Invasive Procedures For Diagnosis Research Articles

Evaluation of Imaging Techniques and Invasive Procedures in Diagnosis of Fatty Liver in Dairy Cows

Evaluation of Imaging Techniques and Invasive Procedures in Diagnosis of Fatty Liver in Dairy Cows

A cross-sectional observational study on quality assurance and radiation safety in interventional radiology

Background Interventional Radiology (IR) is anticipated to play an increasingly pivotal role in modern healthcare, providing vital minimally invasive procedures for diagnosis and treatment. As the frequency and complexity of IR procedures continue to evolve, maintaining impeccable standards in quality assurance (QA) and radiation safety becomes paramount. This study is designed to assess prevailing QA practices comprehensively, gauge adherence to forthcoming radiation safety guidelines, and proactively identify areas primed for advancement within diverse interventional radiology units. Methods Employing a prospective cross-sectional observational design on 48 health professionals, an array of healthcare facilities, each equipped with a state-of-the-art IR unit, will be purposefully selected. The study cohort will encompass diverse participants, including interventional radiologists, radiologic technologists, nurses, and medical physicists. The study will be conducted in the Acharya Vinoba Bhave Rural Hospital’s facilities equipped with interventional radiology units. Analysis will be done by using R studio version 4.3.1 by using t-test and chi-square. Expected results The anticipated quantitative data analysis will undoubtedly yield nuanced insights into the participants’ multifaceted roles, experiences, and prospective perceptions concerning QA and radiation safety practices. In equal measure, the quantitative analysis is poised to uncover recurring thematic strands about the efficacy of current QA frameworks, radiation safety protocols, and the multifarious challenges envisaged in maintaining elevated standards. Study implication As this study unfolds, it will illuminate the evolving landscape of QA and radiation safety intrinsic to interventional radiology. This study is poised to guide future practice improvement, refine training paradigms, and shape forthcoming policies within this dynamic field by casting a discerning eye on potential gaps and imminent challenges. The conclusive insights are anticipated to underscore the enduring commitment required to ensure the safety of patients and healthcare professionals, concurrently fostering the pioneering trajectory of interventional radiology procedures.

Cyfra 21.1: A Useful Tumour Marker in Pancreatic Ductal Adenocarcinoma: Cross-Sectional Study.

Pancreatic cancer is a challenging disease, often requiring invasive procedures for diagnosis. Reliable tumour markers are essential for ensuring early detection and better patient outcomes. Although Carbohydrate Antigen 19-9 is the most commonly used marker, it is marred by low predictive accuracy and high false positivity. Carcino Embryonic Antigen also has limited practical use. A novel antigen, Cytokeratin fragment 21-1, is gaining significance for its diagnostic value in various tumours. This prospective study aimed to evaluate the potential of Cytokeratin fragment 21-1 in comparison with Carbohydrate Antigen 19-9 and Carcino Embryonic Antigen in diagnosing pancreatic cancer. From January 2016 to December 2019, 45 patients with confirmed pancreatic ductal adenocarcinoma were included in this cross-sectional study. Carbohydrate Antigen 19-9 was raised in 22 patients, Carcino Embryonic Antigen was elevated in 17, and Cytokeratin fragment 21-1 was elevated in 30 cases. Carbohydrate Antigen 19-9 was found to be elevated in the presence of jaundice. Both Carbohydrate Antigen 19-9 and Cytokeratin fragment 21-1 had good correlation with stage of cancer, while Carcino Embryonic Antigen had very minimal correlation. In this study, Cytokeratin fragment 21-1 was elevated in a higher number of cases than Carbohydrate Antigen 19-9 and Carcino Embryonic Antigen. Both Cytokeratin fragment 21-1 and Carbohydrate Antigen 19-9 correlated well with cancer stage. Also Cytokeratin fragment 21-1 was not affected by jaundice, unlike Carbohydrate Antigen 19-9. Therefore, Cytokeratin fragment 21-1 has the potential to be an effective individual tumour marker in pancreatic cancer.

