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Ghoneem E, Okasha H, Hammouda M, Gouda MF, Soliman R, Shiha G, Ragab K, Agwa RH. Technical and Clinical Outcomes of Using a Single Wide-Caliber Double-Pigtail Stent for Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage: A Multicenter Prospective Study. GE Port J Gastroenterol 2023; 30:414-421. [PMID: 38476158 PMCID: PMC10928872 DOI: 10.1159/000526852] [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] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/25/2022] [Indexed: 11/14/2023]
Abstract
Introduction Endoscopic ultrasound (EUS)-guided pancreatic cysto-gastrostomy/duodenostomy is the current accepted practice for management of symptomatic pancreatic pseudocysts with insertion of two or more double-pigtail (DP) stents. There is no much work on the efficacy of using a single wide-caliber DP stent, aiming to decrease the time, complications, and accessories used in the procedure. Aim of the Work The aim of this study was to assess technical and clinical outcomes of using a single wide-caliber DP stent in EUSguided pancreatic pseudocyst drainage. Methodology This multicenter prospective study included 57 patients, from which the 35 patients with symptomatic pancreatic pseudocysts enrolled. Patients with cysts with multiple septations (7 cases) or cyst with >30% necrosis (8 cases) of the cyst content and patients with generalized ascites (4 cases) or patients with major comorbidities (3 cases) were excluded. Patients were followed up within 1 month and 6 months after stent placement to assess complete resolution or a decrease in the sizes of cysts with clinical symptomatic improvement. Results From 57 patients, 35 patients (19 females/16 males, median age 40 years) with a symptomatic pancreatic pseudocyst were referred for EUS-guided drainage. All used stents were 10 Fr DP plastic stents. The median duration of the whole procedure was 16 min. Technical success was achieved in all cases. Clinical success was encountered in 32 patients (91.4%) without re-accumulation on follow-up. Minor adverse events were encountered in 3 patients (8.6%) including post-procedure abdominal pain (1 case) and fever (2 cases). Conclusion We suggest that using a wide-caliber single-pigtail stent for EUS-guided cystogastrostomy is safe and effective with short procedure time, with reduced risks from the insertion of another stent(s).
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Affiliation(s)
- Elsayed Ghoneem
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - Hussein Okasha
- Hepatology and Gastroenterology Unit, Kasr al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hammouda
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Reham Soliman
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Gamal Shiha
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - Khaled Ragab
- Theodor Bilharz Research Institute, Cairo, Egypt
| | - Ramy Hassan Agwa
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Habib GM, Ramadan A, El-Ansary M, Abdellatif Z, El-Serafy M, Okasha H. Value of pancreatic cyst fluid SPINK1 and glucose in differentiating potentially malignant cysts from those of benign nature: A prospective cohort study. Saudi J Gastroenterol 2022; 28:348-354. [PMID: 35848704 PMCID: PMC9752528 DOI: 10.4103/sjg.sjg_81_22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Diagnosis of malignant pancreatic cystic lesions (PCLs) is challenging as there is no investigation that offers both high diagnostic sensitivity and specificity for a definite diagnosis. Accurate diagnosis of cyst type is vital in order to not miss opportunities for early treatment of potentially malignant lesions and to avoid unnecessary surgeries. Serine protease inhibitor Kazal type I (SPINK1) and glucose are promising cyst fluid markers for differentiation of mucinous from non-mucinous cysts. We aim to validate the value of SPINK1 and glucose in detecting potentially malignant PCLs. METHODS A prospective study was conducted on 80 patients presenting with PCLs. Endoscopic ultrasound (EUS) evaluation of detailed cyst morphology and EUS with fine needle aspiration (FNA) were done. Fluid analysis for carcinoembryonic antigen (CEA), glucose and SPINK1 and cytopathology were done. We compared these data with the final diagnosis based on cytopathological and postoperative histopathological examination. RESULTS Cyst fluid SPINK1 was significantly higher in malignant or potentially malignant cysts compared to benign cysts (0.91 vs 0.47 ng/ml; P = 0.001). Also, glucose was significantly lower in malignant or potentially malignant cysts compared to benign cysts (21.5 vs 68.5 mg/dl; P = 0.0001). Glucose and SPINK1 had the best sensitivity and specificity for differentiating mucinous from non-mucinous cysts with 84.78% and 73.53% (AUC 0.76; 95% CI [0.65-0.88]; cutoff value = 42 mg/dl), and 70.59% and 65.22% (AUC 0.72; 95% CI [0.64-0.86]; cutoff value = 0.58 ug/L) respectively. CEA level >192 ng/ml, high SPINK1 level and lymph node enlargement were the independent predictors of malignant cysts. CONCLUSION Cyst fluid SPINK1 and glucose are promising diagnostic markers for the diagnosis of potentially malignant PCLs.
