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Stock MR, Fine RO, Rivas Y, Levin TL. Magnetic resonance imaging following the demonstration of a normal common bile duct on ultrasound in children with suspected choledocholithiasis: what is the benefit? Pediatr Radiol 2023; 53:358-366. [PMID: 36333493 DOI: 10.1007/s00247-022-05537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The role of MRI in evaluating children with an in situ gallbladder and suspected choledocholithiasis following a negative or inconclusive US is unclear. OBJECTIVE To determine whether MRI benefits children with suspected choledocholithiasis and a normal common bile duct (CBD) without stones on US. MATERIALS AND METHODS We conducted a retrospective 10-year review of paired US and MRI (within 10 days) in children 18 years or younger with suspected choledocholithiasis. With MRI as a reference standard, two reviewers independently evaluated the images for CBD diameter, choledocholithiasis, cholelithiasis and pancreatic edema. Serum lipase was recorded. We calculated exact binomial confidence limits for test positive predictive values (PPVs) and negative predictive values (NPVs) using R library epiR. RESULTS Of 87 patients (46 female, 41 male; mean age 14 years, standard deviation [SD] 4.6 years; mean interval between US and MRI 1.6 days, SD 1.8 days), 55% (48/87) had true-negative US, without CBD dilation/stones confirmed on MRI; 5% (4/87) had false-positive US showing CBD dilatation without stones, not confirmed on MRI; 33% (29/87) had true-positive US, with MRI confirming CBD dilatation; and 7% (6/87) had false-negative US, where MRI revealed CBD stones without dilatation (2 patients) and CBD dilatation with or without stones (4 patients). Patients with false-negative US had persistent or worsening symptoms, pancreatitis or SCD. The overall US false-negative rate was 17% (6/35). Normal-caliber CBD on US without stones had an NPV of 89% (48/54, 95% confidence interval: 0.77-0.96). CONCLUSION MRI adds little information in children with a sonographically normal CBD except in the setting of pancreatitis or worsening clinical symptoms. Further evaluation is warranted in children with elevated risk of stone disease.
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Affiliation(s)
- Miriam R Stock
- Medical Program, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rona Orentlicher Fine
- Division of Pediatric Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St., Bronx, NY, 10467, USA
| | - Yolanda Rivas
- Division of Pediatric Gastroenterology, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Terry L Levin
- Division of Pediatric Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St., Bronx, NY, 10467, USA.
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Cavero M, Planas T, Goikolea J, Lens S, Bartrés C, Colomer L, García C, Valentí M, Ruiz V, Rivas Y, Benabarre A, Catalan R, Masana G, Colom J, Forns X, Martin-Santos R, Mariño Z. Screnning of viral hepatitis in mental disorder patients: Psiqui-Clinic Programme. Eur Psychiatry 2022. [PMCID: PMC9567413 DOI: 10.1192/j.eurpsy.2022.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The WHO would increase diagnosis and treatment of viral hepatitis in the world by 2030, based on the high efficacy of direct-acting-antivirals against HCV, extended vaccination programs in HBC, and epidemiological data. Diagnostic of HCV/HBV infection has been simplified by point-of-care (POC) devices (cheap/easy-to-use/interprete/qick-results), detecting anti-HCV-antibodies or HBV-antigen in capillary blood at the patients´site. The current seroprevalence of viral hepatitis B/C in general population in Spain is 0.5%/1% and would be higher (3-17%) in people with severe-mental-disorder due to risk factors and traditionally less access to health care. Objectives To design a screening protocol for HCV eradication and HBV-detection, and risk factors among severe-mental-disorder patients in a CommunityMentalHealthCenter. To guarantee equal access to viral hepatitis screening and therapy among this population. Methods Outpatients visited along one-year who accepts participate. Using POC-device for qualitative detection of anti-HCV-antibodies (Quickview-of-Lumiquick-Diagnostics®)/HBsAG (Abbott-Rapid-Diagnostics®). Socio-demographic data; mental disorder(ICD-10); HCV/HBV risk-factors; Neurotoxicity-scale (mood/cognition/sleep/gastrointestinal/sickness/motor); SF-12; Patient-satisfaction. Subjects with positive HCV/HBV POC-test will have a on-site venopuncture to assess hemograme/liver tests, and HCV-RNA (Cobas-TaqMan-RocheDiagnostics)/HBsAg-ELISA (Atellica-Siemens). In positive HCV-RNA (active infection) the psychiatric-team will inform the hepatology-team for non-invasive liver fibrosis assessment and DAA prescription. The patient will receive 8-12-weeks on-site treatment, and assessed (Neurotoxicity/SF-12).HCV cure will be confirmed by HCV-RNA in blood. Chronic-cases will be managed at Hepatology-Unit. Results We will present the results of the implementation of the programme and their ability to detect viral-hepatitis-positive cases among patients with severe-mental-disorders and to treat them effectively. Conclusions Our results may support the generalisation of the programme in among CMHC’s. Disclosure No significant relationships.
