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Current strategies for malignant pedunculated colorectal polyps

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World Journal of Gastrointestinal Oncology 2018年第12期10卷 465-475页

作者： adriana Ciocalteu Dan Ionut Gheonea adrian saftoiu Liliana Streba Nicoleta Alice Dragoescu Tiberiu Stefanita Tenea-Cojan Department of Gastroenterology Research Center of Gastro-enterology and HepatologyUniversity of Medicine and Pharmacy of Craiova Department of Oncology University of Medicine and Pharmacy of Craiova Department of Anesthesiology and Intensive Care Emergency County Hospital of CraiovaUni-versity of Medicine and Pharmacy of Craiova Department of General Surgery C.F. Clinical HospitalUniversity of Medicine and Pharmacy of Craiova

Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from nonpedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.

关键词： Pedunculated colorectal polyps Malignant colorectal polyp Early colorectal cancer Polypoid early colon cancer Advanced adenoma Depth of invasion Colorectal cancer Polypectomy Colorectal surgery Early colorectal carcinoma

Hybrid ultrasound imaging techniques(fusion imaging)

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World Journal of Gastroenterology 2011年第1期17卷 49-52页

作者： Daniela Larisa Sandulescu Daniela Dumitrescu Ion Rogoveanu adrian saftoiu Research Center of Gastroenterology and Hepatology University of Medicine and Pharmacy CraiovaCraiova 200638Romania

Visualization of tumor angiogenesis can facilitate noninvasive evaluation of tumor vascular characteristics to supplement the conventional diagnostic imaging goals of depicting tumor location,size,and *** imaging techniques combine anatomic [ultrasound,computed tomography(CT),and/or magnetic resonance imaging(MRI)] and molecular(single photon emission CT and positron emission tomography) imaging *** example is real-time virtual sonography,which combines ultrasound(grayscale,colour Doppler,or dynamic contrast harmonic imaging) with contrast-enhanced CT/*** benefits of fusion imaging include an increased diagnostic confidence,direct comparison of the lesions using different imaging modalities,more precise monitoring of interventional procedures,and reduced radiation exposure.

关键词： Hybrid imaging Real time virtual sonography Angiogenesis Focal liver lesions

Molecular confocal laser endomicroscopy:A novel technique for in vivo cellular characterization of gastrointestinal lesions

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World Journal of Gastroenterology 2014年第24期20卷 7794-7800页

作者： John Gasdal Karstensen Pia Helene Klausen adrian saftoiu Peter Vilmann Gastro Unit Division of EndoscopyCopenhagen University Hospital Herlev2730 HerlevDenmark Research Center of Gastroenterology and Hepatology Craiova University of Medicine and Pharmacy of Craiova200349 DoljRomania

While flexible endoscopy is essential for macroscopic evaluation,confocal laser endomicroscopy(CLE)has recently emerged as an endoscopic method enabling visualization at a cellular *** systems are currently available,one based on miniprobes that can be inserted via a conventional endoscope or via a needle guided by endoscopic *** second system has a confocal microscope integrated into the distal part of an *** adding molecular probes like fluorescein conjugated antibodies or fluorescent peptides to this procedure(either topically or systemically administered during on-going endoscopy),a novel world of molecular evaluation opens *** method of molecular CLE could potentially be used for estimating the expression of important receptors in carcinomas,subsequently resulting in immediate individualization of treatment regimens,but also for improving the diagnostic accuracy of endoscopic procedures by identifying otherwise invisible mucosal ***,studies have shown that fluorescein labelled drugs can be used to estimate the affinity of the drug to a target organ,which probably can be correlated to the efficacy of the ***,several of the studies in this research field have been conducted in animal facilities or in vitro,while only a limited number of trials have actually been carried out in ***,safety issues still needs further *** review will present an overview of the implications and pitfalls,as well as future challenges of molecular CLE in gastrointestinal diseases.