Infectious causes of fever of unknown origin in developing countries: An international ID-IRI study

BackgroundFever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO. MethodsA multi-center study for infectious causes of FUO in lower middle-income countries (LMIC) and low-income countries (LIC) was conducted between January 1, 2018 and January 1, 2023. In total, 15 participating centers from seven different countries provided the data, which were collected through the Infectious Diseases-International Research Initiative platform. Only adult patients with confirmed infection as the cause of FUO were included in the study. The severity parameters were quick Sequential Organ Failure Assessment (qSOFA) ≥2, intensive care unit (ICU) admission, vasopressor use, and invasive mechanical ventilation (IMV). ResultsA total of 160 patients with infectious FUO were included in the study. Overall, 148 (92.5%) patients had community-acquired infections and 12 (7.5%) had hospital-acquired infections. The most common infectious syndromes were tuberculosis (TB) (n=27, 16.9%), infective endocarditis (n=25, 15.6%), malaria (n=21, 13.1%), brucellosis (n=15, 9.4%), and typhoid fever (n=9, 5.6%). Plasmodium falciparum, Mycobacterium tuberculosis, Brucellae, Staphylococcus aureus, Salmonella typhi, and Rickettsiae were the leading infectious agents in this study. A total of 56 (35.0%) cases had invasive procedures for diagnosis. The mean qSOFA score was 0.76±0.94 {median (interquartile range [IQR]): 0 (0–1)}. ICU admission (n=26, 16.2%), vasopressor use (n=14, 8.8%), and IMV (n=10, 6.3%) were not rare. Overall, 38 (23.8%) patients had at least one of the severity parameters. The mortality rate was 15 (9.4%), and the mortality was attributable to the infection causing FUO in 12 (7.5%) patients. ConclusionsIn LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.

Liquid biopsy in combination with PET/CT versus PET/CT alone in diagnosis of lung cancer in small nodules.

3072 Background: In the National Lung Screening Trial, almost two-thirds of patients that underwent an invasive procedure for diagnosis had benign findings, suggesting a significant number of patients were exposed to risk that could be avoided. Currently, to help distinguish malignant from benign nodules, Positron Emission Tomography/Computed Tomography (PET/CT) is used. However, PET/CT can be limited in its use for lesions less than 2 cm in size. The detection of circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) in the blood stream via liquid biopsy has demonstrated potential as a non-invasive approach in both screening and diagnostic tests. The purpose of this study is to assess whether combining liquid biopsy with PET/CT findings can better detect malignancy in small lung nodules 6-20 mm in size compared to PET/CT alone, possibly allowing earlier cancer detection and reduction in unneeded invasive diagnostic testing. Methods: This was a single-center prospective observational study for which the primary objective was to compare liquid biopsy plus PET/CT to PET/CT alone for detection of lung cancer in patients with newly discovered or newly growing solid lung nodules. Patients with nodules 6-20 mm in size who were scheduled to undergo 18F-Fluorodeoxyglucose PET/CT also underwent blood collection for plasma ctDNA/cfDNA testing using an amplicon-based next-generation sequencing assay incorporating molecular barcodes for error suppression. Tumor diagnosis was based on resolution of the nodule or tissue biopsy. For liquid biopsy, a multiomic model previously built using (1) cfDNA methylation frequencies, (2) ctDNA abundance, (3) somatic ctDNA mutations, and (4) cfDNA fragment size ratio was used to predict malignancy. For imaging, lesions with a maximum standardized uptake value of 2 or greater were considered malignant. Results: Between December 2021 and November 2022, 24 patients were enrolled. Of these, 13 had a definitive diagnosis and were included in the analysis with the remainder still undergoing serial imaging follow-up. Of the 13 patients, 9 were biopsy or surgically proven to be malignant, and 4 were benign based on biopsy or resolution. The median (IQR) nodule size was 14 mm (8-15). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for PET/CT were 0.67, 1, 1, and 0.57, respectively. For multiomic liquid biopsy alone, these values were the same. However, combining multiomic liquid biopsy and PET/CT, the sensitivity, specificity, PPV, and NPV were 0.89, 1, 1, and 0.8, respectively. Conclusions: Combining multiomic liquid biopsy with PET/CT results in improved sensitivity for the detection of early-stage malignant solid lung nodules by 33% compared to PET/CT alone with no reduction in specificity. This could result in improved selection of patients requiring biopsy. Further evaluation with a larger cohort is needed to confirm the findings.

