Comparison of elastography methods in patients with pancreatic masses

INTRODUCTION

Endoscopic ultrasonography (EUS) quantitative elastography methods are developed for non-invasive differentiation of pancreatic masses.

AIMS

First: To evaluate the diagnostic value of strain ratio (SR) and hue histogram (HH) in patients with pancreatic masses and to determine the cut-off value between pancreatic cancer and focal pancreatitis using a pancreatic tissue close to the mass as a reference area. Second: To calculate new variable HH ratio (HHR) in an attempt to improve sensitivity, specificity and accuracy of the method.

METHODS

In a prospective single center study, 149 patients were examined: 105 with the pancreatic masses and 44 controls using Pentax EUS linear probes in combination with Hitachi platforms. SR and HH were automatically calculated by machine software. Finally, two groups were formed: Pancreatic cancer group (58 patients) and focal pancreatitis group (47 patients). All statistical analysis has been made in SPSS 14.0 (SPSS Inc., Chicago, USA).

CONCLUSION

Statistical analysis in our study showed that SR with a cut-off value of 7.59 reaches 100% sensitivity and 95% specificity with overall accuracy of 97% (confidence intervals [CI]: 92-97%) in detection of pancreatic cancer. Statistical analysis also showed that HH with a cut-off value of ≥86 reaches 100% sensitivity and just 45% specificity with overall accuracy of 66% (CI: 61-66%) in detection of pancreatic cancer. New variable HHR with cut-off ≥1.153 was slightly better with 98% sensitivity and 50% specificity, with overall accuracy of 69% (CI: 63-70%). SR showed significantly higher specificity compared with HH and HHR. More HH studies on Hitachi platforms are needed.

Pharmaceutical principles of acid inhibitors: unmet needs

Despite the well-established benefits of currently approved delayed-release proton pump inhibitors (PPIs) in the treatment of acid-related diseases, the unmet needs are still present and although often frustrating, they challenge clinicians. The unmet needs relate to the lack of complete control of acid secretion with oral PPI administration in the management of patients with gastroesophageal symptoms. These substantial groups of patients, who do not respond completely to standard doses of PPIs, are nonresponders, and their lack of response should be considered as PPI failure. Several mechanisms could explain PPI failure: differences in pharmacokinetics, PPI formulation, dosing time and diet, noncompliance, transient lower esophageal sphincter relaxations, esophageal hypersensitivity, and nocturnal acid breakthrough. To increase the quality of life of these patients and avoid multiple medical consultations and unnecessary investigations, we have to go one step forward and use combined therapy or look towards new treatments beyond acid suppression.

Lactobacillus acidophilus as a cause of liver abscess in a NOD2/CARD15-positive patient with Crohn's disease

INTRODUCTION

The development of a fistula and/or an abscess are major complications in patients with Crohn's disease. An abscess can involve any of the major viscera, including the liver and spleen.

CASE REPORT

A 27-year-old male patient with a 6-month history of NOD2/CARD15-positive Crohn's disease with stenosis of the terminal ileum, previously treated with corticosteroids, was admitted with fever, chills, diarrhea, fatigue and cachexia. Diagnostic work-up revealed sepsis, an abscess in the right hepatic lobe, multiple abdominal collections and right-sided pleural effusion. It was felt that his poor general condition prevented surgical intervention and complex conservative treatment was initiated. It consisted of total parenteral nutrition, antibiotics, percutaneous drainage of the liver abscess, and thoracocentesis. Pus and blood cultures showed Lactobacillus acidophilus. There was a gradual improvement in the patient's condition and the liver abscess decreased in diameter from 14 to 2 cm. Aminosalicylates and enteral nutrition were gradually introduced. The patient was discharged after 9 weeks in good general condition.

CONCLUSION

Although extremely rarely, L. acidophilus can cause hepatic abscess and sepsis. This can be explained by immunologic incompetence due to corticosteroid treatment of Crohn's disease.