BACKGROUND Acute pancreatitis(AP)remains a major cause of hospitalization and mortality with important health-related costs worldwide.Using an electronic database of a large tertiary center,we estimated the incidence,...BACKGROUND Acute pancreatitis(AP)remains a major cause of hospitalization and mortality with important health-related costs worldwide.Using an electronic database of a large tertiary center,we estimated the incidence,etiology,severity and costs of hospitalized AP cases in southern Romania.AIM To estimate the incidence,cost and tobacco usage of hospitalized AP cases in southern Romania and to update and upgrade the knowledge we have on the etiology,severity(in regard to Revised Atlanta Classification),outcome,morphology and local complications of AP.METHODS We performed an electronic health care records search on AP patients treated at Emergency University Hospital of Bucharest(Spitalul Universitar de UrgențăBucurești)between 2015 and 2022.The incidence,etiology,and severity were calculated;potential risk factors were evaluated,and the hospitalization costs of AP were documented and analyzed.The cohort of this study is part of the BUCharest-Acute Pancreatitis Index registry.RESULTS A total of 947 consecutive episodes of AP where the patients were hospitalized in the gastroenterology department were analyzed,with 79.45%as 1st episode and the rest recurrent.The majority of the patients were males(68.9%).Alcoholic(45.7%),idiopathic(16.4%)and biliary(15.2%)were the main causes.The incidence was estimated at 29.2 episodes/100000 people.The median length of stay was 7 d.The median daily cost was 747.96 RON(165 EUR).There was a high prevalence of active tobacco smokers(68.5%).The prevalence of severe disease was 11.1%.The admission rate to the intensive care unit was 4.6%,with a mortality rate of 38.6%.The overall mortality was 5.5%.CONCLUSION We estimated the incidence of AP at 29.2 episodes that required hospitalization per 100000 people.The majority of our cases were found in males(68.9%)and were related to alcohol abuse(45.7%).Out of the cases we were able to find data regarding tobacco usage,the majority were active smokers(68.5%).Most patients had a mild course(54.4%),with a mortality rate of 5.5%.Interstitial AP prevailed(45.3%).The median daily cost of hospitalization was 747.96 RON(165 EUR).展开更多
BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are fr...BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.展开更多
Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of diseases that have insulin resistance in common and are associated with metabolic conditions such as obesity, type 2 diabetes mellitus, and dyslipidemia...Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of diseases that have insulin resistance in common and are associated with metabolic conditions such as obesity, type 2 diabetes mellitus, and dyslipidemia. NAFLD ranges from simple liver steatosis, which follows a benign course, to nonalcoholic steatohepatitis (NASH), a more severe entity, with necroinflmmation and f ibrosis, which can progress to cryptogenic cirrhosis and end-stage liver disease. Liver biopsy remains the gold standard for evaluating the degree of hepatic necroinflammation and f ibrosis; however, several noninvasive investigations, such as serum biomarkers, have been developed to establish the diagnosis and also to evaluate treatment response. These markers are currently neither available in all centers nor validated in extensive studies. Examples include high-sensitivity C reactive protein and plasma pentraxin 3, which are associated with extensive liver f ibrosis in NASH. Interleukin-6 correlates with inflammation, and cytokeratin-18 represents a marker of hepatocyte apoptosis (prominent in NASH and absent in simple steatosis). Tissue polypep-tide specif ic antigen seems to have a clinical utility in the follow-up of obese patients with NASH.展开更多
AIM: To assess the feasibility, accuracy and acceptability of PillCam Colon 2 in detection of significant lesions in colorectal cancer risk patients, unable or unwilling to perform colonoscopy. METHODS: This is a pros...AIM: To assess the feasibility, accuracy and acceptability of PillCam Colon 2 in detection of significant lesions in colorectal cancer risk patients, unable or unwilling to perform colonoscopy. METHODS: This is a prospective, single center study using the second generation of PillCam Colon capsule. In all patients the readers were instructed to review the entire colon capsule endoscopy(CCE) examination using Rapid 7 software and additionally to note significant extra-colonic