- Metastatic Cecal Adenocarcinoma to the Gallbladder Presenting with Acute Cholecystitis. [Journal Article]
- CRCase Rep Oncol Med 2018; 2018:5308585
- Colorectal cancer (CRC) is one of the most common cancers and the second highest cause of cancer-related deaths (Jemal et al., 2011). Common presentations of CRC include alterations in bowel habit, w...
Colorectal cancer (CRC) is one of the most common cancers and the second highest cause of cancer-related deaths (Jemal et al., 2011). Common presentations of CRC include alterations in bowel habit, weight loss, and lower gastrointestinal bleeding. We report a case of a 74-year-old male who presented with fever and right upper quadrant pain, with positive Murphy's sign on examination. The case was initially managed with a routine cholecystectomy. Histological examination revealed a moderately differentiated adenocarcinoma with a superimposed histologically proven acute acalculous cholecystitis. CT scan done postsurgery showed a cecal mass with retroperitoneal lymphadenopathy. Biopsy result of cecal mass was remarkable for colon adenocarcinoma. We are not aware of any similar prior cases reported in English literature.
- Evaluation of abdominal aortic aneurysm in patients with nonvariceal upper gastrointestinal hemorrhage. [Letter]
- AJAm J Emerg Med 2018 Nov 07
- Acute esophageal necrosis (black esophagus) complicating calcific uremic arteriolopathy . [Journal Article]
- CNClin Nephrol 2018 Nov 12
- The current case report describes a chronic hemodialysis patient presenting with painful penile ulceration that was clinically and histologically proven to be related to calcific uremic arteriolopath...
The current case report describes a chronic hemodialysis patient presenting with painful penile ulceration that was clinically and histologically proven to be related to calcific uremic arteriolopathy. The patient subsequently developed severe upper gastrointestinal bleeding that was both endoscopically and histologically shown to be due to acute esophageal necrosis (AEN), also known as necrotizing esophagitis and "black esophagus". AEN is a rare condition characterized by diffuse necrosis of the esophageal mucosa. The condition is diagnosed endoscopically with demonstration of circumferential mucosal necrosis involving the distal esophagus that can extend proximally. Mortality rates for both calcific uremic ateriolopathy and acute esophageal necrosis are high. Management of both conditions is reviewed. The patient recovered from the acute illness, but expired 6 months later due to progressive failure to thrive. To our knowledge, AEN has not previously been described secondary to calcific uremic arteriolopathy. .
- First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study. [Journal Article]
- EIEndosc Int Open 2018; 6(11):E1317-E1321
- Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limit...
Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients. Patients and methods This was a retrospective analysis of prospectively collected databases including all patients with UGIB and LGIB who underwent OTCS placement as first-line treatment in eleven tertiary endoscopic referral centers. Technical success, primary hemostasis, rebleeding, blood transfusion, hospital stay, and hemorrhage-related mortality rates were evaluated. Results Data from 286 patients, with either UGIB (N = 214) or LGIB (N = 72) were available. Overall, 112 patients (39.2 %) were receiving antithrombotic therapy. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early rebleeding occurred in 4.4 %, more frequently in those on antithrombotic therapy, and no late rebleeding was observed. Following a successful primary haemostasis, only 5.2 % patients needed blood transfusions, and the median hospital stay was 4 days (range: 3 - 11). Eighteen patients with either technical failure (N = 6) or rebleeding (N = 12) underwent radiological or surgical approaches. Overall, bleeding-related deaths occurred in 5 (1.7 %) patients, including 3 patients with technical procedural failure, and 2 in the rebleeding group. Conclusions Data from our large, multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients and/or lesions both in upper and lower gastrointestinal tract.
- Massive Spontaneous Hemothorax as a Complication of Apixaban Treatment. [Journal Article]
- CRCase Rep Pulmonol 2018; 2018:8735036
- CONCLUSIONS: Spontaneous hemothorax is a rare complication of anticoagulant therapy and might not exhibit the usual radiological signs of traumatic hemothorax. Health care providers should have high index of suspicion for spontaneous hemothorax when evaluating new pleural effusion in patients receiving DOACs therapy. Drainage by small bore pigtail catheter might be as effective as larger chest tubes.
- Massive Gastrointestinal Bleeding from Choriocarcinoma of the Ovary. [Journal Article]
- OMOman Med J 2018; 33(6):527-530
- Choriocarcinoma of the ovary is a rare neoplasm and tends to metastasize early to involve the lungs, brain, and liver. Metastasis to the gastrointestinal tract is rare. We report the case of a young ...
