- A Retrospective Analysis of Cyanoacrylate Injection versus Hemoclip Placement for Bleeding Dieulafoy's Lesion in Duodenum. [Journal Article]
- GRGastroenterol Res Pract 2018; 2018:3208690
- CONCLUSIONS: Both cyanoacrylate injection and hemoclip placement are effective in treating duodenal DL, and neither of them causes significant side effects.
- Intestinal Spirochetosis in an Immunocompetent Patient. [Journal Article]
- CCureus 2018 Mar 15; 10(3):e2328
- Intestinal spirochetosis (IS) is an infestation defined by the presence of spirochetes on the surface of the colonic mucosa. The implicated organisms can be Brachyspiraaalborgior Brachyspirapilosicol...
Intestinal spirochetosis (IS) is an infestation defined by the presence of spirochetes on the surface of the colonic mucosa. The implicated organisms can be Brachyspiraaalborgior Brachyspirapilosicoli. We present the case of a 66-year-old man with a past medical history of diabetes mellitus, hypertension, morbid obesity, and gastroesophageal reflux. The patient was sent to the gastroenterology clinic for a screening colonoscopy due to a prior history of colonic polyps. The patient was completely asymptomatic as he denies any abdominal pain, diarrhea, melena, or hematochezia. A colonoscopy was done showing colitis in the cecum and at the ileocecal valve, for which random biopsies were taken in the terminal ileum, cecum, and ascending colon. The histopathology result was positive for spirochetosis. Due to this finding, the patient was referred to the infectious diseases clinic, where a rapid plasma reagin (RPR) and human immunodeficiency virus (HIV) tests were found to be negative. Since the patient was immunocompetent and asymptomatic, it was decided to monitor and not initiate antibiotic treatment. Human IS are not related to non-intestinal spirochetes like Treponema pallidum. An infection of T. pallidum leads to a malignant picture called syphilitic proctitis and appears in the setting of an immunocompromised patient. The treatment of IS is based on the clinical presentation, severity of symptoms, and immune status. The purpose of this case is to emphasize the correct antibiotic indication in patients with IS.
- Gastric Mucosal Metastasis of Prostate Cancer. [Journal Article]
- GEGastrointest Endosc 2018 May 11
- A 65-year-old male patient who had been hospitalized in the ıntensive care unit for pneumonia presented with hematemesis and melena. He was diagnosed with metastatic adenocarcinoma of prostate (multi...
A 65-year-old male patient who had been hospitalized in the ıntensive care unit for pneumonia presented with hematemesis and melena. He was diagnosed with metastatic adenocarcinoma of prostate (multiple bone and lung metastases), which was accompanied by diabetes mellitus, hypertension, and coronary heart disease. The hemoglobin levels decreased from 11.4 g/dL to 7.3 g/dL during follow-up. Upper endoscopy revealed widespread distribution of numerous umbilicated nodules with varying sizes (from 0.5 to 2 cm) on gastric mucosa (A, B, C). No hemostatic procedure was performed but the nodules were biopsied. The histopathological examination of the biopsy revealed infiltrative small- to medium-sized sheet-like neoplastic glands in the edematous antral mucosa that showed positive staining with prostate specific acid phosphatase (PSAP orig. mag. x200) in immunohistochemistry (D). The patient was diagnosed with gastric metastasis of prostate adenocarcinoma. He was followed-up uneventfully with red blood cell transfusions for GI bleeding. Unfortunately, he died due to septic shock and respiratory failure on the fourth week of hospitalization.
- Henoch-Schönlein purpura with acute pancreatitis: analysis of 13 cases. [Journal Article]
- BPedBMC Pediatr 2018 May 11; 18(1):159
- CONCLUSIONS: Acute pancreatitis is rarely observed in Henoch-Schönlein purpura children and has no specific clinical features that differentiate it from abdominal manifestations of Henoch-Schönlein purpura. Therefore, in Henoch-Schönlein purpura patients with severe abdominal pain, serum amylase levels should be assessed to confirm the diagnosis of acute pancreatitis. Early diagnose of Henoch-Schönlein purpura with acute pancreatitis and treatment timely was very important for good clinical outcomes.