findings. Colonic significant findings were described according to European Society of Gastrointestinal Endoscopy guidelines. CCE procedure completion rate, level of bowel preparation and rate of adverse events were assessed. RESULTS: A total of 70 patients at risk of colorectal cancer were enrolled in the study. In three patients the procedure failed because the capsule was not functioning when entered the colon. PillCam Colon 2 showed positive findings in 23(34%, 95%CI: 21.6%-44.1%) of the remaining 67 patients. Six patients were diagnosedwith tumors: 4 with colon cancers, 1 with gastric cancer and 1 with a small bowel cancer. The capsule findings were confirmed after surgery in all these patients. The capsule excretion rate in twelve hours was 77% with 54 patients having a complete examination. The rectum was not explored during CCE procedure, in 16 patients(23%, 95%CI: 13.7%-34.1%). Every patient accepted CCE as an alternative exploration tool and 65/70(93%) agreed to have another future control by CCE. No complications were reported during or after CCE examination. CONCLUSION: PillCam Colon 2 capsule was effective in detecting significant lesions and might be considered an adequate alternative diagnostic tool in patients unable or unwilling to undergo colonoscopy.展开更多
Mucosal healing(MH)has emerged as a key therapeutic target in inflammatory bowel disease(IBD),and achievement of this goal is documented by endoscopy with biopsy.However,colonoscopy is burdensome and invasive,and subs...Mucosal healing(MH)has emerged as a key therapeutic target in inflammatory bowel disease(IBD),and achievement of this goal is documented by endoscopy with biopsy.However,colonoscopy is burdensome and invasive,and substitution with an accurate noninvasive biomarker is desirable.AIM To summarize published data regarding the performance of noninvasive biomarkers in assessing MH in IBD patients.METHODS We conducted a systematic review of studies that reported the performance of biomarkers in diagnosing MH in patients with IBD.The main outcome measure was to review the diagnostic accuracy of serum and fecal markers that showed promising utility in assessing MH.RESULTS We screened 1301 articles,retrieved 46 manuscripts and included 23 articles for full-text analysis.The majority of the included manuscripts referred to fecal markers(12/23),followed by circulatory markers(8/23);only 3/23 of the included manuscripts investigated combined markers(serum and/or fecal markers).Fecal calprotectin(FC)was the most investigated fecal marker for assessing MH.In ulcerative colitis,for cutoff levels ranging between 58 mcg/g and 490 mcg/g,the sensitivity was 89.7%-100%and the specificity was 62%-93.3%.For Crohn’s disease,the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g(sensitivity 50%-95.9%and specificity 52.3%-100%).The best performance for a serum marker was observed for the endoscopic healing index,which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein.CONCLUSION Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization assessing MH.In ulcerative colitis,for cutoff levels ranging between 58 mcg/g and 490 mcg/g,the sensitivity was 89.7%-100%and the specificity was 62%-93.3%.For Crohn’s disease,the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g(sensitivity 50%-95.9%and specificity 52.3%-100%).The best performance for a serum marker was observed for the endoscopic healing index,which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein.CONCLUSION Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization.展开更多
Increasing evidence of a link between inflammatory bowel disease(IBD) and adverse cardiovascular events has emerged during the last decade.In 2014,an important number of meta-analyses and cohort studies clarified the ...Increasing evidence of a link between inflammatory bowel disease(IBD) and adverse cardiovascular events has emerged during the last decade.In 2014,an important number of meta-analyses and cohort studies clarified the subtle dangerous liaisons between gut inflammation and cardiovascular pathology.The evidence suggests that patients with IBD have a significantly increased risk of myocardial infarction,stroke,and cardiovascular mortality,especially during periods of IBD activity.Some populations(e.g.,women,young patients) may have an even greater risk.Current effective treatment of IBD is aimed at disease remission and seems to reduce cardiovascular risk in these patients.A beneficial effect was demonstrated for salicylates,but not for steroids or azathioprine.tumor necrosis factor-α antagonists,which are highly effective in the reduction of inflammation and in the restoration of the digestive mucosa,lead to conflicting cardiovascular effects,as they seem to reduce the risk for ischemic heart disease but increase the rate of cerebrovascular events.Future supplemental treatment strategies that may reduce the atherothrombotic risk during periods of IBD activity should be explored.展开更多
