Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier's disease with an underlying lipoma: A case report.

BACKGROUND: Ménétrier's disease is a rare condition characterized by enlarged gastric folds, usually located in the whole body and fundus of the stomach. This report presents an unusual case of localized Ménétrier's disease elevated by a submucosal lipoma and thus looking like a polypoid mass and causing an episode of upper gastrointestinal bleeding. The mass was successfully removed with endoscopic submucosal dissection. CASE SUMMARY: Esophagogastroduodenoscopy was performed on a 76-year-old male patient after an episode of upper gastrointestinal bleeding, manifesting as fatigue and melena. A large polypoid mass (4 cm × 1 cm) with enlarged mucosal folds was found in the body of the stomach, between the lesser curvature and posterior wall. A small ulcer at the distal end of the mass was identified as the source of the bleeding. Biopsy was negative for neoplasia. Computed tomography showed a submucosal lesion beneath the affected mucosa, most likely a lipoma. The mass was removed en bloc with tunneling endoscopic submucosal dissection. Final pathology determined that the mass included Ménétrier's disease and a submucosal lipoma. The patient was scheduled for follow-up esophagogastroduodenoscopy. CONCLUSION: Localized Ménétrier's disease can coexist with a submucosal lipoma creating a polypoid mass with risk of bleeding.

Minimally invasive treatment of postoperative fistulas, leakages, and perforations of the upper gastrointestinal tract: a single-center observational study.

Introduction: Most anastomotic leaks in the upper gastrointestinal (GI) tract can be treated with minimally invasive techniques dominated by endoluminal vacuum therapy (EVT) or stent implantation. Chronic leaks often require additional solutions, such as tissue adhesives or cellular growth stimulants. Aim: To present a treatment strategy for postoperative leakage of upper GI anastomoses with noninvasive procedures. Material and methods: A group of 19 patients treated in the period 2015-2023 with postoperative upper GI tract leakage was enrolled for endoscopic treatment. The indication for the therapy was anastomotic dehiscence not exceeding half of the circumference and the absence of severe septic complications. All patients were managed using endoscopic vacuum therapy (EVT) or a self-expanding stent while persistent fistulas were additionally treated with alternative methods. Results: The EVT was successfully implemented in 13 cases, but 7 patients required alternative methods to achieve definitive healing. Self-expanding stent placement was performed in 6 patients; however, in 3 cases a periprosthetic leakage occurred. In this group, 2 patients had the stent removed and the third one died due to septic complications. Post-treatment stenosis was identified in 5 patients after EVT that required balloon dilation with acceptable resolution in all cases. Conclusions: Early detected anastomotic dehiscence limited to half of the circumference most effectively responded to the noninvasive treatment. Nutritional support as well as complementary endoscopic solutions such as tissue adhesives, growth stimulants and hemostatic clips increase the percentage of complete healing.

Endoscopic Surveillance and Treatment of Upper GI Tract Lesions in Patients with Familial Adenomatous Polyposis-A New Perspective on an Old Disease.

Familial adenomatous polyposis (FAP) is an autosomal dominant disease caused by a germline mutation in the adenomatous polyposis coli (APC) gene. Patients with FAP develop up to thousands of colorectal adenomas as well as lesions in the upper GI tract. In FAP, the upper digestive lesions include gastric fundic gland polyps (FGPs), antrum adenomas, duodenal or small intestinal adenomas, and carcinoma. Patients, after colectomy, are still at significant risk for extracolonic malignancies. Advances in endoscope resolution and optical enhancement technologies allow endoscopists to provide assessments of benign and malignant polyps. For this reason, in the past decades, endoscopic resection techniques have become the first line of treatment in patients with polyps in the upper GI, whereby polyps and even early cancers can be successfully cured. In FAP patients, endoscopic ampullectomy appears to be a safe and effective way of treating patients with ampullary tumors. According to current indications, endoscopic retrograde cholangiopancreatography (ERCP) and stenting of the main pancreatic duct follow ampullectomy.

Obesity and inflammation.

The prevalence of obesity has recently increased dramatically and has contributed to the increasing prevalence of various pathological conditions, including type 2 diabetes mellitus, nonalcoholic fatty liver disease, asthma, various types of cancer, cardiovascular and neurodegenerative diseases, and others. Accumulating evidence points to localized inflammation in adipose tissue, which, in turn, promotes systemic low-grade inflammation as a primary force contributing to the development of these pathologies. A better understanding of the underlying mechanisms behind obesity-induced adipose tissue inflammation is required to develop effective therapeutic or prophylactic strategies. This review is aimed to present the current knowledge of adipose tissue inflammation associated with obesity.

The Role of HSP70 Heat Shock Proteins in the Pathogenesis and Treatment of Inflammatory Bowel Diseases.

Heat shock proteins (HSPs) represent an important element in the body's defense against various damaging factors. The probably also play an important role in the pathogenesis and treatment of several diseases, including autoimmune pathology and neoplasms. Recently, several investigators have focused their attention on the involvement of the HSP70 protein family in the morbid process of inflammatory bowel diseases (IBD). The HSP70 family of is represented by two distinct forms of protein, the HSP72 protein (also known as the HSP70.1 protein), the expression of which is clearly increased in conditions of stress; and the HSP73 (or HSC73) protein, which manifests stable expression. HSP70 proteins are present in the colorectal epithelium. In patients with inflammatory bowel diseases, their expression in significantly increased during the active stage of the disease. In experimental studies, overexpression of HSP70 was found to prevent the development of inflammatory process in the large intestinal mucosa provoked by various damaging factors. In physiological conditions, various mechanisms are considered to be responsible for an increased expression of HSP70. One of them involves lymphocyte activity and the production of cytokines (mainly IL-2). Another suggested mechanism involves the presence of bacteria in the large intestine, including both physiological flora (Lactobacillus GG, Bacteroides fragilis) and pathogenic bacteria (Salmonella, Escherichia coli). HSP70 expression is probably also increased by physical activity. There is also a potential for pharmacological stimulation of HSP70 expression, linked (for example) to geranylgeranylacetone, polaprezinc and mesalazine. Thus, augmentation of HSP70 expression may become a new element in IBD therapy.

