Familial Mediterranean fever with colonic lesions: A case report.

A 26-year-old man with a history of ulcerative colitis treatment presented to our clinic with abdominal pain and fever. He had a history of bloody stools and abdominal pain at 19 years of age. A thorough examination by a medical practitioner, including lower gastrointestinal endoscopy, resulted in the diagnosis of ulcerative colitis. After induction of remission with prednisolone (PSL), the patient was treated with 5-aminosalicylate. One year ago in September, his symptoms flared up again, and he was administered 30 mg/day of PSL until November of the same year. However, he was transferred to another hospital and referred to his previous doctor. During the follow-up in December of the same year, flare-ups of abdominal pain and diarrhea were reported. Upon review of the patient's medical history, familial Mediterranean fever was suspected because the patient had periodic fevers ≥38°C and symptoms that persisted even after oral steroid administration and were sometimes accompanied by joint pain. However, he was transferred again, and PSL was administered once more. The patient was referred to our hospital for further treatment. At the time of arrival, his symptoms did not improve with 40 mg/day of PSL, and endoscopy and computed tomography revealed thickening of the colon, with no abnormality in the small intestine. Suspecting familial Mediterranean fever-associated enteritis, the patient was administered colchicine, resulting in an improvement in symptoms. Furthermore, an examination of the MEFV gene showed a mutation in Exon5 (S503C), and atypical familial Mediterranean fever was diagnosed. Endoscopy after colchicine treatment revealed that the ulcers improved remarkably.

Endoscopic treatment of a patient with duodenal major papilla adenoma and ansa pancreatica.

A 35-year-old female who suffered from recurrent pancreatitis was admitted to our hospital. Her magnetic resonance cholangiopancreatography revealed ansa pancreatica. And during endoscopic retrograde cholangiopancreatography, a major duodenal papilla adenoma was identified. Hybrid endoscopic mucosal resection of this lesion was performed with pancreatic stent placement through the minor papilla to prevent recurrent pancreatitis. To our knowledge, this is the first report of a major papilla adenoma associated with ansa pancreatica. These minimally invasive endoscopic treatments solved a difficult clinical problem and avoided traumatic surgery.

Primary gastric inflammatory myofibroblastic tumor treated with non-exposed endoscopic wall-inversion surgery (NEWS): A case report and literature review.

Inflammatory myofibroblastic tumor (IMT) is an intermediate malignancy with myofibroblast proliferation and inflammatory cell infiltration with malignant potential. Primary IMTs are predominantly reported in the lungs, while gastric IMTs are very rare. Therefore, no guidelines exist for the diagnosis and treatment of gastric IMTs. The present case is a 39-year-old man diagnosed with an asymptomatic gastric submucosal tumor. Considering the malignancy of the tumor, we selected non-exposed endoscopic wall-inversion surgery as the resection method and successfully performed local resection. Histopathological analysis showed myofibroblast proliferation and inflammatory cell infiltration, with a diagnosis of primary gastric IMT and negative resection margins. Immunohistochemical staining was negative for anaplastic lymphoma kinase. To the best of our knowledge, including our case, there have been 52 reported cases of primary gastric IMTs that have been treated, with several recurrent cases. In this study, we report the first case of local resection of gastric IMT using non-exposed endoscopic wall-inversion surgery, with a literature review.

Diagnostic performance of endocytoscopy with normal pit-like structure sign for colorectal low-grade adenoma compared with conventional modalities.

Objectives: A "resect-and-discard" strategy has been proposed for diminutive adenomas in the colorectum. However, this strategy is sometimes difficult to implement because of the lack of confidence in differentiating low-grade adenoma (LGA) from advanced lesions such as high-grade adenoma or carcinoma. To perform real-time precise diagnosis of LGA with high confidence, we assessed whether endocytoscopy (EC) diagnosis, considering normal pit-like structure (NP-sign), an excellent indicator of LGA, could have additional diagnostic potential compared with conventional modalities. Methods: All the neoplastic lesions that were observed by non-magnifying narrow-band imaging (NBI), magnifying NBI (M-NBI), magnifying pit pattern, and EC prior to pathological examination between 2005 and 2018 were retrospectively investigated. The neoplastic lesions were classified into two categories: LGA and other neoplastic lesions. We assessed the differential diagnostic ability of EC with NP-sign between LGA and other neoplastic lesions compared with that of NBI, M-NBI, pit pattern, and conventional EC in terms of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC). Results: A total of 1376 lesions from 1097 patients were eligible. The specificity (94.9%), accuracy (91.5%), and area under the receiver operating characteristic curve (0.95) of EC with NP-sign were significantly higher than those of NBI, M-NBI, pit pattern, and conventional EC. Conclusions: EC diagnosis with NP-sign has significantly higher diagnostic performance for predicting colorectal LGA compared with the conventional modalities and enables stratification of neoplastic lesions for "resect-and-discard" with higher confidence.

