Diagnostic possibilities of investigation methods in acute destructive pancreatitis

The article demonstrates the diagnostic effectiveness of clinical, laboratory and instrumental methods for the differentiation of clinical and morphological forms of acute destructive pancreatitis. The importance of such promising methods as minimally invasive multi-frequency bioimpedancemetry of the pathological focus, the crystallographic study of aspirate performed during fine-needle diagnostic puncture and differential diagnosis of exudative complications of acute destructive pancreatitis is shown. The results obtained determine the necessity of a comprehensive approach with the expansion of the diagnostic algorithm by using fine-needle diagnostic puncture. A comprehensive assessment of diagnostic methods significance can increase the effectiveness of differential diagnosis of clinical and morphological forms of destructive pancreatitis, thereby allowing to timely determinate the tactical position in the treatment of this category of patients.

Sporotrichoid dissemination of cutaneous leishmaniasis possibly triggered by a diagnostic puncture

We present the images of a cutaneous leishmaniasis with sporotrichoid dissemination in a Spanish woman who was living in Bolivia for six months. A diagnostic puncture of the ulcer could have been the trigger for the lymphatic dissemination.

MORPHOLOGICAL EVALUATION OF INTENSITY OF DYSTROPHIC CHANGES IN ILIOLUMBAR, SACRO-ILIAC AND SACROTUBERAL LIGAMENTS: POTENTIAL FOR BIOPSY

Objective: to evaluate the potential of the use of a diagnostic puncture for the analysis of intensity of dystrophic changes in ilio-lumbar, sacro-iliac, and sacro-tuberal ligaments. Material and methods. The work presents the comparison of the results of the semi-quantitative morphological evaluation (Bonar scale) of the sectional material and the material obtained during biopsy of the iliac-lumbar, sacroiliac and sacro-ligamentous ligaments from 15 corpses (the average age at death was 64.5 ± 6.5). Results. The comparison of the sectional data and biopsy data detected differences in the evaluations of intensity of dystrophic changes in the part concerning the evaluation of fibroblasts that lead to a decreased final Bonar score by 1 point. Conclusion. Biopsy material can be used for approximate evaluation of intensity of dystrophic changes according to the criteria «interstitial substance», «collagenous fibers» and «vascularization». The evaluation according to the criterion «fibroblastic programed differentiation cells» can be decreased by 1 point, which should be taken in account in the data interpretation.

Cerebrospinal fluid parameters of B cell-related activity in patients with active disease during natalizumab therapy

Recently, the disappearance of oligoclonal bands (OCBs) from the cerebrospinal fluid (CSF) of a few natalizumab-treated patients with multiple sclerosis (MS) has been reported. This is interesting since CSF-restricted OCB are believed to persist in MS. We pooled CSF data from 14 MS centers to obtain an adequate sample size for investigating the suspected changes in central nervous system (CNS)-restricted humoral immune activities in the context of natalizumab therapy. In a retrospective chart analysis, CSF parameters of blood–CSF barrier integrity and intrathecal IgG production from 73 natalizumab-treated MS patients requiring a diagnostic puncture for exclusion of progressive multifocal leukoencephalopathy were compared with CSF data obtained earlier in the course of disease before natalizumab therapy. At the time of repeat lumbar puncture, local IgG production (according to Reibergram) was significantly reduced ( p < 0.0001) and OCB had disappeared in 16% of the patients. We therefore conclude that natalizumab therapy interferes with intrathecal antibody production at least in a significant number of patients.

