Clinical diagnosis and treatment of primary small intestinal lymphoma

Objective: To report experiences in the diagnosis and treatment of primary lymphoma of the small intestine (PSIL). Method: The clinical data of 15 patients with PSIL treated from January 2015 to July 2019 at Guangzhou First People’s Hospital were investigated retrospectively. Among the 15 patients, 9 were male, and 6 were female, with ages ranging from 18 to 73 years, with a median age of 51.6 years. Data relating to gender, age, clinical manifestation, laboratory examination, imaging, diagnosis, and treatment of the patients were reviewed. Results: The most common clinical manifestations were abdominal pain, abdominal lump, bowel obstruction, gastrointestinal hemorrhage, and athrepsy. Serum tumor markers were checked and found to be normal. In all 15 cases, tumors were found by spiral computed tomography (CT), and 12 cases were diagnosed as PSIL. Eleven cases were given barium meal examinations, and positive results were found in 4 cases, with only 1 case considered to be PSIL. All 15 patients underwent surgery. All patients were diagnosed as having nonHodgkin lymphoma by postoperative pathology (8 patients with diffuse large B-cell lymphoma, 5 with mucosa associated lymphoid tissue type B-cell lymphoma and 2 with enteropathy-type intestinal T-cell lymphoma). There were no cases of perioperative deaths. Ten patients received adjuvant chemotherapy with the CHOP (cyclophosphamide, epirubicin, vincristine, and prednisone) regimen after the operation. Fourteen cases were followed up for a mean duration of 30 months (range of 6-52 months). The 1- and 3-year survival rates were 85.7% and 57.1%, respectively. Conclusions: PSIL has no specific clinical manifestations. The diagnostic rate with barium study is low, whereas spiral CT is a promising diagnostic method for PSIL. Surgery combined with chemotherapy is important for the treatment of PSIL

Clinicopathological Study of the Biliary and Duodenal Complications in Patients of Chronic Pancreatitis - A Prospective Observational Study in a Tertiary Care Centre in Eastern India

BACKGROUND Chronic pancreatitis is a chronic inflammatory disease, causing complications related to the duodenum like duodenal obstruction or complications related to the biliary system like cholestasis, cholangitis, secondary biliary cirrhosis and cholangiocarcinoma. The purpose of the study was to observe the occurrence, clinical manifestations and outcome of the complications and foster a deeper understanding of the long-term prognosis of patients suffering from chronic pancreatitis. METHODS This was a prospective observational study. After taking informed consent, total 50 patients admitted in hospital with features suggestive of chronic pancreatitis with or without duodenal or biliary complications were selected and were followed up throughout the course of the disease. All demographic parameters, diabetic status, liver function test, USG findings suggestive of duodenal obstruction or biliary abnormalities, upper GI endoscopy, computed tomography of whole abdomen, MR cholangio pancreatography and barium meal were studied. RESULTS Chronic pancreatitis is more common in male and the common age of presentation is between 45 and 54 years. 12 patients were diabetics. 42 % of the total 50 patients developed transient hyperbilirubinaemia. 5 male patients and 1 female patient had persistent hyperbilirubinaemia and had persistently raised values of alkaline phosphatase. 1 male and 2 female patients also suffered from hypoproteinaemia. About 42 % of the patients of chronic pancreatitis suffered from transient rise in conjugated bilirubin and were managed conservatively. 12 % of the patients suffered from persistently raised conjugated bilirubin, indicating biliary obstruction. 22 % of patients developed cholangitis responding to conservative management. 12 % of cases, 5 males and 1 female suffered from biliary stricture, and were managed surgically with hepaticojejunostomy. No cases of cholangiocarcinoma were detected. CONCLUSIONS The most common complication in patients of chronic pancreatitis is transient biliary stasis, others being cholangitis and persistent hyperbilirubinaemia. No cases of cholangiocarcinoma were detected. KEYWORDS Billiary, Duodenal, Complications, Stricture, Cholestasis, Cholangitis, Chronic, Pancreatitis

Estimation of the Effective Doses from Typical Fluoroscopic Examinations with Barium Contrast

The current study aimed to estimate the effective doses and conversion coefficients (CCs) for typical barium swallow (BS), barium meal (BM) and barium enema (BE) protocols and to evaluate the impact of different examination parameters on the resulting CCs. Data were collected in surgical and therapy departments in St. Petersburg Urban Mariinsky Hospital. Computational models were developed using PCXMC 2.0 software. CCs (μSv × μGy−1 × m−2) were estimated, as follows, for over couch and under couch exposure geometries, respectively: 2.3 and 1.7 for BS (surgical department); 2.4 and 2.0 for BM (surgical department); 2.6 and 2.1 for BE (surgical department) 2.5 and 3.8 for BM (therapy department). The effective doses and CCs are mainly influenced by the combination of different fluoroscopic series and X-ray images taken in different projections, the irradiation field size and the energy characteristics of the X-ray beam.

