Pancreatic duct disruption and nonoperative management: the SEALANTS approach

Pancreatic-duct disruption (PDD) can be difficult to manage, with diverse etiologies and sequelae in a heterogeneous population. Common etiologies include pancreatitis, iatrogenic injury, and trauma. Sequelae of PDD include pseudocyst, pancreatic ascites,

Hepatitis D virus and liver transplantation: Indications and outcomes

Hepatitis D virus(HDV)is a dependent virus that relies on hepatitis B virus for its replication and transmission.Chronic hepatitis D is a severe form of viral hepatitis that can result in end stage liver disease.Currently,pegylated interferon alpha is the only approved therapy for chronic HDV infection and is associated with significant side effects.Liver transplantation(LT)is the only treatment option for patients with end-stage liver disease,hepatocellular carcinoma,or fulminant hepatitis due to coinfection with HDV.As LT for HDV and hepatitis B virus coinfection is uncommon in the United States,most data on the long-term impact of LT on HDV are from international centers.In this review,we discuss the indications and results of LT with treatment options in HDV patients.

玻璃体内注射曲安奈德治疗黄斑水肿后白内障形成及其他并发症

PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with macular edema arising from retinovascular etiologies were treated with 4 mg intravitreal triamcinolone. Eyes were monitored after injection for visual acuity changes and complications, including cataract formation and increase in intraocular pressure (IOP). Cataract progression was analyzed by linear regression analysis of lens scores from lens opacity standards. RESULTS: The mean visual acuity improved from 20/125 to- 1 to 20/100+ 2 by one to two months after injection (P < .001) and was 20/100 at the final examination (P=.006) at a mean of 1.2 years after injection. Complications included a severe, culture-negative inflammatory reaction in one eye (1.1% ). IOP increased to 30 mm Hg or more in nine (9.7% ) of 93 eyes between 1 and 140 days after injection and wasmore frequent in eyes receiving one or more preinjection glaucoma drops (two of 13 eyes, 15.4% , vs seven of 80 eyes, 8.75% , without preinjection glaucoma drops). Nuclear sclerosis increased at a rate of 0.175 U per year, posterior subcapsular cataracts at 0.423 U per year, and cortical cataracts at 0.045U per year. Posterior subcapsular cataract increased by ≥ 1 U or required cataract surgery in 45.2% of eyes followed at least one year. CONCLUSIONS: Intravitreal triamcinolone improves visual acuity in most eyes but eyes must be monitored carefully for increase in IOP. Posterior subcapsular cataract formation becomes visually significant in almost half of eyes by one year after injection.

Hypergastrinemia and recurrent type 1 gastric carcinoid in a young Indian male: Necessity for antrectomy?

Carcinoid tumors are the most common neuroendocrine tumors. Gastric carcinoids represent 2% of all carcinoids and 1% of all gastric masses. Due to the wide-spread use of Esophagogastroduodenoscopy for evaluating a variety of upper gastrointestinal symptoms, the detection of early gastric carcinoids has increased. We highlight an alternative management of a young patient with recurrent type 1 gastric carcinoids with greater than 5 lesions, as well as lesions intermittently greater than 1 cm. Gastric carcinoids have a variable presentation and clinical course that is highly dependent on type. Type 1 gastric carcinoids are usually indolent and have a metastasis rate of less than 2%, even with tumors larger than 2 cm. There are a number of experts as well as organizations that recommend endoscopic resection for all type 1 gastric carcinoid lesions less than 1 cm, with a follow-up every 6-12 mo. They also recommend antrectomy for type 1 gastric carcinoids with greater than 5 lesions, lesions 1 cm or greater, or refractory anemia. However, the American Society of Gastrointestinal Endoscopy guidelines state that type 1 gastric carcinoid surveillance is controversial based on the evidence and could not make an evidence-based position statement on the best treatment modality. Our report illustrates a rare cause of iron deficiency anemia in a young male (without any medical history) due to multiple recurrent gastric carcinoid type 1 lesions in the setting of atrophic gastritis causing hypergastrinemia, and in the absence of a vitamin B12 deficiency. Gastric carcinoid type 1 can present in young males without an autoimmune history, despite the known predilection for women aged 50 to 70 years. Type 1 gastric carcinoids can be managed by endoscopic resection in patients with greater than 5 lesions, even with lesions larger than 1 cm. This course of treatment enabled the avoidance of early antrectomy in our patient, who expressed a preference against more invasive measures at his young age.

