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tom 13
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nr 3
43
EN
Advances in pain treatment in patients with pancreatic cancerThe author discusses the therapeutic possibilities in pancreatic cancer. Quick and initially asymptomatic disease makes analgesic treatment according to WHO treatment guidelines ineffective. The other treatments include: percutaneous use of opioids in the form of patches, intrathecal administration of opioids, celiac plexus neurolysis and endoscopic ultrasound techniques.
PL
Autor omawia możliwości postępowania terapeutycznego w raku trzustki. Szybki i początkowo bezobjawowy przebieg choroby powoduje, że postępowanie przeciwbólowe według zaleceń terapeutycznych WHO jest często mało skuteczne. Z innych sposobów leczenia należy wymienić: przezskórne stosowanie opioidów w postaci plastrów, okołordzeniowe zastosowanie opioidów, neuroliza splotu trzewnego oraz techniki ultrasonografii endoskopowej
EN
Endoscopic ultrasonography (EUS) can differentiate between impression and submucosal tumor (SMT) but it is not known whether EUS criteria can reliably guide management.The aim of this prospective study was to assess an approach to recommend removal versus follow-up investigation based on clinical and EUS criteria, with respect to the predictive values to recognize malignancy versus benign lesions.Material and methods. Over a 7-years time period, all patients referred for the EUS assessment of submucosal upper GI lesions were prospectively enrolled. Extraluminal impressions diagnosed with EUS were not further considered. If submucosal tumors seen with EUS were clearly symptomatic or one of several parameters (tumor size >3 cm, irregular margins, inhomogeneous echotexture and/or enlarged lymph nodes) were found, resection was recommended. The remaining cases were subjected to EUS follow-up.Results. Of cases with 241 submucosal lesions, 65 had impressions and 176 had true submucosal lesions. Of the latter, 29 cases had non-neoplastic lesions (cysts, varices). In 59 cases, removal was deemed necessary due to clinical symptoms and suspicious findings in conventional endoscopy. These subjects underwent either surgical (originating layer, muscularis propria) or endoscopic resection (submucosal origin): 35.6% were malignant, more frequently in the surgical group (41.6% vs 20%). However, in 52.5% (n=31) of the 59 cases with no severe symptoms and true SMT, EUS suggested removal because of their additional criteria. Eighteen patients (12.2%) refused SMT removal and even regular EUS-based follow-up investigation. Clinical follow-up investigation by the family practitioner did not show frank malignancy in these cases (retransferal not registered). Follow-up investigation with EUS was recommended in 70 cases (mean follow-up period, 5 years; range, 1-7 years). The pattern remained unchanged in 67/70, and 2 of the 3 cases with changes underwent surgery for benign leiomyoma (patient refusal, n=1 with no change in the one-year follow-up MRI).Conclusions. An EUS strategy based on defined characteristics to remove SMT with no severe symptoms and suspicious finding in the conventional endoscopy shows a good adherence to the recommended approach and has a reasonable positive predictive value for malignancy (88%). Clinical symptoms alone or with endoscopic finding are frequently too vague to decide for a reasonable SMT resection. The chosen EUS criteria are valuable to: 1) achieve the primary resection of all potentially malignant SMT and 2) avoid to overlook them as shown by the results of the follow-up investigations with no detected malignant lesion.
3
Content available remote Role of optical techniques in combined use of selected methods of medical imaging
75%
EN
The subject matter of this paper concerns advanced techniques of imaging used in diagnosis and minimally invasive procedures applied in non-operable cases of the digestive tract tumour therapy. The role of optical techniques in current medical imaging is significant. Optical properties of transilluminated or illuminated tissues and organs depend on strong light absorption and scattering. Numerous issues related to the result interpretation still remain unsolved. Effectiveness and precision can be especially improved when some combined methods of imaging are used. Videoendoscopy imaging, X-ray imaging, and endoscopic ultrasound imaging are three complementary methods applied during the interventions described in this work. All interventions have concerned with the upper part of the digestive tract. Especially, interdisciplinary issues of combined medical imaging are presented using some examples of a modern approach to imaging of esophagus and biliary stenting. The selected examples of effects obtained during interventions assisted by combined imaging of the operation site are presented. The operator can have great control over the appearance of desirable effects as well as undesirable complications in order to work comfortably and safe.