Dynamic Recognition and Tracking of Barium Flow Field Based on Deglutition Video

Dynamic fluoroscopy was used to study swallowing in 84 adult patients. We proposed a method to extract the barium contrast region by improved interframe difference method, and to indirectly determine the position of epigmatous cartilage and cricopharyngeal muscle according to the location of barium meal. The method is easy to understand, and the extraction effect is good, with 85% probability of successful extraction. On the other hand, in order to evaluate the degree of deglutition difficulty, we used calculation to evaluate variables including displacement, duration, residual quantity, etc., except that there were gender differences in variables and external factors, such as illumination, most of the measurement variables had very good reliability. The experimental results showed that the moving target fluid barium was extracted by quantifying dynamic fluorescence deglutition and using gaussian based background subtraction algorithm. We conclude that this approach significantly reduces the time it takes clinicians to examine moving images. This paper describes how to study swallowing disorders by X-ray barium fluoroscopy, explains the application of interframe difference algorithm and background subtraction in deglutiography, and extracts the residual amounts in three locations: oral cavity, epiglottic cartilage and piriform fosse.

CLINICAL STUDY AND MANAGEMENT OF PSEUDOPANCREATIC CYST

Introduction: The pseudocysts present clinically as epigastric pain, abdominal masses to jaundice. Radiology helps in the diagnosis of the pseudocysts with the help of USG, CT scan, MRI, etc. These investigations govern the therapeutic procedures to be carried out. Aims and objectives: To understand the epidemiology of pancreatic pseudocysts. To analyze the various treatment modalities that can be utilized in the management of the pancreatic pseudocysts. To compare USG guided per-cutaneous aspiration with the other treatment options available in terms of patient and physician factors. Materials and methods: Data was collected from patients who came to Konaseema Institute of Medical Sciences & Research Institute for treatment. Patients diagnosed as pseudopancreatic cyst with help of diagnostic procedure like USG abdomen, Barium meal, if required CT scan Abdomen and admitted patients of both sex and all age groups were included in the study. Results: Commonest treatment was Internal drainage in 50% of the patients followed by conservative management in 36.66% of patients, external catheter drainage was done in 13.33% of the patients. Immediate postoperative pain was present in 16.66% of patients and wound infection in 13.3%. Conclusion: Acute Pancreatic pseudocysts were treated conservatively, infected cysts and ruptured cyst required external drainage.

Analysis of the Value of Laparoscopy Combined with Right Thoracic Small Incision Ivor-Lewis in the Treatment of Cardia Cancer Under X-ray Biomedical Imaging

In order to explore the accuracy of image segmentation algorithm in the biological image segmentation of cardia cancer patients with X-ray barium meal imaging and the effect of laparoscopy combined with right thoracic small incision Ivor Lewis on the prognosis of patients with cardia cancer, 185 patients diagnosed with cardiac cancer in xxx hospital from June 2015 to December 2018 were taken as research objects. Based on X-ray barium meal images, the efficiency of manual segmentation and the proposed watershed based minimum error threshold algorithm for image segmentation was compared. Based on the segmentation results, 185 patients with cardiac cancer were divided into the control group (n = 105) and the test group (n = 80), and the control group received traditional Ivor Lewis surgery, while the test group received laparoscopic Ivor Lewis surgery combined with a small incision in the right chest. Postoperative comparison was made between the two groups of patients on the 3rd day after the operation in the number of lymph node dissection, the incidence of postoperative complications, and the pain score 24 h after the operation. The results showed that the minimum error threshold algorithm based on watershed presented in this study was significantly more accurate than manual segmentation in the segmentation of X-ray barium meal images of cardiac cancer patients. The intraoperative blood loss, postoperative out-of-bed activity time and hospitalization time of the experimental group were significantly lower than that of the control group, and the differences were statistically significant (P < 0.05). The complication rates of postoperative chest drainage volume, postoperative 24 h pain score, postoperative pulmonary infection, bleeding and anastomotic fistula in the 2 d test group were all lower than those in the control group, and the differences were statistically significant (P < 0.05), which indicated that the watershed based minimum error threshold algorithm proposed in this study can effectively achieve the segmentation of X-ray barium meal images of patients with cardiac cancer, while the laparoscopy combined with the right thoracic small incision Ivor Lewis can effectively improve the quality of life of patients.