Stool Xpert MTB/RIF as a possible diagnostic alternative to sputum in Africa: a systematic review and meta-analysis.

Worldwide, COVID-19 pandemic lead to a large fall in the number of newly reported TB cases. In sub-Saharan Africa, microbiological diagnosis of TB is generally based on smear microscopy and Xpert MTB/RIF on sputum samples, but good quality sputum samples are often difficult to obtain, leading clinicians to rely on more invasive procedures for diagnosis. Aim of this study was to investigate pooled sensitivity and specificity of Xpert MTB/RIF on stool samples compared to respiratory microbiological reference standards in African countries. Four investigators independently searched PubMed, SCOPUS, and Web of Science until 12th October 2022, then screened titles and abstracts of all potentially eligible articles. The authors applied the eligibility criteria, considered the full texts. All the studies reported the data regarding true positive (TP), true negative (TN), false positive (FP) and false negative (FN). Risk of bias and applicability concerns were assessed with the Quadas-2 tool. overall, among 130 papers initially screened, we evaluated 47 works, finally including 13 papers for a total of 2,352 participants, mainly children. The mean percentage of females was 49.6%, whilst the mean percentage of patients reporting HIV was 27.7%. Pooled sensitivity for Xpert MTB/RIF assay for detecting pulmonary tuberculosis was 68.2% (95%CI: 61.1-74.7%) even if characterized by a high heterogeneity (I2=53.7%). Specificity was almost 100% (99%, 95%CI: 97-100%; I2 = 45.7%). When divided for reference standard, in the six studies using sputum and nasogastric aspirate the accuracy was optimal (AUC = 0.99, SE = 0.02), whilst in the studies using only sputum for tuberculosis detection the AUC was 0.85 (with a SE = 0.16). The most common source of bias was exclusion of enrolled patients in the analysis. Our study confirms that, in Africa, stool Xpert MTB/RIF may be a useful rule-in test for children above and below 5 years of age under evaluation for pulmonary tuberculosis. Sensitivity increased substantially when using both sputum and nasogastric aspirate as reference samples.

Effects of a Thermoelectric Element Band on Venipuncture-associated Pain and Anxiety: A Randomized Controlled Trial

Venipuncture is an invasive procedure for diagnosis and treatment, which is often attributed to pain and anxiety. In this study, a thermoelectric element (TEE) band was developed to apply heat therapy (40∼45°C), cold therapy (0∼10°C), or thermal grill illusion (TGI) therapy (40∼45°C, 0∼10°C) to cause an illusion of pain by simultaneously applying heat and cold. This band was subsequently used to investigate its effect on patient pain, anxiety, and satisfaction. This was a randomized controlled study. Participants, who were to undergo venipuncture, were randomly assigned to the heat therapy, cold therapy, TGI therapy, or control groups. Each group had 30 participants. The interventions were employed for 10seconds during venipuncture, and the pain, anxiety, and satisfaction were measured before and after the procedure. Subjective pain, anxiety, and physiological responses after TEE band intervention were not significantly different between the four groups. However, there was a significant difference in satisfaction (F=4.21, p=.007) between the four groups, and the cold therapy group showed the highest satisfaction. In this study, when heat, cold, and TGI therapy were applied with a TEE band, pain and anxiety relief effects were not confirmed, but satisfaction was high. TEE band is a newly developed product that can easily apply hot and cold treatments without using ice packs or hot water packs. Further studies with various individual characteristics of chronic pain or repeated venipuncture are warranted to evaluate the effect of TEE.