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Affiliation(s)
- Ghada M. Habib
- Department of Hepatology and Endemic Medicine, Cairo University, Cairo, Egypt,Address for correspondence: Dr. Ghada M. Habib, Hepatology and Gastroenterology at Kasr Al-Ainy School of Medicine, Cairo University, 130 3rd District, Al Hadaba Al Wosta, Mokattam, Cairo, Egypt. E-mail:
| | - Ahmed Ramadan
- Department of Hepatology and Endemic Medicine, Cairo University, Cairo, Egypt
| | - Mervat El-Ansary
- Department of Clinical Pathology, Cairo University, Cairo, Egypt
| | - Zeinab Abdellatif
- Department of Hepatology and Endemic Medicine, Cairo University, Cairo, Egypt
| | - Magdy El-Serafy
- Department of Hepatology and Endemic Medicine, Cairo University, Cairo, Egypt
| | - Hussein Okasha
- Department of Internal Medicine Division of Gastroenterology, Cairo University, Cairo, Egypt
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Ibrahim M, Roshdy N, Taleb A, Alfadda A, Al-Lehibi A, Altonbary A, Galal A, El-Fouly A, Kozlowska A, Khor C, Isayama H, Okasha H, Barthet M, Giovannini M, Pausawasdi N, Eisendrath P, Kongkam P, Ratanachu-ek T, Nakai Y. Evaluation of the ex-vivo porcine simulator on EUS-guided cystogastrostomy using lumen-apposing metal stent training. Endosc Ultrasound 2022; 11:201-207. [PMID: 35708369 PMCID: PMC9258017 DOI: 10.4103/eus-d-21-00109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022] Open
Abstract
Bckground and Objectives EUS-guided cystogastrostomy is a well-established advanced endoscopic technique with a steep-learning curve which necessitates an ex-vivo simulator that would allow for adequate training. The aim of this study is to evaluate the feasibility of the model in allowing training for EUS-guided cystogastrostomy using lumen-apposing metal stent (LAMS). Subjects and Methods The model was created by ROEYA Training Center, Egypt, using native porcine tissue to create fluid collections simulating both cystic and solid lesions. It was designed and tested in advance while the hydrogel was added on-site. The simulator was evaluated prospectively in five training sessions involving 17 international experts. The task was to successfully deploy the LAMS to drain the created cyst. After using the simulator, the experts were asked to fill a questionnaire to assess their experience. The primary endpoint was overall satisfaction with the model as a training tool. Results All of the experts were satisfied with the model as a tool to train endoscopists for the technique. 76.5% (n = 11) of the experts thought the model to be moderately realistic. Proper visualization was reported by 94.1% of the experts. All experts believed the lesions to be either slightly like or very similar to real lesions. The model was graded "easy" in difficulty by 11 of the experts. Conclusions In all parameters assessed, the experts thought the model to be a useful tool for future training. This preliminary study suggests that the aforementioned simulator can be used to train endoscopists on using LAMS in a risk-free environment.
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Affiliation(s)
- Mostafa Ibrahim
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Noran Roshdy
- ROEYA Gastroenterology, Hepatology and Endoscopy Center, Cairo, Egypt
| | | | - Abdulrahman Alfadda
- Department of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abed Al-Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Altonbary
- Department of Gastroenterology and Hepatology, Mansoura University, Egypt
| | - Ahmed Galal
- Department of Gastroenterology, Alexandria Hospital, Egypt
| | - Amr El-Fouly
- Endemic Medicine Department, Helwan University, Egypt
| | - Anna Kozlowska
- Department of Endoscopy, Hospital of Ministry of Internal Affairs, Szczecin, Poland
| | - Christopher Khor
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Hussein Okasha
- Internal Medicine Department, Kasr Al-Ainy School of Medicine, Cairo University, Egypt
| | - Marc Barthet
- Department of Gastroenterology & Hepatology, Hospital Nord, Marseille, France
| | - Marc Giovannini
- Department of Gastroenterology & Hepatology, Paoli Calmettes Institute, Marseille, France
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Pierre Eisendrath
- Department of Hepato-Gastroenterology, Saint-Pierre Hospital, Brussels, Belgium
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, Chulalongkom University, Bangkok, Thailand
| | | | - Yousuke Nakai
- Department of Endoscopy and Endoscopic Surgery, University of Tokyo, Tokyo, Japan
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Okasha H, Abbas W, Altonbary A, Hakim H, Ameen MG, El-Nady M. Role of endoscopic ultrasonography in the diagnosis of solid pseudo-papillary neoplasm: Egyptian multi-centric case series and systematic review. Egypt J Intern Med 2022. [DOI: 10.1186/s43162-022-00105-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractSolid pseudo-papillary neoplasm (SPPN) is a rare type of pancreatic tumor accounting for less than 2% of all pancreatic neoplasms. Accurate diagnosis of these tumors is very important for proper management. In this study, observations were documented from 18 consecutive cases diagnosed with SPPN using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The data of 18 consecutive cases were prospectively collected and reviewed. The collected data included age, gender, symptoms, size and site of the lesion, and type of surgery performed, in addition to mortality and recurrence rates.The mean age of the included cases was 33 years, and most of them were females (94.44%). Abdominal pain was the common symptom, and the pancreatic body was the most affected site. EUS-FNA confirmed the diagnosis in all cases when compared to the surgical specimen obtained. Cases were treated either with pancreatico-duodenectomy or distal pancreatectomy. One case (1/18) had early postoperative mortality due to sepsis. The remaining cases developed no recurrence or metastasis during the follow-up period of 18 months.SPPN is not a common pancreatic tumor. Confirming the diagnosis plays a crucial role prior to surgery as it facilitates intraoperative planning; therefore, EUS-FNA is a golden standard method used to diagnose. Postoperative survival has improved if the tumor is completely removed. EUS-FNA technique is a minimally invasive technique that can provide high yielding in providing detailed diagnostic analysis of SPPN.