- Clinical and Pathological Characteristics of Autoimmune Hepatitis with Acute Presentation. [Journal Article]
- CJCan J Gastroenterol Hepatol 2018; 2018:3513206
- Aim. To study the differences between acute presentation-autoimmune hepatitis (A-AIH) and chronic autoimmune hepatitis (C-AIH). Methods. Through long-term follow-up, 80 patients were included in our...
Aim. To study the differences between acute presentation-autoimmune hepatitis (A-AIH) and chronic autoimmune hepatitis (C-AIH). Methods. Through long-term follow-up, 80 patients were included in our study by using the revised international autoimmune hepatitis group (IAIHG) score and were divided into acute and chronic groups for comparison. Results. No significant difference was found in the gender, age, IAIHG score (pretreatment/posttreatment), definite diagnosis rate, extrahepatic autoimmune disease, onset time, or treatment before biopsy between the acute and chronic groups. In terms of clinical symptoms, A-AIH patients were more prone to jaundice, anorexia, yellow urine, and detesting oil than C-AIH patients, but melena only occurred in chronic group (P < 0.05). The acute group exhibited more severe injury upon histological evaluation, with lobular inflammation and bile duct injury, especially central necrosis of the lobule, more pronounced in this group (P < 0.05). Conclusion. A-AIH had manifestations of acute hepatitis and presented cholestasis. Serum indicators could preliminarily distinguish A-AIH and C-AIH. Histologically, the primary manifestation of A-AIH was lobular inflammation, which was usually accompanied by lobular central necrosis. For the diagnosis of A-AIH, more attention should be paid to long-term follow-up. This study was registered at ClinicalTrials.gov (identifier: NCT02994537).
- Metastatic renal cell carcinoma presenting with melena. [Journal Article]
- CCClin Case Rep 2018; 6(5):961-962
- Renal cell carcinoma is a highly malignant neoplasm. Metastasis to the pancreas and gastrointestinal tract is rare. In this case report, we show images of metastatic renal cell carcinoma to the upper...
Renal cell carcinoma is a highly malignant neoplasm. Metastasis to the pancreas and gastrointestinal tract is rare. In this case report, we show images of metastatic renal cell carcinoma to the upper gastrointestinal tract in a patient who presented with melena.
- [Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis subsequent to rabbit antithymocyte globulin administration and successfully treated with rituximab in a patient with aplastic anemia]. [Journal Article]
- RKRinsho Ketsueki 2018; 59(4):407-413
- Rabbit antithymocyte globulin (ATG) is an effective immunosuppressive therapy for patients with aplastic anemia (AA). However, Epstein-Barr virus-associated lymphoproliferative disorder (EBV-LPD) is ...
Rabbit antithymocyte globulin (ATG) is an effective immunosuppressive therapy for patients with aplastic anemia (AA). However, Epstein-Barr virus-associated lymphoproliferative disorder (EBV-LPD) is a rare but serious complication of the therapy. An 81-year-old man was diagnosed with severe AA on the occasion of melena. Because cyclosporine monotherapy did not improve his condition, rabbit ATG was additionally administered. Thirty-one days after the administration of rabbit ATG, the patient presented with fever and general malaise. His liver and renal function tests showed rapid decline, and the patient went into shock. Although atypical lymphocytes in the peripheral blood, hepatosplenomegaly, and lymphadenopathy were not detected, the peripheral blood EBV-DNA load and serum ferritin levels were high, and his bone marrow aspiration specimen revealed hemophagocytic findings, leading to a diagnosis of EBV-LPD. He was treated with rituximab and recovered immediately. A total of 480 days have passed since the patient was administered the rabbit ATG, and he remains in AA remission without EBV-LPD relapse. This case suggests that rituximab is an effective therapy for EBV-LPD manifesting as EBV-associated hemophagocytic lymphohistiocytosis and indicates that monitoring the EBV-DNA load contributes to the diagnosis.
