Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
Theaimof this study is to identify and consolidate reliable endoscopic features associated with H. pylori infection in gastricmucosa,\nwhich is one of the major causes of gastric cancer. A total of 256 Chinese patients with symptomatic stomach disturbances were\nenrolled. Pathological examination was conducted using a light microscope and biopsy specimens stained with hematoxylin-eosin.\nEndoscopic examination was performed using a high resolution video endoscope. The association between endoscopic features\nand pathological H. pylori diagnosis was compared, and endoscopic features significantly associated with H. pylori infection were\nidentified.Atotal of 14 endoscopic featureswere observed. Six of the 14 endoscopic features, includingmucus on the gastricmucosa,\ndiffuse redness, spotty redness of fundicmucosa, enlarged fold,mucosal edema, and RAC(typeDand type I),were highly associated\nwith H. pylori infection and were significantly sensitive and specific predictors for H. pylori diagnosis. The type R RAC was not\nsignificantly associated with H. pylori diagnosis. Our results indicate that conventional endoscopy features can be used to diagnose\nH. pylori in Chinese patients and can help determine the risk factor for gastric cancer....
Background. For Tis and T1a gallbladder cancer (GbC), laparoscopic cholecystectomy can provide similar survival outcomes\ncompared to open cholecystectomy. However, for patients affected by resectable T1b or more advanced GbC, open approach\nradical cholecystectomy (RC), consisting in gallbladder liver bed resection or segment 4b-5 bisegmentectomy, with locoregional\nlymphadenectomy, is considered the gold standard while minimally invasive RC (MiRC) is skeptically considered. Aim. To analyze\ncurrent literature on perioperative and oncologic outcomes of MiRC for patients affected by GbC. Methods. A Medline review of\npublished articles until June 2016 concerningMiRC for GbC was performed. Results.Data relevant for this review were presented in\n13 articles, including 152 patients undergoing an attempt of MiRC for GbC. No randomized clinical trial was found.The approach\nwas laparoscopic in 147 patients and robotic in five. Conversion was required in 15 (10%) patients. Postoperative complications\nrate was 10% with no mortality. Long-term survival outcomes were reported by 11 studies, two of them showing similar oncologic\nresults when comparing MiRC with matched open RC. Conclusions. Although randomized clinical trials are still lacking and only\ndescriptive studies reporting on limited number of patients are available, current literature seems suggesting that when performed\nat highly specialized centers, MiRC for GbC is safe and feasible and has oncologic outcomes comparable to open RC....
Background: Gastric intestinal metaplasia (IM) is generally considered as a precancerous condition, a related risk\nfactor for intestinal-type gastric cancer. However, an accurate endoscopic diagnosis of IM is a clinical challenge.\nConfocal Laser Endomicroscopy (CLE) is a newly technique that can provide real-time magnified images and\nvisualize tissues at cellular or subcellular levels. The aim of this study is to clarify the diagnostic value of CLE in\ndetection of IM in patients at high risk of gastric cancer.\nMethods: Systematic literature searches up to April 2015 in PubMed, Embase, Web of Science, Cochrane Library\ndatabases were conducted by two reviewers independently. The Quality Assessment of Diagnostic Accuracy\nStudies-2 (QUADAS-2) tool was applied to assess study quality and to reduce potential bias. A meta-analysis using\nMeta-Disc (version 1.4) and STATA software (version 13) was performed.\nResults: A total of four studies enrolled 218 patients and 579 lesions were included in this meta-analysis. On per-lesion\nbasis, the pooled sensitivity and specificity of CLE were 0.97(95 % confidence interval (CI) = 0.94ââ?¬â??0.98) and 0.94\n(95 % CI = 0.91ââ?¬â??0.97) respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR)\nwere 15.20 (95 % CI = 9.46ââ?¬â??24.41) and 0.04 (95 % CI = 0.02ââ?¬â??0.07) respectively. The pooled diagnostic odds ratio (DOR)\nwas 479.59 (95 % CI = 205.64ââ?¬â??1118.51) and summary receiver operating curve (SROC) area under the curve was 0.9884.\nThere was no statistical significance of publication bias.\nConclusion: CLE is a promising endoscopic tool in the detection of IM with the relatively high diagnostic value in\npatients at high risk of gastric cancer...
