Ada Kessler

Initial experience of videocapsule endoscopy for diagnosing small-bowel tumors in patients with GI polyposis syndromes

BACKGROUND Small-bowel tumors frequently occur in familial adenomatous polyposis and other GI polyposis syndromes. These tumors are difficult to detect with conventional techniques. Our aim was to assess the utility of videocapsule endoscopy in the detection of small-bowel tumors in this setting. METHODS We examined 19 familial adenomatous polyposis patients and 3 patients with either Peutz-Jeghers syndrome, hyperplastic polyposis, or Cowden disease. OBSERVATIONS Prevalence of small-bowel polyps on videocapsule endoscopy was 59% in all patients, 52.6% in familial adenomatous polyposis patients, and 75% in a subgroup of familial adenomatous polyposis patients with exon 15 mutations. Videocapsule endoscopy was safe and well tolerated in all patients. CONCLUSIONS Videocapsule endoscopy has a high yield in detecting small-bowel tumors in patients with GI polyposis syndromes. It may be especially indicated in familial adenomatous polyposis patients with the aggressive phenotype of the disease, e.g., mutations in exon 15.

Matrix Metalloproteinases 2 and 9 Are Markers of Inflammation but Not of the Degree of Fibrosis in Chronic Hepatitis C

Background: The degree of liver fibrosis and inflammation is important in patients with chronic hepatitis C (CHC) in terms of therapy as well as prognosis. To obviate the need of liver biopsy, serum markers such as procollagen I, III and hyaluronic acid have been proposed but were found to be inaccurate. Controversy still exists regarding the role of matrix metalloproteinases (MMPs) as valid markers of liver fibrosis. Aim: To assess liver and serum MMP-2 and -9 as markers of fibrosis and inflammation in patients with CHC. Methods: Thirty-five CHC patients and 8 non-hepatitis C patients with normal liver enzymes underwent liver biopsy. Activities of inflammation and fibrosis stage were determined by the Desmet score on a scale of 0–4. Serum and liver tissue MMP-2 and -9 activities were measured by zymography using substrate impregnated gels. Results: Patient and control groups were similar in terms of age (50.8 ± 15.1 vs. 50.6 ± 15.2) and male/female ratio (18/17 vs. 4/4). In serum, MMP-9 activity was increased in patients compared to controls (308 ± 110 vs. 163.5 ± 35 , p < 0.05). In liver tissue, MMP-9 was also higher in patients than in controls (21 ± 4.5 vs. 17.1 ± 5.1, p < 0.05), whereas MMP-2 did not differ between patients and controls. Serum MMP-9 values correlated with liver histologic inflammatory grade (290.4 ± 83 in grade 2 vs. 562.1 ± 128 in grade 3, p < 0.05) but not with fibrosis stage. The highest rising in serum MMP-9 levels was observed between grade 2 to grade 3 and was superior to the rising in serum transaminase levels, indicating its advantage in assessing the progression of disease activity. No correlation between liver MMP activities and liver fibrosis or inflammation was observed. Conclusion: Serum MMPs, in particular MMP-9, can serve as markers of disease activity rather than fibrosis stage in chronic HCV patients.

Pre-operative sonographic diagnosis of incarcerated neonatal Spigelian hernia containing the testis

BackgroundSpigelian hernia (SH) is a ventral hernia that occurs along the semilunar line formed by the fibrous union of the rectus sheath and the anterior abdominal wall muscles, usually containing small bowel segments, omental fat or both. Spigelian hernias are rare in adults and exceedingly rare in children. A few case reports describing SH in the paediatric population have been published and an association with cryptorchidism has been very rarely reported.ObjectiveTo report three examples of SH.ResultsWe describe three examples of SH containing incarcerated testis in two neonates. These were diagnosed preoperatively with US. Ultrasound-guided reduction of the hernia contents was performed successfully in one case.ConclusionsUltrasound plays an important role in the diagnosis and management of these hernias.