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Mamdouh MM, Okasha H, Shaaban HAM, Hafez NH, El-Gemeie EH. Role of Maspin, CK17 and Ki-67 Immunophenotyping in Diagnosing of Pancreatic Ductal Adenocarcinoma in Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology. Asian Pac J Cancer Prev 2021; 22:3299-3307. [PMID: 34711007 PMCID: PMC8858254 DOI: 10.31557/apjcp.2021.22.10.3299] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aim: One of the problems in diagnosing pancreatic ductal adenocarcinoma (PDAC) is differentiation between PDAC cells and benign pancreatic tissue cells in cytologic samples. This study aimed to evaluate the usefulness of Maspin, CK17 and Ki-67 immunocytochemistry (ICC) in differentiation between these two groups of cells. Materials and methods: This retrospective study was carried on 80 cases of PDAC and 25 cell blocks of benign pancreatic tissue cells as a control group for evaluation of Maspin, CK17 and Ki-67 ICC. PDAC cases were sampled by endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNAC), while cell blocks of control group were aspirated from benign pancreatic tissues that were obtained from the pancreatic surgically resected specimens. Immunostaining patterns, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of each antibody as well as possible antibody combined panels of these markers in differentiation between the two groups were evaluated. Results: Positive immunoreactivity for Maspin, CK17 and Ki-67 were 92.5%, 80% and 72.5% in PDAC cases, respectively. In contrast to PDAC cases, all the cell blocks of benign pancreatic tissue cells were negative for these markers. Regarding different panels, combined use of Maspin, CK17 and Ki-67 together as a triple test (at least one of them is positive) achieved the highest sensitivity of 98.8%, specificity of 100%, PPV of 100%, NPV of 96.2% and accuracy of 99% in the differentiation between PDAC and benign pancreatic tissue. Conclusion: Employing this short panel [Maspin, CK17 and Ki-67] is helpful for better differentiation between PDAC and benign pancreatic tissue.
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Affiliation(s)
- Mona M Mamdouh
- Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hussein Okasha
- Department of Internal Medicine, Gastroenterology and Hepatology division, Kasr Al- Aini Hospitals, Cairo University, Cairo, Egypt
| | | | - Nesreen H Hafez
- Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Emad Hamza El-Gemeie
- Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
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Seif El-Din SH, Salem MB, El-Lakkany NM, Hammam OA, Nasr SM, Okasha H, Ahmed LA, Saleh S, Botros SS. Early intervention with probiotics and metformin alleviates liver injury in NAFLD rats via targeting gut microbiota dysbiosis and p-AKT/mTOR/LC-3II pathways. Hum Exp Toxicol 2021; 40:1496-1509. [PMID: 33678036 DOI: 10.1177/0960327121999445] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) constitutes a major health problem worldwide and intimately links with obesity and diabetes. This study aimed to explore the therapeutic impact of early treatment with metformin (MTF) alone or in combination with Lactobacillus reuteri DSM 17938 (L. reuteri) + metronidazole (MTZ) in male Sprague Dawley rats with high-fat diet (HFD)-induced NAFLD. Hepatic steatosis was induced by feeding rats HFD for 6 weeks. MTF (150 mg/kg/day) or L. reuteri (2 × 109 colony forming unit/day) were given orally for 4 weeks; meanwhile, MTZ (15 mg/kg/day, p.o.) was administered for 1 week. Administration of L. reuteri + MTZ in combination with MTF produced a superior effect concerning insulin resistance (IR), lipid profile, liver function, oxidative stress, inflammatory and autophagic markers than using each treatment alone. Besides, this combination resulted in disappearance of steatosis, inflammation and vacuolation within hepatic architecture. Moreover, it normalized short chain fatty acids (SCFAs) as well as Firmicutes and Bacteroidetes faecal contents. In conclusion, early treatment with L. reuteri + MTZ in combination with MTF could prevent NAFLD progression and liver injury through targeting gut dysbiosis, inflammation and autophagic pathways.
