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1.
Medicine (Baltimore) ; 100(12): e24697, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761637

RESUMO

RATIONALE: Carcinosarcoma and sarcomatoid carcinoma of the stomach are rare, malignant, and biphasic tumors with high mortality. The differential diagnosis of these 2 diseases remains challenging. In the present study, we present 2 cases of carcinosarcoma and sarcomatoid carcinoma of the stomach. PATIENT CONCERNS: A 54-year-old woman was admitted with complaints of epigastric pain for 4 months, but she became serious for 10 days accompanied by melena. A 75-year-old man was admitted with complaints of epigastric pain for 1 month. DIAGNOSIS: The female had a Borrmann type III irregular ulcerative lesion (5.0 × 4.0 × 1.0 cm) originating from the gastric antrum. The male had Borrmann type I tumor polypoid exophytic (5.0 × 4.0 × 2.0 cm) in the fundus of stomach near the cardia. Both cases were identified as malignant neoplasms by endoscopic biopsy and further confirmed by performing laparoscopic proximal gastrectomy, esophagogastrostomy, and palliative distal subtotal gastrectomy. The postoperative histopathological morphology and immunohistochemistry studies revealed sarcomatoid carcinoma for the female and gastric carcinosarcoma for the male respectively. INTERVENTIONS: The female patient subsequently underwent laparoscopy-assisted radical distal gastrectomy for gastric cancer followed by systemic chemotherapy with oxaliplatin plus tegafur. The male patient underwent laparoscopic proximal gastrectomy and esophagogastrostomy were performed. OUTCOMES: The female had a mixture of a little poorly-differentiated adenocarcinoma and abundant sarcomatoid spindle cell elements, and is still alive healthy up to date for 2 and a half years after surgery by phone follow-up. The male patient had both adenocarcinoma and fibrosarcoma in a single tumor, and died 1 month after the operation. LESSONS: The present study provides insight into the clinical findings, differential diagnosis, and prognosis of carcinosarcomas and sarcomatoid carcinomas of the stomach. More cases are needed for further studies in the future.


Assuntos
Carcinoma/diagnóstico , Carcinossarcoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Dor Abdominal/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/complicações , Carcinoma/patologia , Carcinoma/terapia , Carcinossarcoma/complicações , Carcinossarcoma/patologia , Carcinossarcoma/terapia , Quimioterapia Adjuvante , Diagnóstico Diferencial , Evolução Fatal , Feminino , Gastrectomia , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , Biópsia Guiada por Imagem , Laparoscopia , Masculino , Melena/etiologia , Pessoa de Meia-Idade , Oxaliplatina/uso terapêutico , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Tegafur/uso terapêutico , Resultado do Tratamento
2.
BMC Cancer ; 21(1): 235, 2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676442

RESUMO

BACKGROUND: Recent studies have shown that mixed predominantly differentiated-type (MD) early gastric cancer (EGC) might have more malignant potential than pure differentiated-type (PD) EGC. However, no study has analyzed all differentiated-type EGC cases treated endoscopically and surgically. This study aimed to compare the differences in clinicopathological features and long-term prognosis between MD- and PD-EGC. METHODS: We evaluated all patients with differentiated-type EGCs who were treated endoscopically and surgically in our hospital between January 2010 and October 2014. The clinicopathological features and long-term prognosis of MD-EGC were compared with those of PD-EGC. RESULTS: A total of 459 patients with 459 lesions were evaluated in this study; of them, 409 (89.1%) and 50 (10.9%) were classified into the PD and MD groups, respectively. Submucosal invasion was found in 96 (23.5%) patients of the PD group and in 33 (66.0%) patients of the MD group (p < 0.01). The rates of positive lymphatic and vascular invasion and ulceration were significantly higher in the MD group than in the PD group (p < 0.01). The proportion of patients with lymph node metastasis was also significantly higher in the MD group than in the PD group (5 (10%) vs 6 (1.5%), p < 0.01). The 5-year overall and EGC-specific survival rates in the PD group were 88.3 and 99.5%, respectively, while they were 94.0 and 98.0% in the MD group, respectively. CONCLUSIONS: MD-EGC has more malignant potential than PD-EGC. However, the long-term prognosis of MD-EGC is good and is not significantly different from that of PD-EGC when treated appropriately.


