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1.
Georgian Med News ; (306): 19-23, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-33130639

RESUMO

Nowadays CT colonoscopy is one of the basic methods for colon disease diagnostic. In Georgia mentioned method is used rarely despite of its high diagnostic potential. The current research aims to populate CT colonoscopy to be widely used in diagnostic as well as preventive healthcare, develop radiological semiotics of colon specifications and pathology changes. The research have been carried out in Batumi Referral Hospital. During the clinical researches patient's complains were gathered in details , also there was considered life , medical history and clinical research data. Following instrumental methods were used: CT colonoscopy, fibrocolonoscopy, irrigography-irrigoscopy, ultrasound research of colon. Computer Tomography researches was carried out on "General Electric" (USA) 16 layer CT scanner with 1.2 mm step by following phases: definition of research indication, preparation of intestine, insufflation, getting image, working on image and interpretation. In all cases intenstine was filled up with common air by manually method. According to 224 patients examination results in colon growing anomalies diagnostic CT colonoscopy responsivity is 98,0%, specificity 100%, diagnostic accuracy 98,2%, diverticulosis diagnostic 92,3%, 95,1%, 92,7%, and accordingly polyps in diagnostic: 87,3%, 85,6%, 85,9%. According to the gained results we can make conclusion, that CT colonoscopy is a reliable, high informational and minimally invasive diagnostic method to discover pathological disorder in colon wall and early stage cancer.


Assuntos
Pólipos do Colo , Colonografia Tomográfica Computadorizada , Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Colonoscopia , República da Geórgia , Humanos , Sensibilidade e Especificidade
2.
Clin Imaging ; 67: 214-218, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32871425

RESUMO

This article reports 2 adult patients who had developed an acute allergic reaction to food ingredients or medications, respectively. Both patients presented with concurrent urticaria of the skin and colon. The latter finding appeared as numerous raised plaques of the colonic mucosa on radiographic and computed tomography (CT) of the abdomen. The urticarial lesions affecting the skin and large bowel resembled each other and resolved after treatment with antihistamines. Pertinent clinical data and previously published cases of this unusual entity are briefly reviewed.


Assuntos
Colo/diagnóstico por imagem , Hipersensibilidade , Urticária/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pele/patologia , Urticária/tratamento farmacológico , Urticária/etiologia
4.
Indian J Gastroenterol ; 39(2): 147-152, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32406008

RESUMO

OBJECTIVES: Constipation is a common problem in children, and most of the time, the cause is defined as functional. Our hypothesis is that children with functional refractory constipation had anatomic alterations of the colon. METHODS: All children with chronic refractory constipation who visited our centre underwent accurate clinical examination, contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsies (RSB). In case of functional constipation, three operators measured the size of the colon using radiograms and calculated the ratio based on the width of the second lumbar vertebra. The measurements carried out were compared with those reported in the literature on patients of the same age without constipation. RESULTS: Over a period of 24 months, 69 patients with chronic refractory constipation, aged between 1 and 14 years, visited our department. A CE was performed on 67, and 2 were excluded because of anal stenosis. Sixty-five underwent anorectal manometry. Rectal suction biopsies were needed in 14 children, and 2 of them were found to have colonic aganglionosis. After a complete evaluation, 57 (82.61%) patients were diagnosed having functional constipation. By comparing the data of the patients with those of normal children reported by the other authors, we found that none of the measurements was statistically significant except for the rectosigmoid length: the mean value in one-year-old patients was 19.03 vs. 9.75, and in older children, it was 19.46 vs. 9.59. CONCLUSIONS: Recognizing an anatomic anomaly in patients suffering from functional constipation is important for specific treatment, especially when the ratio (rectosigmoid length/L2) is higher than 15.


