Pub Date : 2021-09-01DOI: 10.19080/argh.2021.17.555972
Catherine Chioreso, Mary C Schroeder, Irena Gribovskaja Rupp, Eric Ammann, Knute D Carter, Charles F Lynch, Elizabeth A Chrischilles, Mary E Charlton
Introduction: Despite high rectal cancer recurrence rates, knowledge on post-treatment surveillance utilization is limited. Hence, this study aims to estimate patterns of post-treatment surveillance and determine associated factors.
Patients and methods: Retrospective study of 1,024 SEER-Medicare patients >65 years old diagnosed with stage II/III rectal cancer between 2007-2013. Logistic regression was used to determine factors associated with ≥1 colonoscopy, ≥2 physician visits, ≥2 carcinoembryonic antigen (CEA) tests and ≥2 computed tomographic colonography (CT) within 14 months after primary treatment.
Results: Fifty-five percent had ≥1 colonoscopy, 54% had ≥2 physician visits, 47% had ≥2 CEA tests and 20% had ≥2 CTs. In multivariable logistic models, younger age and receipt of chemoradiation therapy (vs none) were significant across all surveillance procedures while clinical factors such as comorbidity were not. Being married (OR=1.69; 95% CI: 1.26-2.26) and proximity to a high-volume hospital (≤15 vs >30 minutes, OR=1.56; 95% CI: 1.00-2.43) were associated with ≥1 colonoscopy. Female gender (OR=1.56; 95% CI: 1.17-2.09), being married (OR=1.56; 95% CI: 1.17-2.08), white race (OR=1.79; 95% CI: 1.23- 2.62) and surgery from high-volume surgeon (OR=1.47; 95% CI: 1.06-2.04) were associated with ≥2 physician visits. Female gender (OR=1.45; 95% CI: 1.08-1.95), being married (OR=1.46; 95% CI: 1.08-1.96) and surgery from high-volume surgeon (OR=1.55; 95% CI: 1.10-2.17) had higher ≥2 CEA tests.
Conclusions: Post-treatment surveillance remains low but is more common among younger patients and recipients of chemoradiation. Distinct profiles of patient characteristics and provider volume were associated with individual surveillance procedures suggesting the need for multicomponent strategies to increase surveillance.
{"title":"Stage II/III Rectal Cancer Post-Treatment Surveillance Patterns of Care: A SEER- Medicare Study.","authors":"Catherine Chioreso, Mary C Schroeder, Irena Gribovskaja Rupp, Eric Ammann, Knute D Carter, Charles F Lynch, Elizabeth A Chrischilles, Mary E Charlton","doi":"10.19080/argh.2021.17.555972","DOIUrl":"https://doi.org/10.19080/argh.2021.17.555972","url":null,"abstract":"<p><strong>Introduction: </strong>Despite high rectal cancer recurrence rates, knowledge on post-treatment surveillance utilization is limited. Hence, this study aims to estimate patterns of post-treatment surveillance and determine associated factors.</p><p><strong>Patients and methods: </strong>Retrospective study of 1,024 SEER-Medicare patients >65 years old diagnosed with stage II/III rectal cancer between 2007-2013. Logistic regression was used to determine factors associated with ≥1 colonoscopy, ≥2 physician visits, ≥2 carcinoembryonic antigen (CEA) tests and ≥2 computed tomographic colonography (CT) within 14 months after primary treatment.</p><p><strong>Results: </strong>Fifty-five percent had ≥1 colonoscopy, 54% had ≥2 physician visits, 47% had ≥2 CEA tests and 20% had ≥2 CTs. In multivariable logistic models, younger age and receipt of chemoradiation therapy (vs none) were significant across all surveillance procedures while clinical factors such as comorbidity were not. Being married (OR=1.69; 95% CI: 1.26-2.26) and proximity to a high-volume hospital (≤15 vs >30 minutes, OR=1.56; 95% CI: 1.00-2.43) were associated with ≥1 colonoscopy. Female gender (OR=1.56; 95% CI: 1.17-2.09), being married (OR=1.56; 95% CI: 1.17-2.08), white race (OR=1.79; 95% CI: 1.23- 2.62) and surgery from high-volume surgeon (OR=1.47; 95% CI: 1.06-2.04) were associated with ≥2 physician visits. Female gender (OR=1.45; 95% CI: 1.08-1.95), being married (OR=1.46; 95% CI: 1.08-1.96) and surgery from high-volume surgeon (OR=1.55; 95% CI: 1.10-2.17) had higher ≥2 CEA tests.</p><p><strong>Conclusions: </strong>Post-treatment surveillance remains low but is more common among younger patients and recipients of chemoradiation. Distinct profiles of patient characteristics and provider volume were associated with individual surveillance procedures suggesting the need for multicomponent strategies to increase surveillance.</p>","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":"17 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10457021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10110441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-23DOI: 10.19080/ARGH.2021.16.555946
P. Apolito
Lung cancer is a malignant neoplasm that is frequently associated with distant metastasis. However, gastrointestinal tract is a rare location for lung cancer metastasis. Herein, we presented a case of a 72-year-old man, who was admitted for chest pain and with radiological evidence of lung cancer with distant metastases and a suspected localization in the right colon. On colonoscopy visual impression showed two yellowish and ulcerative lesions, one in the ascending colon and the other in the transverse colon, which were biopsied. Both were consistent on pathological report with colonic metastases. According to advanced stage of neoplasm (stage IV), patient underwent palliative chemotherapy.