Assuntos
Gastrectomia , Mucosa Gástrica/patologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Gástricas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Diferenciação Celular , Ressecção Endoscópica de Mucosa , Feminino , Seguimentos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(1): 104-107, 2021 Jan 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33678644

RESUMO

Dermatomyositis (DM) is a kind of idiopathic inflammatory myopathy characterized by chronic proximal skeletal muscle weakness and unique skin lesions. However, DM with exfoliation of esophageal mucosa is rare. A 36-year-old male patient complained of muscular soreness of extremities, dysphagia, and pharyngalgia was diagnosed with DM with exfoliation of esophageal mucosa. After treatment with glucocorticoid, immunosuppressant, acupuncture, and endoscopic submucosal dissection (ESD), the above symptoms were disappeared. During the 3-year follow-up period, the results of routine physical examination, laboratory examination, gastroscopy, and imaging examination were normal. High-dose of corticosteroid is needed in the initial treatment, but it must be reduced regularly to avoid adverse reactions. Acupuncture and ESD are also effective as adjuvant therapy.


Assuntos
Dermatomiosite , Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Adulto , Dermatomiosite/complicações , Mucosa Esofágica , Gastroscopia , Humanos , Masculino , Resultado do Tratamento
4.
Ann R Coll Surg Engl ; 103(3): e77-e80, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645270

RESUMO

Trichobezoar is a rare condition that occurs mostly in young women with psychiatric disorders such as trichotillomania and trichophagia. We report the case of a giant gastric trichobezoar in a 21-year-old woman who presented with chronic abdominal pain, vomiting and weight loss. Abdominal examination revealed a large epigastric mass. Endoscopic and imaging findings were highly suggestive of a gastric trichobezoar. Surgical extraction of the huge hair mass was successfully performed through an open gastrotomy. Postoperatively, history of a neglected chronic depression with suicidal ideation was diagnosed. Consequently, the patient was referred to the psychiatric department for mental healthcare, to prevent trichobezoar recurrences.


Assuntos
Bezoares/diagnóstico por imagem , Transtorno Depressivo/diagnóstico , Estômago/diagnóstico por imagem , Bezoares/psicologia , Bezoares/cirurgia , Transtorno Depressivo/psicologia , Feminino , Gastroscopia , Humanos , Laparotomia , Pica/psicologia , Estômago/cirurgia , Tomografia Computadorizada por Raios X , Tricotilomania/psicologia , Adulto Jovem
5.
Clin Transl Gastroenterol ; 12(2): e00314, 2021 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-33620880

RESUMO

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, endoscopists have high risks of exposure to exhaled air from patients during gastroscopy. To minimize this risk, we transformed the oxygen mask into a fully closed negative-pressure gastroscope isolation mask. This study aimed to evaluate the effectiveness, safety, and feasibility of use of this mask during gastroscopy. METHODS: From February 28, 2020, to March 10, 2020, 320 patients undergoing gastroscopy were randomly assigned into the mask group (n = 160) or conventional group (n = 160). Patients in the mask group wore the isolation mask during gastroscopy, whereas patients in the conventional group did not wear the mask. The adenosine triphosphate fluorescence and carbon dioxide (CO2) concentration in patients' exhaled air were measured to reflect the degree of environmental pollution by exhaled air. Patients' vital signs, operation time, and adverse events during endoscopy were also evaluated. RESULTS: Four patients were excluded because of noncooperation or incomplete data. A total of 316 patients were included in the final analysis. The difference between the highest CO2 concentration around patients' mouth and CO2 concentration in the environment was significantly decreased in the mask group compared with the conventional group. There was no significant difference in the adenosine triphosphate fluorescence, vital signs, and operation time between the 2 groups. No severe adverse events related to the isolation mask, endoscopy failure, or new coronavirus infection during follow-up were recorded. DISCUSSION: This new isolation mask showed excellent feasibility of use and safety compared with routine gastroscopy during the COVID-19 pandemic.