Assuntos
Malformações Anorretais/complicações , Malformações Anorretais/diagnóstico , Colo/patologia , Constipação Intestinal/etiologia , Adolescente , Fatores Etários , Biópsia/métodos , Criança , Pré-Escolar , Doença Crônica , Colo/diagnóstico por imagem , Constipação Intestinal/diagnóstico , Constipação Intestinal/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Manometria , Reto/patologia , Reto/fisiopatologia , Estudos Retrospectivos
5.
Aliment Pharmacol Ther ; 52(1): 5-19, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32432797

RESUMO

INTRODUCTION: The prognosis of dysplasia in patients with IBD is largely determined from observational studies from the pre-videoendoscopic era (pre-1990s) that does not reflect recent advances in endoscopic imaging and resection. AIMS: To better understand the risk of synchronous colorectal cancer and metachronous advanced neoplasia (ie high-grade dysplasia or cancer) associated with dysplasia diagnosed in the videoendoscopic era, and to stratify risk according to a lesion's morphology, endoscopic resection status or whether it was incidentally detected on biopsy of macroscopically normal colonic mucosa (ie invisible). METHODS: A systematic search of original articles published between 1990 and February 2020 was performed. Eligible studies reported on incidence of advanced neoplasia at follow-up colectomy or colonoscopy for IBD-dysplasia patients. Quantitative and qualitative analyses were performed. RESULTS: Thirty-three studies were eligible for qualitative analysis (five for the meta-analysis). Pooled estimated proportions of incidental synchronous cancers found at colectomy performed for a pre-operative diagnosis of visible high-grade dysplasia, invisible high-grade dysplasia, visible low-grade dysplasia and invisible low-grade dysplasia were 13.7% (95% CI 0.0-54.1), 11.4% (95% CI 4.6-20.3), 2.7% (95% CI 0.0-7.1) and 2.4% (95% CI 0.0-8.5) respectively. The lowest incidences of metachronous advanced neoplasia, for dysplasia not managed with immediate colectomy but followed up with surveillance, tended to be reported by the studies where high definition imaging and/or chromoendoscopy was used and endoscopic resection of visible dysplasia was histologically confirmed. CONCLUSIONS: The prognosis of IBD-dysplasia diagnosed in the videoendoscopic era appears to have been improved but the quality of evidence remains low. Larger, prospective studies are needed to guide management. PROSPERO registration no: CRD42019105736.


Assuntos
Colo/diagnóstico por imagem , Colonoscopia/métodos , Doenças Inflamatórias Intestinais/complicações , Mucosa Intestinal/diagnóstico por imagem , Colo/patologia , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/etiologia , Hiperplasia/patologia , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Doenças Inflamatórias Intestinais/patologia , Mucosa Intestinal/patologia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Adv Clin Exp Med ; 29(5): 573-580, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32421261

RESUMO

BACKGROUND: Screening colonoscopy is one of the most popular modalities for screening and surveillance of colorectal cancer and other colon disorders. OBJECTIVES: To introduce new ratios to predict the colonoscopy course in patients with similar characteristics. MATERIAL AND METHODS: Five hundred screening colonoscopies (252 females and 248 males) were performed by an experienced endoscopist. Incomplete colonoscopies (without pathologic findings, i.e., disease-unrelated) were included in the study. Collected data was used to determine new ratios. RESULTS: An examination was completed in 231 (91.7%) females (F) and 239 (96.4%) males (M). The majority of incomplete colonoscopies were discontinued in the sigmoid colon: 8 F (38.1%) and 4 M (44.4%) or in the descendosigmoid flexure: 4 F (19%) and 2 M (22.2%). We found statistically significant higher risk of incompleteness in females (p = 0.03), patients after 2 or more surgical treatments (p = 0.007) and in males with lower body mass index (BMI) (p = 0.01) (χ2 tests). Moreover, we discovered a statistically significant correlation with 2 or more previous surgical treatments in the female group (p = 0.02) (χ2 test). We calculated the incomplete colonoscopy anatomy-related (ICAR) and modified ICAR (MICAR) ratios. The range of ICAR and MICAR was 0-0.17; the number of incomplete examinations ranged from 0 to 1 failed out of 6 attempts (calculation: 100:17 = 5.88). CONCLUSIONS: The ICAR and MICAR ratios reflect the various risk of colonoscopy incompleteness (i.e., disease-unrelated) and highlight the differences between patients in similar examination condition.