{"title":"Asymptomatic Colonic Metastases of Lung Cancer: A Case Report","authors":"P. Apolito","doi":"10.19080/ARGH.2021.16.555946","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555946","url":null,"abstract":"Lung cancer is a malignant neoplasm that is frequently associated with distant metastasis. However, gastrointestinal tract is a rare location for lung cancer metastasis. Herein, we presented a case of a 72-year-old man, who was admitted for chest pain and with radiological evidence of lung cancer with distant metastases and a suspected localization in the right colon. On colonoscopy visual impression showed two yellowish and ulcerative lesions, one in the ascending colon and the other in the transverse colon, which were biopsied. Both were consistent on pathological report with colonic metastases. According to advanced stage of neoplasm (stage IV), patient underwent palliative chemotherapy.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42415031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-09DOI: 10.19080/ARGH.2021.16.555945
P. Broens
Background: Classification currently used for functional defecation disorders (FDDs) assumes that the puborectal muscle and external anal sphincter act as a single functional unit. We hypothesize that the puborectal muscle and external anal sphincter do not act as a single functional unit. Methods: We performed anorectal manometry and defecometry tests in 124 adult patients suffering from functional defecation disorder. Anorectal manometry provides information about the pressure profile of the anal canal and the distal part of the rectum. The defecometry test provides information about rectoanal coordination during defecation. Results: We observed that the puborectal muscle and external anal sphincter did not always contribute equally to an FDD. We distinguished three main groups of FDDs: congruent (n=105), anal sphincter-dominated (n=10), and puborectal muscle-dominated (n=9). The propulsive force required to defecate (rectal pressure increase) correlated more strongly with pressure increase at the level of the puborectal muscle (ρ=0.794) than at the level of the external anal sphincter (ρ=0.488). Conclusion: We conclude therefore that the puborectal muscle and external anal sphincter do not, by definition, act as a single functional unit in patients suffering from FDDs and may differ in the degree of dyssynergia. Our modified classification of FDDs can significantly improve the proper diagnosis and, therefore, treatment of FDDs. Furthermore, we conclude that isolated high puborectal pressure impedes defecation more than isolated anal sphincter contraction.