Despite significant therapeutic progress in recent years,inflammatory bowel disease(IBD),which includes Crohn’s disease and ulcerative colitis,remains a challenge regarding its pathogenesis and long-term complication...Despite significant therapeutic progress in recent years,inflammatory bowel disease(IBD),which includes Crohn’s disease and ulcerative colitis,remains a challenge regarding its pathogenesis and long-term complications.New concepts have emerged in the management of this disease,such as the"treat-totarget"concept,in which mucosal healing plays a key role in the evolution of IBD,the risk of recurrence and the need for surgery.Endoscopy is essential for the assessment of mucosal inflammation and plays a pivotal role in the analysis of mucosal healing in patients with IBD.Endoscopy is also essential in the detection of dysplasia and in the identification of the risk of colon cancer.The current surveillance strategy for dysplasia in IBD patients indicates white-light endoscopy with non-targeted biopsies.The new chromoendoscopy techniques provide substantial benefits for both clinicians and patients.Narrow-band imaging(NBI)has similar rates of dysplastic lesion detection as whitelight endoscopy,and it seems that NBI identifies more adenoma-like lesions.Because it is used instinctively by many endoscopists,the combination of these two techniques might improve the rate of dysplasia detection.Flexible spectral imaging color enhancement can help differentiate dysplastic and non-dysplastic lesions and can also predict the risk of recurrence,which allows us to modulate the treatment to gain better control of the disease.The combination of noninvasive serum and stool biomarkers with endoscopy will improve the monitoring and limit the evolution of IBD because it enables the use of a personalized approach to each patient based on that patient’s history and risk factors.展开更多
Whipple's disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei.The infection usually mainly involves the small bowel,but sometimes other organs are affected as ...Whipple's disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei.The infection usually mainly involves the small bowel,but sometimes other organs are affected as well.Since the current standard clinical and biological tests are nonspecific,diagnosis is very difficult and relies on histopathology.Here we present the case of a 52-yearold man with chronic diarrhea and weight loss whose symptoms had been evolving for 2 years and whose diagnosis came unexpectedly after capsule examination.Diagnosis was confirmed by the histopathologic examination of endoscopic biopsy samples,and treatment with co-trimoxazole resulted in remission of symptoms.We present the first images of Whipple's disease obtained with the Pillcam Colon 2 video capsule system.展开更多
Capsule endoscopy(CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients.It has the advantage of excellent visualization of digestive tract mucosa,a good tolerabi...Capsule endoscopy(CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients.It has the advantage of excellent visualization of digestive tract mucosa,a good tolerability and safety in well-selected patients.The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule.The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis,thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings.When symptoms and biomarkers point to a change in the disease's activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards.The appearance of the new capsule from Medtronicthe Pillcam Crohn's might be an important step forward in diagnosis,evaluating disease extent,the severity of the disease,prognosis,management in a treat to target approach,with treatment modifications according to the data from CE examination.Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed.We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.展开更多