Assuntos
Colo/patologia , Neoplasias do Colo/diagnóstico , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Índice de Massa Corporal , Colo/diagnóstico por imagem , Colonoscopia/métodos , Feminino , Humanos , Masculino , Valor Preditivo dos Testes
9.
PLoS One ; 15(4): e0231796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287314

RESUMO

BACKGROUND: Antimicrobial peptide expression is associated with disease activity in inflammatory bowel disease (IBD) patients. IBD patients have abnormal expression of elafin, a human elastase-specific protease inhibitor and antimicrobial peptide. We determined elafin expression in blood, intestine, and mesenteric fat of IBD and non-IBD patients. METHODS: Serum samples from normal and IBD patients were collected from two UCLA cohorts. Surgical resection samples of human colonic and mesenteric fat tissues from IBD and non-IBD (colon cancer) patients were collected from Cedars-Sinai Medical Center. RESULTS: High serum elafin levels were associated with a significantly elevated risk of intestinal stricture in Crohn's disease (CD) patients. Microsoft Azure Machine learning algorithm using serum elafin levels and clinical data identified stricturing CD patients with high accuracy. Serum elafin levels had weak positive correlations with clinical disease activity (Partial Mayo Score and Harvey Bradshaw Index), but not endoscopic disease activity (Mayo Endoscopic Subscore and Simple Endoscopic Index for CD) in IBD patients. Ulcerative colitis (UC) patients had high serum elafin levels. Colonic elafin mRNA and protein expression were not associated with clinical disease activity and histological injury in IBD patients, but stricturing CD patients had lower colonic elafin expression than non-stricturing CD patients. Mesenteric fat in stricturing CD patients had significantly increased elafin mRNA and protein expression, which may contribute to high circulating elafin levels. Human mesenteric fat adipocytes secrete elafin protein. CONCLUSIONS: High circulating elafin levels are associated with the presence of stricture in CD patients. Serum elafin levels may help identify intestinal strictures in CD patients.


Assuntos
Colite Ulcerativa/sangue , Doença de Crohn/complicações , Elafina/sangue , Obstrução Intestinal/diagnóstico , Gordura Abdominal/citologia , Gordura Abdominal/metabolismo , Adipócitos/metabolismo , Adulto , Estudos de Casos e Controles , Linhagem Celular , Colite Ulcerativa/patologia , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia , Constrição Patológica/sangue , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Doença de Crohn/sangue , Doença de Crohn/diagnóstico , Doença de Crohn/patologia , Elafina/metabolismo , Feminino , Fibroblastos , Voluntários Saudáveis , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Obstrução Intestinal/sangue , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Masculino , Cultura Primária de Células , Estudos Prospectivos , Índice de Gravidade de Doença
10.
Nat Commun ; 11(1): 1512, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32251296

RESUMO

Studies of inflammatory bowel disease (IBD) have been inconclusive in relating microbiota with distribution of inflammation. We report microbiota, host transcriptomics, epigenomics and genetics from matched inflamed and non-inflamed colonic mucosa [50 Crohn's disease (CD); 80 ulcerative colitis (UC); 31 controls]. Changes in community-wide and within-patient microbiota are linked with inflammation, but we find no evidence for a distinct microbial diagnostic signature, probably due to heterogeneous host-microbe interactions, and show only marginal microbiota associations with habitual diet. Epithelial DNA methylation improves disease classification and is associated with both inflammation and microbiota composition. Microbiota sub-groups are driven by dominant Enterbacteriaceae and Bacteroides species, representative strains of which are pro-inflammatory in vitro, are also associated with immune-related epigenetic markers. In conclusion, inflamed and non-inflamed colonic segments in both CD and UC differ in microbiota composition and epigenetic profiles.


Assuntos
Colite Ulcerativa/imunologia , Doença de Crohn/imunologia , Epigênese Genética/imunologia , Microbioma Gastrointestinal/imunologia , Interações entre Hospedeiro e Microrganismos/imunologia , Adulto , Idoso , Bacteroides/genética , Bacteroides/imunologia , Bacteroides/isolamento & purificação , Biópsia , Células CACO-2 , Estudos de Casos e Controles , Estudos de Coortes , Colite Ulcerativa/genética , Colite Ulcerativa/microbiologia , Colite Ulcerativa/patologia , Colo/diagnóstico por imagem , Colo/imunologia , Colo/microbiologia , Colo/patologia , Colonoscopia , Doença de Crohn/genética , Doença de Crohn/microbiologia , Doença de Crohn/patologia , DNA Bacteriano/isolamento & purificação , Enterobacteriaceae/genética , Enterobacteriaceae/imunologia , Enterobacteriaceae/isolamento & purificação , Epigenômica , Feminino , Microbioma Gastrointestinal/genética , Interações entre Hospedeiro e Microrganismos/genética , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/imunologia , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , RNA-Seq , Adulto Jovem
12.
Am J Surg Pathol ; 44(7): 955-961, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32235151