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Affiliation(s)
- Sayed H Seif El-Din
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - M B Salem
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - N M El-Lakkany
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - O A Hammam
- Pathology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - S M Nasr
- Biochemistry Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - H Okasha
- Biochemistry Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - L A Ahmed
- Pharmacology and Toxicology Department, 110154Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - S Saleh
- Pharmacology and Toxicology Department, 110154Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - S S Botros
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
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Okasha H, Wahba M, El-Fol HA, Elsherif Y. Preoperative EUS-guided tattooing of a small, firm, deep pancreatic mass. Gastrointest Endosc 2021; 93:769-771. [PMID: 33049264 DOI: 10.1016/j.gie.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/18/2020] [Accepted: 10/02/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Hussein Okasha
- Division of Gastroenterology, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Wahba
- Division of Gastroenterology, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | | | - Yahya Elsherif
- Gastroenterology and Hepatology Unit, Tropical Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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Amer S, El Hefnawy A, Baz A, Okasha H. Evaluation of tuberculosis diagnostic tools, with extending MODS assay use to second line susceptibility testing. Epidemiol Mikrobiol Imunol 2021; 70:161-167. [PMID: 34641690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED Tuberculosis diagnosis and drug susceptibility testing (DST) are considered a priority for prompt initiation of effective therapy, increasing the chance of cure, decreasing the development of resistance, and reducing transmission. AIM Our objective was to evaluate currently applied diagnostic tools for tuberculosis including microscopic examination, GeneXpert, culture, and microscopic observation drug susceptibility (MODS) assay, investigating MODS assay usage for second line DST against culture based methods. MATERIAL AND METHODS In this study the 120 sputum samples collected from suspected cases were over one year duration from December 2018 to January 2020. The samples were subjected to ZN microscopic examination, GeneXpert, MODS assay, and culture for detection of mycobacteria. Moreover, resistance to 5 drugs: isoniazid, rifampicin, ofloxacin, levofloxacin, and amikacin were tested using MODS against the proportion method. RESULTS The sensitivity and specificity of the MODS assay were similar culture method with the advantage of obtaining the results in a median time of 10.7 days. Whereas the specificity of ZN and GeneXpert was high among untreated cases and decreased in subjects with a history of treatment. Monoresistance was the most common form of resistance detected among new cases followed by multidrug resistance, with a categorical agreement between the two methods above 90% for all tested drugs. CONCLUSIONS MODS assay is an attractive option once standardized for second line susceptibility testing and GeneXpert assay is of high sensitivity for rapid detection of MTB and RIF resistance especially in treatment naive cases.
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Okasha H, Matar R, Kaddah M. Detecting papillary GI stromal tumor by EUS from the stomach. Gastrointest Endosc 2020; 92:784-785. [PMID: 32298671 DOI: 10.1016/j.gie.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/27/2019] [Accepted: 04/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Hussein Okasha
- Internal Medicine Division of Gastroenterology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha Matar
- Gastroenterology and Endoscopy Department, Al-Zahraa Hospital University Medical Center, Beirut, Lebanon
| | - Mona Kaddah
- Internal Medicine Division of Gastroenterology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Okasha H, Wahba M. EUS in the diagnosis of rare groove pancreatitis masquerading as malignancy. Gastrointest Endosc 2020; 92:427-428. [PMID: 32112782 DOI: 10.1016/j.gie.2020.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/06/2019] [Accepted: 02/20/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Hussein Okasha
- Internal Medicine Department, Division of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Wahba
- Internal Medicine Department, Division of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Naga M, Wahba M, Okasha H, Farag A, El-Mazny A, Elbadri A, Fouad A, Habib G, Abdellatif Z, Elshobaky M, AbdelHamid MK, Elbaz M, Seif ElNasr S, Essam K. Comparative study of tissue adhesive therapy versus band ligation in control of actively bleeding esophageal varices. Acta Gastroenterol Belg 2020; 83:5-10. [PMID: 32233265] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND STUDY AIMS Bleeding esophageal varices is a common life-threatening emergency that carries a significant morbidity and mortality. Acute variceal bleeding is considered active when spurting and/or oozing varix is seen at the time of endoscopy, or inactive in the presence of large esophageal varices with blood in the stomach with no other bleeding source at the time of endoscopy. Aim: comparing endoscopic variceal ligation (EVL) versus cyanoacrylate injection (CI) in active esophageal variceal bleeding control. PATIENTS AND METHODS a retrospective single tertiary center study from April 2014 to February 2018, including 401 patients with active esophageal variceal bleeding. RESULTS Endoscopic hemostasis was achieved by both endoscopic variceal ligation in 182 patients (91.9%) and cyanoacrylate injection in 197 patients (97.05%) without significant difference (P value 0. 15). Re-bleeding occurred more frequently in EVL group 20 patients (10.1%) compared to 14 patients (6.9%) in CI (P value 0.01). Early six-week Mortality was higher among EVL group (20.7%) compared to CI (17.2%) without statistical significance (P value 0.3). CONCLUSION Both EVL and CI are almost as effective in achieving endoscopic hemostasis. CI is more effective, feasible, and could be used as a salvage therapy and/or spared for risky active bleeding esophageal varices.
