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Boettler T, Newsome PN, Mondelli MU, Maticic M, Cordero E, Cornberg M, Berg T. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep 2020; 2:100113. [PMID: 32289115 PMCID: PMC7128473 DOI: 10.1016/j.jhepr.2020.100113] [Citation(s) in RCA: 330] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses an enormous challenge to healthcare systems in affected communities. Older patients and those with pre-existing medical conditions have been identified as populations at risk of a severe disease course. It remains unclear at this point to what extent chronic liver diseases should be considered as risk factors, due to a shortage of appropriate studies. However, patients with advanced liver disease and those after liver transplantation represent vulnerable patient cohorts with an increased risk of infection and/or a severe course of COVID-19. In addition, the current pandemic requires unusual allocation of healthcare resources which may negatively impact the care of patients with chronic liver disease that continue to require medical attention. Thus, the challenge hepatologists are facing is to promote telemedicine in the outpatient setting, prioritise outpatient contacts, avoid nosocomial dissemination of the virus to patients and healthcare providers, and at the same time maintain standard care for patients who require immediate medical attention.
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Key Words
- ACE-I, angiotensin-converting enzyme inhibitor
- ACE2, angiotensin-converting enzyme 2
- ACLF, acute-on-chronic liver failure
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- COVID-19, coronavirus disease 2019
- EGD, esophagogastroduodenoscopy
- ERC, endoscopic retrograde cholangiography
- HCC, hepatocellular carcinoma
- MELD, model for end-stage liver disease
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NUC, nucleoside analogue
- PIs, protease inhibitors
- RdRp, RNA-dependent RNA polymerase
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- ULN, upper limit of normal
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Helmers RA, Dilling JA, Chaffee CR, Larson MV, Narr BJ, Haas DA, Kaplan RS. Overall Cost Comparison of Gastrointestinal Endoscopic Procedures With Endoscopist- or Anesthesia-Supported Sedation by Activity-Based Costing Techniques. Mayo Clin Proc Innov Qual Outcomes 2017; 1:234-241. [PMID: 30225422 PMCID: PMC6132202 DOI: 10.1016/j.mayocpiqo.2017.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE Endoscopic/colonoscopic procedures are either done with gastroenterologist-administered conscious sedation or with anesthesia-administered sedation with propofol. There are potential benefits to anesthesia-administered sedation, but the concern has been the associated increased cost. METHODS To perform this study, we used the time-derived activity-based costing (TDABC) technique to accurately assess the true cost of gastrointestinal procedures done with gastroenterologist-administered conscious sedation vs anesthesia-administered sedation in 2 areas of our practice that use predominantly conscious sedation or anesthesia-administered sedation. This type of study has never been reported using such an integrated approach. This study was performed on 2 different days in June 2015. RESULTS The true cost associated with anesthesia-administered sedation in our practice was associated with only 9% to 24% greater cost when the TDABC technique was applied. CONCLUSION Gastrointestinal procedures with anesthesia-administered sedation are not as costly when all factors are considered. Using novel approaches to cost measurement, such as the TDABC, allows a total cost measurement approach across an episode of care that existing cost measurements in health care are incapable of.
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Abstract
The outcome of liver transplantation (LT) is dependent on many factors including graft quality, surgical techniques, postoperative care, immunosuppressive regimens and most importantly, careful pre-transplant recipient evaluation and selection. Currently, the expected 1-year and 5-year survival rates after LT are 85-95% and 75-85%, respectively. The improvement in outcomes and better awareness has resulted in an increasing demand for LT around the world including India. Transplant physicians have responded to this increased demand by developing several strategies including the use of older donors, grafts from hepatitis C positive donors or those with previous hepatitis B infection (positive hepatitis B virus [HBV] core immunoglobulin G [IgG] antibody), graft from nonheart beating donors, domino transplantation (liver from patients with familial amyloid polyneuropathy transplanted into older recipients), split-liver grafts, and live donor liver transplant (LDLT). Currently, the only treatment that prolongs survival in those with end-stage acute or chronic liver failure is transplantation of either partial or full liver donor graft. Because of the enormous disparity in supply and demand for donor organs, costs, and potential morbidity and mortality of live donors in LDLT, it has become incumbent on the transplant community to ration the available organs in a way that provides the best outcomes and in the process, serves the best interest of the population as a whole. When evaluating a potential candidate for LT, it is imperative to determine whether the recipient is going to benefit from the procedure immediately and in the long-term. In this review, we will discuss the process of selection and optimal evaluation of potential LT recipients.