Assuntos
/transmissão , Gastroscopia/efeitos adversos , Máscaras/virologia , Isoladores de Pacientes/virologia , Trifosfato de Adenosina/metabolismo , Adulto , /epidemiologia , Dióxido de Carbono/análise , Estudos de Casos e Controles , Desenho de Equipamento/métodos , Expiração/fisiologia , Estudos de Viabilidade , Feminino , Fluorescência , Gastroscopia/métodos , Humanos , Masculino , Máscaras/efeitos adversos , Máscaras/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Segurança , Resultado do Tratamento
6.
J Int Med Res ; 49(2): 300060520985742, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33541174

RESUMO

BACKGROUND: Phlegmonous gastritis is a rare bacterial infection of the gastric wall, characterised by purulent inflammation of the gastric mucosa, submucosa and muscularis layers. Phlegmonous gastritis has a high mortality rate, even with correct diagnosis and antimicrobial therapy. CASE PRESENTATION: A 22-year-old man presented for acute epigastric pain associated with aqueous diarrhoea, vomiting and sustained fever. Abdominal computed tomography showed diffuse oedema and thickened gastric wall, increased number and size of abdominal lymph nodes and the absence of pneumoperitoneum. Fibregastroscopy revealed oedematous, ridged and thickened gastric mucosa with abundant purulent secretion, especially in the antrum, consistent with phlegmonous gastritis, which was confirmed by histological evaluation of gastric biopsies. Cultures of the tissue biopsies and purulent secretion were positive for Enterococcus cecorum. He was treated with sensitive antibiotics according to the antibiogram, and importantly, with continuous gastric lavage and individualised nutritional support therapy. He eventually recovered well and was discharged with no abdominal symptoms. CONCLUSIONS: Our case indicates that early diagnosis and immediate treatment are crucial to achieve positive outcomes. The combination of sensitive antibiotics, gastric lavage and early enteral nutrition via nasojejunal feeding might be an effective alternative for the comprehensive treatment of acute phlegmonous gastritis.


Assuntos
Antibacterianos/administração & dosagem , Celulite (Flegmão)/terapia , Nutrição Enteral/métodos , Lavagem Gástrica , Gastrite/terapia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/microbiologia , Celulite (Flegmão)/patologia , Terapia Combinada/métodos , Enterococcus/isolamento & purificação , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastrite/diagnóstico , Gastrite/microbiologia , Gastrite/patologia , Gastroscopia , Humanos , Intubação Gastrointestinal , Masculino , Resultado do Tratamento , Adulto Jovem
7.
Acta Gastroenterol Belg ; 84(1): 9-17, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33639688

RESUMO

Background and study aims: Atrophic gastritis (AG) and intestinal metaplasia (IM) are established premalignant gastric lesions. Many studies documented a poor correlation between esophagogastroduodenoscopy (EGD) and histopathological (HP) findings of precancerous gastric lesions. The aim was to bridge the gap between endoscopy and HP in detection of chronic gastritis, AG and IM. Patients and methods: a prospective single-center study involved 150 patients with endoscopic criteria of gastric lesions with upper gastrointestinal symptoms referred for upper GI endoscopy met the endoscopic criteria and classified according to HP of biopsies from targeted gastric lesions into chronic gastritis (GI), AG(GII) or IM(GIII). We correlated the endoscopic criteria of the 3 groups with the HP results. Results: (73 males & 75 females) with ages ranged17-75 years and mean± SD was 41.96 ± 15.95. GI, GII & GIII were [42 patients (28%),82 patients (54.7%) and 26 patients (17.3%)], respectively. Diffuse gastric mottling was more common in GI (74.3%, P<0.001), visible submucosal vessels, gastric atrophy predominated in GII (75.6, 82.3 & 73.1% (P 0.005,0.4 & <0.01)), respectively. Whitish raised lesions were more specific in GIII (85.7%) (P<0.001). The sensitivity and specificity of endoscopic suspicion of chronic gastritis were (86&88% in GI), (87&85% in GII) and (54% & 100% in GIII) (p-0.001). The logistic regression model for risk factors was χ2= 25.74 and 49.32, p < 0.001. Conclusion: Conventional endoscopy has high sensitivity and specificity for suspicion of chronic gastritis and AG, but low sensitivity and very high specificity for IM. Targeted biopsies may be valuable with image enhanced techniques.