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Affiliation(s)
- M Naga
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - M Wahba
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - H Okasha
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - A Farag
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - A El-Mazny
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - A Elbadri
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - A Fouad
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - G Habib
- Cairo University, Kasr Alainy Faculty of Medicine, Tropical Medicine, Cairo, Egypt
| | - Z Abdellatif
- Cairo University, Kasr Alainy Faculty of Medicine, Tropical Medicine, Cairo, Egypt
| | - M Elshobaky
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - M Kamel AbdelHamid
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - M Elbaz
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - S Seif ElNasr
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
| | - K Essam
- Cairo University, Kasr Alainy Faculty of Medicine, Internal Medicine division of Gastroenterology, Cairo, Egypt
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Okasha H, E Behiry M, Ramadan N, Ezzat R, Yamany A, El-Kholi S, Ahmed G. Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions. Arab J Gastroenterol 2019; 20:86-90. [PMID: 31182342 DOI: 10.1016/j.ajg.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/01/2018] [Revised: 04/14/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS pancreatic cysts are commonly found lesions and proper diagnosis is very important for planning further management. The study aims to evaluate the role of cyst fluid amylase and tumour markers as cancer antigen (CA 19-9) and carcinoembryonic antigen (CEA) in addition to mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. PATIENTS AND METHODS This prospective study was conducted on 184 patients diagnosed to have pancreatic cystic lesions from January 2013 to January 2018. Fluid analysis for CA 19-9, CEA, amylase, mucin stain and cytopathology were done. We compared these data with the final diagnosis based on histopathology after surgical resection, positive cytopathology and long period of follow up of the patients for at least 18 months. RESULTS The highest AUC was that of cystic CEA with cut-off value of 160 ng/ml; it had a sensitivity of 60.4% and a specificity of 85%. The best cut-off value for cystic CA 19-9 was 1318 U/ml with a sensitivity of 64.1% and a specificity of 68.1%. The cut-off value of cyst amylase level was 5500 U/L, with 84.2% sensitivity and 37.1% specificity. The sensitivity of mucin stain in detecting mucinous cystic neoplasm was 85.45%, specificity was 86.05% with accuracy 85.87%. CONCLUSION Cyst fluid analysis by investigating amylase, mucin, CA 19-9, CEA and EUS examination improves the diagnosis of different pancreatic cysts.
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Affiliation(s)
- Hussein Okasha
- Internal Medicine, Faculty of Medicine, Cairo University, Egypt
| | - Mervat E Behiry
- Internal Medicine, Faculty of Medicine, Cairo University, Egypt.
| | - Nagwa Ramadan
- Internal Medicine, Faculty of Medicine, Cairo University, Egypt
| | - Reem Ezzat
- Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Yamany
- Internal Medicine, Faculty of Medicine, Cairo University, Egypt
| | | | - Ghada Ahmed
- Internal Medicine, Faculty of Medicine, Cairo University, Egypt
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Okasha H, Elkholy S, Sayed M, El-Sherbiny M, El-Hussieny R, El-Gemeie E, Al-Nabawy W, Mohamed MS, Elsherif Y. Ultrasound, endoscopic ultrasound elastography, and the strain ratio in differentiating benign from malignant lymph nodes. Arab J Gastroenterol 2018; 19:7-15. [DOI: 10.1016/j.ajg.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)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 08/17/2017] [Accepted: 01/30/2018] [Indexed: 12/19/2022]
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Ahmed O, Ogura T, Eldahrouty A, Khalaf H, Mohammed E, Okasha H, Sameer A, Abdelaal U, Higuchi K. Endoscopic ultrasound-guided gallbladder drainage: Results of long-term follow-up. Saudi J Gastroenterol 2018; 24:183-188. [PMID: 29652030 PMCID: PMC5985638 DOI: 10.4103/sjg.sjg_506_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/10/2023] Open
Abstract
BACKGROUND/AIM Recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged using a self-expandable metallic stent (SEMS). The aim of the study was to evaluate the long-term outcomes of this procedure. In addition, the efficacy and safety of EUS-GBD with SEMS were assessed. PATIENTS AND METHODS Thirteen consecutive patients who underwent EUS-GBD for acute cholecystitis between February 2014 and September 2016 were included in this retrospective study. EUS-GBD was performed under the guidance of EUS and fluoroscopy, through puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. RESULTS The rates of technical success, functional success, and adverse events were 100%, 92.3% and 7.7%, respectively. The median procedure time was 26.9 min (range 19-42 min). The median follow-up time was 240 days (range 14-945 days) and during this follow-up period recurrence of cholecystitis was observed in one patient (7.7%). CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis in high surgical risk patients. Long-term outcomes after EUS-GBD were promising.