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Key Words
- AFP, alfa-feto protein
- ANA, anti-nuclear antibody
- CMV, cytomegalovirus
- CT, computed tomography
- CTP, Child-Turcotte-Pugh
- CXR, chest X-ray
- DEXA, dual-emission X-ray absorptiometry
- EBV, Epstein-Barr virus
- EGD, esophagogastroduodenoscopy
- ERCP, endoscopic retrograde cholangiopancreatography
- FAP, familial amyloid polyneuropathy
- HAV, hepatitis A virus
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- HSV, herpes simplex virus
- HTN, hypertension
- Hepatocellular carcinoma
- INR, international normalized ratio
- LDLT, live donor liver transplant
- LT, liver transplantation
- MELD, model for end-stage liver disease
- MRI, magnetic resonance imaging
- PSA, prostate-specific antigen
- PSC, primary sclerosing cholangitis
- RPR, rapid plasma reagin
- live donor liver transplant
- liver transplantation
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Acute stroke from air embolism to the middle cerebral artery following upper gastrointestinal endoscopy. Radiol Case Rep 2015; 5:359. [PMID: 27307849 PMCID: PMC4898213 DOI: 10.2484/rcr.v5i1.359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute stroke from cerebral-artery air embolism is a very rare occurrence during esophagogastroduodenoscopy (EGD). Computed tomography is a quick and reliable method of detecting cerebral air embolism if performed within an appropriate timeframe. We found 20 reported cases of air embolism with EGD in the literature; only seven of those resulted in cerebral air embolus. We report an eighth such case in which the patient suffered cerebral air embolus with neurological signs of a stroke while undergoing upper gastrointestinal endoscopy.
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Ashktorab H, Russo T, Oskrochi G, Latella G, Massironi S, Luca M, Chirumamilla LG, Laiyemo AO, Brim H. Clinical and Endoscopic Outcomes in Coronavirus Disease-2019 Patients With Gastrointestinal Bleeding. GASTRO HEP ADVANCES 2022; 1:487-499. [PMID: 35287301 PMCID: PMC8907011 DOI: 10.1016/j.gastha.2022.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Over 404 million people worldwide have been infected with coronavirus disease-2019 (COVID-19), 145 million in the United States (77 million) and Europe (151 million) alone (as of February 10, 2022). This paper aims to analyze data from studies reporting gastrointestinal bleeding (GIB) and/or endoscopic findings in COVID-19 patients in Western countries. METHODS We conducted a systematic review of articles on confirmed COVID-19 cases with GIB in Western countries published in PubMed and Google Scholar databases from June 20, 2020, to July 10, 2021. RESULTS A total of 12 studies reporting GIB and/or endoscopic findings in 808 COVID-19 patients in Western countries were collected and analyzed. Outcomes and comorbidities were compared with 18,179 non-GIB COVID-19 patients from Italy and the United States. As per our study findings, the overall incidence of GIB in COVID-19 patients was found to be 0.06%. When compared to the non-GIB cohort, the death rate was significantly high in COVID-19 patients with GIB (16.4% vs 25.4%, P < .001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. The most common presentation in GIB patients is melena (n = 117, 47.5%). Peptic, esophageal, and rectal ulcers were the most common endoscopic findings in upper (48.4%) and lower (36.4%) endoscopies. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) than the non-GIB cohort. Death was strongly associated with hypertension (P < .001, r = 0.814), hematochezia (P < .001, r = 0.646), and esophagogastroduodenoscopy (P < .001, r = 0.591) in COVID-19 patients with GIB. CONCLUSIONS Overall, the incidence of GIB in COVID-19 patients is similar to that estimated in the overall population, with melena being the most common presentation. The common endoscopic findings in GIB COVID-19 patients were ulcers, esophagitis, gastritis, and colitis. Patients with GIB were more prone to death than non-GIB COVID-19 patients.