Analyses of cytokine gene expression and fecal microbiota in a patient with Cronkhite-Canada syndrome successfully treated with prednisolone.

Although prednisolone treatment is effective in Cronkhite-Canada syndrome (CCS), its mechanisms of action are poorly understood. We performed analyses of cytokine expression and fecal microbiota in a patient with the concurrent occurrence of CCS and rectal cancer, in whom regression of polyposis was achieved by prednisolone. Regression of CCS polyps was accompanied by downregulation of proinflammatory cytokine expression and alterations in microbiota composition; a decrease in Bacteroides fragilis and Peptostreptococcus anaerobius with the promotion of inflammation. We could not completely exclude the possibility that alterations in fecal microbiota composition might be influenced by the presence of advanced cancer. However, this case suggests that the administration of PSL might lead to the regression of CCS polyps through alterations in gut microbiota composition and suppression of proinflammatory cytokine responses.

Paracingulin recruits CAMSAP3 to tight junctions and regulates microtubule and polarized epithelial cell organization.

Paracingulin (CGNL1) is recruited to tight junctions (TJs) by ZO-1 and to adherens junctions (AJs) by PLEKHA7. PLEKHA7 has been reported to bind to the microtubule minus-end-binding protein CAMSAP3, to tether microtubules to the AJs. Here, we show that knockout (KO) of CGNL1, but not of PLEKHA7, results in the loss of junctional CAMSAP3 and its redistribution into a cytoplasmic pool both in cultured epithelial cells in vitro and mouse intestinal epithelium in vivo. In agreement, GST pulldown analyses show that CGNL1, but not PLEKHA7, interacts strongly with CAMSAP3, and the interaction is mediated by their respective coiled-coil regions. Ultrastructure expansion microscopy shows that CAMSAP3-capped microtubules are tethered to junctions by the ZO-1-associated pool of CGNL1. The KO of CGNL1 results in disorganized cytoplasmic microtubules and irregular nuclei alignment in mouse intestinal epithelial cells, altered cyst morphogenesis in cultured kidney epithelial cells, and disrupted planar apical microtubules in mammary epithelial cells. Together, these results uncover new functions of CGNL1 in recruiting CAMSAP3 to junctions and regulating microtubule cytoskeleton organization and epithelial cell architecture.

Comparison of blue laser imaging and light-emitting diode-blue light imaging for the characterization of colorectal polyps using the Japan narrow-band imaging expert team classification: The LASEREO and ELUXEO COLonoscopic study.

Objectives: Although the laser light is optically ideal for producing narrow-band light, it has not been used in some areas of the world. Endoscopic light sources using light-emitting diodes (LEDs) are used worldwide. The purpose of this study was to compare blue laser imaging (laser-BLI) and LED-blue light imaging (LED-BLI) for the characterization of colorectal polyps using the Japan narrow band imaging expert team (JNET) classification. Methods: Colorectal lesions were prospectively examined using magnifying narrow-band light generated by a laser (laser-BLI) or LEDs (LED-BLI). Twelve endoscopists (six non-experts and six experts from three institutions) evaluated each still-magnified image of lesions using the JNET classification. Results: Seven hundred and fifty-six images from 63 lesions were reviewed. The mean polyp size was 24.5 ± 13.4 mm. Histopathology included 13 serrated lesions and 50 neoplasms. The rate of agreement between laser-BLI and LED-BLI using the JNET classification was 92.5% (699/756). The weighted κ-statistic was 0.99. The percentages of "almost similar" comparing scores of surface patterns, vessel patterns, and brightness among all endoscopists were 95.4%, 95.9%, and 95.0%, respectively. Conclusions: This multicenter study demonstrates that the rate of agreement between laser-BLI and LED-BLI using the JNET Classification is very high. The surface patterns, vessel patterns, and brightness are almost similar.

Severe obstructive colitis treated with repeated colonoscopic decompression.

