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PubMed2004

Chronic pancreatitis: controversies in etiology, diagnosis and treatment.

The pathogenesis of idiopathic chronic pancreatitis remains poorly understood despite the high expectations for ascribing the pancreatic damage in affected patients to genetic defects. Mutations in the cationic trypsinogen gene, pancreatic secretory trypsin inhibitor, and the cystic fibrosis conductance regulator gene do not account for the chronic pancreatitis noted in most patients with idiopathic chronic pancreatitis. Small duct chronic pancreatitis can be best diagnosed with a hormone stimulation test. Endoscopic ultrasonography can detect abnormalities in both the parenchyma and ducts of the pancreas. The true value of endoscopic ultrasonography in diagnosing small duct chronic pancreatitis remains to be fully defined and is under active investigation. It is not clear whether endoscopic ultrasonography is more sensitive for early structural changes in patients with small duct disease or is over diagnosing chronic pancreatitis. Pancreatic enzyme supplementation with non-enteric formulation along with acid suppression (H2 blockers or proton pump inhibitors) is an effective therapy for pain in patients with small duct chronic pancreatitis. The role of endoscopic ultrasonography-guided celiac plexus block should be limited to treating those patients with chronic pancreatitis whose pain has not responded to other modalities. Total pancreatectomy followed by autologous islet cell autotransplantation appears to be potential therapeutic approach but for now should be considered experimental.

Chronic Disease↗

PubMedDate not supplied

[Role of endoscopy in the palliative therapy of pancreatic cancer].

The incidence of pancreatic cancer continues to increase and, although improving of diagnostic techniques, the prognosis is very poor with 5-year survival less than 5% and high mortality cancer rate. Neural and lymphatic micrometastases appear in early stages and curative resection is possible in few selected cases; in these patients there is a high local recurrence rate and a low median survival. Most patients with pancreatic cancer need palliative care of the obstructive jaundice (90%), duodenal stenosis and abdominal pain; endoscopic procedures have an important role in the treatment of these patients. Endoscopic placement of plastic biliary stents is a safe and efficient technique to perform a biliary drainage with a short hospital stay. The use of metal stent, instead of plastic prosthesis, improve median patency of the prosthesis with a low incidence of cholangitis, but they should be used only in patients with a life expectancy of more than six months, because of their high costs. Laparoscopic gastro-entero-anastomosis is a valid alternative to laparotomic procedure in the treatment of the duodenal stenosis, with a shorter hospital stay and a lower morbidity rate. The endoscopic treatment of abdominal pain with pancreatic endoprosthesis placement or with endosonography-guided celiac plexus neurolysis is an alternative approach to radiotherapy and analgesic drugs.

Abdominal Pain↗

PubMed1999

[Optimizing palliative therapy in pancreatic carcinoma].

Only an interdisciplinary approach between surgeon, medical oncologist and radiologist may allow the optimisation of palliative treatment for pancreatic carcinoma. If imaging diagnostics do not allow to decide about the resectability of a tumour, an explorative laparotomy should be performed, unless this is precluded by comorbidity. Due to similar morbidity and mortality, but better long-term results, a choloedocho-jejunostomy should be performed for intra-operatively unresectable tumors in favour of a cholecysto-jejunostomy. In selected patients a gastro-enterostomy may be indicated. However, this is not justified prophylactically. If imaging diagnostics show definite signs of unresectability in the absence of a gastric outlet obstruction, the treatment depends on the general condition of the patient: Insertion of a pigtail-catheter is sufficient for patients in poor general condition and a short life expectancy; metal wallstents should be preferred for patients in good general condition and a life expectancy in excess of six months, due to better results regarding quality of life. Chemoablation of the celiac plexus is an useful method to control the sever pain, which is common in these patients; radiotherapy or analgesic therapy may be used alternatively.

Anastomosis, Roux-en-Y↗

PubMed1999

Pain management of pancreatic cancer.