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Affiliation(s)
- Omar Ahmed
- Department of Internal Medicine, Osaka Medical College, Osaka, Japan,Department of Tropical Medicine, Minia University Hospital, Minia, Egypt
| | - Takeshi Ogura
- Department of Internal Medicine, Osaka Medical College, Osaka, Japan,Address for correspondence: Dr. Takeshi Ogura, Department of Internal Medicine, Osaka Medical College, 1-1 Daigakuchou, Takatsukishi, Osaka 464-8681, Japan. E-mail:
| | - Ali Eldahrouty
- Department of Tropical Medicine, Minia University Hospital, Minia, Egypt
| | - Hanaa Khalaf
- Department of Tropical Medicine, Minia University Hospital, Minia, Egypt
| | - Ehab Mohammed
- Department of Tropical Medicine, Minia University Hospital, Minia, Egypt
| | - Hussein Okasha
- Department of Internal Medicine, Cairo University, Cairo, Egypt
| | - Ayat Sameer
- Department of Tropical Medicine, Minia University Hospital, Minia, Egypt
| | - Usama Abdelaal
- Department of Internal Medicine, Sohag University Hospital, Sohag, Egypt
| | - Kazuhide Higuchi
- Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Okasha H, Elkholy S, El-Sayed R, Wifi MN, El-Nady M, El-Nabawi W, El-Dayem WA, Radwan MI, Farag A, El-sherif Y, Al-Gemeie E, Salman A, El-Sherbiny M, El-Mazny A, Mahdy RE. Real time endoscopic ultrasound elastography and strain ratio in the diagnosis of solid pancreatic lesions. World J Gastroenterol 2017; 23:5962-5968. [PMID: 28932088 PMCID: PMC5583581 DOI: 10.3748/wjg.v23.i32.5962] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/10/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions (SPL).
METHODS A total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.
RESULTS SPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL.
CONCLUSION Combining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.
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Affiliation(s)
- Hussein Okasha
- Mohamed Naguib Wifi, Mohamed El-Nady, Ali Farag, Ahmed Salman, Mohamed El-Sherbiny, Ahmed El-Mazny, Internal Medicine Department, Cairo University, Cairo 11311, Egypt
| | - Shaimaa Elkholy
- Mohamed Naguib Wifi, Mohamed El-Nady, Ali Farag, Ahmed Salman, Mohamed El-Sherbiny, Ahmed El-Mazny, Internal Medicine Department, Cairo University, Cairo 11311, Egypt
| | - Ramy El-Sayed
- Department of Tropical Medicine, Zagazig University, Elsharkiah 44519, Egypt
| | | | | | - Walid El-Nabawi
- Internal Medicine Department, Beni Suef University, Beni Suef 71515, Egypt
| | - Waleed A El-Dayem
- Department of Tropical Medicine, Zagazig University, Elsharkiah 44519, Egypt
| | - Mohamed I Radwan
- Department of Tropical Medicine, Zagazig University, Elsharkiah 44519, Egypt
| | | | - Yahya El-sherif
- Tropical Medicine Department, El Manial Specialized Hospital, Cairo University, Cairo 11311, Egypt
| | - Emad Al-Gemeie
- Pathology Department, National Cancer Institute, Cairo University, Cairo 11311, Egypt
| | | | | | | | - Reem E Mahdy
- Internal Medicine Department, Assiut University, Assiut 71515, Egypt
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Okasha H, Elkholy S, Ezzat Mahdy R, El-Kafrawi A. Isolated Pulmonary Valve Vegetations in a Patient with Gastric Lymphoma Diagnosed by Endoscopic Ultrasound. Acta Gastroenterol Belg 2017; 80:430-431. [PMID: 29560679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Hussein Okasha
- Faculty of Medicine, Cairo University, Department of Internal Medicine, Cairo, Egypt
| | - Shaimaa Elkholy
- Faculty of Medicine, Cairo University, Department of Internal Medicine, Cairo, Egypt
| | - Reem Ezzat Mahdy
- Faculty of Medicine, Assuit University, Department of Internal Medicine, Assuit, Egypt
| | - Ahmed El-Kafrawi
- Faculty of Medicine, Cairo University, Department of Internal Medicine, Cairo, Egypt
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Okasha H, Elkholy S, Sayed M, Salman A, Elsherif Y, El-Gemeie E. Endoscopic ultrasound-guided fine-needle aspiration and cytology for differentiating benign from malignant lymph nodes. Arab J Gastroenterol 2017. [PMID: 28624157 DOI: 10.1016/j.ajg.2017.05.