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Costa PA, Ho S, Manvar A, Rivas Y, Novak I. Use of Lumen-apposing Metal Stents for Endoscopic Drainage of Intra-abdominal Fluid Collections in Pediatric Patients. J Pediatr Gastroenterol Nutr 2020; 70:258-260. [PMID: 31978029 DOI: 10.1097/mpg.0000000000002538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Intraabdominal fluid collections that previously required surgical intervention can now be drained with less invasive techniques. The use of lumen-apposing metal stents (LAMS) to treat pancreatic pseudocysts and perirectal abscesses has been shown to be a safe and effective technique in adults. We aim to evaluate the indications, outcomes, and complications of the use of LAMS in pediatric patients at our institution. METHODS A retrospective chart review was performed to study patients up to 18 years of age at the Children's Hospital at Montefiore who underwent drainage of intraabdominal fluid collections with the use of LAMS. The main outcome measures were technical and clinical success and associated adverse events with LAMS placement. RESULTS Seven patients (2 girls) ranging from 9 to 18 years were identified. Four patients had perirectal abscess postperforated appendicitis and 3 patients had pancreatic pseudocysts. All of the patients had complete resolution of the collections, with no recurrence, and our technical and clinical success rate was 100%. Only 1 patient had mild bleeding after placement that spontaneously resolved. DISCUSSION Our study demonstrates the efficacy and safety of the use of LAMS for the drainage of intraabdominal fluid collections in pediatric patients, although the number of patients included is limited.
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Affiliation(s)
- Peter A Costa
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital at Montefiore
| | - Sammy Ho
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Amar Manvar
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Yolanda Rivas
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital at Montefiore
| | - Inna Novak
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital at Montefiore
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Reddy P, Rivas Y, Golowa Y, KoganLiberman D, Ho S, Jan D, Ovchinsky N. Novel Non-Surgical Interventions for Benign Inflammatory Biliary Strictures in Infants: A Report of Two Cases and Review of Current Pediatric Literature. Pediatr Gastroenterol Hepatol Nutr 2019; 22:565-570. [PMID: 31777722 PMCID: PMC6856500 DOI: 10.5223/pghn.2019.22.6.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/31/2019] [Indexed: 11/14/2022] Open
Abstract
Benign biliary strictures are uncommon in children. Classically, these cases are managed surgically, however less invasive approaches with interventional radiology and or endoscopy may have similar results and improved safety profiles While benign biliary strictures have been described in literature on several occasions in young children, (most older than 1 year and once in an infant 3 months of age), all reported cases were managed surgically. We present two cases of benign biliary strictures in infants less than 6 months of age that were managed successfully with novel non-invasive procedures and a review of all current pediatric cases reported in the literature. Furthermore, we describe the use of a Rendezvous procedure, which has not been reported as a treatment approach for benign biliary strictures.
