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Imaging of common bile duct by linear endoscopic ultrasound

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World Journal of Gastrointestinal Endoscopy 2015年第15期7卷 1170-1180页

作者： Malay Sharma Amit Pathak Abid Shoukat Chittapuram Srinivasan Rameshbabu Akash Ajmera Zeeshn Ahamad Wani Praveer rai Department of Gastroenterology Jaswant Rai Speciality Hospital Department of Anatomy Muzaffarnagar Medical College Department of Medicine Marshall University jaswant rai speciality hospital Sanjay Gandhi Post Graduate Institute

Imaging of common bile duct(CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound(EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations:(1) the fundus of stomach;(2) body of stomach;(3) duodenal bulb;(4) descending duodenum; and(5) antrum. Following down the upper 1/3rd of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3rd of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS.

关键词： Endoscopic ultrasound Common bile duct Pancreas Pa

Linear endoscopic ultrasound evaluation of hepatic veins

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World Journal of Gastrointestinal Endoscopy 2018年第10期10卷 283-293页

作者： Malay Sharma Piyush Somani Chittapuram Srinivasan Rameshbabu Department of Gastroenterology Jaswant Rai Speciality Hospital Department of Gastroenterology Thumbay Hospital Department of Anatomy Muzaffarnagar Medical College

Liver resection surgery can be associated with significant perioperative mortality and morbidity. Extensive knowledge of the vascular anatomy is essential for successful, uncomplicated liver surgeries. Various imaging techniques like multidetector computed tomographic and magnetic resonance angiography are used to provide information about hepatic vasculature. Linear endoscopic ultrasound(EUS) can offer a detailed evaluation of hepatic veins, help in assessment of liver segments and can offer a possible route for EUS guided vascular endotherapy involving hepatic veins. A standard technique for visualization of hepatic veins by linear EUS has not been described. This review paper describes the normal EUS anatomy of hepatic veins and a standard technique for visualization of hepatic veins from four stations. With practice an imaging of all the hepatic veins is possible from four stations. The imaging from fundus of stomach is the easiest and most convenient method of imaging of hepatic veins. EUS of hepatic vein and the tributaries is an operator dependent technique and in expert hands may give a mapping comparable to computed tomographic and magnetic resonance imaging. EUS of hepatic veins can help in identification of individual sectors and segments of liver. EUS guided interventions involving hepatic veins may require approach from different stations.

关键词： Endoscopic ultrasound Hepatic vein Portal vein Liver segments Caudate lobe Inferior vena cava Liver Cantlie line Falciform ligament Gall bladder

Imaging of gall bladder by endoscopic ultrasound

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World Journal of Gastrointestinal Endoscopy 2018年第1期10卷 10-15页

作者： Malay Sharma Piyush Somani Tagore Sunkara Department of Gastro-enterology Jaswant Rai Speciality Hospital Department of Gastroenterology and Hepatology the Brooklyn Hospital Center Clinical Affliate of the Mount Sinai Hospital

Endoscopic ultrasonography(EUS) is considered a superior investigation when compared to conventional ultrasonography for imaging gall bladder(GB) lesions as it can provide high-resolution images of small lesions with higher ultrasound frequencies. Examination of GB is frequently the primary indication of EUS imaging. Imaging during EUS may not remain restricted to one station and multi-station imaging may provide useful information. This review describes the techniques of imaging of GB by linear EUS from three different stations. The basic difference of imaging between the three stations is that effective imaging from station 1 is done above the neck of GB, from station 2 at the level of the neck of GB and from station 3 below the level of the neck of GB.

关键词： Gallbladder Gallbladder cancer Gallstones Biliary sludge Antrum Duodenal bulb Endoscopic ultrasound

Stepwise evaluation of liver sectors and liver segments by endoscopic ultrasound

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World Journal of Gastrointestinal Endoscopy 2018年第11期10卷 326-339页

作者： Malay Sharma Piyush Somani Chittapuram Srinivasan Rameshbabu Tagore Sunkara Praveer rai Department of Gastroenterology Jaswant Rai Speciality HospitalMeerut 25001Uttar PradeshIndia Department of Gastroenterology Thumbay HospitalDubai 415555United Arab Emirates Department of Anatomy Muzaffarnagar Medical CollegeMuzaffarnagar 251001Uttar PradeshIndia Department of Gastroenterology and Hepatology the Brooklyn Hospital CenterClinical Affliate of The Mount Sinai HospitalBrooklynNY 11201United States

The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segment Ⅰ(the caudate lobe). Standard anatomical description of the liver segments is available by computed tomographic scan and ultrasonography. Endoscopic ultrasound(EUS) has been used for a detailed imaging of many intra-abdominal organs and for the assessment of intra-abdominal vasculature. A stepwise evaluation of the liver segments by EUS has not been described. In this article, we have described a stepwise evaluation of the liver segments by EUS. This information can be useful for planning successful radical surgeries, preparing for biopsy, portal vein embolization, transjugular intrahepatic portosystemic shunt, tumour resection or partial hepatectomy, and for planning EUS guided diagnostic and therapeutic procedures.

关键词： Endoscopic ultrasound Hepatic vein Liver sectors Portal vein Liver segments Caudate lobe Cantlie’s line Falciform ligament Gallbladder

Obstructive sleep apnea is associated with severity and long-term prognosis of acute coronary syndrome

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Journal of Geriatric Cardiology 2018年第2期15卷 146-152页

作者： Shuo JIA Yu-Jie ZHOU Yi YU Si-Jing WU Yan SUN Zhi-Jian WANG Xiao-Li LIU Bright Eric King Ying-Xin ZHAO Dong-Mei SHI Yu-Yang LIU Zhi-Ming ZHOU Bejing Anzhen hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Disease Beijing China

Background Obstructive sleep apnea （OSA） is a common disease in patients with acute coronary syndrome （ACS） and associated with an increased risk of fatal and nonfatal cardiovascular events. However, most patients in previous study were treated with bare metal stents and the sample sizes were relatively low. The goal of this study was to evaluate the influence of OSA on the severity and prognosis of patients admitted for ACS. Methods In this prospective cohort study, we enrolled patients with ACS who were hospitalized for coronary angiogram/percutaneous coronary intervention and undergone polysomnography. We divided the patients into two groups： moderate to severe OSA group [apnea-hypopnea index （AHI）〉 15 events/h] and control group （AHI ≤ 15 events/h）. They were followed up for up 32 months. Then, we compared the ACS severity and long-term major adverse cardiovascular events （MACE） in patients with different severity of OSA. Results Five hundred and twenty nine patients were included in the final analysis, with 76% of them being men and an average age of 59 ＋ 10 years. The overall mean AHI is 29 ± 19 events/h, 70.5% of them （373/529） being with moderate to severe OSA and 29.5% （156/529） assign into control group. Compared with controls, patients with moderate or severe OSA exhibited a higher prevalence of hypertension as well as higher body mass index, SYNTAX score, Epworth score and length of hospitalization. With a median follow-up duration of 30 months, accumulative rate of MACE was also higher in patients with moderate or severe OSA than that in the control group （8.6% vs. 3.2%, P = 0.028）. After adjusting for baseline confounders by cox regression model, moderate to severe OSA was an independent risk factor of long-term MACE （P = 0.047, HR = 1.618, 95% CI： 1.069-3.869）. Conclusions The results of this study demonstrate that moderate or severe OSA is correlated with disease severity and associated with worse long-term prognosis in ACS patients. The results rai

关键词： Coronary angiogram Coronary artery disease Obstructive sleep apnea Outcomes