BACKGROUND Primary appendiceal tumors are histologically diverse and have an insidious onset and few specific clinical manifestations.In the majority of cases,these tumors are discovered after appendectomy during path...BACKGROUND Primary appendiceal tumors are histologically diverse and have an insidious onset and few specific clinical manifestations.In the majority of cases,these tumors are discovered after appendectomy during pathological exam of the resected tissue.Treatment may include appendectomy(simple or radical)and right hemicolectomy depending on factors such as histological type,tumor size and lymph node/organ involvement.The aim of this case study is to describe a rare case of a giant appendicular mucocele and raise awareness of this condition and its management options and follow-up protocol.CASE SUMMARY We present the case of a 43-year-old patient who presented to our emergency department with mild right lower quadrant pain.After the initial check-up and imaging exams,he underwent surgery,where a giant 20 cm×13 cm appendicular tumor was found and resected.Appendicular mucocele was suspected due to the macroscopic appearance and was later confirmed by the pathological exam.The patient’s postoperative evolution was uneventful,and after discharge,he was included in our follow-up program.CONCLUSION In conclusion,mucinous appendiceal neoplasms embody a rare pathology;they are asymptomatic or have few,unspecific clinical signs and in many cases are discovered after appendectomy.展开更多
文摘BACKGROUND Acute pancreatitis(AP)remains a major cause of hospitalization and mortality with important health-related costs worldwide.Using an electronic database of a large tertiary center,we estimated the incidence,etiology,severity and costs of hospitalized AP cases in southern Romania.AIM To estimate the incidence,cost and tobacco usage of hospitalized AP cases in southern Romania and to update and upgrade the knowledge we have on the etiology,severity(in regard to Revised Atlanta Classification),outcome,morphology and local complications of AP.METHODS We performed an electronic health care records search on AP patients treated at Emergency University Hospital of Bucharest(Spitalul Universitar de UrgențăBucurești)between 2015 and 2022.The incidence,etiology,and severity were calculated;potential risk factors were evaluated,and the hospitalization costs of AP were documented and analyzed.The cohort of this study is part of the BUCharest-Acute Pancreatitis Index registry.RESULTS A total of 947 consecutive episodes of AP where the patients were hospitalized in the gastroenterology department were analyzed,with 79.45%as 1st episode and the rest recurrent.The majority of the patients were males(68.9%).Alcoholic(45.7%),idiopathic(16.4%)and biliary(15.2%)were the main causes.The incidence was estimated at 29.2 episodes/100000 people.The median length of stay was 7 d.The median daily cost was 747.96 RON(165 EUR).There was a high prevalence of active tobacco smokers(68.5%).The prevalence of severe disease was 11.1%.The admission rate to the intensive care unit was 4.6%,with a mortality rate of 38.6%.The overall mortality was 5.5%.CONCLUSION We estimated the incidence of AP at 29.2 episodes that required hospitalization per 100000 people.The majority of our cases were found in males(68.9%)and were related to alcohol abuse(45.7%).Out of the cases we were able to find data regarding tobacco usage,the majority were active smokers(68.5%).Most patients had a mild course(54.4%),with a mortality rate of 5.5%.Interstitial AP prevailed(45.3%).The median daily cost of hospitalization was 747.96 RON(165 EUR).
文摘BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.
文摘Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of diseases that have insulin resistance in common and are associated with metabolic conditions such as obesity, type 2 diabetes mellitus, and dyslipidemia. NAFLD ranges from simple liver steatosis, which follows a benign course, to nonalcoholic steatohepatitis (NASH), a more severe entity, with necroinflmmation and f ibrosis, which can progress to cryptogenic cirrhosis and end-stage liver disease. Liver biopsy remains the gold standard for evaluating the degree of hepatic necroinflammation and f ibrosis; however, several noninvasive investigations, such as serum biomarkers, have been developed to establish the diagnosis and also to evaluate treatment response. These markers are currently neither available in all centers nor validated in extensive studies. Examples include high-sensitivity C reactive protein and plasma pentraxin 3, which are associated with extensive liver f ibrosis in NASH. Interleukin-6 correlates with inflammation, and cytokeratin-18 represents a marker of hepatocyte apoptosis (prominent in NASH and absent in simple steatosis). Tissue polypep-tide specif ic antigen seems to have a clinical utility in the follow-up of obese patients with NASH.
