuses on the use of iron oxide nanoparticles for the diagnosis and treatment of liver cancer and offers a walkthrough from the MNPs imaging applicability to further therapeutic options, including their potential flaws. The MNP unique physical and biochemical properties will be mentioned in close relationship to their subsequent effects on the human body, and, also, their toxic potential will be noted. A presentation of what barriers the MNPs should overcome to be more successful will conclude this review.
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Affiliation(s)
| | | | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology of Craiova, Craiova, Romania; Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Herlev Hospital, Copenhagen, Denmark
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Pădureanu V, Boldeanu MV, Streaţă I, Cucu MG, Siloşi I, Boldeanu L, Bogdan M, Enescu AŞ, Forţofoiu M, Enescu A, Dumitrescu EM, Alexandru D, Şurlin VM, Forţofoiu MC, Petrescu IO, Petrescu F, Ioana M, Ciurea ME, Săftoiu A. Determination of VEGFR-2 (KDR) 604A>G Polymorphism in Pancreatic Disorders. Int J Mol Sci 2017; 18:ijms18020439. [PMID: 28218664 PMCID: PMC5343973 DOI: 10.3390/ijms18020439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/03/2017] [Indexed: 12/15/2022] Open
Abstract
Pancreatic disorders have a high prevalence worldwide. Despite the fact that screening methods became more effective and the knowledge we have nowadays about pancreatic diseases has enhanced, their incidence remains high. Our purpose was to determine whether single nucleotide polymorphism (SNP) of VEGFR-2/KDR (vascular endothelial growth factor receptor 2/kinase insert domain receptor) influences susceptibility to develop pancreatic pathology. Genomic DNA was extracted from blood samples collected from patients diagnosed with acute pancreatitis (n = 110), chronic pancreatitis (n = 25), pancreatic cancer (n = 82) and healthy controls (n = 232). VEGFR-2 (KDR) 604A>G (rs2071559) polymorphism frequency was determined with TaqMan allelic discrimination assays. Statistical assessment was performed by associating genetic polymorphism with clinical and pathological data. In both pancreatic disorders and healthy control groups the polymorphism we studied was in Hardy-Weinberg equilibrium. Association between increased risk for pancreatic disorders and studied polymorphism was statistically significant. KDR 604AG and AG + GG genotypes were more prevalent in acute pancreatitis and pancreatic cancer patients than in controls. These genotypes influence disease development in a low rate. No association was found between chronic pancreatitis and KDR 604AG and AG + GG genotypes. In Romanian cohort, we found an association between the KDR 604A→G polymorphism and acute pancreatitis and pancreatic cancer. Carriers of the -604G variant allele were more frequent among acute pancreatitis and pancreatic cancer than among controls, suggesting that KDR 604G allele may confer an increased risk for these diseases. In the future, more extensive studies on larger groups are necessary, in order to clarify the role of VEGFR2 polymorphisms in pancreatic pathology.
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Affiliation(s)
- Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Mihail Virgil Boldeanu
- Department of Immunology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
- Medico Science SRL-Stem Cell Bank Unit, 1B Brazda lui Novac Street, 200690 Craiova, Romania.
| | - Ioana Streaţă
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Mihai Gabriel Cucu
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Isabela Siloşi
- Department of Immunology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Lidia Boldeanu
- Medico Science SRL-Stem Cell Bank Unit, 1B Brazda lui Novac Street, 200690 Craiova, Romania.
| | - Maria Bogdan
- Maria Bogdan, Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Anca Ştefania Enescu
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Maria Forţofoiu
- Department of Medico-Surgical Emergencies, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Aurelia Enescu
- Department of Medico-Surgical Emergencies, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Elena Mădălina Dumitrescu
- Faculty of Nursing and Midwifery, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Dragoş Alexandru
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Valeriu Marian Şurlin
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Mircea Cătălin Forţofoiu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Ileana Octavia Petrescu
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Florin Petrescu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Mihai Ioana
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Marius Eugen Ciurea
- Department of Plastic Surgery, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania.
