Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 11 Articles
Objectives: Liver biopsy remains the gold standard for diagnosis of chronic liver diseases. Outpatient\npercutaneous biopsy is generally safe with a mortality rate of 0.17% and hospitalization rate\nfor bleeding of 3%. Von Willebrand disease (vWD) syndrome is the most common inherited hematological\ndisorder with a prevalence of 1% - 3% globally. We sought to study whether vWD increases\nthe risk of bleeding for liver biopsies. Methods: All patients (n = 120) who underwent\noutpatient percutaneous liver biopsies from 1997 to 2007 were analyzed. Demographics, PT/INR,\nplatelet count, vW antigen and ristocetin induced platelet aggregation were studied. Results: No\nvWD patients had major bleeding that required transfusion, hospitalization or surgery but 9 (75%)\nhad minor local bleeding and all had ecchymosis, which resolved spontaneously within 24 hours.\nConclusions: Patients with vW factor deficiency can undergo percutaneous liver biopsy without\nmajor bleeding. Minor bleeding may occur at a slightly higher rate. vWD is not a contraindication\nto percutaneous liver biopsy....
Myeloproliferative neoplasms (MPNs) are the leading cause of Budd-Chiari syndrome (BCS), and the C allele of JAK2 rs4495487\nwas reported to be an additional candidate locus that contributed to MPNs. In the present study, we examined the role of JAK2\nrs4495487 in the etiology and clinical presentation of Chinese BCS patients. 300 primary BCS patients and 311 healthy controls were\nenrolled to evaluate the association between JAK2 rs4495487 polymorphism and risk of BCS. All subjects were detected for JAK2\nrs4495487 by real-time PCR. Results.The JAK2 rs4495487 polymorphism was associated with JAK2 V617F-positive BCS patients\ncompared with controls (...
Pancreatic cancer (PDAC) is the fourth leading cause of cancer-related mortality in the Western world and, even in 2014, a\ntherapeutic challenge. The only chance for long-term survival is radical surgical resection followed by adjuvant chemotherapy\nwhich can be performed in about 20% of all PDAC patients by the time of diagnosis. As pancreatic surgery has significantly changed\nduring the past years, extended operations, including vascular resections, have become more frequently performed in specialized\ncentres and the border of resectability has been pushed forward to achieve a potentially curative approach in the respective patients\nin combination with neoadjuvant and adjuvant treatment strategies. In contrast to adjuvant treatment which has to be regarded\nas a cornerstone to achieve long-term survival after resection, neoadjuvant treatment strategies for locally advanced findings are\ncurrently under debate. This overview summarizes the possibilities and evidence of vascular, namely, venous and arterial, resections\nin PDAC surgery....
Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular\nhemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan\nAssociation for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal\nbleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage\naccount for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an\ninitial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of\nsmall intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be\nsuccessfully managed by endoscopic therapy before surgery in the era of deep enteroscopy....
The aim of the present study was to determine the outcome of patients undergoing pancreatic resection with (VR+) or without\n(VRâË?â??) mesenteric-portal vein resection for pancreatic carcinoma. Between January 1998 and December 2012, 241 patients with\npancreatic cancer underwent pancreatic resection: in 64 patients, surgery included venous resection for macroscopic invasion of\nmesenteric-portal vein axis. Morbidity and mortality did not differ between the two groups (VR+: 29% and 3%; VRâË?â??: 30% and\n4.0%, resp.). Radical resection was achieved in 55/64 (78%) in the VR+ group and in 126/177 (71%) in the VRâË?â?? group. Vascular\ninvasion was histologically proven in 44 (69%) of the VR+ group. Survival curves were not statistically different between the two\ngroups.Mean and median survival time were 26 and 15 months, respectively, in VRâË?â?? versus 20 and 14 months, respectively, in VR+\ngroup (...
Consensus advocating a principle of early organ support, nutritional optimisation, followed ideally by delayed minimally invasive\nintervention within a ââ?¬Å?step-upââ?¬Â framework where possible has radically changed the surgical approach to complications of\nacute pancreatitis in the last 20 years. The 2012 revision of the Atlanta Classification incorporates these changes, and provides\na background which underpins the complexities of individual patient management decisions. This paper discusses the place\nfor delayed minimally invasive surgical intervention (percutaneous necrosectomy, video-assisted retroperitoneal debridement\n(VARD)), and the rationale for opting to adopt a percutaneous approach over endoscopic or laparoscopic approaches in different\nclinical situations....