RESUMO

Surveillance colonoscopies focused to detect dysplasia are recommended to prevent colorectal cancer in patients with long-standing colonic inflammatory bowel disease (IBD). To date, histologic diagnosis and gradation of IBD-related dysplasia has been challenged by a high variability among pathologists. We aimed to analyze the observer characteristics that are correlated with concordance deviations in this diagnosis. Eight pathologists evaluated a set of 125 endoscopic biopsy samples with a representative distribution of nondysplastic and dysplastic lesions from long-standing IBD patients. Two rounds of diagnosis were carried out during a period of 18 months. The κ test was applied to analyze concordance. Pathologists were grouped on the basis of their experience. A subanalysis was performed by eliminating the highly prevalent nondysplastic samples, as well as an analysis after observers' grouping. Overall interobserver agreement was good (κ=0.73), with an even higher pairwise value (κ=0.86) as well as the intraobserver agreement values (best κ=0.85). After eliminating the highly prevalent nondysplastic samples, the interobserver agreement was still moderate to good (best overall κ=0.50; best paired κ=0.72). Notable differences were seen between the pathologists with a high-volume and low-volume practice (best overall κ=0.61 and 0.41, respectively). The agreement in the diagnosis of dysplasia in IBD endoscopic biopsies may have been undervalued over time. This is the first study evaluating pathologists' diagnostic robustness in this field. The results suggest that examining a large volume of samples is the key factor to increase the consistency in the diagnosis and gradation of IBD-related dysplasia.


Assuntos
Colo/patologia , Colonoscopia , Neoplasias Colorretais/patologia , Doenças Inflamatórias Intestinais/patologia , Mucosa Intestinal/patologia , Lesões Pré-Cancerosas/patologia , Biópsia , Colo/diagnóstico por imagem , Neoplasias Colorretais/diagnóstico por imagem , Consenso , Humanos , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Mucosa Intestinal/diagnóstico por imagem , Variações Dependentes do Observador , Patologistas , Lesões Pré-Cancerosas/diagnóstico por imagem , Estudos Prospectivos
13.
J Trauma Acute Care Surg ; 88(6): 770-775, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32118825

RESUMO

BACKGROUND: The American Association for the Surgery of Trauma (AAST) developed a severity scale for surgical conditions, including diverticulitis. The Hinchey classification requires operative intervention yet remains the established scoring system for acute diverticulitis. This is a pilot study to compare the AAST grading scale for acute colonic diverticulitis with the traditional Hinchey classification. We hypothesize that the AAST classification scale is equivalent to the Hinchey in predicting outcomes. METHODS: This is a retrospective cohort study at an academic medical center. A consecutive sample of patients with acute diverticulitis and computed tomography imaging was reviewed. Chart review identified demographic and physiologic data with interventional and clinical outcomes. Each computed tomography scan was assigned AAST and modified Hinchey classification scores by a radiologist. Multivariate regression and receiver operating characteristic curve analysis compared six outcomes: need for procedure, complication, intensive care unit (ICU) admission, length of stay, 30-day readmission, and mortality. RESULTS: One hundred twenty-nine patients were included. Of the total patients, 42.6% required procedural intervention, 21.7% required ICU admission, 18.6% were readmitted, and 6.2% died. Both AAST and Hinchey predicted the need for operation (AAST odds ratios, 1.55, 12.7, 18.09, and 77.24 for stages 2-5; Hinchey odds ratios, 8.85, 11.49, and 22.9 for stages 1b-3, stage 4 predicted perfectly). The need for operation c-statistics (area under the curve) for AAST and Hinchey was 0.80 and 0.83 for Hinchey and AAST, respectively (p = 0.35). The complication c-statistics curve for AAST and Hinchey was 0.83 and 0.80, respectively (p = 0.33). The AAST and Hinchey scores were less predictive for ICU admission, readmission, and mortality with c-statistics of less than 0.80. CONCLUSION: The AAST grading of acute diverticulitis is equivalent to the modified Hinchey classification in predicting procedural intervention and complications. The AAST system may be preferable to Hinchey because it can be applied preoperatively. Although this pilot study demonstrated that the AAST score predicts surgical need, a larger study is required to evaluate the AAST score for other outcomes. LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III.