PATIENT PERSISTENCY WITH TOPICAL PROSTAGLANDIN THERAPY IN THE MANAGEMENT OF GLAUCOMA

Purpose: The purpose was to evaluate persistency (time on therapy) with prostaglandin analogues in the treatment of glaucoma or ocular hypertension. Methods: This population-based, retrospective cohort study used prescription and medical claims databases from multiple managed care organizations. Patients

CLINICAL AND ECONOMIC OUTCOMES OF LATANOPROST BIMATOPROST OR TRAVOPROST THERAPY IN GLAUCOMA PATIENTS: A THREE-MONTH RETRO-SPECTIVE STUDY

Purpose: To evaluate rates of hyperemia in patients treated with latanoprost, bimatoprost, or travoprost and to compare groups in IOP response and costs. Methods: This 3-month, retrospective, multicenter, non-randomized, medical chart review included patients from 10 U.S. sites, who either initiated or changed to latanoprost, bimatoprost, or travoprost for the treatment of primary open-angle glaucoma or ocular hypertension after January 1, 2001. Patients had follow-up data for at least 3 months fol-

Cold stress-regulated immune responses: Insights, challenges, and perspectives

1 Cold stress reshapes the immune status The winter of 2019 marked history with the advent of the COVID-19 Coronavirus pandemic;Cross-country skiers are more susceptible to asthmatic symptoms than their peers in warmer places[1].The influenza virus causes a more severe infection in winter than in warmer seasons[2].These phenomena suggest that exposure to cold weather increases a person’s vulnerability to health concerns such as the aforementioned“colds”and asthma.While it is accepted that the term“cold”covers a wide array of ailments,it has long been questioned how cold weather brings forth these illnesses.The underlying mechanisms remain to be determined.

Hepatocellular Carcinoma and the Role of Liver Transplantation:A Review

Hepatocellular carcinoma(HCC)is one of the leading causes of cancer deaths worldwide and liver transplantation(LT)is the only potentially curative treatment.Over the years,Milan criteria has been used for patient selection.There is ongoing research in this field with introduction of new biomarkers for HCC that can help guide future treatment.Furthermore,newer therapies for downstaging of the tumor are being implemented to prevent dropout from the transplant list.In addition,combination therapies for better outcome are under investigation.Interestingly,the concept of living-donor LT and possible use of hepatitis C virus-positive donors has been implemented as an attempt to expand the organ pool.However,there is a conflict of opinion between different centers regarding its efficacy and data is scarce.The aim of this review article is to outline the various selection criteria for LT,discuss the outcomes of LT in HCC patients,and explore future directions of LT for HCC.Therefore,a comprehensive PubMed/MEDLINE review was conducted.To expand our search,references of the retrieved articles were also screened for additional data.After selecting the studies,the authors independently reviewed them to identify the relevant studies.After careful evaluation 120 studies relevant to out topic are cited in the manuscript.Three tables and two figures are also included.In conclusion LT for HCC has evolved over the years.With the introduction of several expanded criteria beyond Milan,the introduction of bridging therapies,such as transcatheter arterial chemoembolization and radiofrequency ablation,and the approval of newer systemic therapies,it is evident that there will be more LT recipients in the future.It is promising to see ongoing trials and the continuous evolution of protocols.Prospective studies are needed to guide the development of a pre-LT criteria that can ensure low HCC recurrence risk and is not overly stringent,clarify the role of LDLT,and determine the optimal bridging therapies to LT.