- Visiting Clinical Professor, Gastrointestinal Unit, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark.
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Affiliation(s)
- Sevastiţa Iordache
- Department of Gastroenterology, Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Dana-Maria Albulescu
- Department of Imaging, Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
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Affiliation(s)
- Mădălin Ionuţ Costache
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.,Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Craiova, Romania
| | - Daniela Dumitrescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Craiova, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.,Department of Endoscopy, Gastro-Unit, Copenhagen University Hospital Herlev, Denmark
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Popa SG, Ungureanu BS, Gheonea IA, Mitrea A, Ardeleanu CM, Ghiluşi MC, Şurlin V, Georgescu EF, Georgescu I, MoŢa M, Marioara OM, Săftoiu A. Pitfalls in diagnosing a pancreatic neuroendocrine tumor: a case report. Rom J Morphol Embryol 2016; 56:1495-502. [PMID: 26743299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pancreatic neuroendocrine tumors are a rare subset of pancreatic neoplasms. We report the case of a 33-year-old female patient who was admitted to the Diabetes Clinic of Craiova, Romania, due to a two-year history of episodic neuroglycopenic hyperinsulinemic hypoglycemic symptoms, suggestive for insulinoma associated with facial and upper trunk flushing characteristic to carcinoid syndrome. During these episodes, the laboratory investigations showed hypoglycemia (38 mg/dL), hyperinsulinemia (54.72 μU/mL) and normal values of beta-hydroxybutyrate, chromogranin A, serotonin, anti-insulin antibodies and urinary levels of 5-hydroxyindoleacetic acid. Endoscopic ultrasound with SonoVue and 3T MRI revealed an 18.3/16.3 mm hypervascular tissular mass situated in the uncinate process of the pancreatic head in close contact with the superior mesenteric vein without invasion and no other detectable secondary lesions in the pancreas or any other abdominal viscera. Patient underwent enucleation of pancreatic tumor. The histological and immunohistochemical findings indicated a functional well-differentiated pancreatic neuroendocrine tumor, G1 category according to the World Health Organization (WHO) criteria, with uncertain behavior (Ki67 index was 3%), confined to the pancreas, but with tumoral invasion of the delimiting conjunctive capsule. No evidence of tumoral CK19 staining, mitoses and necrosis, angioinvasion or extra-pancreatic invasion was observed. A post-operative nine-month follow-up showed resolution of hypoglycemic symptoms, normalized blood glucose and insulin levels and no evidence of recurrence. Our case report highlights the pitfalls in diagnosing a functional pancreatic neuroendocrine tumor due to atypical symptoms, the difficulty of identification and precise location of the small-size tumor and uncertain histopathological and immunohistochemical behavior.
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Affiliation(s)
- Simona Georgiana Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, Romania;
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Ewertsen C, Săftoiu A, Calliada F, Gilja OH. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2:E2-7. [PMID: 27689163 DOI: 10.1055/s-0035-1569413] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Department "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Săftoiu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | | | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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Štefănescu D, Pereira SP, Filip MM, Săftoiu A, Cazacu S. Advanced Endoscopic Imaging Techniques for the Study of Colonic Mucosa in Patients with Inflammatory Bowel Disease. ACTA ACUST UNITED AC 2016; 54:11-23. [PMID: 27141566 DOI: 10.1515/rjim-2015-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBD) associated with colorectal cancer risk in long-standing diseases. In order to assess the colonic mucosa and to discover dysplastic or neoplastic lesions, advanced endoscopic techniques are needed. Such techniques are detailed in this review: chromoendoscopy, autofluorescence imaging (AFI), narrow band imaging (NBI), i-SCAN, Fujinon Intelligent Color Enhancement (FICE) and confocal laser endomicroscopy (CLE). AIM The aim of the review is to describe and establish the clinical impact of advanced endoscopic techniques, that could be used in IBD patients'examination in order to assess mucosal healing, microscopic inflammation, dysplasia or neoplasia. MATERIALS AND METHODS A literature research about new endoscopic approaches of patients with IBD was made. RESULTS A lot of studies have been performed to reveal which imaging technique might be used for IBD surveillance. Regarding dysplasia or neoplasia detection and mucosal healing or inflammation assessment, CE proved to be superior to white light endoscopy (WLE), while NBI and AFI did not show an encouraging result. I-SCAN did not improve the colonoscopy quality while FICE has been used in a few studies. CLE could be used to characterize a lesion, providing the same results as conventional histology. CONCLUSION At the moment, CE is the only technique which has been included in guidelines for IBD surveillance. CLE can be used to assess any lesion detected with WLE during surveillance, while the other imaging techniques require.more studies to determine their efficacy or inefficacy.