Quality of life is receiving increasing attention as a criterion for the assessment of treatment, not least for surgery, in pancreatic cancer. In exocrine pancreatic cancer there are three main symptoms that must be dealt with: pain, loss of weight and jaundice. All of them seriously impair quality of life, but most often pain is the most feared by the patients. Despite this, the intensity and the quality of the pain is all too often only scantly described. In 85 consecutive patients with newly diagnosed pancreatic cancer we have prospectively registered the quality and quantity of their pain and correlated it to tumor and patient characteristics. It was found that about one fourth of the patients were totally pain free and half of all suffered a pain described by two or less on a Visual Analogue Scale. Only one in ten had severe pain. Although more and more patients were treated with morphine, it was still about one third of all patients that had no or only little pain in the last part of their life. Pain had a strong correlation to survival. This may be due to secondary effects like depressing the mood of the patient and reducing the food intake, but is probably more often a reflection of that generalized cancer induces more pain. Analgesic drugs are the cornerstone of the pharmacologic management of pain due to pancreatic cancer. A significant part of the patients do well with only paracetamol and nonsteroidal antiinflammatory agents. Combining these agents with narcotic analgesics can enhance pain control while lessening the dose of narcotics. A wide range of narcotics are available as well as different modes for delivery: regular pills, slow release forms, injections, subcutaneous injections, epidural etc. Each patient's pain management should be individualized, based on the intensity of pain, the type of pain and the side effects. It is essential not only to describe the medication, but also to follow-up the development of the pain and the patient's total experience of the situation. As an alternative to narcotics, plexus celiac blocks have been used with somewhat different result; in the hands of the experts the percutaneous approach is usually sufficient, but in the hands of other also poor results are reported. During the last years thoracoscopic splanchnicectomy has been tried as a complement giving long-standing pain relief with little or no side effects in the majority of patients. With this approach the sympathetic fibers lead by the symphathetic chain and further by the nervus splanchnicus major, minor and minors are divided. The denervation is easily done and can be performed bilateraly in one seance. This method will probably be used more often as the technique is now well described.

Humans↗

PubMedDate not supplied

[Endoscopic fenestration of median supratentorial cerebrospinal fluid cysts].

Mid-supratentorial liquor cysts are a relatively rare and generally congenital abnormality of the cerebral ventricles and subdural spaces. The data and views available in the literature on rational surgical policy is contradictory. The authors' experience in treating 16 patients was used to consider whether endoscopic techniques can be employed for invasive fenestration of the cysts. The goal of surgery was to remove the masses caused by cystic malformations and their local compression of the brain via fenestration of the walls of the cysts and via communication of their cavities with the ventricles and cisterns. There were solitary cysts in all cases (arachnoidal cysts of the interpedicular cistern and the third ventricle in 9; cysts of the ventricular septum in 4, ependicular cysts of the lateral ventricle in 2, and cysts of the celiac plexus of the third ventricle in other 2 cases, in 1 cases a liquor cyst was located in the midbrain thickness). The clinical picture was characterized by a combination of hypertensive, hydrocephalic and focal symptoms of damages to the hypothalamic and thalamic structures and the adjacent formations of the brain (pyramidal and extrapyramidal disorders, ataxia, chiasmal syndrome, metabolic and endocrine disorders, etc.). In 6 cases these symptoms were persistent despite preimplanted VP anastomosis. Rigid Storz endoscopes (Germany) with an external coat, 6 mm in diameter, and a Codman fibroendoscope (USA), 4 mm in diameter, were employed. Cystic ventriculostomy and cystic ventriculocisternostomies were made in 11 and 6 patients, respectively; one patient underwent endoscopic resection of the walls of an ependymal cyst. In one patient with signs of decreased liquor resorption, endoscopic fenestration was concurrently developed into a ventricle-peritoneal anastomosis. In other 4 anastomosis-dependent patients, the preimplanted mechanically consistent bypass system was left at its site. In 2 of these cases, cystic ventriculostomy was supplemented by ventricular septal fenestration and third-ventricular bottom perforation. Twelve patients were followed up for 6 to 36.5 months (mean 15 months). There has been no information about 6 patients since their discharge. In 12 (66.5%) surgery yielded expected results and the fenestration of cystic walls was followed by their retraction and a steady-state regression of local and/or hypertensive symptoms. In 5 (28%) patients, the complaints and clinical data remained unchanged despite although incomplete but objective cystic relaxation. This was most frequently noted in patients (n = 4) with arachnoidal cysts of the interpedicular cistern and the third ventricle who had endocrine disorders. In one case the operation was stopped due to bleeding. Totally, 5 patients were found to have complications (hemorrhage, ventriculitis). None patient died. Some aspects of indications for endoscopy and surgical techniques are considered. It is concluded that endoscopic internal bypass surgery in patients wit median cystic liquor malformations is the treatment of choice. When equipment is adjusted, fenestration of the membranous walls of these cysts by using an endoscope is reliable and safe. Such patients may be recommended endoscopic technology used as the method of choice.