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND STUDY AIMS Intra-abdominal and mediastinal lymphadenopathy are often difficult to diagnose, particularly in the absence of a primary lesion. Endosonography (EUS)-guided fine-needle aspiration and cytology (FNAC) has provided an easy and safe access to these lymph nodes, sparing the use of invasive and costly interventions. The main aim of this study is to assess the specificity, sensitivity, and predictive value of EUS-guided FNAC in the diagnosis of benign and malignant lymph nodes. In addition, the study aims to determine significant EUS features that could help in predicting lymph node malignancy. PATIENTS AND METHODS This prospective study included 142 patients with intra-abdominal or intrathoracic lymphadenopathy who were referred for EUS-guided FNAC because of inaccessibility by other imaging modalities. Ninety (63.3%) patients were found to have malignant lymph nodes, and 52 (36.6%) had lymphadenopathy of benign nature. RESULTS EUS-guided FNAC had a sensitivity and specificity of 92% and 100% respectively. It had positive and negative predictive values of 100% and 88% for malignancy, respectively. By logistic regression analysis, EUS features and shortest diameter were found to be potential predictors of malignancy with p-value of <0.0001. CONCLUSION EUS-guided FNAC is a powerful modality in the diagnosis of benign and malignant lymph nodes. Additional complementary EUS features could be added to this technique for definitive diagnosis.
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Affiliation(s)
- Hussein Okasha
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaimaa Elkholy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mohamed Sayed
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Salman
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yahia Elsherif
- Liver Unit, El Manial Specialized Hospital, Tropical Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad El-Gemeie
- Pathology Department, Cancer Liver Institute, Cairo University, Cairo, Egypt
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multisystem involvement, including the gastrointestinal (GI) tract. There is a significant variation in the clinical presentation and severity of GI disorders. When GI symptoms present as the initial manifestation of SLE, there is likely to be a delay in the diagnosis. The cause of these GI manifestations in SLE may be the disease, or the side effects of medications, or infections. In this study we investigated the GI manifestations in a group of SLE patients. Our study was conducted on 40 SLE patients and 30 healthy controls to assess the prevalence of GI symptoms in SLE patients. The prevalence of gastrointestinal manifestations in our study was 42.5%. GI manifestations in our SLE patients were: acute abdominal pain (due to pleurisy and peritonitis), 6%; diffuse abdominal pain, 23.5%; epigastric pain, 29%; epigastric pain with vomiting, 23.5%; epigastric pain with chronic constipation, 6%; chronic constipation, 6%; and diffuse abdominal pain with bleeding per rectum, 6%. In our study, we found a higher incidence of Giardia infestation in SLE patients than in healthy controls, and 10% of these patients were asymptomatic. There was more Giardia infestation in patients with GI symptoms as compared with patients with no GI symptoms, with a P value of 0.009. In our study SLE patients with GI symptoms had a peak systolic velocity (cm/s) with a mean of 108.4 ± 32.1 standard deviation (SD) in the celiac Doppler study. Patients without GI symptoms had a peak systolic velocity with a mean of 111.9 ± 37.7 SD, meaning that our patients mostly had no evidence of celiac trunk stenosis, but there was significant difference between SLE patients without GI symptoms and controls, as the mean was higher in SLE patients than in the controls. Also, the celiac end diastolic velocity was higher in both groups of SLE patients with GI symptoms and those without GI symptoms, compared to controls.
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Affiliation(s)
- M Fawzy
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
| | - A Edrees
- 2 Department of Internal Medicine University of Missouri-Kansas City, Kansas City, USA
| | - H Okasha
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
| | - A El Ashmaui
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
| | - G Ragab
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
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Okasha H, Mahmoud M. Treatment for resistant subphrenic abscess by combined intracavitary doxycycline and cyanoacrylate injection. J Adv Res 2015; 5:409-11. [PMID: 25685508 PMCID: PMC4294747 DOI: 10.1016/j.jare.2013.08.001] [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: 06/23/2013] [Revised: 08/11/2013] [Accepted: 08/11/2013] [Indexed: 11/30/2022] Open
Abstract
We report the case of a male patient with resistant subphrenic abscess complicating radiofrequency ablation (RFA) of two left lobe hepatocellular carcinoma (HCCs). The causative organism was multidrug resistant Escherichia coli. Percutaneous pigtail drainage together with IV antibiotics failed to resolve the abscess which persisted for 4 months. Intracavitary doxycycline injection causes moderate reduction in the volume of the drained fluid. This was followed by percutaneous cyanoacrylate injection inside the abscess cavity and the fistulous tract which causes complete resolution of the abscess.