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Sethi S, Simonetto DA, Abdelmoneim SS, Campion MB, Kaloiani I, Clayton AC, Kremers WK, Halling KC, Kamath PS, Talwalkar J, Shah VH. Comparison of circulating endothelial cell/platelet count ratio to aspartate transaminase/platelet ratio index for identifying patients with cirrhosis. J Clin Exp Hepatol 2012; 2:19-26. [PMID: 25755402 PMCID: PMC3940317 DOI: 10.1016/s0973-6883(12)60078-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/16/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Circulating endothelial cells (CECs) are indicative of vascular injury and correlate with severity of vascular diseases. A pilot study showed that the ratio of CEC to platelet count (CEC/PC) was effective in predicting cirrhosis. Therefore, we evaluated CEC/PC in a larger cohort of patients, correlated it with cirrhosis, and compared its operating characteristics with previously described biomarker for cirrhosis, the AST/platelet ratio index (APRI). METHODS Fifty-three patients with cirrhosis, 20 matched healthy controls, and 9 patients with noncirrhotic liver disease were recruited. Peripheral blood sample was collected and analyzed to enumerate nucleated CEC CD146+, CD105+, CD45- using a commercial assay. RESULTS Median CEC counts were significantly higher in patients with cirrhosis (62 cells/4 mL, interquartile range [IQR]: 43.5-121) as compared with controls (31 cells/4 mL, IQR: 22.2-40). The CEC/PC was also significantly elevated in cirrhotics (0.69, IQR: 0.39-1.48) compared with controls (0.12, IQR: 0.09-0.20) and noncirrhotics (0.21, IQR: 0.08-0.43). Receiver operator characteristic (ROC) analysis revealed that CEC cutoff value of ≥37 cells/4 mL showed sensitivity of 81% and specificity of 75% for differentiating cirrhosis from controls (area under the curve [AUC]: 0.80; 95% confidence interval [CI] 0.67-0.91). The CEC/PC ratio cutoff value of ≥0.23 showed sensitivity of 91% and specificity of 82% (AUC: 0.92; 95% CI 0.83-0.99). The APRI cutoff value of ≥0.4 showed sensitivity of 94% and specificity of 85% for differentiating cirrhosis from control patients (AUC: 0.96; 95% CI 0.90-1.0). A product of CEC and APRI, termed CAPRI (CEC-APRI), effectively distinguished patients with cirrhosis from controls; with cutoff value of ≥12.7, showing higher sensitivity of 98% and specificity of 85% (AUC: 0.98; 95% CI 0.96-1.0). CONCLUSION The CEC/PC ratio is significantly elevated in patients with cirrhosis and demonstrates comparable operating characteristics to previously described APRI. Furthermore, CAPRI, compiled as product of CEC to APRI showed outstanding ability to distinguish patients with cirrhosis from controls, although larger studies are necessary for validation.
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Key Words
- APRI
- APRI, AST/platelet ratio index
- AST, aspartate aminotransferase
- AUC, area under the curve
- CAPRI
- CAPRI, CEC with APRI
- CEC, circulating endothelial cell
- CTP, Child–Turcotte–Pugh
- EGD, esophagogastroduodenoscopy
- ELF, enhanced liver fibrosis
- IQR, interquartile range
- MELD, model for end-stage liver disease
- PC, platelet count
- ROC, receiver operator characteristic
- circulating endothelial cells
- cirrhosis
- non-invasive markers
- portal hypertension
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Bawany F, Franco AI, Beck LA. Dupilumab: One therapy to treat multiple atopic diseases. JAAD Case Rep 2020; 6:1150-1152. [PMID: 33134458 PMCID: PMC7591322 DOI: 10.1016/j.jdcr.2020.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tagliaferri A, Melki G, Mohamed A, Cavanagh Y, Grossman M, Baddoura W. Gastric pneumatosis in immunocompromised patients: A report of 2 cases and comprehensive literature review. Radiol Case Rep 2023; 18:1152-1155. [PMID: 36660578 PMCID: PMC9842963 DOI: 10.1016/j.radcr.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Gastric pneumatosis (GP) is a rare finding. It can be seen with both gastric emphysema (GE) and emphysematous gastritis (EG); however, both conditions present similarly and differentiating between the 2 is difficult radiographically. Moreover, the treatment is vastly different for both conditions, in which treatment for GE is focused on supportive care while treatment for EG may even involve gastrectomy. Making the distinction between GE and EG is crucial because GE has a benign clinical course, while EG carries significant mortality. Early endoscopy may be a useful tool in differentiating between the 2 conditions and to guide further management. Herein, we present a case series of 2 immunocompromised patients who presented with symptoms and radiographic evidence consistent with gastric pneumatosis. We found that early endoscopy assisted in risk stratification and helped guide our management strategy. We recommend consideration of endoscopic evaluation as part of ritualized evaluation of patients presenting with gastric pneumatosis.
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Ulcerated Gastrointestinal Stromal Tumor (GIST) with Ingested Bone Foreign Body Mimicking a Perforation with Abscess. Radiol Case Rep 2006; 1:83-6. [PMID: 27298690 PMCID: PMC4891552 DOI: 10.2484/rcr.v1i3.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) have a variety of appearances and can present as an intraluminal, extraluminal, solid or ulcerated mass. We present an unusual case of a patient presenting with pain, elevated white count, and computed topography (CT) findings suggesting an abscess containing bone. CT guided drainage was performed, and resulted in bowel perforation, leading to surgical intervention and the diagnosis of an ulcerated gastrointestinal stromal tumor containing bone.