Obstructive colitis is an acute condition caused by colorectal strictures and requires a combination of therapeutic strategies, including surgery, endoscopic interventions, and medications. Here, we describe the case of a 69-year-old man who developed severe obstructive colitis owing to diverticular stenosis of the sigmoid colon. We immediately performed endoscopic decompression to avoid perforation. The mucosa of the dilated colon appeared black, suggesting severe ischemia. We considered surgical total colectomy owing to the extensive colitis. However, considering the invasiveness of the emergent surgery, we adopted a conservative approach as enhanced computed tomography demonstrated colonic dilation with maintained blood flow in the deeper layer of the colonic wall and no signs of colonic necrosis, such as peritoneal irritation sign or elevation of deviation enzymes, were observed. Moreover, the patient preferred a conservative approach, and surgeons in our team agreed with this conservative approach. While relapses of colonic dilation occurred several times, antibiotic treatment and repeated endoscopic decompression successfully suppressed the dilation and systemic inflammation. The colonic mucosa healed gradually, and we performed a colostomy without resecting a large portion of the colorectum. In conclusion, severe obstructive colitis with maintained blood flow can be treated with endoscopic decompression instead of emergent resection for a wide portion of the colorectum. Moreover, endoscopic images of improved colitic mucosa obtained through repeated colorectal procedures are rare and noteworthy.

Endoscopic ultrasound-guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction.

Objectives: Malignant gastric outlet obstruction (GOO) has traditionally been managed with enteral stenting and surgical gastrojejunostomy. Our study aimed to compare outcomes between endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) using a lumen-apposing metal stent and robotic GJ (R-GJ) for unresectable malignant GOO. Methods: Patients undergoing EUS-GJ or R-GJ for unresectable malignant GOO were retrospectively analyzed. The primary outcome was clinical success defined by the ability to tolerate oral intake at the time of discharge. Secondary outcomes included technical success, procedure duration, adverse events, and post-procedure length of stay (LOS). Results: A total of 44 patients met the inclusion criteria. Of the 44, 29 underwent EUS-GJ and 15 underwent R-GJ. Age, gender, malignant etiology, and presence of ascites were similar between the two groups. Patients treated with EUS-GJ had a higher mean Charlson comorbidity index (10.3 vs. 7.0; p ≤ 0.0001) and a lower preoperative body mass index (22.3 vs. 27.2; p = 0.007). Technical and clinical success was achieved in 100% of patients in both groups (p > 0.99). EUS-GJ was associated with shorter procedure duration (57.5 vs. 146.3 min; p < 0.0001), hospital LOS (4.3 vs. 8.2 days, p = 0.0009), and time to oral intake (1.0 vs. 5.8 days; p < 0.0001) when compared to R-GJ. Adverse events occurred in 5 of the R-GJ patients and none of the EUS-GJ patients (p = 0.003). Conclusions: EUS-GJ has similar efficacy and superior clinical outcomes compared to R-GJ in the management of malignant GOO. Prospective studies with longer follow-up duration are needed to validate these findings.

Shaeer's corporal rotation IV: length-preserving correction of congenital ventral penile curvature.

BACKGROUND: For cases with severe penile curvature, the loss in length with shortening techniques or the loss in rigidity with incision grafting can compromise the results, hence the advent of Shaeer's corporal rotation III technique, which corrects the most severe degrees of ventral penile curvature without loss in length, though with a certain degree of narrowing. AIM: We sought to describe Shaeer's corporal rotation IV, aiming at correction of moderate-to-severe ventral penile curvature with minimal shortening, minimal narrowing, and minimal mobilization of the neurovascular bundle, among other improvements such as using thicker suture material to decease recurrence while inverting the surgical knots. METHODS: Forty-two patients with congenital ventral penile curvature were selected for the study with a curve ranging from 60° to 90°. Patients were randomized into 1 of the 2 groups: Shaeer's corporal rotation III (SCR-III) and SCR-IV. In SCR-IV, rotation is used to correct the main brunt of curvature, up to 70% to 80% of the curve. Plication is used to correct the residual curvature up to 100% straightness. This keeps the rotation points fewer and closer to the midline, thereby minimizing narrowing and mobilization of the neurovascular bundle. OUTCOMES: Both groups were compared with regard to intraoperative erection angle, length, and girth, before and after rotation, as well as subjectively reported postoperative recurrence, penile sensitivity, satisfaction, and IIEF. RESULTS: The postcorrection angle was zero for all cases in the 2 groups. Dorsal length decreased by 3% in the SCR-IV group compared with 0.5% in the SCR-III group (2.5% difference). The difference in circumference between the narrowest and widest points was 2% in the SCR-IV group vs 9.3% in the SCR-III group (7.3% difference). The average operative time was 19.2% shorter with SCR-IV. Girth asymmetry was reported in 1 (4.8%) of 21 patients in the SCR-IV group compared with 15 (71.4%) of 21 in the SCR-III group. Partial hyposensitivity of the penis was reported in 9.5% in the SCR-IV group compared with 19% in the SCR-III group. CLINICAL IMPLICATIONS: SCR-IV is an improvement over former versions of the technique, with higher patient satisfaction. STRENGTHS AND LIMITATIONS: A strength of the study is the long follow-up period. Limitations include being a single-center study and reliance on patient reporting to evaluate recurrence and satisfaction. CONCLUSION: The SCR-IV technique corrects moderate and severe degrees of congenital ventral penile curvature, with little or no compromise in penile length, girth, or sensitivity.