Objectives. The aim of the study was to establish whether fecal calprotectin concentration (FCC) may be useful in children with\nchronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders,\nand functional gastrointestinal disorders. Methods. The study included 163 patients (median age 13 years), who were assigned to\nfour study groups: group 0 (control), 22 healthy children; group 1, 33 children with functional gastrointestinal disorders; group\n2, 71 children with inflammatory gastrointestinal disorders other than IBD; group 3, 37 children with IBD. FCC was measured\nusing ELISA assay. Results. In group 0 and group 1 FCCs were below 100 ...
Background. Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations\nin study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure. Methods. The\ncharacteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of\npalliative gastrectomy and to identify potential prognostic factors. Results. Median overall patient survival was 6.5 months. To\nattenuate potential selection bias, patients with adequate performance and survival time of � 2months since diagnosiswere included\nfor risk factor analysis (...
Background: Portal hypertensive gastropathy (PHG) is a frequently overlooked complication of liver cirrhosis (LC).\nThe clinical implications of PHG as a prognostic factor of LC or a predictive factor for the development of\nhepatocellular carcinoma (HCC) have not been established. The aim of this study was to assess the clinical\nsignificance of PHG in patients with LC.\nMethods: Patients with LC were prospectively enrolled and followed in a single tertiary hospital in the Republic of\nKorea. Baseline hepatic vein pressure gradient (HVPG) was measured, and esophagogastroduodenoscopy (EGD) was\nperformed. The associations of PHG with HVPG, survival and the development of HCC were evaluated.\nResults: A total of 587 patients were enrolled. The mortality rate was 20.3 % (n = 119), and HCC developed in 9.2 %\n(n = 54) during the follow-up period (32.6 Ã?± 27.8 months). The grade of PHG was well correlated with HVPG (no\nPGH: median 9.2 [IQR: 7.2ââ?¬â??16.7], mild PHG: 14.6 [10.1ââ?¬â??19.3], and severe PHG: 17.3 [12.3ââ?¬â??21.5], P < 0.001), as well as\nwith Child-Pugh class, MELD score or survival. However, it was not associated with the development of HCC. The\ngrade of PHG (HR 3.29, 95 % CI: 1.12ââ?¬â??9.63, severe vs. no PHG) and Child-Pugh class (HR 3.53, 95 % CI: 1.79ââ?¬â??6.97,\nChild C vs A) showed significant associations with mortality.\nConclusion: PHG was well correlated with portal hypertension and could be used as a prognostic factor for LC but\nnot for the prediction of HCC....
Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication\nof liver cirrhosis and carries high mortality rate. Several risk factors that predict early\nrebleeding and mortality have been studied and there is no similar study in our country, so the\naim of this study was to identify the risk factors of early rebleeding and mortality after bleeding\nepisode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic\npatients with AVH who were admitted to the main public hospitals in Sanaââ?¬â?¢a between April 2014\nand March 2015. Demographic information, medical histories, physical examination findings, and\nlaboratory test results were collected. Endoscopic and pharmacologic treatment was performed.\nThe patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding\nand mortality after the acute attack. Univariate and multivariate analyses were performed to\nidentify independent risk factors for rebleeding and mortality. Survival analysis was estimated\nusing the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%)\nrebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding\nwithin 6 weeks period in univariate analysis were clot on varix at index endo- scope (P < 0.0001),\nhigh serum bilirubin (P = 0.02), CTP score (P < 0.05) and MELD score (P < 0.05). Independent risks\nfactors remained in multivariate analysis as significant predictors of early rebleeding were clot on\nvarix (OR: 11.6, CI: 2.87 - 47.29, P = 0.001) and high serum bilirubin (>3) (OR: 1.1, CI: 1.02 - 1.19, P\n= 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with\nsignificant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count\n(P < 0.0001), low serum sodium (P = 0.04), high AST (P < 0.0001), high ALT (P = 0.02), high INR (P\n< 0.0001), high serum bilirubin (P < 0.0001), low serum albumin (P = 0.005), ascites (P = 0.001), CTP score (P < 0.0001) and MELD score (P < 0.0001). By multiple regression analysis high MELD\nscore - 1.41, P < 0.0001) and WBCs over 10.3 Ã?â?? 109/l (OR: 1.2, CI: 1.02 - 1.40,\nP < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early\nrebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high\nserum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score\n( and WBCs over 10.3 Ã?â?? 109/l....
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