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Affiliation(s)
- Pooja Reddy
- Division of Pediatric Gastroenterology and Nutrition, Columbia University Medical Center, New York, NY, USA
| | - Yolanda Rivas
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Yosef Golowa
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Deborah KoganLiberman
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Sammy Ho
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Dominique Jan
- Division of Pediatric Surgery, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Nadia Ovchinsky
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital at Montefiore, Bronx, NY, USA
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5
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Mink R, Schwartz A, Carraccio C, High P, Dammann C, McGann KA, Kesselheim J, Herman B, Baffa G, Herman B, Turner DA, Fussell J, High P, Hsu D, Stafford D, Aye T, Sauer C, Kesselheim J, Myers A, McGann K, Dammann C, Chess P, Mahan J, Weiss P, Curran M, Schwartz A, Carraccio C, Herman B, Mink R, Havalad V, Pinheiro J, Alderman E, Fuloria M, McCabe ME, Mehta J, Rivas Y, Rosenberg M, Doughty C, Hergenroeder A, Kale A, Lee-Kim Y, Rama JA, Steuber P, Voigt B, Hardy K, Johnston S, Boyer D, Mauras C, Schonwald A, Sharma T, Barron C, Dennehy P, Jacobs ES, Welch J, Kumar D, Mason K, Roizen N, Rose JA, Bokor B, Chapman JI, Frank L, Sami I, Schuette J, Lutes RE, Savelli S, Amirnovin R, Harb R, Kato R, Marzan K, Monzavi R, Vanderbilt D, Doughty L, McAneney C, Rice W, Widdice L, Erenberg F, Gonzalez BE, Adkins D, Green D, Narayan A, Rehder K, Clingenpeel J, Starling S, Karpen HE, Rouster-Stevens K, Bhatia J, Fuqua J, Anders J, Trent M, Ramanathan R, Nicolau Y, Dozor AJ, Kinane TB, Stanley T, Rao AN, Bone M, Camarda L, Heffner V, Kim O, Nocton J, Rabbitt AL, Tower R, Amaya M, Jaroscak J, Kiger J, Macias M, Titus O, Awonuga M, Vogt K, Warwick A, Coury D, Hall M, Letson M, Rose M, Glickstein J, Lusman S, Roskind C, Soren K, Katz J, Siqueira L, Atlas M, Blaufox A, Gottleib B, Meryash D, Vuguin P, Weinstein T, Armsby L, Madison L, Scottoline B, Shereck E, Henry M, Teaford PA, Long S, Varlotta L, Zubrow A, Barlow C, Feldman H, Ganz H, Grimm P, Lee T, Weiner LB, Molle-Rios Z, Slamon N, Guillen U, Miller K, Federman M, Cron R, Hoover W, Simpson T, Winkler M, Harik N, Ross A, Al-Ibrahim O, Carnevale FP, Waz W, Bany-Mohammed F, Kim JH, Printz B, Brook M, Hermiston M, Lawson E, van Schaik S, McQueen A, Booth KVP, Tesher M, Barker J, Friedman S, Mohon R, Sirotnak A, Brancato J, Sayej WN, Maraqa N, Haller M, Stryjewski B, Brophy P, Rahhal R, Reinking B, Volk P, Bryant K, Currie M, Potter K, Falck A, Weiner J, Carney MM, Felt B, Barnes A, Bendel CM, Binstadt B, Carlson K, Garrison C, Moffatt M, Rosen J, Sharma J, Tieves KS, Hsu H, Kugler J, Simonsen K, Fastle RK, Dannaway D, Krishnan S, McGuinn L, Lowe M, Witchel SF, Matheo L, Abell R, Caserta M, Nazarian E, Yussman S, Thomas AD, Hains DS, Talati AJ, Adderson E, Kellogg N, Vasquez M, Allen C, Brion LP, Green M, Journeycake J, Yen K, Quigley R, Blaschke A, Bratton SL, Yost CC, Etheridge SP, Laskey T, Pohl J, Soprano J, Fairchild K, Norwood V, Johnston TA, Klein E, Kronman M, Nanda K, Smith L, Allen D, Frohna JG, Patel N, Estrada C, Fleming GM, Gillam-Krakauer M, Moore P, El Khoury JC, Helderman J, Barretto G, Levasseur K, Johnston L. Creating the Subspecialty Pediatrics Investigator Network. J Pediatr 2018; 192:3-4.e2. [PMID: 29246355 DOI: 10.1016/j.jpeds.2017.09.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Mink
- Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance, CA
| | | | | | - Pamela High
- W Alpert Medical School of Brown University, Providence, RI
| | | | | | | | - Bruce Herman
- University of Utah/Primary Children's Hospital, Salt Lake City, UT
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Affiliation(s)
- Debra H Pan
- Division of Pediatric Gastroenterology and Nutrition, The Children's Hospital at Montefiore, Bronx, NY
| | - Yolanda Rivas
- Division of Pediatric Gastroenterology and Nutrition, The Children's Hospital at Montefiore, Bronx, NY
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Rudolph B, Rivas Y, Kulak S, Pan D, Ewart M, Levin TL, Thompson JF, Scharbach K. Yield of diagnostic tests in obese children with an elevated alanine aminotransferase. Acta Paediatr 2015; 104:e557-63. [PMID: 26341254 DOI: 10.1111/apa.13176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/15/2015] [Accepted: 09/01/2015] [Indexed: 01/14/2023]
Abstract
AIM Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and affects roughly 10% of children. However, NAFLD is often diagnosed by exclusion - that is, obese children with an elevated alanine aminotransferase (ALT) are screened for other liver diseases in the absence of a biopsy. This testing is nonstandardized, and professional society recommendations differ. This study examines the yield of testing for disorders other than NAFLD in this patient population. METHODS A retrospective study was performed in 120 obese, asymptomatic, noncholestatic children with an ALT ≥40 U/L and additional diagnostic testing. RESULTS No patients were found to have Wilson's, hepatitis A, hepatitis B, hepatitis C, cytomegalovirus, alpha-1 antitrypsin deficiency, autoimmune hepatitis, celiac disease or Epstein-Barr virus. Only one patient (1/120) was identified with definite disease other than NAFLD, which was muscular dystrophy. The positive predictive value of a screening test was 5%, and the specificity was 97%. Of 70 children with an abdominal ultrasound, no significant abnormalities were identified. CONCLUSION Extensive testing in asymptomatic, noncholestatic, obese children with an elevated ALT may be of limited diagnostic value and false-positive tests are likely. Large, prospective studies are needed to help focus the work up in this patient population.