Fetal Hemodynamic Response to Anemia in Early Gestation: UsingHemoglobin Bart's Disease as a Study Model.

To assess fetal hemodynamic changes in response to anemia in early gestation, using fetal Hb Bart's disease as a study model. A prospective study was conducted on pregnancies at risk for fetal Hb Bart's disease at 12-14 weeks of gestation. Fetal hemodynamics were comprehensively assessed by 2Dultrasound, Doppler velocity, and cardio-STIC just prior to the invasive procedure for diagnosis. The various hemodynamic parameters of the affected and unaffected fetuses were compared. Of 56 fetuses at risk, 17 had Hb Bart's disease and 39 were unaffected. The right and combined ventricular cardiac outputs (CO) were significantly higher in the affected fetuses (0.993 vs. 1.358; p < 0.001 and 1.010 vs. 1.236; p < 0.001, respectively), whereas the left CO tended to be higher but not significantly (1.027 vs. 1.113; p = 0.058). Cardiac dimensions, middle-cerebral artery peak systolic velocity, Tei index, and isovolemic contraction time were significantly increased, while the global sphericity index was significantly decreased. Interestingly, cardiac preload, ventricular wall thickness, shortening fraction, isovolemic relaxation time, and fetal heart rate were unchanged. Four fetuses had hydropic changes, but all cardiac functions were normal. Fetal anemia induces hypervolemia and increases cardiac output to meet the tissue oxygen requirement, resulting in an increase in size without hypertrophy, volume load without pressure load, and a decrease in the globular sphericity index. The heart works very well but works harder, especially systolic ventricular load. Hydrops fetalis due to anemia appears not to be caused by heart failure as previously believed but rather by volume load with high vascular permeability at least in early pregnancy.

Differential expression of miRNA in histological subtype of Wilms tumor.

Wilms tumor is the most common renal malignancy in children and difficult to differentiate from other paediatric abdominal tumors radiologically, necessitating an invasive procedure for diagnosis. Previous studies have shown the potential role of miRNA as biomarkers for diagnosis, histological subtyping and prognosis. In this study, we are exploring the role of miRNA in the histological subtyping of Wilms tumor in the Indian population. A total of 15 cases of Wilms tumor were evaluated for global miRNA expression analysis by microarray. Total RNA was extracted from fresh frozen tumor and miRNA expression analysis was performed using Agilent platform. Unsupervised clustering was done to analyse the data. Using unpaired student T test, top 10 significantly differentially expressed miRNA were selected which could differentiate among different histological subtypes by unsupervised hierarchical clustering and principal component analysis. The presence of necrosis, heterologous differentiation led to change in miRNA expression profile and led to a distinct cluster formation. A panel of 5 miRNAs (miR1, 133b, 299-3p, 499a-5p, 491-3p) could differentiate among different histological subtypes of Wilms tumor, thus avoiding an invasive procedure in children, however, further confirmation using real time PCR analysis will be needed.

Duchenne Muscular Dystrophy: Genetic and Clinical Profile in the Population of Rajasthan, India.

Background:Duchenne Muscular Dystrophy (DMD) is an X-linked recessive muscular dystrophy that affects young boys and is caused by mutation of the dystrophin gene located over X chromosome.Materials and Methods:In this prospective study, 120 clinically diagnosed DMD patients were tested for exon deletions, duplication or point mutation.Results:Of the 120 clinically suspected DMD patients, the diagnosis of DMD was confirmed by the genetic study or muscle biopsy in 116 patients. The mean age of onset was 3.2 years and the mean age at presentation was 7.2 years. 110/120 cases were confirmed by genetic testing and six were by absence of staining for dystrophin on muscle biopsy. DMD gene deletion was present in 78.5%, duplication in 5.3% and point mutation in 11.2% cases. 70.3% of patients had deletion located at a distal hot spot region. Single exon deletion was found in 16.5%. Distal hotspot exons 47, 48 and 50 were the commonly deleted exons.Conclusions:In our study, 94.8% cases showed genetic change in the DMD gene. Muscle biopsy was the choice of investigation in earlier days. Detection of DMD by DNA based method eliminates the need to do an invasive procedure for diagnosis. Hence the genetic testing should be the investigation of choice in suspected cases of DMD. The pattern of deletion, obtained in the population of Rajasthan was similar when compared with other ethnic groups of the Indian population. It would be helpful for researchers to develop drugs specific to exons or for ongoing mutation-specific therapies.