关键词： Confocal laser endomicroscopy Endoscopy imaging Colorectal carcinoma Barrett's esophagus Gastric carcinoma Inflammatory bowel disease

Contrast-enhanced ultrasonography parameters in neural network diagnosis of liver tumors

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World Journal of Gastroenterology 2012年第32期18卷 4427-4434页

作者： Costin Teodor Streba Mihaela Ionescu Dan Ionut Gheonea Larisa Sandulescu Tudorel Ciurea adrian saftoiu Cristin Constantin Vere Ion Rogoveanu Research Center of Gastroenterology and Hepatology University of Medicine and Pharmacy of Craiova200349 CraiovaRomania Department of Bioinformatics and Statistics University of Medicine and Pharmacy Craiova200349 CraiovaRomania

AIM:To study the role of time-intensity curve(TIC) analysis parameters in a complex system of neural networks designed to classify liver ***:We prospectively included 112 patients with hepatocellular carcinoma(HCC)(n = 41),hypervascular(n = 20) and hypovascular(n = 12) liver metastases,hepatic hemangiomas(n = 16) or focal fatty changes(n = 23) who underwent contrast-enhanced ultrasonography in the Research Center of Gastroenterology and Hepatology,Craiova,*** recorded full length movies of all contrast uptake phases and post-processed them offline by selecting two areas of interest(one for the tumor and one for the healthy surrounding parenchyma) and consecutive TIC *** difference in maximum intensities,the time to reaching them and the aspect of the late/portal phase,as quantified by the neural network and a ratio between median intensities of the central and peripheral areas were analyzed by a feed forward back propagation multi-layer neural network which was trained to classify data into five distinct classes,corresponding to each type of liver ***:The neural network had 94.45% training accuracy(95% CI:89.31%-97.21%) and 87.12% testing accuracy(95% CI:86.83%-93.17%).The automatic classification process registered 93.2% sensitivity,89.7% specificity,94.42% positive predictive value and 87.57% negative predictive *** artificial neural networks(ANN) incorrectly classified as hemangyomas three HCC cases and two hypervascular metastases,while in turn misclassifying four liver hemangyomas as HCC(one case) and hypervascular metastases(three cases).Comparatively,human interpretation of TICs showed 94.1% sensitivity,90.7% specificity,95.11% positive predictive value and 88.89% negative predictive *** accuracy and specificity of the ANN diagnosis system was similar to that of human interpretation of the TICs(P = 0.225 and P = 0.451,respectively).Hepatocellular carcinoma cases showed contrast uptake during the arterial phase

关键词： Hepatocellular carcinoma Liver tumors Contrast enhanced ultrasound Time-intensity curve Artificial neural network Computer-aided diagnosis system

Tumor neoangiogenesis detection by confocal laser endomicroscopy and anti-CD105 antibody:Pilot study

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World Journal of Gastrointestinal Oncology 2015年第11期7卷 361-368页

作者： adriana Ciocalteu adrian saftoiu Daniel Pirici Claudia-Valentina Georgescu Tatiana Cartana Dan Ionut Gheonea Lucian Gheorghe Gruionu Cosmin Gabriel Cristea Gabriel Gruionu Research Center of Gastroenterology and Hepatology University of Medicine and Pharmacy of Craiova Department of Research Methodology University of Medicine and Pharmacy of Craiova Department of Pathology Emergency County Hospital Department of Mechanical Engi-neering University of Craiova Edwin Steele Laboratory of Tumor Biology Department of Radiation OncologyMassachusetts General HospitalHarvard Medical School