Adolescent↗

PubMedDate not supplied

[Selenium and its role in nutrition].

The review presents data available in the literature on the spread of selenium deficiency. Epidemiological surveys show that there is a potential risk for selenium deficiency in pregnant females and in 7-10-year-old children. The negative impact of radiation on serum selenium levels was evidenced by a survey of Chernobyl Atomic Power Station workers. Higher selenium levels in the hairs of the pubis, beard, celiac plexus, and axillary spaces than those in the hair of the head (by 1.41, 1.34, 1.36, and 1.14 times, respectively) confirm that there is a relationship between selenium and sexual hormones in the body. Dietary fiber concentrates that are derived from plant materials and contain a complex of structural carbohydrates and lignin may be used in combination with selenium compounds in human diets to prevent selenium deficiency.

Adult↗

PubMed2000

[Invasive techniques in chronic pain control].

A wide range of invasive techniques are available for pain treatment. Treatment must be adapted to the severity of the underlying disease and the intensity of pain. Very few controlled studies concerning these techniques have been performed, and it is therefore difficult to assess their short and long term efficacy. Optimal effectiveness will be obtained if the indication is correct. This non exhaustive revue presents the indications, techniques and results of neural conduction blocks as peripheral blocks, Alcock canal block, zygapophysial joint blocks and also central blocks illustrated by epidural and intrathecal injections and finally sympathetic nervous system blocks as celiac plexus block, stellate ganglion block and intravenous blocks for complex regional pain syndromes. The indications, techniques and results of thermal neurolyse (radiofrequency, thermocoagulation), transcutaneous electrical nervous stimulation (TENS) and implant central stimulation are also presented. A multidisciplinary approach is used to evaluate the risk/benefit ratio of these invasive techniques for each patient.

Catheter Ablation↗

PubMed2001

[Acute pancreatitis after resection of stomach for low duodenal ulcer].

Results of the treatment of 71 patients with postbulbar ulcer of the duodenum are presented. Stomach resection by Bilrot-II was performed in 22 (30.9%) patients, by Bilrot-I--in 2 (2.8%), by Roux with plastic reconstruction of duodenal stump with intestinal tube--in 16 (22.5%) patients. Precardial proximal vagotomy with drainage operation was performed in 31 (43.6%) patients with massive periulcerous infiltration. Acute postoperative pancreatitis (APP) was seen in 29 (40.8%) patients chiefly after resection of stomach, 6 (8.4%) of them had pancreonecrosis. Postoperative lethality in the group of patients with APP was 12.6%. Ultrasonic examination of the pancreas and its vascular structures is the main method for diagnosis of postoperative pancreatitis. The cause of APP is the mechanic deformation and spasm of major duodenal papilla (MDP) that may be associated with cholinergic denervation and edema of MDP after resection and trauma of tissues. The removal of MDP spasm is an effective prophylactic measure for elimination of pancreatic hypertension. One of the methods of removal of MDP spasm is periarterial sympathectomy of gastroduodenal artery and prolonged drug blockade of celiac plexus in addition to stomach resection.