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Calderwood AH, Calderwood MS, Williams JL, Dominitz JA. Impact of the COVID-19 Pandemic on Utilization of EGD and Colonoscopy in the United States: An Analysis of the GIQuIC Registry. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2021; 23:313-321. [PMID: 34345871 PMCID: PMC8323550 DOI: 10.1016/j.tige.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The coronavirus disease 2019 (COVID-19) pandemic has limited the ability to perform endoscopy. The aim of this study was to quantify the impact of the pandemic on endoscopy volumes and indications in the United States. METHODS We performed a retrospective analysis of data from the GI Quality Improvement Consortium (GIQuIC) registry. We compared volumes of colonoscopy and esophagogastroduodenoscopy (EGD) during the pandemic (March-September 2020) to before the pandemic (January 2019-February 2020). The primary outcome was change in monthly volumes. Secondary outcomes included changes in the distribution of procedure indications and in procedure volume by region of United States, patient characteristics, trainee involvement, and practice setting, as well as colorectal cancer diagnoses. RESULTS Among 451 sites with 3514 endoscopists, the average monthly volume of colonoscopies and EGDs dropped by 38.5% and 33.4%, respectively. There was regional variation, with the greatest and least decline in procedures in the Northeast and South, respectively. There was a modest shift in procedure indications from prevention to diagnostic, an initial increase in performance in the hospital setting, and a decrease in procedures with trainees. The decline in volume of colonoscopy and EGD during the first 7 months of the pandemic was equivalent to approximately 2.7 and 2.4 months of prepandemic productivity, respectively. Thirty percent fewer colorectal cancers were diagnosed compared to expected. CONCLUSION These data on actual endoscopy utilization nationally during the pandemic can help in anticipating impact of delays in care on outcomes and planning for the recovery phase.
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Key Words
- ASA, American Society of Anesthesiologists
- ASC, ambulatory surgical center
- COVID-19
- COVID-19, coronavirus disease 2019
- Colonoscopy
- EGD, esophagogastroduodenoscopy
- ERCP, endoscopic retrograde cholangiopancreatography
- EUS, endoscopic ultrasound
- FIT, fecal immunochemical test
- GERD, gastroesophageal reflux disease
- GI, GI Quality Improvement Consortium
- GI, gastroenterology
- NPI, national provider identification
- US, United States
- Upper gastrointestinal endoscopy
- Volume
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Sharma S, Agarwal S, Gunjan D, Kaushal K, Anand A, Gopi S, Mohta S, Saraya A. Outcomes of Portal Pressure-Guided Therapy in Decompensated Cirrhosis With Index Variceal Bleed in Asian Cohort. J Clin Exp Hepatol 2021; 11:443-452. [PMID: 34276151 PMCID: PMC8267357 DOI: 10.1016/j.jceh.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Hemodynamic response to pharmacotherapy improves survival in patients with cirrhosis post variceal bleeding, but long-term outcomes remain unexplored especially in this part of the world. We aimed to study the long-term impact of portal pressure reduction on liver-related outcomes after index variceal bleed. METHODS Patients with hepatic venous pressure gradient (HVPG) more than 12 mm Hg after index variceal bleed were given non-selective beta-blockers in combination with variceal band ligation. HVPG response was assessed after 4 weeks. Patients were followed up for rebleed events, survival, additional decompensation events and safety outcomes. Rebleed and other decompensations were compared using competing risks analysis, taking death as competing event, and survival was compared using Kaplan-Meier analysis. RESULTS Forty-eight patients (29 responders and 19 non-responders) were followed up for a median duration of 45 (24-56) months. Rebleeding rates at 1, 3 and 5 years were 10.3%, 20.7% and 20.7% in responders and 15.8%, 44.7% and 51.1% in non-responders, respectively (Gray's test, P = 0.044). Survival rates at 1, 3 and 5 years were 89.7%, 72.1% and 51.9% in responders and 89.5%, 44% and 37.7% in non-responders, respectively (log-rank test, P = 0.1). Both severity of liver disease (MELD score, multivariate sub-distributional hazards ratio: 1.166 [1.014-1.341], P = 0.030) and HVPG non-response (multivariate sub-distributional hazards ratio: 2.476 [1.87-7.030], P = 0.045) predicted rebleeding risk while survival was dependent only on severity of liver disease (MELD > 12, multivariate hazards ratio: 2.36 [1.04-5.38], P = 0.041). CONCLUSION Baseline severity of liver disease predicted survival and rebleed in these patients. Hemodynamic response, although associated with lower rebleeding rate, had limited impact on survival.