文摘AIM: To assess the feasibility, accuracy and acceptability of PillCam Colon 2 in detection of significant lesions in colorectal cancer risk patients, unable or unwilling to perform colonoscopy. METHODS: This is a prospective, single center study using the second generation of PillCam Colon capsule. In all patients the readers were instructed to review the entire colon capsule endoscopy(CCE) examination using Rapid 7 software and additionally to note significant extra-colonic findings. Colonic significant findings were described according to European Society of Gastrointestinal Endoscopy guidelines. CCE procedure completion rate, level of bowel preparation and rate of adverse events were assessed. RESULTS: A total of 70 patients at risk of colorectal cancer were enrolled in the study. In three patients the procedure failed because the capsule was not functioning when entered the colon. PillCam Colon 2 showed positive findings in 23(34%, 95%CI: 21.6%-44.1%) of the remaining 67 patients. Six patients were diagnosedwith tumors: 4 with colon cancers, 1 with gastric cancer and 1 with a small bowel cancer. The capsule findings were confirmed after surgery in all these patients. The capsule excretion rate in twelve hours was 77% with 54 patients having a complete examination. The rectum was not explored during CCE procedure, in 16 patients(23%, 95%CI: 13.7%-34.1%). Every patient accepted CCE as an alternative exploration tool and 65/70(93%) agreed to have another future control by CCE. No complications were reported during or after CCE examination. CONCLUSION: PillCam Colon 2 capsule was effective in detecting significant lesions and might be considered an adequate alternative diagnostic tool in patients unable or unwilling to undergo colonoscopy.
文摘Mucosal healing(MH)has emerged as a key therapeutic target in inflammatory bowel disease(IBD),and achievement of this goal is documented by endoscopy with biopsy.However,colonoscopy is burdensome and invasive,and substitution with an accurate noninvasive biomarker is desirable.AIM To summarize published data regarding the performance of noninvasive biomarkers in assessing MH in IBD patients.METHODS We conducted a systematic review of studies that reported the performance of biomarkers in diagnosing MH in patients with IBD.The main outcome measure was to review the diagnostic accuracy of serum and fecal markers that showed promising utility in assessing MH.RESULTS We screened 1301 articles,retrieved 46 manuscripts and included 23 articles for full-text analysis.The majority of the included manuscripts referred to fecal markers(12/23),followed by circulatory markers(8/23);only 3/23 of the included manuscripts investigated combined markers(serum and/or fecal markers).Fecal calprotectin(FC)was the most investigated fecal marker for assessing MH.In ulcerative colitis,for cutoff levels ranging between 58 mcg/g and 490 mcg/g,the sensitivity was 89.7%-100%and the specificity was 62%-93.3%.For Crohn’s disease,the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g(sensitivity 50%-95.9%and specificity 52.3%-100%).The best performance for a serum marker was observed for the endoscopic healing index,which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein.CONCLUSION Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization assessing MH.In ulcerative colitis,for cutoff levels ranging between 58 mcg/g and 490 mcg/g,the sensitivity was 89.7%-100%and the specificity was 62%-93.3%.For Crohn’s disease,the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g(sensitivity 50%-95.9%and specificity 52.3%-100%).The best performance for a serum marker was observed for the endoscopic healing index,which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein.CONCLUSION Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization.
基金Supported by(in part)Sectorial Operational Program Human Resources DevelopmentEuropean social fundand the Romanian government,No.POSDRU 141531
文摘Increasing evidence of a link between inflammatory bowel disease(IBD) and adverse cardiovascular events has emerged during the last decade.In 2014,an important number of meta-analyses and cohort studies clarified the subtle dangerous liaisons between gut inflammation and cardiovascular pathology.The evidence suggests that patients with IBD have a significantly increased risk of myocardial infarction,stroke,and cardiovascular mortality,especially during periods of IBD activity.Some populations(e.g.,women,young patients) may have an even greater risk.Current effective treatment of IBD is aimed at disease remission and seems to reduce cardiovascular risk in these patients.A beneficial effect was demonstrated for salicylates,but not for steroids or azathioprine.tumor necrosis factor-α antagonists,which are highly effective in the reduction of inflammation and in the restoration of the digestive mucosa,lead to conflicting cardiovascular effects,as they seem to reduce the risk for ischemic heart disease but increase the rate of cerebrovascular events.Future supplemental treatment strategies that may reduce the atherothrombotic risk during periods of IBD activity should be explored.