Assuntos
Gastrite Atrófica , Infecções por Helicobacter , Helicobacter pylori , Lesões Pré-Cancerosas , Neoplasias Gástricas , Adolescente , Adulto , Idoso , Biópsia , Feminino , Mucosa Gástrica , Gastrite Atrófica/diagnóstico , Gastroscopia , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
8.
Medicine (Baltimore) ; 100(2): e24055, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466161

RESUMO

ABSTRACT: Magnetic foreign bodies ingestion is a special cause for attending emergency department. Here, we aim to analyze the characteristics and treatments of children who ingested magnetic foreign bodies (Buckyballs). Data were collected from children who ingested Buckyballs between February 2017 and October 2019. A retrospective analysis was performed to summarize the experiences of conservative treatment, gastroscopy and surgery when dealing with Buckyballs ingestion.A total of 49 patients with buckyballs ingestion were identified, of whom 11 underwent conservative treatments, 6 underwent gastroscopy, and 32 underwent surgery. Among such individuals, eight patients (72.7%) had a successful conservative treatment (number of Buckyballs [NB]: 3.5[IQR: 2.0-4.0]); four patients (66.7%) had Buckyballs successfully removed by gastroscopy (NB: 3.5[IQR: 3.0-5.5]); 16 asymptomatic (50%) patients (NB: 4.0[IQR: 3.0-8.0]) and 16 symptomatic (50%) patients (NB: 8.5 [IQR: 6.25-11.75]) received emergency surgery. Compared to patients who received conservative treatment, the number of ingested Buckyballs was significantly higher in patients who received surgery or gastroscopy (7.0 [IQR: 3.0-10.75] vs 3.5 [IQR: 2.0-4.0], P < .05). The risk of intestinal perforation was significantly higher in symptomatic patients (P < .05) compared to asymptomatic patients.Gastroscopy is recommended when Buckyballs are in the stomach or esophagus. In asymptomatic patients, conservative treatment can be considered for 4 to 6 days. Patients failing conservative treatment, or those who are symptomatic should undergo emergency surgery.


Assuntos
Abdome , Tratamento Conservador/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Corpos Estranhos/terapia , Gastroscopia/estatística & dados numéricos , Imãs , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Am J Case Rep ; 22: e928021, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33473099

RESUMO

BACKGROUND Cameron lesions are linear erosions and ulcers on the crests of gastric mucosal folds in the neck of a hiatal hernia and can be difficult to diagnose and treat. This report is of a case of chronic iron deficiency in a 61-year-old woman with a late diagnosis of a Cameron lesion, who did not respond to a single treatment with the proton pump inhibitor (PPI) pantoprazole, but was then treated with oral poloxamer 407 with hyaluronic acid and chondroitin sulfate in addition to PPI. CASE REPORT We report the case of a 61-year-old women with recurrent iron-deficiency anemia, first diagnosed 40 years prior to her presentation at our Endoscopy Unit, and an ongoing melena. We discovered an intrahiatal gastric mucosal defect, which we at first treated with proton pump inhibitors and sucralfate. After a follow-up gastroscopy revealed the persistence of the lesion, we decided to incorporate into the treatment a gel-like substance containing, among others, hyaluronic acid and chondroitin sulfate, and observed that the lesion resolved completely. CONCLUSIONS This report highlights that Cameron lesions should be considered in patients with hiatal hernia who have iron-deficiency anemia and can be diagnosed on upper endoscopy. Further clinical studies are required to determine the role of combined poloxamer 407 with hyaluronic acid and chondroitin sulfate in the management of Cameron lesions.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Úlcera Gástrica/complicações , Úlcera Gástrica/tratamento farmacológico , Adjuvantes Imunológicos/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Doença Crônica , Portadores de Fármacos , Feminino , Gastroscopia , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Humanos , Ácido Hialurônico/uso terapêutico , Pessoa de Meia-Idade , Pantoprazol/uso terapêutico , Poloxâmero/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Úlcera Gástrica/diagnóstico
10.
JAMA Netw Open ; 4(1): e2032542, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33410877