Suprapapillary needle puncture for common bile duct access: laboratory profile

BACKGROUD: Biliary cannulation to perform endoscopic retrograde cholangiopancreatography may be difficult due to technical reasons and often is necessary to perform papillotomy, where complications as pancreatitis and perforation may occur AIM: To show minimal complications by a new model of biliary access by means of the suprapapillary needle puncture and its laboratory profile. PATIENTS AND METHODS: After the approval of the protocol by the Scientific Ethics Committee of the institution a free and informed consent was signed by all patients participating in the study. From July 2003 to August 2004, fulfilling the inclusion and exclusion criteria, 30 patients were selected for endoscopic retrograde cholangiopancreatography, using the suprapapillary puncture technique. All patients remained hospitalized, fasting and with basal hydroelectrolytic replacement, were clinically followed up and samples for the determination of serum amylase, lipase and C-RP (C-reactive protein) were collected before and 4 h, 12 h and 24 h after the procedure and reevaluated 60 days after the procedure. Laboratory parameters were submitted to statistical study using analysis of variance for repeated measurements. Multiple comparisons were made based on Wald's statistics RESULTS: The technique was successful in 93.4% (28/30) of the patients. No statistically significant difference regarding to the laboratory profile were observed. Complications related to the technique of papillary puncture occurred in 1/28 patients by not using the guide wire and in 1/28 where mild hemorrhage after dilation of the papillary fistula occurred. Regarding complications related to therapeutic procedures, there were 2/28 retroduodenal perforations, with one (1/30) following unsuccessful puncture and another due to the passage of Dormia's basket through the dilated fistula path. All patients submitted to diagnostic puncture and evaluated 60 days after the procedure presented with the major duodenal papilla of normal aspect. The patients with dilation of the suprapapillary fistula showed the fistula continuing to drain clear bile CONCLUSION: Suprapapillary puncture allows investigative and therapeutic procedures without significant increases in amylase, lipase and C-RP. Patients submitted to diagnostic puncture present complete recovery of the papilla, while dilation of the fistula maintains it pervious later on, but without complications.

sICAM-1 in meningoencephalitis due to Angiostrongylus cantonensis

INTRODUCTION: Angiostrongylus cantonensis meningoencephalitis is an emergent disease in the Americas. METHOD: Twelve children suffering from eosinophilic meningoencephalitis due to this parasite aged between 6-10 years were studied. Cerebrospinal fluid (CSF) and serum samples were taken simultaneously in the first diagnostic puncture at admission. RESULTS: All cases showed typical findings on the routine CSF and serum analysis: increased CSF total protein, increased Q (CSF/serum) albumin accompanied by eosinophilia in CSF. No intrathecal synthesis of immunoglobulins was found. Mean serum and CSF sICAM-1 values were 337.4 and 3.97 ng/mL. Qalbumin and QsICAM-1 mean values were 4.1 and 6.2 respectively. In 50% of the patients an increased brain-derived fraction of sICAM-1 was found. CONCLUSION: It may be suggested that a dynamic of the sICAM-1 brain derived fraction is perhaps associated to the immune response in the evolution of the disease.sICAM-1 may be an agent in negative feedback for eosinophils passage through the blood-CSF barrier into the inflammatory brain response.

Ultrasound Diagnosis of Striated Muscles Pathology

Ultrasound examination of 897 patients with injuries and pathology of striated muscles was performed. Ultrasound criteria of muscle diseases and injuries were detected. The evaluation of diagnostic efficacy of ultrasound data relative to data of invasive methods (surgical interventions and diagnostic puncture) was performed. Ultrasound examination of striated muscles is showed to be a highly specific and sensitive method for diagnosis of traumatic muscle tissue lesions. Ultrasound allows to assess the hematoma volume, injury degree of muscle and diastasis length between muscle fibers; regeneration stage and developed scar of injured muscle as well as to detect cystic changes, ossificans myositis, hernia and tumor-like diseases.

Intraoral Ultrasonography in the Diagnosis of Peritonsillar Abscess

The diagnosis of quinsy is traditionally established on the basis of clinical observations and sometimes several diagnostic punctures. The present study has focused on the possible usefulness of intraoral ultrasonography (IOU) as a diagnostic tool when a peritonsillar abscess is suspected. The results show that it is possible to demonstrate, with a high degree of accuracy, the presence of an abscess, its volume, location, and its relation to the carotid artery. With this information an exact and safe diagnostic puncture can be performed when necessary and avoided in cases with clinical signs of quinsy with no abscess.