{"title":"The Puborectal Muscle and External Anal Sphincter Can Act Independently of each other in Functional Defecation Disorders","authors":"P. Broens","doi":"10.19080/ARGH.2021.16.555945","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555945","url":null,"abstract":"Background: Classification currently used for functional defecation disorders (FDDs) assumes that the puborectal muscle and external anal sphincter act as a single functional unit. We hypothesize that the puborectal muscle and external anal sphincter do not act as a single functional unit. Methods: We performed anorectal manometry and defecometry tests in 124 adult patients suffering from functional defecation disorder. Anorectal manometry provides information about the pressure profile of the anal canal and the distal part of the rectum. The defecometry test provides information about rectoanal coordination during defecation. Results: We observed that the puborectal muscle and external anal sphincter did not always contribute equally to an FDD. We distinguished three main groups of FDDs: congruent (n=105), anal sphincter-dominated (n=10), and puborectal muscle-dominated (n=9). The propulsive force required to defecate (rectal pressure increase) correlated more strongly with pressure increase at the level of the puborectal muscle (ρ=0.794) than at the level of the external anal sphincter (ρ=0.488). Conclusion: We conclude therefore that the puborectal muscle and external anal sphincter do not, by definition, act as a single functional unit in patients suffering from FDDs and may differ in the degree of dyssynergia. Our modified classification of FDDs can significantly improve the proper diagnosis and, therefore, treatment of FDDs. Furthermore, we conclude that isolated high puborectal pressure impedes defecation more than isolated anal sphincter contraction.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43853227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.19080/ARGH.2021.16.555944
M. Trzpis
Endoanal ultrasound (EUS) is the gold standard for diagnosing anal sphincter defects often seen in patients with fecal incontinence (FI). Threedimensional, high-resolution anorectal manometry (3D-HRARM) is a newer technique that might also be used to diagnose sphincter defects. We aimed to investigate whether FI is associated with anal sphincter defects detected by EUS and 3D-HRARM. Retrospectively, we included all adult patients who had undergone EUS and 3D-HRARM for FI, between January 2012 and February 2015 (N = 37). During 3D-HRARM, the presence of sphincter defects was examined in rest and during maximal anal sphincter contraction. All patients also underwent a balloon retention test to objectively determine whether they suffered from FI for solid stool. Of the 37 patients, 12 patients (32%) suffered from FI. The presence of a sphincter defect detected with EUS, and with 3D-HRARM during contraction, was not associated with the prevalence of FI and no significant correlations were found between these variables. The presence of a sphincter defect, detected by 3D-HRARM in rest, was negatively correlated with the presence of FI (rs -.372, P = .024). Moreover, the prevalence of sphincter defects was lower in patients with FI, detected by 3D-HRARM in rest, than in patients without FI (13% versus 88%, P = .035). FI is not associated with anal sphincter defects detected by EUS and 3D-HRARM. The outcomes of EUS and 3D-HRARM do not thus predict the presence of FI. Instead, extensive anorectal function tests should be performed to form a complete picture of a patient’s anorectal functions and to determine the underlying causes of FI.
{"title":"The Outcomes of Endoanal Ultrasound and Three-Dimensional, High-Resolution Anorectal Manometry do not Predict Fecal Incontinence","authors":"M. Trzpis","doi":"10.19080/ARGH.2021.16.555944","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555944","url":null,"abstract":"Endoanal ultrasound (EUS) is the gold standard for diagnosing anal sphincter defects often seen in patients with fecal incontinence (FI). Threedimensional, high-resolution anorectal manometry (3D-HRARM) is a newer technique that might also be used to diagnose sphincter defects. We aimed to investigate whether FI is associated with anal sphincter defects detected by EUS and 3D-HRARM. Retrospectively, we included all adult patients who had undergone EUS and 3D-HRARM for FI, between January 2012 and February 2015 (N = 37). During 3D-HRARM, the presence of sphincter defects was examined in rest and during maximal anal sphincter contraction. All patients also underwent a balloon retention test to objectively determine whether they suffered from FI for solid stool. Of the 37 patients, 12 patients (32%) suffered from FI. The presence of a sphincter defect detected with EUS, and with 3D-HRARM during contraction, was not associated with the prevalence of FI and no significant correlations were found between these variables. The presence of a sphincter defect, detected by 3D-HRARM in rest, was negatively correlated with the presence of FI (rs -.372, P = .024). Moreover, the prevalence of sphincter defects was lower in patients with FI, detected by 3D-HRARM in rest, than in patients without FI (13% versus 88%, P = .035). FI is not associated with anal sphincter defects detected by EUS and 3D-HRARM. The outcomes of EUS and 3D-HRARM do not thus predict the presence of FI. Instead, extensive anorectal function tests should be performed to form a complete picture of a patient’s anorectal functions and to determine the underlying causes of FI.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42107718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-22DOI: 10.19080/ARGH.2021.16.555943
Elvis Vargas Castillo
Objective: The aim of this study is to determine the clinical and therapeutic relevance of manometric findings in patients with chronic anal fissure. Methods: Descriptive, prospective study of 139 patients with chronic anal fissure (CAF) treated with Isosorbide Dinitrate 2% cream (Master Formula) for 6 to 8 weeks with a maximum of 2 treatment cycles. Physical exam findings were recorded prior to treatment, which included location of the fissure(s) and rectal sphincter tone. One week after beginning treatment, High resolution Anal Manometry (HRAM) was performed discriminating the rest pressure (RP) in low (<40 mmHg), normal (40-70 mmHg), and increased (> 70 mmHg) sphincter pressure. The increased (>70 mmHg) category was further subclassified as: mildly increased (71 -100 mmHg), moderately increased (101-150 mmHg) and severely increased (> 150 mmHg) with the intention of further describing the associations between the patients’ therapeutic evolution and their HRAM pressures. Results: Mean age 42 ± 13 and 51.8% of patients were female. Posterior fissures were present in 87.8% of patients. 61 patients were found to have moderately increased RP (43.9%). 46% of patients with normal RP were classified as hypertonic on digital rectal examination (p = 0.01). Mean healing rate was 80% with medical treatment, this percentage was positively correlated with higher RP (p = 0.004). 20% underwent surgery, with the surgical technique depending on the RP, without reports of complications or fecal incontinence. Conclusions: HRAM is a guiding tool in the evolution of the CAF, finding that the higher the RP is, the better the response to medical treatment. Additionally, in non-responders patients, to reduce complications, surgical management can and should take the RP into consideration and not only to the physical examination.