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Key Words
- ACLF, acute on chronic liver failure
- AFP, alpha-fetoprotein
- AVB, acute variceal bleed
- CT, computed tomography
- CTP, Child–Turcotte–Pugh
- EASL-CLIF, European Association of Study of Liver Disease – Chronic Liver Failure Consortium
- EBL, endoscopic band ligation
- EGD, esophagogastroduodenoscopy
- HE, hepatic encephalopathy
- HRS, hepatorenal syndrome
- HVPG, hepatic venous pressure gradient
- MELD, model for end-stage liver disease
- NSBB, non-selective beta-blockers
- SBP, spontaneous bacterial peritonitis
- acute variceal bleed
- hemodynamic response and carvedilol
- hepatic venous pressure gradient
- non-selective beta-blockers
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The role of nuclear imaging in multiple endocrine neoplasia 1 (MEN 1). Radiol Case Rep 2010; 5:452. [PMID: 27307880 PMCID: PMC4901017 DOI: 10.2484/rcr.v5i4.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Multiple endocrine neoplasia 1 (MEN 1) is a rare genetic disorder classically characterized by a predisposition to tumors of the parathyroid glands, anterior pituitary gland, and pancreatic islet cells (1). In addition to exhibiting these characteristic tumors, MEN 1 patients also have an increased propensity for other tumors such as carcinoids, adrenal adenomas, angiofibromas, and lipomas (1, 2, 3). Although MEN 1 is rare, with a prevalence of approximately 2 per 100,000 people, recognition of this syndrome is extremely important for both patient treatment and evaluation of family members (1, 4). The tumors of MEN 1 are usually benign; however, malignancy of some carcinoid, islet cell, and gastrointestinal tract tumors can cause mortality (5, 6, 7, 8). Diagnosis of MEN 1 is usually made by a combination of history and physical examination, biochemical serum testing, and various imaging modalities (9, 10). We present a classic case of MEN 1 with unique presentation and diagnosis using predominantly nuclear imaging in order to emphasize the role of nuclear imaging in diagnosing and treating MEN 1.
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Arora A, Sharma P. Battle in Search for Simple Reliable Non-invasive Marker of Liver Fibrosis. J Clin Exp Hepatol 2012; 2:7-9. [PMID: 25755400 PMCID: PMC3940104 DOI: 10.1016/s0973-6883(12)60077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 03/14/2012] [Indexed: 12/12/2022] Open
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Saeed MI, Stephens R, Nwogbo O, Gani IY, Kapoor R, Doroodchi A. Cytomegalovirus pancreatitis in an immunocompetent patient. IDCases 2020; 22:e00932. [PMID: 33299793 PMCID: PMC7708617 DOI: 10.1016/j.idcr.2020.e00932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022] Open
Abstract
Cytomegalovirus (CMV) is a double-stranded DNA virus, which infects a large portion of the adult population. In immunocompetent patients, it typically is asymptomatic or manifests as mild and self-limiting flu-like illness symptoms, whereas in immunocompromised patients, CMV can cause significant disease. Herein we report an unusual case of CMV pancreatitis in an immunocompetent 75-year-old female. Patient developed severe significant pancreatic necrosis that failed non-operative management, and ultimately underwent pancreatic necrosectomy. Later on, she developed three spontaneous gastric perforations. The first two perforations were managed operatively, but after the third perforation family decided not to undergo another operation. The CMV pancreatitis diagnosis was based on pancreatic histopathology and confirms by a prompt response to ganciclovir. Patient was promptly started on intravenous (IV) ganciclovir which resulted in clinical recovery and she remained asymptomatic more than one-year post op. This is a rare case of CMV pancreatitis with gastric perforations in an immunocompetent patient. High degree of suspicion and appropriate treatment are important for such clinical scenarios.
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Key Words
- ALT, alanine transferase
- AST, aspartate transferase
- BMI, body mass Index
- CKD, chronic kidney disease
- CMV, cytomegalovirus
- CT, computed tomography
- Cytomegalovirus
- DIC, disseminated intravascular coagulation
- EBV, Epstein Barr virus
- EGD, esophagogastroduodenoscopy
- GI, gastrointestinal
- Ganciclovir
- Gastric perforation
- ICU, intensive care unit
- OR, operating room
- PCR, polymerase chain reaction
- POD, post-operative day
- Pancreatic necrosis
- Pancreatitis
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