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Affiliation(s)
- Bryan Rudolph
- Division of Pediatric Gastroenterology and Nutrition; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
| | - Yolanda Rivas
- Division of Pediatric Gastroenterology and Nutrition; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
| | - Shulamit Kulak
- Division of Pediatrics; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
| | - Debra Pan
- Division of Pediatric Gastroenterology and Nutrition; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
| | - Michelle Ewart
- Division of Pathology; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
| | - Terry L. Levin
- Division of Radiology; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
| | - John F. Thompson
- Division of Pediatric Gastroenterology and Nutrition; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
| | - Kathryn Scharbach
- Division of Pediatrics; Children's Hospital at Montefiore; Albert Einstein College of Medicine; Bronx NY USA
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8
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Abstract
BACKGROUND AND OBJECTIVE Pediatric endoscopic procedures are essential in the evaluation and treatment of gastrointestinal diseases in children. Although pediatric endoscopists are greatly interested in increasing efficiency and through-put in pediatric endoscopy units, there is scarcely any literature on this critical process. The goal of this study was to improve the timeliness of pediatric endoscopy procedures at Children's Hospital at Montefiore. METHODS In June 2010, a pediatric endoscopy quality improvement initiative was formed at Children's Hospital at Montefiore. We identified patient-, equipment-, and physician-related causes for case delays. Pareto charts, cause and effect diagrams, process flow mapping, and statistical process control charts were used for analysis. RESULTS From June 2010 to December 2012, we were able to significantly decrease the first case endoscopy delay from an average of 17 to 10 minutes (P < .001), second case delay from 39 to 25 minutes (P = .01), third case delay from 61 to 45 minutes (P = .05), and fourth case delay from 79 to 51 minutes (P = .05). Total delay time decreased from 196 to 131 minutes, resulting in a reduction of 65 minutes (P = .02). From June 2010 to August 2011 (preintervention period), an average of 36% of first endoscopy cases started within 5 minutes, 51% within 10 minutes, and 61% within 15 minutes of the scheduled time. From September 2011 to December 2012 (postintervention period), the percentage of cases starting within 5 minutes, 10 minutes, and 15 minutes increased to 47% (P = .07), 61% (P = .04), and 79% (P = .01), respectively. CONCLUSIONS Applying quality improvement methods and tools helped improve pediatric endoscopy timeliness and significantly decreased total delays.
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Affiliation(s)
- Gitit Tomer
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition and
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Abstract
Encephalitozoon cuniculi is an obligate intracellular microsporidian parasite that can result in clinical and subclinical infection in many species. It is also considered the cause of a potential zoonotic disease. In the present study, a serological survey was conducted using samples from pet dogs in the state of Florida. Twenty-seven of 125 serum samples, or 21.6%, were found to demonstrate reactivity by ELISA, with titers ranging from 1:32 to 1:512. There were no significant differences by age or sex. This is the first report on the detection of E. cuniculi antibodies in dogs in the United States.