Increased accumulation of skin advanced glycation end products is associated with microvascular complications in type 1 diabetes.

BACKGROUND: Skin autofluorescence (AF) measured with an AF reader device is a noninvasive tool to measure the tissue accumulation of advanced glycation end products (AGEs). The aim of the study was to assess the association between AF and microvascular complications in type 1 diabetes mellitus (DM1). METHODS: The study population consisted of 140 DM1 patients, 28 years old (interquartile range [IQR], 23-35), 76 of whom were women, with disease duration of 13 years (IQR, 8-19). We used the AGE Reader (DiagnOptics, Groningen, The Netherlands) to measure the AF phenomenon, which occurs because of fluorescent properties of AGEs. The patients were divided according to the presence or absence of diabetes-associated microvascular complications: retinopathy, nephropathy, and neuropathy and any microangiopathy. RESULTS: The median AF was 2.0 (IQR, 1.7-2.4). In the univariate logistic regression AF was significantly associated with retinopathy (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.26-4.84, P = 0.008), nephropathy (OR 3.15, 95% CI 1.34-7.39, P = 0.008), neuropathy (OR 3.17, 95% CI 1.46-6.90, P = 0.003), and any microvascular complication (OR 2.94, 95% CI 1.46-5.92, P = 0.002). Multivariate logistic regression showed that skin AF was independently associated only with diabetic neuropathy (OR 2.98, 95% CI 0.99-8.90, P = 0.05). CONCLUSIONS: The tissue accumulation of AGE is significantly associated with microvascular complications in DM1.

Assessment of skin autofluorescence as a marker of advanced glycation end product accumulation in type 1 diabetes.

INTRODUCTION: Advanced glycation end products (AGEs) are important in the pathogenesis of atherosclerosis and reflect the risk of cardiovascular mortality. AGE levels are significantly higher in patients with diabetes. OBJECTIVES: The aim of the study was to compare AGE accumulation in the skin of patients with type 1 diabetes and nondiabetic population as well as to assess its association with disease duration and metabolic control. We also aimed to assess the potential usefulness of this method in the monitoring of diabetes control, especially in a long-term follow-up. PATIENTS AND METHODS: The study included 140 type 1 diabetes patients (mean age 30.4 ± 9.7 years; mean disease duration 13.6 ± 8.5 years) and 57 nondiabetic subjects. AGE accumulation in the skin was assessed noninvasively with the AGE Reader device, which measures autofluorescence (AF) that occurs because some AGEs have fluorescent properties. RESULTS: Mean AF in the diabetes group was 2.13 ± 0.55 and it was significantly higher than in controls (AF 1.70 ± 0.27, P <0.05). A significant positive correlation between AF and the age of patients was found for the whole study population (P <0.05). In diabetic subjects, we observed a significant positive correlation between AF and diabetes duration (P <0.05), and between AF and glycated hemoglobin (HbA1c) (P <0.05). CONCLUSIONS: AF measurement is a simple and noninvasive method of assessing AGE accumulation in the skin. It may be useful as a secondary method of assessing metabolic control, as it reflects glycemic control over a longer period of time than that reflected by HbA1c levels.

[The Polish model of physiotherapeutic conduct in rheumatoid arthritis and recommendation of Ottawa Panel]. / Polskie podejscie fizjoterapeutyczne usprawniania w reumatoidalnym zapaleniu stawów a zalecenia Panelu Ottawskiego.

THE AIM: The aim of the research was to evaluate how the suggestions of the Ottawa Panel are implemented with regard to the patents suffering from rheumatoid arthritis in Poland. MATERIAL AND METHOD: in the research there was a test group of 41 people (33 women and 8 men) with rheumatoid arthritis. The criterion that was decisive in this study was the phase of reemission of the illness and whether the patient was taking part in physiotherapeutic treatment. The age of the subjects varied from 25 and 79 (the average age was 53.11). The average duration of the illness was 12.17 years. The research was conducted from November 2006 until September 2007 in Wiktor Dega Orthopedic-Rehabilitation Clinical Hospital (O-RSK4) in Poznan and in 22nd Military Rehabilitation Hospital in Ciechocinek. RESULTS: It was shown in the tested group there was a deep correlation between the joints with movement restrictions and the ones that caused most pain (r = 0.6086 for sum of painful joints with those with movement restrictions). Any link between the presence of deformation within the lower limb and exercising the suggested elements of gait during rehabilitation has not been found. Similarly, there was no dependence between the presence of deformations in the upper limb and the appropriate physiotherapeutic treatment. However, only in one patient the physical treatment recommended by the Panel was not used at all. CONCLUSIONS: The majority of the Ottawa Panel recommendations is implemented in the Polish model. A big part of patients has access to rehabilitation and usually the physical treatment techniques that proved to be the most beneficial are used. However, certain changes should be introduced to kinesis therapy, which tends to be focused more on joint deformation than on global work on the improvement of functionality and thus--the quality of patient's life.