Recurrence of H pylori after eradication is rare in developed countries and more frequent in developing countries. Recrudescence (recolonization of the same strain within 12 mo after eradication) rather than reinfecti...Recurrence of H pylori after eradication is rare in developed countries and more frequent in developing countries. Recrudescence (recolonization of the same strain within 12 mo after eradication) rather than reinfection (colonization with a new strain, more than 12 mo after eradication) is considered to be responsible for most of the cases. This observation was confirmed only in developed countries, while in developing countries a recent meta-analysis demonstrated a high rate of reinfection. The proportion of H pylori annual recurrence was 2.67% and 13.00% in developed and developing countries, respectively. Nested meta-analysis (only cases with a longer follow-up and a negative 13CUBT a year after eradication) revealed annual recurrence rate of 1.45% [relative risk (RR), 0.54] and 12.00% (RR, 0.92) in developed and developing countries, respectively. These findings support the notion that in developed countries many cases of recurrence are due to recrudescence within the first year after eradication, with a 46% drop in the recurrence rate after the first year post eradication, while in developing countries reinfection is more pronounced, and continue at the same rate since eradication. A different approach for follow-up after H pylori eradication is probably needed in patients of developing countries, since reinfection is highly prevalent.展开更多
AIM： To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding. METHODS： Retrospective study of patients with gas- trointestinal bleeding secondary to Dieulafoy...AIM： To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding. METHODS： Retrospective study of patients with gas- trointestinal bleeding secondary to Dieulafoy＇s lesion （DL） from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastro- intestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy de- scribed a lesion compatible with Dieulafoy. We exclud- ed patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures. RESULTS： Twenty-nine patients with DL were identi- fied. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach （51.7%）. The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial （spurting） bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was ap- plied to nine patients （31%）, eight of them with adren- aline and one with argon, while 69% of the patients received combined treatment. Six patients （20.7%） presented with recurrent bleeding at a median of 4 d after endoscopy （interquartile range = 97.75）. Within these six patients, the new endoscopic treatment ob- tained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding （50% vs 33.3% for other type of bleeding） rP = 0.024, odds ratio （OR） = 8.5, 95% CI = 1.13-63.87]. The use of combined en- doscopic treatment prevented the recurrence of bleed- ing （10% vs 44.4% of single treatment） （P = 0.034, OR = 0.14, 95% CI = 0.19-0.99）. CONCLUSION： Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial （spurting） bleeding are associated with a high rate of bleeding recurrence.展开更多
Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendic...Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leu-kemia relapse.Pathological findings of the appendix revealed transmural infiltrates of myeloblasts,which indicated a diagnosis of leukemia.Unfortunately,the patient died from progression of the disease on the 19th d after admission.Although leukemic cell infiltration of the appendix is uncommon,patients with leu-kemia relapse can present with symptoms mimicking acute appendicitis.展开更多
Desmoid tumor is a locally invasive,myofibroblastic,nonmetastatic tumor.Its pathogenesis remains unclear and it may involve genetic abnormalities,sex hormones and traumatic injury,including surgery.Postoperative intra...Desmoid tumor is a locally invasive,myofibroblastic,nonmetastatic tumor.Its pathogenesis remains unclear and it may involve genetic abnormalities,sex hormones and traumatic injury,including surgery.Postoperative intra-abdominal desmoid tumor is rare,especially in the retroperitoneum.We report a case of postoperative retroperitoneal desmoid tumor that developed 29 mo after the first excision of a gastrointestinal stromal tumor.Sporadic trauma-related intraabdominal desmoid tumors reported in the English literature are also reviewed.Despite an extremely low incidence,postoperative desmoid tumor should be considered in the differential diagnosis when a recurrent neoplasm is found at least one year after operation.However,it is a clinical challenge to distinguish recurrent malignant neoplasms from desmoid tumors,and surgical resection is the treatment option depending on the anatomic location.展开更多
AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up. METHODS We enrolled 41 patients treated with curative gastrect...AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up. METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1). We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2). We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis) of 41 cases matched with Group 1 according to demographic and pathological characteristics. RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients. In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns: lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.展开更多
文摘Recurrence of H pylori after eradication is rare in developed countries and more frequent in developing countries. Recrudescence (recolonization of the same strain within 12 mo after eradication) rather than reinfection (colonization with a new strain, more than 12 mo after eradication) is considered to be responsible for most of the cases. This observation was confirmed only in developed countries, while in developing countries a recent meta-analysis demonstrated a high rate of reinfection. The proportion of H pylori annual recurrence was 2.67% and 13.00% in developed and developing countries, respectively. Nested meta-analysis (only cases with a longer follow-up and a negative 13CUBT a year after eradication) revealed annual recurrence rate of 1.45% [relative risk (RR), 0.54] and 12.00% (RR, 0.92) in developed and developing countries, respectively. These findings support the notion that in developed countries many cases of recurrence are due to recrudescence within the first year after eradication, with a 46% drop in the recurrence rate after the first year post eradication, while in developing countries reinfection is more pronounced, and continue at the same rate since eradication. A different approach for follow-up after H pylori eradication is probably needed in patients of developing countries, since reinfection is highly prevalent.
文摘AIM： To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding. METHODS： Retrospective study of patients with gas- trointestinal bleeding secondary to Dieulafoy＇s lesion （DL） from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastro- intestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy de- scribed a lesion compatible with Dieulafoy. We exclud- ed patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures. RESULTS： Twenty-nine patients with DL were identi- fied. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach （51.7%）. The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial （spurting） bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was ap- plied to nine patients （31%）, eight of them with adren- aline and one with argon, while 69% of the patients received combined treatment. Six patients （20.7%） presented with recurrent bleeding at a median of 4 d after endoscopy （interquartile range = 97.75）. Within these six patients, the new endoscopic treatment ob- tained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding （50% vs 33.3% for other type of bleeding） rP = 0.024, odds ratio （OR） = 8.5, 95% CI = 1.13-63.87]. The use of combined en- doscopic treatment prevented the recurrence of bleed- ing （10% vs 44.4% of single treatment） （P = 0.034, OR = 0.14, 95% CI = 0.19-0.99）. CONCLUSION： Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial （spurting） bleeding are associated with a high rate of bleeding recurrence.
文摘Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leu-kemia relapse.Pathological findings of the appendix revealed transmural infiltrates of myeloblasts,which indicated a diagnosis of leukemia.Unfortunately,the patient died from progression of the disease on the 19th d after admission.Although leukemic cell infiltration of the appendix is uncommon,patients with leu-kemia relapse can present with symptoms mimicking acute appendicitis.
基金Supported by The Buddhist Dalin Tzu-Chi General Hospital
文摘Desmoid tumor is a locally invasive,myofibroblastic,nonmetastatic tumor.Its pathogenesis remains unclear and it may involve genetic abnormalities,sex hormones and traumatic injury,including surgery.Postoperative intra-abdominal desmoid tumor is rare,especially in the retroperitoneum.We report a case of postoperative retroperitoneal desmoid tumor that developed 29 mo after the first excision of a gastrointestinal stromal tumor.Sporadic trauma-related intraabdominal desmoid tumors reported in the English literature are also reviewed.Despite an extremely low incidence,postoperative desmoid tumor should be considered in the differential diagnosis when a recurrent neoplasm is found at least one year after operation.However,it is a clinical challenge to distinguish recurrent malignant neoplasms from desmoid tumors,and surgical resection is the treatment option depending on the anatomic location.
文摘AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up. METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1). We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2). We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis) of 41 cases matched with Group 1 according to demographic and pathological characteristics. RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients. In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns: lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.