- Zenker Diverticulum Treatment: Endoscopic or Surgical? [Journal Article]
- CChirurgia (Bucur) 2018 Mar-Apr; 113(2):234-243
- Introduction: The Zenker Diverticulum is a rare pathology, the selection of patients for invasive treatments is questionable, as well as the applied therapeutic method. The aim of the study is to eva...
Introduction: The Zenker Diverticulum is a rare pathology, the selection of patients for invasive treatments is questionable, as well as the applied therapeutic method. The aim of the study is to evaluate the main methods of classical and endoscopic surgical treatment in this pathology and to correlate pathophysiological aspects with clinical consequences.
- Synchronous gastric and duodenal metastases from head and neck squamous cell carcinoma: a unique presentation of upper gastrointestinal bleeding. [Journal Article]
- AGAnn Gastroenterol 2018 May-Jun; 31(3):381-383
- Metastatic disease to the stomach or duodenum is an infrequent diagnosis, and head and neck squamous cell carcinoma (HNSCC) is one of the least common primary malignancies that lead to gastric or duo...
Metastatic disease to the stomach or duodenum is an infrequent diagnosis, and head and neck squamous cell carcinoma (HNSCC) is one of the least common primary malignancies that lead to gastric or duodenal metastases. We report the case of a 65-year-old man with human immunodeficiency virus infection and previously diagnosed HNSCC who presented with melena. The patient had a percutaneous endoscopic gastrostomy tube placed 3 months prior to his presentation. Laboratory testing was significant for normocytic anemia and a digital rectal examination was positive for melena. Esophagogastroduodenoscopy revealed numerous cratered nodules with contact bleeding in the stomach as well as the duodenum that appeared malignant. Biopsies of the gastric and duodenal nodules were positive for p40 and CK 5/6, consistent with metastatic squamous cell carcinoma.
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- Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing. [Journal Article]
- MMedicine (Baltimore) 2018; 97(18):e0665
- Gastrointestinal (GI) bleeding is an unwanted side effect common to all chemical types of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in elderly people. However, the risk factors of G...
Gastrointestinal (GI) bleeding is an unwanted side effect common to all chemical types of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in elderly people. However, the risk factors of GI bleeding associated with NSAIDs for elderly people remain unknown. This study aims to evaluate the risks of GI bleeding associated with NSAIDs in 4728 elderly people over 60 years old based on database from a hospital in Beijing.This retrospective hospital-based study included 4728 patients over 60 years old prescribed with NSAIDs, of which 928 patients had GI bleeding and 3800 did not have. Odds ratios (OR) for the risk of GI bleeding associated with NSAIDs were determined by logistic regression analysis. Mean Decrease Gini (MDG) involved in random forest algorithm was used to rank the associated factors with GI bleeding.In multivariate analysis, family history of GI bleeding (OR, 3.348; P = .000), history of peptic ulcers (OR, 4.068; P = .000), history of cardiovascular and cerebrovascular disease (OR, 1.476; P = .001), diabetes mellitus (OR, 1.408; P = .000), antiplatelet drugs (OR, 3.106; P = .000), Helicobacter pylori infection (OR, 1.312; P = .001), cholesterol level (OR, 0.516; P = .000), upper abdominal discomfort (OR, 3.467; P = .000), anorexia (OR, 2.038; P = .000), and NSAIDs used for 0.5 to 3 months (OR, 0.780; P = .000) were associated with GI bleeding. After ranked the MDG of each factor, the top 5 ranked factors associated with GI bleeding were melena, hematemesis, antiplatelet drugs, cholesterol level, and upper abdominal discomfort.We found that family history of GI bleeding, history of peptic ulcers, history of cardiovascular and cerebrovascular disease, diabetes mellitus, antiplatelet drugs, Helicobacter pylori infection, hypocholesterolemia, and NSAIDs used for 0.5 to 3 months were independent risk factors for GI bleeding on people over 60 years old. Meanwhile, upper abdominal discomfort might be the predictor of GI bleeding associated with NSAIDs elderly users.