DOES QUANTIFICATION OF DIFFUSION (ADC VALUE) AID IN IDENTIFYING MALIGNANT VERTEBRAL LESIONS? A CROSS SECTIONAL OBSERVATIONAL STUDY.

Background: Characterization of vertebral pathologies as benign or malignant is a frequent dilemma that often requires invasive procedures for diagnosis. Today, imaging is sufcient for diagnosis of most benign vertebral pathologies with further conrmation on response to therapy. With better understanding of diffusion characteristics of tissues, attempt is being made to assess various imaging characteristics to make a denite diagnosis of malignant lesions as well. In this study we quantied apparent diffusion coefcient (ADC) of lesions in an effort to determine whether ADC values are different for benign or malignant vertebral body lesions. Consecutive patients that reported to the department of Radiodiagnosis, during 1st November 2017 to 31st March 2019, were included in the study. In this cross sectional observational study, for 32, that is, 22 benign and ten malignant vertebral lesions, diffusion weighted (DW) MRI sequence was done and ADC values were recorded. Conrmation was done with post treatment follow up or wherever feasible, tissue diagnosis. All malignant cases had histopathology conrmation from the site of primary lesion. Quantitative variables using independent t-test were used for comparison of ADC values between two groups. Results: The difference in mean ADC values of benign and malignant lesions were statistically signicant (P&lt;0.0001). The optimal cutoff of ADC -3 2 value for differentiating benign from malignant vertebral body lesion was 0.950 x 10 mm /s with sensitivity of 80% and specicity of 95.45%. Conclusion:In all cases, DWI/ ADC, along with routine MR sequences, were able to characterize the lesion either as benign or malignant except in two cases of tubercular infection of spine and one each of spindle cell sarcoma &amp; metastasis from cancer lung where there was overlap of ADC values.

The Significance of Apolipoprotein E Measurement in the Screening of Fetal Down Syndrome.

Prenatal screening for Down syndrome (DS) is based on both noninvasive and invasive methods. Noninvasive, cell-free fetal DNA genetic tests are expensive, whereas biochemical methods remain imprecise. Amniocentesis is the most frequently used invasive diagnosis procedure, characterized by 99.8% diagnostic efficiency and less than 1% risk of miscarriage. The aim of this study was to evaluate the screening value of apolipoprotein E (ApoE) as a potential noninvasive biomarker for prenatal DS assessment. This study was conducted on a group of female patients who decided to undergo routine amniocentesis between the 15th and 18th week of pregnancy at the Department of Reproduction and Gynecological Endocrinology of the Medical University of Bialystok, Poland. For the purpose of this study, 20 women with DS fetuses were selected as the study group, and 20 healthy pregnant women with euploid fetus karyotypes as the control group. The plasma levels of ApoE were significantly higher in the study group compared to healthy subjects (p < 0.05). The area under the receiver operating characteristic (ROC) curve was 0.978 (p < 0.001), with the cut-off set to 1.37 mg/mL, which was characterized by 80% of sensitivity and 100% of specificity. The high sensitivity and specificity demonstrate the screening utility of maternal ApoE concentration in prenatal fetal DS screening.

Minimally invasive procedure for diagnosis and treatment of vallecular cysts in children: review of 156 cases.