文摘Despite significant therapeutic progress in recent years,inflammatory bowel disease(IBD),which includes Crohn’s disease and ulcerative colitis,remains a challenge regarding its pathogenesis and long-term complications.New concepts have emerged in the management of this disease,such as the"treat-totarget"concept,in which mucosal healing plays a key role in the evolution of IBD,the risk of recurrence and the need for surgery.Endoscopy is essential for the assessment of mucosal inflammation and plays a pivotal role in the analysis of mucosal healing in patients with IBD.Endoscopy is also essential in the detection of dysplasia and in the identification of the risk of colon cancer.The current surveillance strategy for dysplasia in IBD patients indicates white-light endoscopy with non-targeted biopsies.The new chromoendoscopy techniques provide substantial benefits for both clinicians and patients.Narrow-band imaging(NBI)has similar rates of dysplastic lesion detection as whitelight endoscopy,and it seems that NBI identifies more adenoma-like lesions.Because it is used instinctively by many endoscopists,the combination of these two techniques might improve the rate of dysplasia detection.Flexible spectral imaging color enhancement can help differentiate dysplastic and non-dysplastic lesions and can also predict the risk of recurrence,which allows us to modulate the treatment to gain better control of the disease.The combination of noninvasive serum and stool biomarkers with endoscopy will improve the monitoring and limit the evolution of IBD because it enables the use of a personalized approach to each patient based on that patient’s history and risk factors.
文摘Whipple's disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei.The infection usually mainly involves the small bowel,but sometimes other organs are affected as well.Since the current standard clinical and biological tests are nonspecific,diagnosis is very difficult and relies on histopathology.Here we present the case of a 52-yearold man with chronic diarrhea and weight loss whose symptoms had been evolving for 2 years and whose diagnosis came unexpectedly after capsule examination.Diagnosis was confirmed by the histopathologic examination of endoscopic biopsy samples,and treatment with co-trimoxazole resulted in remission of symptoms.We present the first images of Whipple's disease obtained with the Pillcam Colon 2 video capsule system.
文摘Capsule endoscopy(CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients.It has the advantage of excellent visualization of digestive tract mucosa,a good tolerability and safety in well-selected patients.The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule.The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis,thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings.When symptoms and biomarkers point to a change in the disease's activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards.The appearance of the new capsule from Medtronicthe Pillcam Crohn's might be an important step forward in diagnosis,evaluating disease extent,the severity of the disease,prognosis,management in a treat to target approach,with treatment modifications according to the data from CE examination.Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed.We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.
文摘BACKGROUND Primary appendiceal tumors are histologically diverse and have an insidious onset and few specific clinical manifestations.In the majority of cases,these tumors are discovered after appendectomy during pathological exam of the resected tissue.Treatment may include appendectomy(simple or radical)and right hemicolectomy depending on factors such as histological type,tumor size and lymph node/organ involvement.The aim of this case study is to describe a rare case of a giant appendicular mucocele and raise awareness of this condition and its management options and follow-up protocol.CASE SUMMARY We present the case of a 43-year-old patient who presented to our emergency department with mild right lower quadrant pain.After the initial check-up and imaging exams,he underwent surgery,where a giant 20 cm×13 cm appendicular tumor was found and resected.Appendicular mucocele was suspected due to the macroscopic appearance and was later confirmed by the pathological exam.The patient’s postoperative evolution was uneventful,and after discharge,he was included in our follow-up program.CONCLUSION In conclusion,mucinous appendiceal neoplasms embody a rare pathology;they are asymptomatic or have few,unspecific clinical signs and in many cases are discovered after appendectomy.