Acute Disease↗

PubMed2001

[Chronic pancreatitis: diagnostic and therapeutic management].

NATURAL HISTORY: Alcoholism is a common cause of chronic calcifying pancreatitis. Abdominal pain, weight loss and acute complications are the early manifestations. Besides chronic pain, about 80% of the patients develop acute pancreatitis, pseudocysts, compression of the main bile duct, serous effusion or digestive bleeding during the first five years of the disease course. Painful episodes are more frequent after 5 to 10 years, with a risk of jaundice and persistent pseudocyst formation. CHRONIC COURSE: Beyond 10 years, calcified stones and fibrosis progressively replace the pancreas parenchyma. Painful events become more parse and after 15 years, diabetes and exocrine insufficiency predominate. TREATMENT: Abstention from alcoholic beverages, analgesics administration and balanced diet are essential therapeutic elements. Insulin is required for the diabetes and pancreas extracts in gastroprotected microcapsules are needed to compensate for the chronic exocrine insufficiency. This medical treatment may be able to control pain but interventional radiology (pseudocyst drainage, antalgesic infiltration of the celiac plexus), interventional endoscopy (pseudocyst drainage, biliary stent, pancreatic endoprosthesis), or surgery (deviation of the bile ducts, wirsungojejunal derivation, exceptionally resection) may also be required.

Chronic Disease↗

PubMedDate not supplied

Interventional endosonography.

Endoscopic ultrasound (EUS) has become the most accurate imaging modality for locoregional cancer staging of the gastrointestinal (GI) tract. Fine-needle aspiration (FNA) capabilities have added a whole new level of accuracy in nodal staging with reported numbers in the 90% range for luminal and pancreaticobiliary disease. In addition, new non-GI applications are being evaluated like the role of EUS-FNA for non-small cell lung carcinoma and exploration of the posterior mediastinum. Furthermore, the same capabilities that allow for safe tissue sampling are being explored for interventional applications like EUS-guided celiac plexus neurolysis and fine-needle injection. The following review describes the current clinical status of EUS in GI oncology as well as future and novel indications and therapeutic strategies for this technology.

Biopsy, Needle↗

PubMedDate not supplied

Palliative treatment in "peri"-pancreatic carcinoma: stenting or surgical therapy?

Mostly, patients with peri-pancreatic cancer (including pancreatic, ampullary and distal bile duct tumors) are diagnosed in a stage in which curative resection is not possible. The median survival rate of patients with non resectable peri-pancreatic cancer varies between 6 and 12 months. During this period palliative treatment is necessary, which should focus on major symptoms as obstructive jaundice, duodenal obstruction and pain. Controversy exists about how to provide optimal palliative treatment. Both surgical and non surgical palliative procedures relief obstructive jaundice. From early retrospective and prospective randomized studies it is known that in the early phase after treatment, more complications are found after surgical palliation, whereas in the late phase more complications are seen after endoscopic palliation. Because more recent studies clearly showed improved results after surgical palliation, current recommendations probably should be that patients with a suspected poor short-term survival (< 6 months) should be offered non surgical palliative therapy and those with a longer life expectancy may best be treated with bypass surgery. Unfortunately, valid criteria for estimating the remaining survival time are not available, except for the presence of metastases. The use of a prognostic score chart might assist in estimating the prognosis. Literature does not give sufficient information to make a well deliberated (evidence based) selection between the different types of surgical bypasses, but a choledochojejunostomy is generally preferred. After stenting, a correlation is found between survival and the development of duodenal obstruction, and between 9% and 21% of the patients who underwent a surgical biliary bypass without a prophylactic gastric bypass, will develop gastric outlet obstruction. Therefore, in patients with a relatively good prognosis it is recommended to perform routinely a double--biliary and gastric--bypass. Pain is a frequent symptom and is related with poor survival. Pain management aside from pain medication can be performed by means of a celiac plexus blockade or a thorascopic splanchnicectomy, and also radiotherapy seems to have a positive result on pain.