Vallecular cyst is an uncommon but potentially life-threatening disease. The aim of this study was to review the presentation, evaluation, and treatment of vallecular cysts in children. Medical records of 156 patients treated for vallecular cysts between 2013 and 2016 were retrospectively reviewed. The patients were divided into four age groups for comparison of clinical data: A, < 1month; B, 1-6months; C, 7-12months; and D, > 1year. The median age of all patients (98 males and 58 females) was 12.1months (range 1day-11years), including 21, 86, 21, and 28 patients in group A, B, C, and D, respectively. A diagnosis of vallecular cysts was made for 135 patients using a combination of flexible laryngoscopy and ultrasound, and ten patients (all in group A) required pre-surgery ventilation support. The most common symptoms were wheezing (59.6%) and stridor (36.5%). Ten patients experienced difficulty with intubation. Endoscopic-assisted transoral coblation marsupialization was performed for all patients, combined with supraglottoplasty for 41 out of 68 patients with concurrent laryngomalacia. Patients in group D had a longer operation time and higher incidence of intraoperative bleeding, two of whom experienced post-operation recurrence, and symptoms resolved after a second operation in both cases. Flexible laryngoscopy and ultrasound are recommended for a diagnosis in suspected cases of vallecular cysts. Coblation marsupialization has advantages of minor damage, low recurrence rate, and suitability for all age groups.

Infantile Hepatic Hemangioma: Avoiding Unnecessary Invasive Procedures.

Infantile hepatic hemangioma, the most common vascular tumor of the liver in infancy, can occur with acute postnatal liver and congestive heart failure. Nevertheless, its course is often benign, and many children can be diagnosed and treated without surgical intervention. The distinction from malignant diseases is not always easy and it not clear whether invasive procedures for diagnosis and therapy should be performed. Here we report our experiences in our Center for Pediatric Liver Disease and postulate that large studies are needed to avoid unnecessary invasive procedures for these patients in the future.

Diagnostic Role of Bone Marrow Examination in Detecting Haematological and Nonhaematological Disorders

Introduction: Bone marrow study has wide application in clinical medicine. It is important test not only for diagnosis of haematological diseases but also for various systemic illnesses. The aim of this study is to determine the indications, the spectrum of haemotological and non haematological disorders diagnosed by using this procedure.&#x0D; Materials &amp; Methods: It was a prospective study comprising 152 patients who underwent bone marrow examination for evaluation of haematological and nonhaematological disorders in the Department of Haematology, Enam Medical College Hospital during the period of 2012 to 2017.&#x0D; Results: In our study male to female ratio was 1.6:1 and common age group was &gt;45years (n-65, 42.76%). Most common indications for bone marrow examination were pancytopenia (26.97%, n-41) and diagnosis of leukaemia/myeloproliferative neoplasm (25.66%, n-38). 90.13% (n-137) marrows were pathological. Non-malignant conditions were 40.79% (n-62) and malignant conditions were 49.43% (n-75). Non malignant haematological condition were 33.55% (n-51), malignant haematological conditions were 47.37% (n-72). Most common nonmalignant haematological conditions were aplastic anaemia (15.13%, n-23) and immune thrombocytopenic purpura (9.87%, n-15). Visceral leishmaniasis was found 3.29% (n-5). Acute myelogenous leukaemia (14.47%, n-22) and multiple myloma (11.18%, n-17) were the most common malignant haematological condition. Secondary deposit was found 1.97% (n-3).&#x0D; Conclusion: Bone marrow examination is a simple invasive procedure for diagnosis of both haematological and nonhaematological diseases when routine investigations failed to reach the final diagnosis.&#x0D; Medicine Today 2019 Vol.31(1): 15-18