Choriocarcinoma of the ovary is a rare neoplasm and tends to metastasize early to involve the lungs, brain, and liver. Metastasis to the gastrointestinal tract is rare. We report the case of a young lady, who presented with life-threatening gastrointestinal bleeding, secondary to jejunal involvement. The site of bleeding was localized using a computed tomography angiogram following inconclusive upper and lower gastrointestinal endoscopies. The bleeding jejunal segment was resected and the metastatic disease responded to combination chemotherapy. Metastatic choriocarcinoma of the ovary should be considered a possible diagnosis in patients presenting with gastrointestinal bleeding.
- Is it Possible to Implant HeartMate 3 Less Invasively? New Pump, New Approach. [Journal Article]
- AOArtif Organs 2018 Nov 04
- HeartMate 3 (HM3) left ventricular assist device (LVAD) is a compact, intrapericardial, centrifugal flow pump with a fully magnetically levitated rotor and a wide range of operation (2-10 L/min) to a...
HeartMate 3 (HM3) left ventricular assist device (LVAD) is a compact, intrapericardial, centrifugal flow pump with a fully magnetically levitated rotor and a wide range of operation (2-10 L/min) to accommodate a broad range of clinical needs. We analyzed our experience with Heartware VAD (HVAD) and HM3 implantation through minimally invasive left thoracotomy (MILT) and upper minimal J sternotomy. Between March 2015 and October 2016, 31 patients who underwent LVAD implantation through MILT were included in this study. Twenty-three patients had HVAD (Group A) implantation, whereas 8 patients had HM3 (Group B). To compare outcomes of these pumps, measures were; mortality, cardiopulmonary bypass (CPB) time, duration of mechanical ventilatory support, blood loss and transfusion, intensive care unit (ICU) stay, right ventricular failure (RVF) and requirement of support with temporary devices, stroke, pump thrombosis, gastrointestinal bleeding and driveline infection rates. Interagency Registry for Mechanically Assisted Circulatory Support profiles, Pennsylvania and Michigan Risk Scores, right ventricular stroke work index and central venous pressure/pulmonary capillary wedge pressure ratio did not differ between these two groups. There was no difference in the length of ICU stay (P = 0.056), post-operative blood product administration (P = 0.701), total time on mechanical ventilation (P = 0.386), RVF (P = 1) or duration of CPB (P = 0.836). In-hospital cerebrovascular event rate was 13% in Group A and 0% in Group B, respectively. The HM3 assist system can be successfully implanted with minimally invasive techniques. This technique has proved to be safe and reproducible, with good clinical outcomes. Further, large collaborative studies are needed to identify the advantages of this approach.
- Outcomes and Predictors of Readmissions with GI Bleeding in Patients with Left Ventricular Assist Devices. [Journal Article]
- SMSouth Med J 2018; 111(11):666-673
- CONCLUSIONS: After LVAD implantation, there is a fivefold increased risk of readmission with GI bleeding within 60 days. Gastroduodenal and small intestinal arteriovenous malformations are the most common culprit lesions. These findings suggest that small bowel enteroscopy should be considered as the initial test of choice in patients with suspected upper gastroduodenal bleeding. Readmissions with bleeding in patients with LVADs increase morbidity and cost of care but not mortality. Older patients and those with a history of bleeding during LVAD implantation are at higher risk of bleeding readmission and may benefit from close monitoring and cautious anticoagulation to prevent rebleeding.
- Risk factors of upper gastrointestinal hemorrhage with acute coronary syndrome: A nested case-control study. [Journal Article]
- AJAm J Emerg Med 2018 Jun 24
- CONCLUSIONS: History of diabetes, vasopressin or terlipressin use, smoking, liver cirrhosis, hemoglobin level and history of ACS are risk factors to develop ACS in elderly patients with UGH. Importantly, diabetes, smoking and lower hemoglobin level are key variables for mortality.
New Search Next
- Carvedilol versus traditional, non-selective beta-blockers for adults with cirrhosis and gastroesophageal varices. [Review]
- CDCochrane Database Syst Rev 2018 Oct 29; 10:CD011510
- CONCLUSIONS: We found no clear beneficial or harmful effects of carvedilol versus traditional, non-selective beta-blockers on mortality, upper gastrointestinal bleeding, serious or non-serious adverse events despite the fact that carvedilol was more effective at reducing the hepatic venous pressure gradient. However, the evidence was of low or very low quality, and hence the findings are uncertain. Additional evidence is required from adequately powered, long-term, double-blind, randomised clinical trials, which evaluate both clinical and haemodynamic outcomes.