Type B congenital pyloric atresia: a case report

This is a case of congenital pyloric atresia type B not associated with any other anomaly rare condition, seen as an isolated anomaly with excellent prognosis) of two days female child presenting with vomiting since birth. X-ray abdomen showed only stomach air bubble, sonography showed distended stomach with echoes and on barium meal no passage of contrast was seen beyond pyloric antrum even after 24 hours. Patient underwent Heineke-Mikulicz pyloroplasty and postoperative recovery was uneventful.

A Clinical Randomized Controlled Trial of Acupuncture Treatment of Gastroparesis Using Different Acupoints

Objective. To explore the effect of “selecting acupoints by site” on the synergy effect of “acupoint compatibility” according to the clinical efficacy of acupuncture treatment of patients with gastroparesis. Methods. A total of 99 patients who met the diagnostic criteria for gastroparesis were enrolled in 3 clinical centers and randomly divided into group A (33 cases), group B (33 cases, 1 case of shedding), and group C (33 cases, 1 case of shedding). In group A, acupuncture was performed at Zhongwan (CV 12) and Zusanli (ST 36); in group B, acupuncture was performed at Neiguan (PC 6) and Zusanli (ST 36); in group C, acupuncture was performed at nonacupoint and Zusanli (ST 36). Treatment was performed for 30 minutes every day, 5 days as a course of treatment. There were 2 days off between courses and three courses in total. Differences in a main symptom index of gastroparesis (GCSI) scores, 9 symptom scores, and a health questionnaire (SF-36) were compared between each group before and after treatment and 4 weeks after the end of treatment. The difference of gastric emptying rate was compared before and after treatment. Results. The GCSI scores of each group after treatment and at follow-up were significantly lower than those before treatment (P<0.01), and the reduction in group A was greater than that of groups B and C (P<0.01). The score of each symptom was meaningfully lower than that before treatment (P<0.01 or P<0.05). The effect was best in group A, followed by group B. After treatment, the barium meal in the stomach of the three groups was significantly reduced compared with before treatment (P<0.01). There was no statistical difference between the groups. The results of SF-36 showed that acupuncture treatment can improve health status, to a certain extent, and there was no significant difference in the three groups. Conclusion. (1) Acupuncture is an effective method for the treatment of gastroparesis. (2) The combination of Zhongwan (CV 12) with Zusanli (ST 36) showed the most promising effect on relief of the symptoms in patients with gastroparesis. (3) “Selecting acupoints by site” is the key factor affecting the synergy effect of “acupoint compatibility.” This trial was registered with the International Center for Clinical Trials (registration no. NCT02594397).

Surgical management of abdominal tuberculosis in a tertiary care referral center

Background: Abdominal tuberculosis encompasses gastrointestinal, visceral and peritoneal forms of tuberculosis in different proportions. Their clinical presentation and radiological findings are varied and non-specific often warranting surgical intervention either for confirmation of diagnosis or for definitive management. It is not very clear as of now as to which type of patients would require surgical intervention for diagnosis or treatment of abdominal tuberculosis. This study aims to profile such patients accurately to revalidate the need for surgical intervention in cases of abdominal tuberculosis.Methods: This study is a retrospective descriptive observational study wherein the documents of patients whose final diagnosis was confirmed as ‘Abdominal Tuberculosis’ from January 2011 to December 2013 were analysed. Their demographic and clinical profile, hematological, biochemical and radiological investigations including barium meal follow-through, ultrasonography, CT scan abdomen, colonoscopy and biopsy, HIV status and ascitic fluid analysis were analysed. Patients in whom diagnosis was not confirmed by these investigations, and therefore underwent diagnostic laparoscopy or exploratory laparotomy were studied. Simultaneously, patients in whom, the diagnosis was confirmed, but still underwent surgical intervention for therapeutic purposes were also analysed.Results: It was found that 44 out of 54 patients (81.4%) underwent surgical procedure. 28 (52%) required surgical intervention for confirmation of diagnosis (diagnostic procedures: diagnostic laparoscopy- 21 and exploratory laparotomy- 07) while 16 (29.4%) required therapeutic procedures (emergency- 08; elective- 08).Conclusions: In spite of extensive investigations, many patients of abdominal tuberculosis require surgical management either minimally invasive or otherwise, both for confirmation of diagnosis and for definitive management.