AIM: To evaluate neoangiogenesis in patients with colon cancer by two fluorescently labeled antibodies on fresh biopsy samples imaged with confocal laser endomicroscopy(CLE).METHODS: CLE is an imaging technique for gastrointestinal endoscopy providing in vivo microscopy at subcellular *** important question in validating tumor angiogenesis is what proportion of the tumor vascular network is represented by preexisting parent tissue vessels and newly formed ***105(endoglin) represents a proliferation-associated endothelial cell adhesion *** contrast to panendothelial markers,such as CD31,CD105 is preferentially expressed in activated endothelial cells that participate in ***,we evaluated CD105 and CD31 expression from samples of ten patients with primary rectal adenocarcinoma,using a dedicated endomicroscopy system.A imaging software was used to obtain the Z projection of the confocal serial images from each biopsy sample previously combined into *** density and vessel diameters were measured within two 50 μm x 475 μm rectangular regions of interest centered in the middle of each image in the horizontal and vertical *** results were averaged over all the patients and were expressed as the mean ± ***: The use of an anti-CD105 antibody was found to be suitable for the detection of blood vessels in colon *** anti-CD31 antibodies stained blood vessels in both normal and pathologic colon equally,CD105 expression was observed primarily in malignant lesions,with little or no expression in the vessels of the normal mucosa(244.21 ± 130.7 vessels/mm3 in only four patients).The average diameter of antiCD105 stained vessels was 10.97 ± 0.6 μm in tumor tissue,and the vessel density was 2787.40 ± 134.8 vessels/*** using the anti-CD31 antibody,the average diameter of vessels in the normal colon tissue was 7.67 ± 0.5 μm and the vessel density was 3191.60 ± 387.8 vessels/mm3,while in the tumors w

关键词： Rectal cancer Neoangiogenesis Confocal laser endomicroscopy Panendothelial markers Anti-CD105 antibody

Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma

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World Journal of Gastroenterology 2016年第19期22卷 4741-4749页

作者： Yi Dong Wen-Ping Wang Vito Cantisani Mirko D'Onofrio Andre Ignee Lorenzo Mulazzani adrian saftoiu Zeno Sparchez Ioan Sporea Christoph F Dietrich Department of Ultrasound Zhongshan Hospital Fudan University Department of Radiological Sciences Oncology and Pathology Policlinico Umberto I University Sapienza Department of Radiology GB Rossi University Hospital University of Verona Medizinische Klinik 2 Caritas-Krankenhaus Bad Mergentheim Department of Medical and Surgical Sciences St. Orsola-Malpighi Hospital University of Bologna Department of Gastroenterology Research Center of Gastroenterology and Hepatology University of Medicine and Pharmacy Department of Endoscopy Gastrointestinal Unit Copenhagen University Hospital Department of Gastroenterology Institute for Gastroenterology and Hepatology University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca and Institute for Gastroenterology and Hepatology "O.Fodor" Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Victor Babes

AIM: To analyze contrast-enhanced ultrasound(CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma(HEHE) in comparison to other multilocular benign focal liver lesions(FLL).METHODS: Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in ***: HEHE manifested as a single(n = 3) or multinodular(n = 22) FLL. On CEUS, HEHE showed rim-like(18/25, 72%) or heterogeneous hyperenhancement(7/25, 28%) in the arterial phase and hypoenhancement(25/25, 100%) in the portal venous and late phases(PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas(18/25, 72%); in seven patients(7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature(P < 0.01).CONCLUSION: CEUS allows for characterization of unequivocal FLL. By analyzing the hypoenhancement in the PVLP, CEUS can determine the malignant nature of HEHE.

关键词： Guidelines Recommendations Liver tumor Biopsy Liver transplantation Contrast enhanced ultrasound

Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy

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World Journal of Gastrointestinal Endoscopy 2015年第10期7卷 981-986页

作者： Daniela Elena Burtea Anca Dimitriu Anca Elena Malo? adrian saftoiu Research Center of Gastroenterology and Hepatology Craiova University of Medicine and Pharmacy Craiova Endoscopy Department Clinical County Emergency Hospital Craiova Anesthesiology Department Clinical County Emergency Hospital Craiova Endoscopy Department Gastrointestinal Unit Copenhagen University Hospital Herlev

Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and metaanalyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.

关键词： Non-anesthesiologist administered pro-pofol sedation Advanced interventional endoscopy Endoscopic ultrasound Endoscopic retrograde cholangio-pancreatography