Subcapsular Hematoma: An Unusual Complication of ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) developed in 1968 is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic disease. Complications include cholangitis, perforation, bleeding and pancreatitis. They occur in 2.5-8% of cases with mortality rates ranging 0.5-1.0%. Hepatic hematoma post ERCP is an exceedingly rare complication with only a limited number of cases described in the literature. Presented is a case of a subcapsular hematoma following ERCP. A 39-year-old female presented with acute, diffuse abdominal pain associated with non-bloody, non-bilious vomiting one day after ERCP for elevated liver tests. ERCP showed a 3cm stricture in the mid common bile duct (CBD) with proximal dilation of the biliary tree and CBD to 14mm. A 7 Fr x 7mm CBD stent was placed. Sphincterotomy was not performed. On admission, vital signs were within normal limits. Labs were significant for total bilirubin 2.4 mg/dL, alkaline phosphatase 215 U/L, AST 208 U/L, ALT 496 U/L, lipase 2730 U/L, Hgb 12.9 g/dL. CT abdomen showed a 5.8 x 5.6 x 18cm collection in relation to the right lobe of the liver concerning for subcapsular hematoma. Due to persistent abdominal pain, repeat CT was performed showing expansion now measuring 12 x 6.8 x 21cm. A right hepatic arteriogram was performed by IR revealing a pseudoaneurysm arising from a peripheral branch of the right hepatic artery that was embolized. She had ultrasound-guided drainage of the subcapsular hematoma with 500cc of blood drained. She completed 5 days of ceftriaxone and metronidazole for prophylaxis and was discharged on hospital day 8. Subcapsular hematoma is a rare complication that requires early identification and intervention. Presentation with severe abdominal pain and/or hypotension with associated nausea and/or vomiting should raise concern for a subcapsular hematoma. Symptoms often occur within the first 24 hours but can present as late as 2 weeks post-ERCP. A decreasing hemoglobin or hematocrit is the only laboratory finding that may raise suspicion in certain cases. Hematomas can occur as a result of incidental rupture of small caliber intrahepatic vessels due to advancement of the ERCP guide wire. Post ERCP diagnostic imaging consists of abdominal ultrasound, CT or MRI. In our case, due to an active bleeding vessel, embolization was warranted, but in a majority of cases conservative measures were the treatment of choice.1947_A Figure 1. CT Abdomen performed on admission showing a 5.8 x 5.6 x 18cm collection.1947_B Figure 2. CT Abdomen performed 12 hours after admission showing a 12 x 6.8 x 21cm collection.

Colorectal Liver Metastases: A Pathologist's Guide to Creating an Informative Report and Improving Patient Care.

In this era of minimally invasive procedures for diagnosis, prognosis, and treatment, pathologists are at the forefront of analyzing specimens and are expected to make more specific diagnoses, providing additional information from the material they receive. To familiarize pathologists with the essential components of surgical pathology reports for colorectal liver metastases (CRLM) resections. Colorectal cancer is the third most common cancer in the world and the liver is the most frequent site of metastases. Not all patients are candidates for surgery initially and may be treated with neoadjuvant chemotherapy, most commonly with FOLFOX (5-fluorouracil/leucovorin and oxaliplatin) and FOLFIRI (5-fluorouracil/leucovorin and irinotecan), after which they may become surgical candidates. When CRLM resections are received post neoadjuvant, the pathologist needs to not only report margin status but also report details regarding the tumor's response to treatment, and should evaluate the nonneoplastic parenchyma for chemotherapy-related injury, such as sinusoidal obstruction syndrome and/or steatohepatitis that may be caused by treatment. If ancillary tests, such as molecular studies (eg, KRAS, BRAF, NRAS, and microsatellite instability), have been previously conducted, these results should be included in the report. If not, they should be ordered for the resection specimen. In this review, we will describe strategies and practical approaches to maximize the information gained from CRLM resections. A checklist is provided that may be used while signing out these cases to remind pathologists of additional components they may wish to include in their reports to best guide patient management.