RESUMO

Importance: The rapidly increasing number of gastric cancer examinations performed over a short period might influence screening performance. Accessing the association between calendar month and gastric cancer detection rates might improve policy and guide institutional support. Objective: To evaluate the association between the increased number of examinations over a certain period and gastric cancer detection rates among a large population included in the Korean National Cancer Screening Program (KNCSP). Design, Setting, and Participants: This retrospective, population-based cohort study used data from the KNCSP comprising 26 765 665 men and women aged 40 years or older who participated in the screening program between January 1, 2013, and December 31, 2016. Data were analyzed from November 1, 2019, to March 31, 2020. Exposures: Gastric cancer screening with endoscopy. Main Outcomes and Measures: The primary outcome was monthly gastric cancer detection rates in the KNCSP. A negative binomial regression model was used to evaluate the association between the screening month and detection rates. Results: In total, 21 535 222 individuals underwent endoscopy (mean [SD] age, 55.61 [10.61] years; 11 761 709 women [54.62%]). The quarterly number of participants was the highest in the last quarter of the study period (2013-2014: 4 094 951 [41.39%], 2015-2016: 4 911 629 [42.19%]); this proportion was 2.48 to 2.84 times greater than that of the first quarter. Cancer detection rates were the lowest in December (2013-2014: 0.22; 95% CI, 0.22-0.23; 2015-2016: 0.21; 95% CI, 0.21-0.22); this was approximately a 40.0% to 45.0% reduction compared with the rates in January. The age group was the significant factor for monthly detection rates. After adjustment for the age group and taking account of the number of screenings, the estimated coefficient range for the screening month was negative and the detection rate in December was significantly different than in January for both the consequent cycles (2013-2014: -0.05 to -0.18; P < .001; and 2015-2016: -0.06 to -0.19; P < .001). In the multivariable logistic model, the association of calendar month with detected cancer remained after adjusting for other confounding factors (December, 2013-2014: odds ratio, 0.82; 95% CI, 0.76-0.87; P < .001; 2015-2016: odds ratio, 0.83; 95% CI, 0.79-0.89; P < .001). Conclusions and Relevance: The findings of this cohort study suggest that the workload of endoscopists increased with the increasing number of examinations toward the end of the year, as demonstrated by the decreased cancer detection rates. These findings may help to improve gastric cancer detection rates of screening programs by controlling the monthly screening number and policy modifications.


Assuntos
Gastroscopia , Programas de Rastreamento/estatística & dados numéricos , Neoplasias Gástricas/diagnóstico , Adulto , Idoso , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/epidemiologia , Fatores de Tempo
11.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495179

RESUMO

We present an unusual case of an acutely unwell patient with an upper gastrointestinal bleed whose resuscitation efforts were delayed by the discovery of his, similarly, acutely unwell pet on the medical high dependency unit. We highlight the challenges this provided the clinical team and focus on the issues relating to patient safety, consent and multidisciplinary action which may be more relevant to daily clinical practice.


Assuntos
Transfusão de Sangue , Hemorragia Gastrointestinal/terapia , Gastroscopia , Pesar , Animais de Estimação , Animais , Galinhas , Humanos , Masculino , Competência Mental , Pessoa de Meia-Idade , Preferência do Paciente , Assistência Centrada no Paciente
13.
Acta Gastroenterol Belg ; 83(4): 533-539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33321008