Assuntos
Doença Diverticular do Colo/diagnóstico , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Doença Aguda/mortalidade , Doença Aguda/terapia , Adulto , Colo/diagnóstico por imagem , Doença Diverticular do Colo/mortalidade , Doença Diverticular do Colo/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Sociedades Médicas , Tomografia Computadorizada por Raios X , Traumatologia , Estados Unidos , Adulto Jovem
14.
Sci Rep ; 10(1): 2295, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041974

RESUMO

It is understood that colorectal adenomas progress to colonic adenocarcinoma. Adenoma detection rate (ADR) at endoscopy has been used as a key performance indicator at endoscopy and is inversely associated with diagnosis of interval colorectal cancer. As most endoscopy reporting systems do not routinely incorporate histological assessment, ADR reporting is a cumbersome task. Polyp Detection Rate (PDR) has therefore been adopted as a surrogate marker for ADR. A prospectively maintained database of colonoscopies performed between July 2015 and July 2017 was analysed. This was cross referenced with a histological database. Statistical analysis was performed using IBM SPSS, version 24. Inferential procedures employed included the Pearson's correlation coefficient (r) and Binomial logistic regression. Of 2964 procedures performed by 8 endoscopists, overall PDR was 27% and ADR was 19%. The PDR, ADR, adenoma to polyp detection rate quotient (APDRQ) and estimated ADR (PDR x APDRQ group average = 0.72) was calculated for each individual. There was a strong positive linear correlation between PDR and ADR,r(8) = 0.734, p = 0.038 and between PDR and estimated ADR, r(8) = 0.998, p < 0.001. Adenoma detection rate strongly correlated with estimated ADR, r(8) = 0.720, p = 0.044. With the exclusion of a moderate outlier, these correlations increased in both strength and significance. There was a stronger correlation between PDR and ADR,r(7) = 0.921, p = 0.003 and between ADR and estimated ADR, r(7) = 0.928, p = 0.003.


Assuntos
Adenocarcinoma/epidemiologia , Pólipos Adenomatosos/epidemiologia , Pólipos do Colo/epidemiologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Pólipos Adenomatosos/diagnóstico , Pólipos Adenomatosos/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo/diagnóstico por imagem , Colo/patologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/patologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Progressão da Doença , Feminino , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reto/diagnóstico por imagem , Reto/patologia , Estudos Retrospectivos , Adulto Jovem
15.
Sci Rep ; 10(1): 2748, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066744

RESUMO

We present a comprehensive analysis of the submissions to the first edition of the Endoscopy Artefact Detection challenge (EAD). Using crowd-sourcing, this initiative is a step towards understanding the limitations of existing state-of-the-art computer vision methods applied to endoscopy and promoting the development of new approaches suitable for clinical translation. Endoscopy is a routine imaging technique for the detection, diagnosis and treatment of diseases in hollow-organs; the esophagus, stomach, colon, uterus and the bladder. However the nature of these organs prevent imaged tissues to be free of imaging artefacts such as bubbles, pixel saturation, organ specularity and debris, all of which pose substantial challenges for any quantitative analysis. Consequently, the potential for improved clinical outcomes through quantitative assessment of abnormal mucosal surface observed in endoscopy videos is presently not realized accurately. The EAD challenge promotes awareness of and addresses this key bottleneck problem by investigating methods that can accurately classify, localize and segment artefacts in endoscopy frames as critical prerequisite tasks. Using a diverse curated multi-institutional, multi-modality, multi-organ dataset of video frames, the accuracy and performance of 23 algorithms were objectively ranked for artefact detection and segmentation. The ability of methods to generalize to unseen datasets was also evaluated. The best performing methods (top 15%) propose deep learning strategies to reconcile variabilities in artefact appearance with respect to size, modality, occurrence and organ type. However, no single method outperformed across all tasks. Detailed analyses reveal the shortcomings of current training strategies and highlight the need for developing new optimal metrics to accurately quantify the clinical applicability of methods.