{"title":"Manometry in Chronic Anal Fissures: Clinical and Therapeutic Correlation","authors":"Elvis Vargas Castillo","doi":"10.19080/ARGH.2021.16.555943","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555943","url":null,"abstract":"Objective: The aim of this study is to determine the clinical and therapeutic relevance of manometric findings in patients with chronic anal fissure. Methods: Descriptive, prospective study of 139 patients with chronic anal fissure (CAF) treated with Isosorbide Dinitrate 2% cream (Master Formula) for 6 to 8 weeks with a maximum of 2 treatment cycles. Physical exam findings were recorded prior to treatment, which included location of the fissure(s) and rectal sphincter tone. One week after beginning treatment, High resolution Anal Manometry (HRAM) was performed discriminating the rest pressure (RP) in low (<40 mmHg), normal (40-70 mmHg), and increased (> 70 mmHg) sphincter pressure. The increased (>70 mmHg) category was further subclassified as: mildly increased (71 -100 mmHg), moderately increased (101-150 mmHg) and severely increased (> 150 mmHg) with the intention of further describing the associations between the patients’ therapeutic evolution and their HRAM pressures. Results: Mean age 42 ± 13 and 51.8% of patients were female. Posterior fissures were present in 87.8% of patients. 61 patients were found to have moderately increased RP (43.9%). 46% of patients with normal RP were classified as hypertonic on digital rectal examination (p = 0.01). Mean healing rate was 80% with medical treatment, this percentage was positively correlated with higher RP (p = 0.004). 20% underwent surgery, with the surgical technique depending on the RP, without reports of complications or fecal incontinence. Conclusions: HRAM is a guiding tool in the evolution of the CAF, finding that the higher the RP is, the better the response to medical treatment. Additionally, in non-responders patients, to reduce complications, surgical management can and should take the RP into consideration and not only to the physical examination.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47301426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-02DOI: 10.19080/ARGH.2021.16.555942
Palmieri Luna Alfonso
We present the clinical case of a 54-year-old female patient, who came to the emergency department for abdominal pain of 2 days of evolution, predominantly mesogastric and radiating to the right iliac fossa, accompanied by nausea and vomiting, does not refer fever. The clinical and paraclinical symptoms are suggestive of acute appendicitis. With Alvarado’s criteria with a high probability of acute appendicitis, she motivates herself and prepares for appendectomy, finding retroileal appendicular plastron. In the immediate postoperative period, complications inherent to the procedure arise: medically managed retroileal hematoma x 72 hours, decrease in hemoglobin levels, which requires a transfusion of compatible packed red blood cells, significant retroileal hematoma drainage is performed with infiltration in the ileum walls Cecal, bizarre evolution, torpid, with vomiting, abdominal distention, absence of stools and flatus on postoperative day 10, an Abdomen Rx is performed where they report air-fluid levels, Contrasting Computerized Axial Tomography of the abdomen reports narrow ileus cecal union, which is why it is motivated for Laparotomy explorer, finding stenosis of the ileo cecal segment due to stenosis, distortion of the segment, performing a right hemicolectomy and ileotransverse anastomosis, good evolution in the Intensive Care Unit until the 8th day when she presented leakage of intestinal contents through the penrose drain, quantifying m As of 500 cc a day, classifying high-output fistula, signs of abdominal sepsis, it is motivated for exploratory relaparotomy, with a frozen abdominal cavity, by multiple peritoneal adhesions, peritonitis, managing to identify the fistula of the anastomosis, friable tissue, performing drainage of localized peritonitis of the right hemiabdomen, ileostomy plus transverse colostomy, subsequently suffers alkaline burn at the operative site, despite handling with the colotomy kit isolating the ostomy from the skin, enters into hydro-electrolyte imbalance with severe hypokalemia, managing it with Parenteral replacement of potassium, until stabilizing and overcoming abdominal sepsis, being discharged after the 2nd month of hospitalization.