PL
W artykule przedstawiono możliwości aplikacyjne oraz ograniczenia nowoczesnej i wciąż rozwijanej metody diagnostycznej jaką jest endoskopowa ultrasonografia (EUS), wykorzystująca dwie techniki obrazowania: wideoendoskopię i ultrasonografię. Wrowadzona za pomocą endoskopu wirująca minigłowica USG powoduje powstawanie obrazu rekonstruowanego dookoła niej, w płaszczyźnie prostopadłej do osi. Małe rozmiary sond i odpowiednie częstotliwości umożliwiają głęboką penetrację. Możliwa jest precyzyjna diagnostyka z ominięciem zakłóceń powstających przy ultrasonograficznym badaniu przez powłoki ciała. Obrazowanie EUS można zaliczyć do technik wspomagających efektywną diagnostykę i terapię on-line.
EN
The subject of the paper is devoted to a modern and still developing diagnostic method called the endoscopic ultrasonography (EUS). This method is based on two imaging techniques: videoendoscopy and ultrasonography. Rotating the USG miniprobes incorporated at the endoscope enables acquiring images vertical to an axis for the round angle area. Small diameters and adequate frequencies of these miniprobes make it possible their deep penetration. Utilization of the EUS has allowed precise diagnostics without disturbances occurring at the conventional ultrasound imaging. EUS imaging can be included into a group of techniques that make it possible to aid efficient patients diagnostics and on-line therapy.
EN
Precise evaluation of the presence of bile duct stones, performed using the most non-invasive method, is important for the planning of optimal treatment. Not only simple imaging procedures (like conventional transabdominal ultrasound – US) but also more sophisticated imaging methods (CT or MRI) are frequently unreliable. The optimal method of bile duct stone non-invasive diagnostics is magnetic resonance cholangiography. The role of endoscopic retrograde cholangiopancreatography in diagnostics has receded into the background due to the possibility of numerous serious complications. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, diagnostic endoscopic ultrasonography followed by simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis. The use of endoscopic ultrasonography allows one to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the ampulla of Vater followed by mechanical evacuation of stone deposits from the ducts still remains a the optimal procedure in the treatment of choledocholithiasis.
PL
Precyzyjna diagnostyka obecności kamicy żółciowej przewodowej, przeprowadzona możliwie najmniej inwazyjnymi metodami, jest ważna przy podejmowaniu decyzji terapeutycznych. Nie tylko proste badania (jak konwencjonalna ultrasonografia – USG), ale też bardziej wyszukane metody obrazowania (tomografia komputerowa, rezonans magnetyczny) są często zawodne. Złotym standardem nieinwazyjnej diagnostyki kamicy przewodowej jest cholangiografia rezonansu magnetycznego – cholangio MRI. Rola cholangiopankreatografii wstecznej – ECPW w diagnostyce nieco przesunęła się na dalszy plan, ze względu na możliwość licznych istotnych powikłań. Pomimo pewnych wad, takich jak potencjalnie zwiększony koszt leczenia, konieczność wykonywania zabiegu przez lekarza doświadczonego zarówno w endoskopowej cholangiopankreatografii, jak i endoskopowej ultrasonografii, najbardziej efektywnym schematem postępowania diagnostyczno-terapeutycznego w przypadku podejrzenia kamicy przewodowej jest wykonanie diagnostycznej endoskopowej ultrasonografii z następową, jednoczasową endoskopową cholangiopankreatografią celem usunięcia złogów. Zastosowanie endoskopowej ultrasonografii pozwala ograniczyć liczbę wykonywanych endoskopowych cholangiopankreatografii o ponad 2/3. Endoskopowa cholangiopankreatografia wsteczna połączona z endoskopowym nacięciem zwieracza brodawki Vatera i mechaniczną ewakuacją złogów z przewodu nadal pozostaje złotym standardem w leczeniu kamicy przewodowej.
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