RESUMO

Background and study aims: Pediatric gastroscopy is a widely used invasive procedure and causes significant anxiety. In this prospective trial, the efficacy of a new original single-page illustration in reducing anxiety was evaluated. Patients and methods: One hundred fifty-two consecutive children aged between 7 and 18 years who were scheduled to undergo gastroscopy were randomized to receive a standard consent form plus the new single-page visual illustration (group I) and the usual text consent brochure (group II). The Hospital Anxiety and Depression Scale (HADS) was administered to mothers just before, at the first hour, and at the second week after gastroscopy. Also, Visual Analogue Scale (VAS) scores were obtained from children to measure anxiety at the same time intervals. Results: The demographic characteristics of the groups were similar. A higher number of cases refused gastroscopy in group II (p=0.040). The proportion of mothers with significant HADS- Anxiety scores at the baseline evaluation (≥8) was 33.8% in group I, whereas it was 58.1% in group II (p=0.003). This remarkable difference in anxiety was also observed at the first hour and second week. Moreover, significant baseline HADS-Depression scores (≥8) of the mothers were more common in group II (2.7% vs. 12.7%, p=0.028). In addition, overall HADS scores revealed considerably higher values in group II at all time intervals. VAS scores in children revealed significantly less anxiety in group I at both the baseline and the first hour assessment. Conclusions: Lower anxiety scores were observed in both mothers and children with the incorporation of the single-page illustration. This new modality may provide less anxiety and prevent insufficient comprehension with higher acceptance of gastroscopy.


Assuntos
Ansiedade , Gastroscopia , Adolescente , Ansiedade/diagnóstico , Criança , Humanos , Estudos Prospectivos
14.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370944

RESUMO

A 59-year-old man with refractory Cronkhite-Canada syndrome (CCS) had poor clinical response to high-dose intravenous steroids, azathioprine, total parenteral nutrition and best supportive care. He remained highly symptomatic with abdominal pain, diarrhoea, recurrent sepsis and profound weight loss. Infliximab induction was given as rescue therapy, with marked clinical improvement observed within 3 weeks. This allowed steroid taper. Within 12 months of infliximab therapy, he achieved complete clinical remission and returned to his baseline weight and a full oral diet. Sequential endoscopies observed significant regression of previous marked gastrointestinal polyposis, including histological remission on colonic biopsies at 3.5 and 5 years of treatment. He currently remains in remission following 6 years of combination therapy with 5 mg/kg 8 weekly infliximab and azathioprine, and there is ongoing discussion with regard to the benefits and risks of therapy de-escalation. This case demonstrates the effectiveness of infliximab in inducing and maintaining remission in refractory CCS.


Assuntos
Fármacos Gastrointestinais/uso terapêutico , Imunossupressores/farmacologia , Infliximab/uso terapêutico , Polipose Intestinal/tratamento farmacológico , Azatioprina/farmacologia , Azatioprina/uso terapêutico , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia , Resistência a Medicamentos , Fármacos Gastrointestinais/farmacologia , Gastroscopia , Glucocorticoides/farmacologia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Quimioterapia de Indução/métodos , Infliximab/farmacologia , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Polipose Intestinal/diagnóstico , Masculino , Pessoa de Meia-Idade , Antro Pilórico/diagnóstico por imagem , Antro Pilórico/patologia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(45): e23061, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157963

RESUMO

OBJECTIVE: This study is aims to compare the anesthetic safety of propofol combined with etomidate for painless gastroscopy. METHODS: Three hundred patients undergoing painless gastroscopy were randomly assigned to P, PE1, and PE2 groups. Patients were anesthetized with propofol (P group) or propofol combined with etomidate (volume ratio 1: 1, PE1 group; volume ratio 2: 1, PE2 group). The hemodynamics and adverse reactions were observed. The sleep quality satisfaction and nature of dreams were recorded. RESULTS: Compared with pre-anesthesia, the mean arterial pressure and heart rate of the 3 groups were significantly slower during the examination and at the end of the examination. PE1 group had a higher incidence of muscle spasm, body moving, choking, and deglutition. The incidence of hypoxemia and injection pain was higher in P group. P and PE2 group had higher sleep quality satisfaction and dream incidence after awaking. However, there was no difference in the nature of dreams among 3 groups. CONCLUSION: Our data indicate that the combination of 10 ml 1.0% propofol and 5 ml 0.2% etomidate for painless gastroscopy reduces adverse reactions while not affecting the patients respiratory function. Moreover, it is safe and effective, which is worthy of clinical application and promotion.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Etomidato/efeitos adversos , Gastroscopia/métodos , Propofol/efeitos adversos , Adulto , Obstrução das Vias Respiratórias/induzido quimicamente , Anestésicos Intravenosos/administração & dosagem , Pressão Arterial/efeitos dos fármacos , Estudos de Casos e Controles , Quimioterapia Combinada , Etomidato/administração & dosagem , Feminino , Gastroscopia/tendências , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Hipóxia/induzido quimicamente , Incidência , Reação no Local da Injeção , Masculino , Pessoa de Meia-Idade , Mioclonia/induzido quimicamente , Propofol/administração & dosagem , Segurança , Espasmo/induzido quimicamente , Espasmo/epidemiologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(40): e22581, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019473