{"title":"Acute Appendicitis and Its Complications: Diagnostic Challenge and Treatment, Literature Review","authors":"Palmieri Luna Alfonso","doi":"10.19080/ARGH.2021.16.555942","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555942","url":null,"abstract":"We present the clinical case of a 54-year-old female patient, who came to the emergency department for abdominal pain of 2 days of evolution, predominantly mesogastric and radiating to the right iliac fossa, accompanied by nausea and vomiting, does not refer fever. The clinical and paraclinical symptoms are suggestive of acute appendicitis. With Alvarado’s criteria with a high probability of acute appendicitis, she motivates herself and prepares for appendectomy, finding retroileal appendicular plastron. In the immediate postoperative period, complications inherent to the procedure arise: medically managed retroileal hematoma x 72 hours, decrease in hemoglobin levels, which requires a transfusion of compatible packed red blood cells, significant retroileal hematoma drainage is performed with infiltration in the ileum walls Cecal, bizarre evolution, torpid, with vomiting, abdominal distention, absence of stools and flatus on postoperative day 10, an Abdomen Rx is performed where they report air-fluid levels, Contrasting Computerized Axial Tomography of the abdomen reports narrow ileus cecal union, which is why it is motivated for Laparotomy explorer, finding stenosis of the ileo cecal segment due to stenosis, distortion of the segment, performing a right hemicolectomy and ileotransverse anastomosis, good evolution in the Intensive Care Unit until the 8th day when she presented leakage of intestinal contents through the penrose drain, quantifying m As of 500 cc a day, classifying high-output fistula, signs of abdominal sepsis, it is motivated for exploratory relaparotomy, with a frozen abdominal cavity, by multiple peritoneal adhesions, peritonitis, managing to identify the fistula of the anastomosis, friable tissue, performing drainage of localized peritonitis of the right hemiabdomen, ileostomy plus transverse colostomy, subsequently suffers alkaline burn at the operative site, despite handling with the colotomy kit isolating the ostomy from the skin, enters into hydro-electrolyte imbalance with severe hypokalemia, managing it with Parenteral replacement of potassium, until stabilizing and overcoming abdominal sepsis, being discharged after the 2nd month of hospitalization.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46295120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-25DOI: 10.19080/ARGH.2021.16.555941
R. D. Greca
A 48-year-old man with metabolic-dysfunction associated fatty liver cirrhosis was first on the transplant waitlist. Upon hospital admission, he complained of jaundice over the past month. Laboratory: total bilirubin 31.6 mg/dL (normal range <1.2); direct bilirubin 25.7 mg/dL (<0.2); alkaline phosphatase 200 U/L (<104); international normalized ratio 1.64 (<1.25). Serum alpha-fetoprotein was normal and all cultures were negative. Both ultrasound, tomography and magnetic resonance cholangiography (Figure 1) showed a biliary dilation of the right hepatic lobe, with no evidence of an obstructive factor. He had a normal enhanced tomography for hepatocellular carcinoma (HCC) surveillance (because of obesity) two months before. With no signs of infection, a transplantation was performed.