Cholestasis↗

PubMed2002

Anesthetic pain management in Siriraj Hospital: a retrospective review.

Neural blockade has been used as the single method to anesthetize a part of the body or used in combination with general anesthesia to lessen perioperative pain. Currently, nerve blocks are used for diagnostic, prognostic, therapeutic and prophylactic proposes for management of chronic, acute and cancer pain in a Pain Clinic. Reviewing the records of the 3,349 patients at Siriraj Pain Clinic, we found 2,662 and 687 cases had chronic and acute pain problems respectively, and only 646 patients were treated with anesthetic interventions during 1990 to 1998. They consisted of 317 male and 329 female. The techniques included stellate ganglion block, paravertebral nerve block, celiac plexus block, hypogastric plexus block, mesenteric plexus block, sacral nerve block, epidural steroid, lumbar sympathectomy, first and second thoracic sympatholysis, facet joints injection, sacroiliac joint injection, intravenous regional block with guanethidine or ketanserin, continuous opioid infusion, intravenous lidocaine infusion, and a phentolamine test. The common problems of pain included brachial plexus injury, chronic spinal pain, herpetic neuralgia, ischemic pain, central post-stroke pain, and causalgia. This retrospective review showed that 38 per cent of them reported 50 per cent pain relief with temporary effect. 34 per cent experienced good and satisfactory pain relief while 9 per cent reported excellent pain relief. 17 per cent did not gain benefit from any technique of pain relief and about 2 per cent could not be evaluated due to they did not return for follow-up. One serious complication after thoracic sympatholysis was brachial plexus injury. The neural blockade is proven to be one of the useful adjunct in the management of chronic pain but the selection of the technique is subjected to its critical appraisal.

Female↗

PubMed2002

[Intraoperative radiotherapy (IORT) for unresectable stage IVb pancreatic cancer].

We evaluated the efficacy of IORT for unresectable Stage IVb (Japan Pancreas Society classification) pancreatic cancer. Twelve patients were treated with IORT, 17 with external beam radiotherapy (ERT) and 17 with chemotherapy (CHT, 8 patients doxorubicin-based, 7 patients 5-FU-based). Survival, hospital-free survival and pain relief were compared among the three groups. In the IORT group, 7 patients underwent bypass surgery, 3 celiac plexus blockade, 3 ERT, 2 hyperthermia and 2 CHT. In the ERT group, 1 patient underwent bypass surgery, 7 hyperthermia and 14 CHT. Distant metastases were more frequently found in the CHT group than in the IORT group. Median survival and median hospital-free survival were 208 and 79 days in the IORT group, 125 and 32 days in the ERT group and 76 and 9 days in the CHT group, respectively. Pain relief was obtained in 45% (5/11) of symptomatic patients after IORT and in 27% (4/15) after ERT. No patient (0/13) in the CHT group experienced pain relief. In conclusion, our experience suggests that IORT can reduce pain and improve QOL in patients with unresectable pancreatic cancer.

Combined Modality Therapy↗

PubMedDate not supplied

[Role of the sympathetic nervous system in the formation of indomethacin-induced hemorrhage and ulceration of the stomach in albino rats].

The authors studied changes of electrical activity of the gastroduodenal smooth muscles, sympathetic efferent impulses in the postganglionic branches of the celiac plexus and macro-morphology of the gastric mucosa during the development of indomethacin gastropathies. By the end of the 3rd hour and later after the injection of the drug (15, 30 mg/kg) progressive inhibition of impulses and basal rhythm of gastric smooth muscles was encountered in intensified electrical activity of the duodenal smooth muscles, as well as destructions in the gastric mucosa even to the development of ulcers (6-24 hours). It is concluded that the development of indomethacin hemorrhages and ulcerations along with other factors is caused by excitation of the sympathetic nervous system attended by phasic changes of the sympathetic efferent impulses and electrical activity of the gastroduodenal zone.