RESUMO

RATIONALE: Angiosarcoma is a highly invasive tumour with a low incidence rate but high rates of local recurrence and distant metastasis and a poor prognosis. Understanding the endoscopic characteristics of angiosarcoma will help with early diagnosis and treatment of this disease. PATIENT CONCERNS: The patient was a 77-year-old female who was admitted to the hospital due to recurring melena for 3 months. Outpatient gastroscopy showed that the patient had multiple gastric erosions. Colonoscopy revealed the presence of multiple protruding lesions in the colon and multiple rectal polyps. Pathological biopsy indicated that the patient had a tubular adenoma, which was removed by endoscopic resection. DIAGNOSES: Postsurgical pathologic assessment suggested that the histological subtype was epithelioid angiosarcoma. Positron emission tomography-computed tomography (PET-CT) revealed multiple metastases in the lymph nodes and bone. INTERVENTIONS: The patient underwent acid suppression to protect the stomach, fluid supplementation and red blood cell infusion, and subsequently, surgery, radiotherapy and chemotherapy were recommended. The patient's family refused further treatments for the patient and requested discharge. OUTCOMES: The patient refused further treatment and was not followed-up. LESSONS: Colorectal angiosarcoma is an extremely rare and highly malignant tumour, and understanding its endoscopic morphology will help aid in its diagnosis.


Assuntos
Pólipos do Colo/diagnóstico por imagem , Hemangiossarcoma/secundário , Melena/etiologia , Adenoma/cirurgia , Idoso , Biópsia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Pólipos do Colo/patologia , Colonoscopia/métodos , Feminino , Gastroscopia/métodos , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Melena/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Retais/patologia , Recusa do Paciente ao Tratamento
17.
Anticancer Res ; 40(11): 6387-6398, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109577

RESUMO

BACKGROUND/AIM: Helicobacter pylori (Hp) infection affects a substantial proportion of the world population and is a major risk factor of gastric cancer (GC). The caveats of common Hp-tests can be evaded by a serological biomarker test (GastroPanel®, Biohit Oyj, Helsinki), the most comprehensive Hp-test on the market. The clinical validation of Helicobacter pylori IgG ELISA of the new-generation GastroPanel® test is reported. The aim of the study is to validate the clinical performance of the Helicobacter pylori IgG ELISA test in diagnosis of biopsy-confirmed Hp-infection in gastroscopy referral patients. PATIENTS AND METHODS: A cohort of 101 patients (mean age=50.1 years) referred for gastroscopy at the outpatient Department of Gastroenterology (SM Clinic, St. Petersburg) were examined by two test versions to validate the new-generation GastroPanel®. All patients were examined by gastroscopy and biopsies, which were stained with Giemsa for specific identification of Hp in the antrum (A) and corpus (C). RESULTS: Biopsy-confirmed Hp-infection was found in 64% of patients, most often confined to antrum. The overall agreement between Hp IgG ELISA and gastric biopsies in Hp-detection was 91% (95%CI=84.1-95.8%). Hp IgG ELISA diagnosed biopsy-confirmed Hp (A&C) with sensitivity (SE) of 92.3%, specificity (SP) of 88.6%, positive predictive value (PPV) of 93.8% and negative predictive value (NPV) of 86.1%, with AUC=0.904 (95%CI=0.842-0.967). In ROC analysis for Hp detection (A&C), Hp IgG ELISA shows AUC=0.978 (95%CI=0.956-1.000). CONCLUSION: The Hp IgG ELISA test successfully concludes the clinical validation process of the new-generation GastroPanel® test, which retains the unrivalled diagnostic performance of all its four biomarkers, extensively documented for the first-generation test in different clinical settings.