Assuntos
Algoritmos , Artefatos , Endoscopia/normas , Interpretação de Imagem Assistida por Computador/normas , Imageamento Tridimensional/normas , Redes Neurais de Computação , Colo/diagnóstico por imagem , Colo/patologia , Conjuntos de Dados como Assunto , Endoscopia/estatística & dados numéricos , Esôfago/diagnóstico por imagem , Esôfago/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Imageamento Tridimensional/estatística & dados numéricos , Cooperação Internacional , Masculino , Estômago/diagnóstico por imagem , Estômago/patologia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Útero/diagnóstico por imagem , Útero/patologia
17.
Medicine (Baltimore) ; 99(8): e19343, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080155

RESUMO

RATIONALE: Foreign body (FB) ingestion is a relatively common clinical situation in the emergency department. However, multiple sharply pointed foreign bodies located in different organs are rare conditions and no definite treatment guidelines has been established. PATIENT CONCERNS: A 31-year-old amateur magician visited the outpatient clinic with a chief complaint of epigastric discomfort. He might have accidentally swallowed some needles while practicing a magic trick 2 days before. DIAGNOSIS: Imaging tests revealed 1 needle was stuck in the left liver lobe through the stomach wall, 1 was in the third portion of the duodenum, 3 were in the ascending colon, and 2 were in the transverse colon. INTERVENTIONS: A needle in the duodenum and 5 in the colon were removed by endoscopy. The needle stuck in the liver from the stomach was not visible inside the stomach and was successfully removed by laparoscopy a few days later. OUTCOMES: The patient was able to tolerate an oral diet and was discharged on postoperative day 4 without any complications. LESSONS: Developing a treatment plan in cases of multiple sharp FB may be difficult. A multidisciplinary team of endoscopists and surgeons is needed to determine the best possible treatment plan. This experience illustrates the importance of the planning of the sequence and method of removal of multiple foreign bodies from the gastrointestinal tract.


Assuntos
Endoscopia do Sistema Digestório , Corpos Estranhos/cirurgia , Laparoscopia , Agulhas , Acidentes , Adulto , Colo/diagnóstico por imagem , Colo/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Magia , Masculino , Radiografia , Estômago/diagnóstico por imagem , Estômago/cirurgia
18.
Can Assoc Radiol J ; 71(2): 140-148, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063002

RESUMO

The accuracy of computed tomography (CT) colonography (CTC) requires that the radiologist be well trained in the recognition of pitfalls of interpretation. In order to achieve a high sensitivity and specificity, the interpreting radiologist must be well versed in the causes of both false-positive and false-negative results. In this article, we review the common and uncommon pitfalls of interpretation in CTC.


Assuntos
Colonografia Tomográfica Computadorizada , Ceco/diagnóstico por imagem , Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Meios de Contraste , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Imageamento Tridimensional , Interpretação de Imagem Radiográfica Assistida por Computador , Reto/diagnóstico por imagem , Sensibilidade e Especificidade
20.
Gastroenterology ; 158(5): 1232-1249.e3, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31945360

RESUMO

With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics, and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or, in rare cases, anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting µ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patient history and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.


Assuntos
Constipação Intestinal/terapia , Defecação/fisiologia , Motilidade Gastrointestinal/fisiologia , Doença Crônica/epidemiologia , Doença Crônica/terapia , Colo/diagnóstico por imagem , Colo/inervação , Colo/metabolismo , Colo/fisiopatologia , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Defecografia , Fibras na Dieta/administração & dosagem , Suplementos Nutricionais , Exame Retal Digital , Eletromiografia , Motilidade Gastrointestinal/efeitos dos fármacos , Humanos , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/fisiopatologia , Laxantes/administração & dosagem , Imagem por Ressonância Magnética , Manometria , Diafragma da Pelve/inervação , Diafragma da Pelve/fisiopatologia , Prevalência , Receptores Opioides mu/antagonistas & inibidores , Receptores Opioides mu/metabolismo , Reto/diagnóstico por imagem , Reto/inervação , Reto/metabolismo , Reto/fisiopatologia , Secretagogos/administração & dosagem
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