AIM: To determine if a new brush design could im-prove the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography proce...AIM: To determine if a new brush design could im-prove the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to proto-col implementation in July 2011, after which, a new 9 French wire-guided cytology brush(Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pa-thologists who determined whether the sample waspositive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen. RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular find-ings consistent with malignancy as compared to 17 of 46(37%) in the historical control group(P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes(21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to his-torical controls. CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased di-agnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clus-ters obtained.展开更多
肿瘤化疗相关性血小板减少症(chemotherapy-induced thrombocytopenia,CIT)是化疗药物常见的剂量限制性不良反应,患者化疗后骨髓抑制可能引起血小板计数减少,增加出血风险,严重者出现内脏器官出血、脑出血等,甚至危及生命。所以,如何高...肿瘤化疗相关性血小板减少症(chemotherapy-induced thrombocytopenia,CIT)是化疗药物常见的剂量限制性不良反应,患者化疗后骨髓抑制可能引起血小板计数减少,增加出血风险,严重者出现内脏器官出血、脑出血等,甚至危及生命。所以,如何高效且安全地处理CIT是临床实践中的重要挑战。我们收治了1例66岁卵巢癌患者,术后化疗反复出现血小板减少,前期应用IL-11和重组人促血小板生成素(recombinant human thrombopoietin,rhTPO)治疗后血小板恢复正常水平。第6疗程化疗后第3周血小板再次持续减少,IL-11、rhTPO治疗后血小板水平无明显恢复。加用血小板生成素受体激动剂艾曲波帕1月后血小板水平仍未见明显恢复,但转氨酶升高,改用阿伐曲泊帕治疗,血小板恢复至正常水平,且未再出现不良反应。提示阿伐曲泊帕为CIT患者提供了新的治疗选择,疗效确切且安全,值得临床医生参考。展开更多
文摘AIM: To determine if a new brush design could im-prove the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to proto-col implementation in July 2011, after which, a new 9 French wire-guided cytology brush(Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pa-thologists who determined whether the sample waspositive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen. RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular find-ings consistent with malignancy as compared to 17 of 46(37%) in the historical control group(P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes(21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to his-torical controls. CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased di-agnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clus-ters obtained.
文摘肿瘤化疗相关性血小板减少症(chemotherapy-induced thrombocytopenia,CIT)是化疗药物常见的剂量限制性不良反应,患者化疗后骨髓抑制可能引起血小板计数减少,增加出血风险,严重者出现内脏器官出血、脑出血等,甚至危及生命。所以,如何高效且安全地处理CIT是临床实践中的重要挑战。我们收治了1例66岁卵巢癌患者,术后化疗反复出现血小板减少,前期应用IL-11和重组人促血小板生成素(recombinant human thrombopoietin,rhTPO)治疗后血小板恢复正常水平。第6疗程化疗后第3周血小板再次持续减少,IL-11、rhTPO治疗后血小板水平无明显恢复。加用血小板生成素受体激动剂艾曲波帕1月后血小板水平仍未见明显恢复,但转氨酶升高,改用阿伐曲泊帕治疗,血小板恢复至正常水平,且未再出现不良反应。提示阿伐曲泊帕为CIT患者提供了新的治疗选择,疗效确切且安全,值得临床医生参考。
