Gastric Duplication Cyst Presenting as Massive Gastrointestinal Bleeding / 대한소아소화기영양학회지

Gastric duplication cysts (GDCs) are rare congenital anomalies. Presentation of GDCs varies from an asymptomatic abdominal mass to fulminant or massive gastrointestinal (GI) bleeding. Herein, we describe a case of a GDC in a 10-month-old infant presenting with unexplained massive GI hemorrhage and hematemesis. An abdominal ultrasound was negative, while computerized tomography was, initially, inaccessible. Through a series of repeated esophagogastroduodenoscopies, we documented penetration of the GDC into the gastric cavity that was later confirmed by computerized tomography. The patient was treated successfully with surgical resection.

Body mass index and quality of bowel preparation: real life vs. clinical trials

Background and study aims: Obesity is a recognised risk factor for poor bowel preparation in retrospective studies whilst corresponding data in prospective trials are marginally reported. Aims are to evaluate the relation between body mass index [BMI] and preparation quality in retrospective and interventional prospective settings and within a single centre

Patients and methods: Data from a recent colorectal cancer screening registry were retrospectively analysed for the relation between BMI and adequacy of preparation. Patients were categorised as underweight [BMI < 20 kg/m2], normal [20-25 kg/m2], overweight [25-30 kg/m2], and obese [>30 kg/m2]. Data from a recent prospective colon preparation trial were similarly analysed

Results: 541 registry patients were included. Multivariate analysis showed BMI to be an independent risk factor for inadequate preparation. Obesity was associated with odds ratio [OR] of 5.3 [95% confidence interval [CI] 1.4-19.8; p = 0.01] compared to normal BMI. A significant difference was also noted in underweight but otherwise healthy individuals [OR = 11.1, 95% CI 2-60; p = 0.005]. In the prospective study of 195 patients, obese patients had comparable rates of inadequate preparation to normal-weight individuals [OR = 0.7, 95% CI 1.1-3.96; p = 0.68]. Underweight patients had a significantly worse preparation compared to normal BMI individuals [OR = 8, 95% CI 1.1-58; p = 0.04]

Conclusions: In real life, bowel preparations in obese individuals have a lower quality in comparison to normal individuals. This finding is not replicated in clinical trials. This discrepancy is likely the result of focused patient education suggesting that this is primarily a dietary compliance phenomenon. Underweight individuals appear to have worse quality of preparation independent of study design or setting

Severe hepatotoxicity associated with the combination of spiramycin plus metronidazole

Drug-induced liver injury [DILI] is a leading cause of acute liver failure and is the most frequent reason for post-marketing drug withdrawal. The spectrum of liver injury is wide, ranging from mild and subclinical injury, noticeable only on routine biochemical testing, to fulminant liver failure and death. Antibiotics, as a group, are a leading cause of DILI. We herein describe 4 patients who developed moderate to severe hepatotoxicity after exposure to a commercially - available combination of two antibiotics - spiramycin and metronidazole -commonly used for the treatment and prevention of periodontal infections. No other aetiology for liver injury could be identified in all cases. Two patients recovered spontaneously, and two had a more severe course, one responding to corticosteroids and mycophenolate mofetil and the other requiring liver transplantation for subacute massive necrosis

Biliary Fascioliasis. case report and review of the literature

Hepatobiliary parasitic diseases are rare in Lebanon. We recently encountered biliary fascioliasis in a Lebanese native. The clinical and laboratory findings were nonspecific. The biliary parasite [Fasciola hepatica] was identified by sonography and confirmed at ERCP that has retrieved the parasite from the common bile duct

Cancer screening for the primary care physician

Cancer screening guidelines are developed by numerous agencies. These guidelines are often conflicting leaving the primary care physician in a difficult position. He [she] is requested to choose the best test for his or her patients taking into consideration the principles of screening, the test cost and most importantly the patient's emotional and physical well-being. Screening for some cancers, like lung cancer, has been considered of no benefit. Other cancers, like breast, colon, cervix and prostate, have been the subject of numerous recommendations: For breast cancer, clinical examination and mammography are recommended every 1-2 years for women between 50 to 70 years. For cervical cancer, PAP smear is suggested every 1-3 years and for colorectal cancer, a yearly fecal occult blood, sigmoidoscopy or colonoscopy every 5-10 years. Annual serum prostate specific antigen [PSA] and digital rectal examination screening for prostate cancer are still controversial