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Affiliation(s)
- Hussein Okasha
- Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Mohammed Mahmoud
- Tropical Medicine Department, Faculty of Medicine, Cairo University, Egypt
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20
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Okasha H, El-Kassas M, Naguib M, Ezzat R, El-Gemeie E. Gastric mucosa-associated lymphoid tissue lymphoma associated with pancreatic non-Hodgkin's lymphoma: A case report. Endosc Ultrasound 2014; 3:S6-7. [PMID: 26425533 PMCID: PMC4569933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Mucosa-associated lymphoid tissue (MALT) lymphomas are extranodal lymphomas that arise from B lymphocytes located in the marginal zone of lymphoid follicles. Although, there is a substantial amount of lymphoid tissue in the gastrointestinal tract, MALT lymphomas usually arise in chronically inflamed sites that are normally devoid of lymphoid tissue. The best example is gastric MALT lymphoma that is almost always associated with Helicobacter pylori. Primary pancreatic lymphoma (PPL) is an extremely rare tumor (1% incidence) and is often confused with pancreatic adenocarcinoma. By suspecting PPL on clinical and imaging grounds, surgery and its associated complications can be avoided, since the mainstay of the treatment is non-surgical strategies including chemotherapy. We represent a case of a 45-year-old male presented with abdominal pain and vomiting. Upper endoscopy showed multiple gastric ulcers, biopsies revealed non-specific inflammatory ulcers. The patient was given 4-weeks course of proton pump inhibitor with no improvement. After few months, he complained of severe abdominal pain relieved by leaning forward and associated with repeated vomiting. Upper endoscopy revealed multiple umbilicated gastric masses, 10-20 mm in diameter. Biopsies were taken, histopathology and immunohistochemistry revealed MALT lymphoma. Endoscopic ultrasonography was done to the patient and it showed a pancreatic head mass, fine-needle aspiration was done, histopathology and immunohistochemistry revealed PPL. The patient received chemotherapy for MALT lymphoma with near total relief of symptoms and disappearance of gastric and pancreatic masses. CONCLUSION This is a rare case having MALT lymphoma associated with PPL.
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Okasha H, Naguib M, Ezzat R. Role of high resolution ultrasonography/endoscopic ultrasonography and elastography in predicting lymph node malignancy. Endosc Ultrasound 2014; 3:S6. [PMID: 26425532 PMCID: PMC4569932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasonography (EUS)-elastography in predicting malignant lymphadenopathy. METHODS This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real-time elastography pattern and the B-mode US/EUS images was compared to the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), Tru-Cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months. RESULTS Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% were hypoechoic, while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cut-off value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while Score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while Score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%. CONCLUSION Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.
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Abdallah A, Gharraf H, Okasha H. Early ICU energy deficit: Is it a risk factor for ventilator-associated pneumonia? Egyptian Journal of Chest Diseases and Tuberculosis 2014. [DOI: 10.1016/j.ejcdt.2013.11.012] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
BACKGROUND Ultrasonography is considered useful to distinguish between solid and cystic thyroid nodules and to stratify a nodule's risk of cancer as low, medium, or high. Ultrasound (US) elastography has been applied to study the hardness/elasticity of nodules to differentiate malignant from benign lesions. Elastography possibly can solve the dilemma in reaching an accurate diagnosis for the cytologically known as indeterminate nodules. AIM To evaluate the sensitivity and specificity of US elastography in the diagnosis of thyroid cancer. PATIENTS AND METHODS This prospective study included 40 patients. The total number of nodules was 46, they were all euthyroid. Laboratory investigations were done including FT3, FT4, and TSH to exclude hot nodules. Neck US, US elastography, and fine-needle aspiration were done to all patients, and US elastography scoring system from 1 to 4 was used. RESULTS Four out of the 46 studied nodules were malignant. The ROC curve for elastography score (E-score) showed high sensitivity, specificity for the diagnosis of malignant thyroid nodules with a cut-off value of E-score 4 and high significance (p<0.001), the area under curve was 0.92. The sensitivity was 75.0% and specificity was 100%. For E-score more than 2, the sensitivity was 100% and specificity was 85.37%. CONCLUSION US elastography can be used to increase both the sensitivity and the specificity of US for the detection of malignant thyroid nodules, and so it seems to have great potential as a new tool for the diagnosis of thyroid cancer.
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Affiliation(s)
- Mona Mansor
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Okasha H, Kamal N, Naga M, El-Karaksy H, El-Koofy N. A comparative study of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in children with chronic liver disease. ACTA ACUST UNITED AC 2008. [PMID: 18923212 DOI: 10.4103/0019-5359.43120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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