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Affiliation(s)
- C Cray
- Division of Comparative Pathology, Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
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10
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Rudolph B, Rivas Y. Nonalcoholic fatty liver disease. Pediatr Rev 2010; 31:e52-3. [PMID: 20595439 DOI: 10.1542/pir.31-7-e52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Gonzalez A, De Vita S, Rivas Y, Rifakis P, Del Pilar-Pallares M, Rodriguez-Morales A. P231 Pelvic peritoneal tuberculosis presenting as a large abdominal and pelvic tumour: case report and review. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70450-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Devesa M, Loureiro CL, Rivas Y, Monsalve F, Cardona N, Duarte MC, Poblete F, Gutierrez MF, Botto C, Pujol FH. Subgenotype diversity of hepatitis B virus American genotype F in Amerindians from Venezuela and the general population of Colombia. J Med Virol 2008; 80:20-6. [PMID: 18041024 DOI: 10.1002/jmv.21024] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The objective of this study was the evaluation of the genetic diversity found in HBV circulating among Venezuelan Amerindians and the general population in Colombia. Phylogenetic analysis of the S region in 194 isolates showed that genotype F is highly predominant in Colombia and Venezuela. This might be related to the genetic background of the population. F3 is the main subgenotype which circulates in both countries. Phylogenetic analysis of 61 complete genome sequences of HBV American genotypes confirms the presence of two genotypes F and H, and 4 F subgenotypes. In Venezuela, subgenotypes F1, F2, and F3 circulate in East and West Amerindians, while only F3 was found among South Amerindians. Japreira community derived from Yucpa Amerindians around 150 years ago. However, several Japreira HBV sequences were forming a clade that can be classified as subgenotype 2b, differing from Yucpa sequences that belong mainly to subgenotype F3. The apparent absence of correlation between the phylogenetic groupings of HBV isolates with the ethnical origin in aboriginal populations might be suggesting a recent origin of HBV American subgenotypes, or a genetic drift effect.
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Affiliation(s)
- M Devesa
- Laboratorio de Virología Molecular, CMBC, IVIC, Caracas, Venezuela
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13
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Abstract
Gastric diverticulum is a rare entity; the patient usually presents with vague abdominal pain, nausea, vomiting, and weight loss. Diverticulectomy is required for patients with intractable symptoms or complications. We report the laparoscopic excision of a gastric diverticulum in a 15-year-old girl who had been symptomatic for 5 years. A five-port technique and a linear cutting and stapling device were used.
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Affiliation(s)
- Monica E Lopez
- Division of Pediatric Surgery, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, NY 10467, USA
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14
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Flumeri EN, Edde RA, Tortolero F, Marum M, Rivas Y, Pacheco V. [Jejunal interposition by the Merendino technique. Report of a case]. G E N 1990; 44:233-6. [PMID: 2152313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A jejunal interposition, as a Merendinos' Technic, was made in a benign esophageal stenosis secondary to acid-peptic disease in the Hospital Central de Valencia, Venezuela. The esophago-jejunal junction was performed by an E.E.A. instrument No. 28. We emphasized the jejunum functional and anatomic advantages as an esophageal substitution organ. We believe that the jejunum, in short esophagus resections, is a good alternative, even though the stomach is the first substitution organ in these procedures, followed by the colon.
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Affiliation(s)
- E N Flumeri
- Departamento de Cirugía, Hospital Central de Valencia
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15
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Flumeri EN, Caporale A, Giuliani A, Teneriello F, Marum MY, Rivas Y. [Surgical treatment of toxic megacolon in ulcerative rectocolitis. Analysis of 16 patients]. G E N 1989; 43:266-71. [PMID: 2535446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The clinical aspects, surgical treatment and outcome of 16 consecutive patients treated for toxic megacolon secondary to ulcerative colitis at the 1st department of surgery at the university of Rome between 1976 and 1987 were reviewed. The surgical management consisted in total colectomy and immediate ileo-rectal anastomosis, without protective ileostomy in 14 patients and total colectomy with terminal ileostomy and ileorectal anastomosis in 2 patients, 5 months later. No postoperative mortality was observe the immediate complications were: anastomotic leakage, (one case) and rectal bleeding (three cases). The late complications were: ileo-anastomotic stump fistula and perforation (two cases). Protectomy, due to colitis recrudescence, in the rectal remnant 10 months after surgery. These results encourage the total colectomy with immediate ileorectal anastomosis for the treatment of toxic megacolon.
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16
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Flumeri E, Rodríguez M, de Bissotti R, Rivas Y, Miraz MC, Torres L. [Diagnosis and treatment of primary gastrointestinal non-Hodgkin's lymphoma in the Valencia General Hospital. Apropos of 9 cases]. G E N 1986; 40:144-54. [PMID: 3135231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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