Animals↗

PubMed2004

Endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of pancreatic masses.

Endoscopic ultrasound (EUS) represents a highly sensitive method for the detection of pancreatic masses. When available, EUS-guided fine needle aspiration (FNA) is the best technique for the diagnosis and staging of pancreatic cancer due to its ability to obtain tissue for diagnosis. The standardized indications for pancreatic EUS-FNA comprise the definite diagnosis of malignancy and histopathological confirmation of adenocarcinoma before surgical resection, chemo/radiotherapy, or celiac plexus neurolysis. The technique of performing EUS-FNA is described in detail, from the vizualization of the target lesion and adequate placement of the transducer to allow optimal needle access, to needle penetration and sampling of the targeted lesion. We report a series of 9 patients who underwent EUS-FNA and shortly review the indications, technique, results and impact of EUS-FNA on the management of these patients.

Aged↗

PubMedDate not supplied

Complications of palliative hepaticojejunostomy and gastrojejunostomy in unresectable periampullary cancer: patient- and disease-related risk factors.

BACKGROUND/AIMS: Under 20% of the patients with periampullary cancer can be treated with curative resection. When the tumor is only found to be unresectable for cure during the operation, it is generally accepted to perform hepaticojejunostomy on the jaundiced patients. Gastric emptying problems develop after laparotomy in only 7-17% of the patients with unresectable periampullary cancer, which has made the justification of prophylactic gastrojejunostomy less clear. Because the quality of life is the most important aim in palliative surgery, the risks should be minimized. The aim of our study was to evaluate the possible risk factors for the development of complications, after palliative hepaticojejunostomy and gastrojejunostomy in patients whose periampullary tumors were not found to be unresectable for cure until during the operation. METHODOLOGY: Thirty-three patients underwent routine palliative hepaticojejunostomy (Roux-Y) and gastrojejunostomy (retrocolic) and 17 (52%) underwent also operative celiac plexus blockade (50% ethanol ad 20mL both sides), when their periampullary tumor was found not resectable for cure at laparotomy. Jaundice had been relieved preoperatively in 26 (79%) patients, with an endoscopic stent (ERCP-stent) in 13 (39%) patients and with a percutaneous transhepatic drainage (PTD) in 13 (39%) patients. Gastric emptying problems were found preoperatively in 12 (36%) patients: 7 (58%) had verified partial duodenal obstruction and 5 (42%) had only vomiting without anatomical findings. Antimicrobial and antithrombotic prophylaxis was used routinely. Patients were divided into two groups: 1) complication group (n=12, 36%) and 2) no complication group (n=21, 64%). RESULTS: Hospital mortality was 0%. In the complication group the tumor diameter was more often over 4cm compared to the no complication group (10/12 vs. 7/21, p=0.007) and gastric emptying problems were more common in the complication group (7/12 vs. 5/21, p=0.02). We also found a tendency to higher preoperative alkaline phosphatase level in the complication group (mean +/- SEM, [943 +/- 201 vs. 578 +/- 84 IU/L], p=0.06). In multivariate analysis we clarified the influence of gastric emptying problems, tumor size, treatment method of preoperative jaundice (ERCP-stent, PTD), preoperative alkaline phosphatase level and age of the patient on the risk for the development of complications, and found two independent risk factors: patients with symptoms possibly relating to gastric emptying problems developed more complications (OR=6.9, p=0.002), whereas ERCP-stent seemed to protect from complications (OR=0.2, p=0.047). The risk for developing complications in patients with two positive risk factors (gastric emptying problems and unsuccessful ERCP-stent) was 67%, with one positive risk factor 50%, compared to 8% when neither of the two significant risk factors were observed. CONCLUSIONS: Gastric emptying problems and missing ERCP-stent are risk factors for developing complications in patients who undergo palliative hepaticojejunostomy and gastrojejunostomy because of periampullary cancer. These data can be utilized in patient information and when stratifying patients in future trials.