Assuntos
Anticorpos Antibacterianos/isolamento & purificação , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Imunoglobulina G/isolamento & purificação , Adolescente , Adulto , Anticorpos Antibacterianos/genética , Anticorpos Antibacterianos/imunologia , Biópsia , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Gastrinas/genética , Gastrinas/isolamento & purificação , Gastrite Atrófica/diagnóstico , Gastrite Atrófica/genética , Gastrite Atrófica/microbiologia , Gastrite Atrófica/patologia , Gastroscopia/métodos , Infecções por Helicobacter/genética , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/genética , Helicobacter pylori/patogenicidade , Humanos , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Pepsinogênio A/genética , Pepsinogênio A/isolamento & purificação , Pepsinogênio C/genética , Pepsinogênio C/isolamento & purificação , Encaminhamento e Consulta , Estômago/microbiologia , Estômago/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/genética , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologia , Adulto Jovem
18.
BMC Infect Dis ; 20(1): 754, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054791

RESUMO

BACKGROUND: Herpes esophagitis is uncommon disease caused by Herpes simplex virus (HSV). While the disease most often occurs in immunocompromised patients, including post-chemotherapy, immunosuppression with organ transplants, and in AIDS, Herpes esophagitis can also occur in immunocompetent individuals. CASE PRESENTATION: We report a case of herpes esophagitis in a 72 year- old woman who was presumed to be immunocompromised following prolonged radiotherapy and chemotherapy for lymphoma. Her main symptom was epigastric pain. Upper endoscopy showed multiple rounded ulcers in lower esophagus. The diagnosis was confirmed histologically by multiple biopsies. The patient received Valacyclovir for 2 weeks and started to get better within 3 days of treatment. CONCLUSION: Although there are few published cases of Herpes esophagitis disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing immuno-compromised patients presenting with non-specific abdominal symptoms.


Assuntos
Esofagite/virologia , Herpes Simples/complicações , Dor Abdominal/etiologia , Dor Abdominal/virologia , Idoso , Biópsia , Diagnóstico Diferencial , Esofagite/diagnóstico , Esofagite/tratamento farmacológico , Esofagite/patologia , Feminino , Gastroscopia , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Úlcera/patologia , Úlcera/virologia
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(10): 944-948, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33053989

RESUMO

The detection rate of submucosal tumors in the gastric cardia increases year by year. Most of these tumors are benign or borderline tumors, among which leiomyoma and gastrointestinal stromal tumor are more common. The functional preservation of the gastric cardiac region is closely related to the anatomical structure of the esophagogastric junction. The esophageal reflux is mainly evaluated directly or indirectly by upper gastrointestinal radiography, gastroscopy, CT examination and manometric measurements of the lower esophagus. For tumors at this specific region, the risk of lymph node metastasis is very low, and according to the tumor free principle, usually only complete removal of the tumor is required. We aim to introduce the minimally invasive and function preserving procedures, including endoscopic therapy alone, laparoscopic and endoscopic cooperative surgery, and totally laparoscopic surgery. The selection of this tailored treatment should be based on the tumor location, size, shape and growth pattern (intraluminal or extraluminal), and the experience of the surgical team, so as to improve postoperative quality of life of the patients.


Assuntos
Cárdia , Mucosa Gástrica/cirurgia , Neoplasias Gástricas , Cárdia/cirurgia , Gastrectomia , Gastroscopia , Humanos , Qualidade de Vida , Neoplasias Gástricas/cirurgia
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