[An MRI for Every Patient with Back Pain?] / Jedem Rückenpatienten sein MRI?

An MRI for Every Patient with Back Pain? Abstract. Imaging in spinal disorders has changed in the past years. Improved MRI techniques allow for better image interpretation. Unchanged, however, close correlation between clinical evaluation and imaging results remains crucial for correct diagnoses and subsequent therapeutical decisions. Reimbursement cuts have made MRI more affordable in Switzerland while being widely available. This allows - if used according to guidelines - for optimal treatment of patients with spinal disorders.

[When to Manipulate a Patient with Low Back Pain?] / Wann soll der Rückenpatient manipuliert werden?

When to Manipulate a Patient with Low Back Pain? Abstract. The roots of manual treatment date back to well before the birth of Christ. Today, various professions are engaged in manual therapy, which is an established, accepted and evidence-based treatment for various musculoskeletal complaints. Elemental to the success of manual therapy are the mechanical, neuro-reflective and psychological effects. There are different levels upon which the indication for manual treatment can be established. These include the organ/structural level, the functional level (hypo- vs. hypermobility) and the pain level (acute vs. chronic).

[When Does the Patient with Low Back Pain Need Rehabilitation?] / Wann braucht der Patient mit Rückenschmerzen eine Rehabilitation?

When Does the Patient with Low Back Pain Need Rehabilitation? Abstract. If functional impairments or participation restrictions persist in patients with low back pain after completion of acute therapy, a rehabilitation is indicated. Rehabilitation refers to the coordinated use of medical, social, professional, technical, and educational measures in order to optimize a patient's functional health and to achieve an independent participation in everyday life. Rehabilitation is also indicated when return to work is at risk, or when the affected person is unable to return to their usual work. The functional limitations of the patient require the use of an interdisciplinary team and a multimodal therapeutic approach. In addition to a function-oriented therapy, Pilates and McKenzie exercises also seem to be effective to improve functional capacities in the context of rehabilitation. On the other hand, passive modalities play only a minor role.

[Interventional Pain Management - Are Targeted Infiltrations Efficient?] / Interventionelle Schmerztherapie.

Interventional Pain Management - Are Targeted Infiltrations Efficient? Abstract. Interventional Pain Management offers a low-risk, partially invasive, but ultimately non-structurally altering targeted intervention option. It has the potential to point on the nociceptive structure and to relieve pain and improve function. Thereby spine surgery can be regularly avoided.

[Low Back Pain - Value of Prevention and Physiotherapy?] / Rückenschmerzen.

Low Back Pain - Value of Prevention and Physiotherapy? Abstract. Physiotherapy plays a central role in the prevention and treatment of lumbar back pain. There is no clear evidence in science on the effectiveness of individual preventive measures; however, movement and active training as central elements are indispensable here. In the treatment of lumbar back pain, however, the picture is clear: while passive measures such as heat or cold applications as well as ultrasound and electrotherapy should no longer be used alone due to the lack of evidence, the combination of active exercises and patient education shows promising success. If these are supplemented by sporadically applied manual therapy methods, the result is an evidence-based management of both acute and chronic lumbar back pain. One example of a successful implementation of current evidence for the treatment of back pain is GLA:D®, which is also in use in Switzerland since 2021.