Adult↗

PubMed2004

Plasma Beta-endorphin levels before and after relief of cancer pain.

BACKGROUND: Plasma Beta endorphin (BE) is an endogenous peptide opioid derived form pro-opiomelanocortin. Although the role of plasma BE in pain regulation is unclear, plasma BE levels have been reported to correlate inversely with pain levels in cancer pain. OBJECTIVE: To measure BE levels in patients with cancer before and after pain relief with different analgesic modalities, to evaluate the relationship between cancer pain, pain control and plasma BE levels. METHODS: Prospective interventional study conducted in a university hospital setting. Patients with intractable pain due to upper abdominal visceral malignancies (pancreatic, liver and gastric cancers) agreed to participate in the study. Pain relief was provided with one of four primary modalities: 1) oral continuous release morphine, 2) thoracic epidural morphine boluses, 3) alcohol celiac plexus blocks or 4) interpleural infusions of bupivacaine. Blood samples for plasma BE levels were taken before treatment and at the time of maximal pain relief obtained with the particular treatment modality. Pain levels were determined using a 10 cm visual analogue scale. BE levels were measured by competitive radioimmunoassay using 125I Beta endorphin. RESULTS: Average pain scores decreased from 7.3 +/- 1.27 (SD) before treatment to 1.2 +/- 1.18 (SD) after treatment (p<0.0001). Satisfactory pain relief was obtained with each of the four treatment modalities and was associated with a significant increase in plasma Beta levels. The mean plasma BE level for all groups before treatment was 18.9 +/- 5.4 pg/ ml (range 2.0 to 29.6 pg/ml) compared to 38.7 +/- 17.6 pg/ml (range 13.2 to 67.9 pg/ml) after pain relief (p < 0.0001). Plasma BE levels increased with improved pain control with each of the four analgesic modalities, including oral and epidural morphine. CONCLUSION: Plasma BE levels increased with improved pain control in patients with upper abdominal gastrointestinal malignancies. Although the role of plasma BE in pain pathophysiology is unclear, it appears that pain relief per se, and not the analgesic technique, modulates plasma BE levels. This suggests that plasma BE levels may serve as an objective measure of cancer pain severity and corroborate the patient's report of pain relief.

Journal Article↗

PubMedDate not supplied

[The role of endoscopic ultrasound in digestive tract diseases in era of advanced techniques of computed tomography].

During the last 20 years endoscopic ultrasound (EUS) has been established as a highly accurate method in the diagnosis of digestive tract diseases. This method enables analysis of the lesions within the bowel wall, pancreas, and biliary system with utmost precision. Good results have also been achieved in evaluation of regional lymphadenopathy in staging of malignant diseases. Principal limitations of this method originate from its low accesibility and technical complexity which requires well trained sinologist and scientific evaluation of results in order to achieve adequate level of skill. Complications occur rarely with numbers comparable to other endoscopic procedures. With new software and hardware device introduced, computerized tomography (CT) (this refers in the first place to multidetector row CT) has been tremendously upgraded approaching the EUS in diagnostic accuracy in mentioned indications, and overcoming it in detection of distant metastases. Implementation of 3D reconstruction techniques allowed CT to enter the area of classic endoscopy, as in the case of virtual gastroscopy and/or colonoscopy. CT is a noninvasive method, very acceptable to majority of patients, and therefore popular and more prevalent compared to EUS. Although comparable in diagnostic accuracy in majority of indications, endosonography retains advance in evaluation of lesions within GI tract wall (including the early stages of carcinoma), detection of small biliary stones and small pancreatic tumors. Moreover, EUS is indespensable in therapeutic indications. Experiences with fine needle aspiration, punctions and drainage of cysts and abscesses, celiac plexus neurolysis and creation of digestive anastomosis confirm its place and value among the minimally invasive procedures which minimize the need for surgical intervention, patients' trauma and treatment costs.

Digestive System Diseases↗