Colorectal cancer is usually considered a disease of the elderly. However, a small fraction of patients develops colorectal cancer\nearlier. The aim of our study was to define the frequency of known hereditary colorectal syndromes and to characterise genetic\nand epigenetic features of early nonhereditary tumors. Thirty-three patients �40 years with diagnosis of colorectal cancer and\n41 patients with disease at >60 years of age were investigated for MSI, Mismatch Repair proteins expression, KRAS and BRAF\nmutations, hypermethylation, and LINE-1 hypomethylation. Detection of germline mutations was performed inMismatch Repair,\nAPC and MUTYH genes. Early onset colorectal cancer showed a high incidence of hereditary forms (18%). KRAS mutations were\ndetected in 36% of early nonhereditary tumors. Early onset colorectal cancer disclosed an average number of methylated genes\nsignificantly lower when compared to the controls (...
The bulb ulcer stenosis, becoming exceptional in developed countries, remains frequent in our\ncountry despite the use of the antisecretory. The purpose of our study was to study epidemiological,\ndiagnostic, and evolutionary complication particularities, and to find potential predictive factors\nof resistance of ulcer stenosis of the bulb to the pump inhibitors Proton through a recent series.\nThis is a retrospective and descriptive study involving 105 patients, treated for ulcer stenosis of\nthe bulb between January 2007 and December 2012. All our patients had received inhibitors of\nProton pump, parenterally for 7 days. They were divided into 2 groups according to their response\nto treatment: the first group (G1) was sensitive and the second (G2) was resistant. All patients of\nthe G2 were operated. We had compared the two groups. There was no statistically significant difference\nconcerning age, sex, blood group and smoking between the two groups. In univariate\nstudy, the age of the epigastralgies was greater than or equal to 9 years; the clapotage fasting, dilation\nand gastric atony, objectified by the oesogastroduodenal transit were significantly associated\nwith the failure of medical treatment. Only gastric atony and seniority of the disease over 9\nyears were independent risk factors of resistance to the Proton pump inhibitors in multivariate\nstudy....
Background. No guideline on repeat esophagogastroduodenoscopy (EGD) in functional dyspepsia (FD) exists. This study aimed\nto define yield, findings, and predictors of positive findings on repeat EGD in FD. Methods. FD patients who underwent at least 2\nEGDs during October 2005 to November 2011 were enrolled and reviewed. Yield and findings were analyzed and univariate and\nmultivariate analyses were performed to identify predictors of positive repeat EGD. Results. The median time to repeat EGD was\n34 months. Among 146 patients, 115 patients (79%) had negative and 31 (21%) had positive repeat EGD, including erosive gastritis\n(13.0%), peptic ulcer (7.5%), reflux esophagitis (1.4%), and Barrettââ?¬â?¢s esophagus (0.7%). Four independent predictors of positive\nrepeat EGD were smoking (HR 3.88, 95% CI 1.31ââ?¬â??11.51, ...
Background: Gastrointestinal stromal tumors (GISTs) are commonly driven by activating mutations in either KIT or\nPDGFRA. Importantly, different mutations within these two genes can lead to very different levels of sensitivity or\nresistance to kinase inhibitor therapy. Due to rarity, sensitivity or resistance of exon 12 PDGFRA mutant GIST to kinase\ninhibitor therapy is not well defined.\nCase summary: We report the case of a patient with a PDGFRA exon 12 mutated GIST. The patient experienced a\nvery good response to imatinib in the neoadjuvant setting, but then relapsed while still on adjuvant imatinib. In this\npatient, we report a dramatic response to second line treatment with sunitinib, with complete resolution of two liver\nlesions at the time of first restaging.\nConclusions: This is the first report detailing a response to treatment with sunitinib of a gastrointestinal stromal\ntumor with an uncommon exon 12 PDGFRA mutation. Based on the observed efficacy, GIST patients with this rare\nmolecular subtype should be considered for sunitinib therapy....
Diffuse splanchnic venous thrombosis (DSVT), formerly defined as contraindication for liver transplantation (LT), is a serious\nchallenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis,\nand finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients\nwith preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition\n(4x) and renoportal anastomosis (1x). Median follow-up was 58 months (range: 0,5 to 130 months). Two patients with previous\nradiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients\nhad excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal\nbleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although\ncavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate\nallograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the\ncomplications of (segmental) portal hypertension....
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