Intratesticular Varicocele Gray Scale and Color Doppler Sonographic Appearance

The purpose of this study was to evaluate the gray scale and color Doppler appearances of intratesticular varicocele (ITV) in a relatively large series of men and to compare the findings with those previously reported.

Non-neoplastic intratesticular lesions mimicking tumour on ultrasound

Abstract. It has recently been emphasized that the incidence of benign testicular lesions is much higher than previously suspected. Sonography is reported to have a high sensitivity but poor specificity in the evaluation of intratesticular abnormalities. This report reviews the common and unusual lesions that can mimic testicular tumour on ultrasound, and discusses the clinical and sonographic features that may help to narrow the differential diagnosis and guide management.

Femoral artery pseudoaneurysm: Doppler sonographic features predictive for spontaneous thrombosis

The objective of this prospective study was to evaluate whether Doppler imaging characteristics can be used to predict spontaneous thrombosis of femoral artery pseudoaneurysms (PAs).

Budd-Chiari Syndrome and Acute Portal Vein Thrombosis: Management by a Transjugular Intrahepatic Portosystemic Shunt (TIPS) and Portal Vein Interventions via a TIPS

Acute portal vein thrombosis (PVT) is a devastating complication of Budd-Chiari syndrome (BCS). Con-servative approach, anticoagulation, systemic or transarterial thrombolysis, and urgent liver transplanta-tion were applied in this scenario but with poor results. We present and discuss an approach to treat BCS complicated by acute PVT. Two young female patients presented with acute liver failure, rapidly pro-gressive tense ascites, renal- and respiratory failure. The diagnosis of chronic BCS complicated by acute PVT was confirmed with ultrasound Doppler. Initial treatment was supportive. Right portal vein local-ization was by transarterial portogram or by computed tomography-guided microcoil placement. Trans-jugular intrahepatic portosystemic shunt (TIPS) was performed and included Wallstents and a Jograft in one case and Viatorr stentgraft that was extended later with a Hemobahn stentgraft in another. Mechan-ical clot removal from the portal system was performed in the primary procedure and in a revision pro-cedure in the following few days. Stents were placed precisely with no extension into the inferior vena cava or deeply into the main portal vein. Patients were fully anticoagulated and patency was assessed by ultrasound Doppler. The procedures were performed on days 5 and 10 following admission. In both cases, successful thrombectomies were reveised and maintained. Partial occlusion of the TIPS and reaccumulation of ascites were reversed with repeated procedure. Both patients were discharged without ascites and normal liver function. In conclusion, urgent TIPS and portal vein thrombectomy via TIPS are emerging therapeutic options that offer a safe and effective treatment to patients with BCS complicated by acute portal vein thrombosis.

Colour Doppler ultrasound imaging findings in paediatric periocular and orbital haemangiomas

Purpose:  To evaluate the combined grey‐scale ultrasonography (US) and colour Doppler imaging (CDI) as the first and primary imaging modalities in diagnosing paediatric orbital haemangiomas.

Vascular and Biliary Abnormalities Mimicking Cholangiocarcinoma in Patients With Cavernous Transformation of the Portal Vein Role of Color Doppler Sonography

The purpose of this study was to describe and evaluate the sonographic and color Doppler features of tumorlike biliary and venous changes in patients with cavernous transformation of the portal vein (CTPV).

Triple Gallbladder Preoperative Sonographic Diagnosis

Triplication of the gallbladder (GB) (vesica fellea triplex) is a rare congenital Tanomaly of the biliary tract not likely to be revealed unless there are associated symptoms. To our knowledge, only 10 cases have been reported in the literature. 1 - 1 0 The first reported case was described in a human cadaver in 1752. 1 In the most recent case, reported in 2003, triple GB was diagnosed during laparoscopy, whereas preoperative sonography failed to show the abnormality. 2 We present a case of this rare anomaly diagnosed preoperatively by sonography and endoscopic sonography confirmed on laparoscopic cholecystectomy.