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Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis

World Journal of Gastroenterology 2015年第12期21卷 3579-3586页

作者： Chiang J Tyng Maria Fernanda A Almeida Paula NV Barbosa almir gv bitencourt José Augusto AG Berg Macello S Maciel Felipe JF Coimbra Luiz Henrique O Schiavon Maria Dirlei Begnami Marcos D Guimares Charles E Zurstrassen Rubens Chojniak Department of Imaging AC Camargo Cancer Center S?o Paulo Department of Abdominal Surgery AC Camargo Cancer Center S?o Paulo

AIM: To evaluate the techniques, results, and complications related to computed tomography(CT)-guided percutaneous core needle biopsies of solid pancreatic ***: CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle(10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect(transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form. RESULTS: A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year(range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm(range: 15-195 mm). Most(75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2%(23/103) of cases and indirect transhepatic or transgastric access was used in 4.8%(5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1%(101/103) of cases, confirming3.9%(4/103) of tumors were benign and 94.2%(97/103) were malignant; results were atypical in 1.9%(2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients(8.7%),and they were more commonly associated with biopsies of lesions located in the head/uncinate process(n =8), than of those located in the body/tail(n = 1) of the pancreas, but this difference was not ***: CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally invasive diagnosis.

关键词： Computed tomography Image-guided biopsy Large-core

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Nonalcoholic fatty liver disease in asymptomatic Brazilian adolescents

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World Journal of Gastroenterology 2009年第4期15卷 473-477页

作者： Raquel Rocha Helma Pinchemel Cotrim almir Galvo Vieira bitencourt Daniel Batista Valente Barbosa Adméia Souza Santos Alessandro de Moura Almeida Bruno Cunha Isabel Guimares Postgraduate Course in Medicine and Health Federal University of BahiaSchool of Medicine Federal University of Bahia School of Medicine NASH Project University Hospital Professor Edgard SantosFederal University of Bahia

AIM： To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease （NAFLD） among asymptomatic Brazilian adolescents. METHODS： Transversal observational study included asymptomatic adolescents with central obesity from private and public schools in Salvador-Bahia, northeastern Brazil. The children answered a questionnaire that in- cluded age, gender, race, and medical history, and were submitted to a complete physical exam and abdominal ultrasound. Biochemical exams included： ALT, AST, GGT, C reactive protein （CRP）, fasting glucose, insulin, cholesterol and triglycerides. Criteria for NAFLD included： the presence of steatosis in ultrasound and/or high level of ALT, negative or occasional historic of intake of alcohol （4 140 g/wk）, negative investigation for hepatitis A, B, C, auto-immune hepatitis, Wilson disease and ***： From October, 2005 to October, 2006, the study included 1801 subjects between 11 and 18 years of age and a mean age of 13.7± 2.0 years. One hun- dred ninety-nine had central obesity. The prevalence of NAFLD was 2.3%, most of whom were male and white. Insulin resistance （IR） was observed in 22.9% of them and had positive correlations with ALT and GGT （P 〈 0.05）. Elevated CRP was observed in 6.9% of the cases; however, it was not associated with WC, IR or liver enzymes. CONCLUSION： The prevalence of NAFLD in Brazilian adolescents was low. The ethnicity may have influence this frequency in the population studied, which had a large proportion of African descendents.

关键词： Nonalcoholic fatty liver disease Insulinresistance Central obesity Ethnicity Adolescents

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Fatty liver disease in severe obese patients:Diagnostic value of abdominal ultrasound

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World Journal of Gastroenterology 2008年第9期14卷 1415-1418页

作者： Alessandro de Moura Almeida Helma Pinchemel Cotrim Daniel Batista Valente Barbosa Luciana Gordilho Matteoni de Athayde Adimeia Souza Santos almir Galvo Vieira bitencourt Luiz Antonio Rodrigues de Freitas Adriano Rios Erivaldo Alves Faculdade de Medicina da Bahia Universidade Federal da Bahia SalvadorBahia 41830-020Brasil Faculdade de Medicina da Bahia Universidade Federal da BahiaSalvadorBahia 41830-020Brasil Faculdade de Medicina da Bahia Universidade Federal da Bahia SalvadorBahia 41830-020Brasil Faculdade de Medicina da Bahia Universidade Federal da BahiaSalvadorBahia 41830-020 Brasil Núcleo de Cirurgia da Obesidade SalvadorBahia 41830-020Brasil

AIM:To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis. METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard. RESULTS: The study included 105 patients. The mean age was 37.2 ± 10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis onUS was associated to advanced grades of steatosis on histology (P = 0.016). CONCLUSION: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.

关键词： Bariatric surgery Obesity Hepatic steatosis Abdominal ultrasound diagnosis Fatty liver

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