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Karstensen JG, Săftoiu A, Brynskov J, Hendel J, Klausen P, Cârtână T, Klausen TW, Riis LB, Vilmann P. Confocal laser endomicroscopy: a novel method for prediction of relapse in Crohn's disease. Endoscopy 2016; 48:364-72. [PMID: 26583952 DOI: 10.1055/s-0034-1393314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Confocal laser endomicroscopy (CLE) has been shown to predict relapse in ulcerative colitis in remission, but little is currently known about its role in Crohn's disease. The aim of this study was to identify reproducible CLE features in patients with Crohn's disease and to examine whether these are risk factors for relapse. PATIENTS AND METHODS This was a single-center prospective feasibility study of CLE imaging in patients with Crohn's disease. CLE imaging was performed in the terminal ileum and four colorectal sites, and was correlated with histopathology and macroscopic appearance. Clinical relapse, defined as the need for treatment escalation or surgical intervention, was recorded during follow-up. RESULTS The study included 50 patients: 39 with Crohn's disease (20 in remission), and 11 controls. Ileal fluorescein leakage and microerosions were significantly more frequent in patients with endoscopically active Crohn's disease compared with patients with inactive Crohn's disease and controls (P = 0.005 and (P = 0.006, respectively). The same applied to colorectal fluorescein leakage and vascular alterations ((P = 0.043 and (P = 0.034, respectively). During a 12-month follow-up period, ileal fluorescein leakage and microerosions were significant risk factors for relapse in the subgroup of patients in remission (log rank (P = 0.009 and (P = 0.007, respectively) as well as in the entire group of patients with Crohn's disease (log rank (P = 0.006 and (P = 0.01, respectively). Inter- and intraobserver reproducibility was almost perfect (κ > 0.80) or substantial (κ > 0.60) for the majority of CLE parameters. CONCLUSIONS CLE can identify reproducible microscopic changes in the terminal ileum that are risk factors for relapse in patients with otherwise inactive Crohn's disease. TRIAL REGISTRATION ClinicalTrials.gov (NCT01738529).
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Affiliation(s)
- John Gásdal Karstensen
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Adrian Săftoiu
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jørn Brynskov
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jakob Hendel
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Pia Klausen
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Tatiana Cârtână
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Lene Buhl Riis
- Department of Pathology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Peter Vilmann
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
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Iordache S, Costache MI, Popescu CF, Streba CT, Cazacu S, Săftoiu A. Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA. Med Ultrason 2016; 18:18-24. [PMID: 26962549 DOI: 10.11152/mu.2013.2066.181.ich] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS. MATERIAL AND METHODS We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established. RESULTS For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer. CONCLUSIONS The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses.
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Affiliation(s)
- Sevastiţa Iordache
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Mădălin Ionuţ Costache
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Carmen Florina Popescu
- Cytology Laboratory, Pathology Department, Clinical Emergency County Hospital Craiova, Romania
| | - Costin-Teodor Streba
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Sergiu Cazacu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Adrian Săftoiu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania; Endoscopy Department, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark.
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