Glutamatergic disturbance after arthroscopy in the non- elderly patients with or without chronic pain: a magnetic resonance spectroscopy study

Objective Patients with joint disease are often plagued by chronic pain and arthroscopy is an effective and minimally invasive procedure for diagnosis and treatment. But long- term painful torture may cause the change for brain structure and function. This study sought to evaluate the effect of long- term pain on brain metabolism. Methods This study was a prospective cohort study performed between August 2016 and December 2016. Patients were subjected to arthroscopic surgery for joint diseases. A visual analog scale (VAS) was used to measure pain intensity. The magnetic resonance spectroscopy (MRS) was used to identify the concentration of neuro- metabolites in the periaqueductal gray (PAG) and medial prefrontal cortex (mPFC) before and after arthroscopies. Results Eight patients with chronic pain and 7 without chronic pain were enrolled. The mean age was 32 years ole. In the patients with chronic pain, glutamic acid and glutamine (Glx) in PAG were elevated after operation (1.64±0.46 vs. 1.22±0.23). The patients with chronic pain had a higher post- operation Glx of PAG than controls (1.64±0.46 vs. 1.21±0.19). Conclusion There was a glutamatergic disturbance after arthroscopy in the non- elderly patients with chronic pain. Key words: Chronic pain; Arthroscopy; Joint disease; Magnetic resonance spectroscopy; Periaqueductal gray

Fine needle aspiration cytology of cervical lymph nodes: Our experience

Background: Fine Needle Aspiration Cytology (FNAC) is simple, quick, inexpensive and minimally invasive technique used to diagnose different types of swellings located in the head and neck.Methods: A prospective study was performed in a tertiary health care centre from January 2016 to September 2016 in Vadodara, Gujarat. Fine Needle Aspiration Diagnosis was correlated with detail of relevant clinical findings and investigation.Results: In this study, total of 260 cases of suspected cervical lymphadneopathy were subjected to cytological evaluation. The lesions cases were broadly categorised as inflammatory lesions, cystic lesions, benign tumor &amp; tumor like conditions, salivary gland lesions and malignant lesions. Out of these 260 cases, 184 cases were given the diagnosis of either inflammatory or benign conditions and rest 76 cases were diagnosed positive for malignancy. Out of 76 cases positive for malignancy, 65 cases gave the diagnosis of Squamous cell carcinoma metastasing to lymphnode.Conclusion: Fine Needle Aspiration Cytology is easy, simple, safe and non invasive procedure for diagnosis of head and neck swelling and easy way for surgeon whether to decide surgery or not. DOI: 10.21276/APALM.1197

Rationale of Using Dynamic Imaging for Characterization of Suspicious Lung Masses into Benign or Malignant on Contrast Enhanced Multi Detector Computed Tomography.

Objectives:To assess the utility of dynamic imaging namely, wash-in and wash-out characteristics through multidetector contrast-enhanced computed tomography in differentiating benign and malignant pulmonary masses.Materials and Methods:Seventy-three patients who were suspected to have malignant pulmonary mass on the basis of clinical symptoms and chest radiograph were included in the study. All the patients underwent multidetector computed tomography scanning, and three series of images were obtained for each patient-noncontrast, early enhanced, and 15 min delayed enhanced scans. Computed tomography (CT) findings were assessed in terms of washin, absolute, and relative percentage washout of contrast. Biopsy of the mass was done and sent for histopathological evaluation. Sensitivity, specificity, and area under curve for diagnosing malignancy in the lung masses were calculated by considering both the wash-in and wash-out characteristics at dynamic CT and plotting the receiver operating curve after the final diagnosis which was obtained by histopathological evaluation.Results:Threshold net enhancement (washin) value of >22.5 HU had sensitivity, specificity, and diagnostic accuracy of 88.5%, 57.1%, and 82%, respectively, in predicting malignancy. Threshold relative percentage washout of <16.235% had 98.1%, 85.7%, and 94% sensitivity, specificity, and diagnostic accuracy, respectively, and threshold absolute percentage washout of <42.72% had 98.1%, 95.2%, and 95% sensitivity, specificity, and diagnostic accuracy, respectively, in predicting malignancy.Conclusion:Threshold net enhancement (washin), absolute and relative washout percentages can be used to predict malignancy with very high diagnostic yield, and possibly obviate the need of invasive procedures for diagnosis of bronchogenic carcinoma.