{"title":"Intraductal Hepatocellular Carcinoma Leading to Obstructive Jaundice","authors":"R. D. Greca","doi":"10.19080/ARGH.2021.16.555941","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555941","url":null,"abstract":"A 48-year-old man with metabolic-dysfunction associated fatty liver cirrhosis was first on the transplant waitlist. Upon hospital admission, he complained of jaundice over the past month. Laboratory: total bilirubin 31.6 mg/dL (normal range <1.2); direct bilirubin 25.7 mg/dL (<0.2); alkaline phosphatase 200 U/L (<104); international normalized ratio 1.64 (<1.25). Serum alpha-fetoprotein was normal and all cultures were negative. Both ultrasound, tomography and magnetic resonance cholangiography (Figure 1) showed a biliary dilation of the right hepatic lobe, with no evidence of an obstructive factor. He had a normal enhanced tomography for hepatocellular carcinoma (HCC) surveillance (because of obesity) two months before. With no signs of infection, a transplantation was performed.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48343745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-10DOI: 10.19080/ARGH.2021.16.555940
G. Monif
The IDI (Infectious Diseases Incorporated) classification of Crohn’s disease is a distillate of nearly 20 years of studying of Mycobacterium avium subspecies paratuberculosis and Crohn’s diseases. Unraveling the events that combine to produce Crohn’s disease has allowed for the construction of a disease classification based on the disease’s pathogenesis rather than disease severity. Over-emphasis of disease’s immune-mediated character and insufficient focus on the invasive gastrointestinal bacterial flora has created therapeutic ambiguity.
{"title":"The IDI Classification of Crohn’s Disease","authors":"G. Monif","doi":"10.19080/ARGH.2021.16.555940","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555940","url":null,"abstract":"The IDI (Infectious Diseases Incorporated) classification of Crohn’s disease is a distillate of nearly 20 years of studying of Mycobacterium avium subspecies paratuberculosis and Crohn’s diseases. Unraveling the events that combine to produce Crohn’s disease has allowed for the construction of a disease classification based on the disease’s pathogenesis rather than disease severity. Over-emphasis of disease’s immune-mediated character and insufficient focus on the invasive gastrointestinal bacterial flora has created therapeutic ambiguity.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46124852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-29DOI: 10.19080/ARGH.2021.16.555939
P. Malhotra
Objective: Whipple’s disease, a rare systemic infectious disease, having an annual incidence of 3 in one million, can prove to be fatal if not diagnosed early and treated appropriately. Clinical presentation: We present a young male of 18 years who was admitted to the hospital with symptoms of pain abdomen. The diagnosis was made based on colonoscopy and histopathological findings of large intestine biopsies. Conclusion: Whipple’s disease should be kept behind mind as it may present both with classical as well as atypical features.
{"title":"Atypical Presentation of Whippels Disease","authors":"P. Malhotra","doi":"10.19080/ARGH.2021.16.555939","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555939","url":null,"abstract":"Objective: Whipple’s disease, a rare systemic infectious disease, having an annual incidence of 3 in one million, can prove to be fatal if not diagnosed early and treated appropriately. Clinical presentation: We present a young male of 18 years who was admitted to the hospital with symptoms of pain abdomen. The diagnosis was made based on colonoscopy and histopathological findings of large intestine biopsies. Conclusion: Whipple’s disease should be kept behind mind as it may present both with classical as well as atypical features.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43682979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-29DOI: 10.19080/ARGH.2021.16.555938
P. Malhotra
Objective: Hookworm is a pan global, easily treatable worm infestation, commonly seen in underdeveloped countries, manifests with variable presentations and proper diagnosis & treatment can effectively reduce morbidity associated with it. Clinical Presentation: We present a young female of 18 years who was admitted to the hospital with symptoms of pain abdomen, fever, and passage of worms from umbilicus. The diagnosis of hookworm infection was confirmed on the basis of presence of ova on stool examination and microscopic examination of live worms which were coming out from umbilicus. Conclusion: Hookworm passage from various natural openings of body like oral cavity, anal canal, nostrils, and umbilicus has been documented in literature but this is first case report in which multiple live hookworms’ passage from umbilicus is being reported.
{"title":"Rare Presentation of Hookworm Infection","authors":"P. Malhotra","doi":"10.19080/ARGH.2021.16.555938","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555938","url":null,"abstract":"Objective: Hookworm is a pan global, easily treatable worm infestation, commonly seen in underdeveloped countries, manifests with variable presentations and proper diagnosis & treatment can effectively reduce morbidity associated with it. Clinical Presentation: We present a young female of 18 years who was admitted to the hospital with symptoms of pain abdomen, fever, and passage of worms from umbilicus. The diagnosis of hookworm infection was confirmed on the basis of presence of ova on stool examination and microscopic examination of live worms which were coming out from umbilicus. Conclusion: Hookworm passage from various natural openings of body like oral cavity, anal canal, nostrils, and umbilicus has been documented in literature but this is first case report in which multiple live hookworms’ passage from umbilicus is being reported.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47290525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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