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Esophageal stenosis with sloughing esophagitis:A curious manifestation of graft-vs-host disease

World Journal of Gastroenterology 2015年第30期21卷 9217-9222页

作者： daniel trabulo Sara Ferreira Pedro Lage Rafaela Lima Rego Gilda Teixeira A Dias Pereira Gastroenterology Department Hospital de S?o BernardoCentro Hospitalar de Setúbal E.P.E.2910-446 SetúbalPortugal Gastroenterology Department Instituto Português de Oncologia de Lisboa de Francisco Gentil Pathology Department Instituto Português de Oncologia de Lisboa de Francisco Gentil Hemathology Department Instituto Português de Oncologia de Lisboa de Francisco Gentil

We report a case of a 56-year-old woman with a history of allogenic bone marrow transplantation for two years,complaining with dysphagia and weight loss. Upper endoscopy revealed esophageal stenosis and extensive mucosa sloughing. Biopsies confirmed the diagnosis of graft-vs-host disease(GVHD). Balloon dilation,corticosteroids and cyclosporin resulted in marked clinical improvement. Gastrointestinal tract is involved in the majority of patients with chronic GVHD. Esophageal manifestations are rare and include vesiculobullous disease,ulceration,esophageal webs,casts or strictures. Sloughing esophagitis along with severe stenosis requiring endoscopic dilation has never been reported in this context.

关键词： Dysphagia Esophageal stenosis Sloughingesophagitis Balloon dilation Graft-vs -host-disease

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Metabolic syndrome and colorectal neoplasms:An ominous association

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World Journal of Gastroenterology 2015年第17期21卷 5320-5327页

作者： daniel trabulo Suzane Ribeiro Cláudio Martins Cristina Teixeira Cláudia Cardoso Jo?o Mangualde Ricardo Freire élia Gamito Ana L Alves Fátima Augusto Ana P Oliveira Isabelle Cremers Gastroenterology Department Hospital de S?o BernardoCentro Hospitalar de Setúbal2910-446 SetúbalPortugal

AIM:To evaluate the association of metabolic syndrome(MS) and colorectal cancer and adenomas in a Western country,where the incidence of MS is over 27%.METHODS:This was a prospective study between March 2013 and March *** was diagnosed according to the National Cholesterol Education ProgramATP *** characteristics,anthropometric measurements,metabolic risk factors,and colonoscopic pathologic findings were assessed in patients with MS(group 1) who underwent routine colonoscopy at our *** data was compared with consecutive patients without metabolic syndrome(group 2),with no differences regarding sex and *** with incomplete colonoscopy,family history,or past history of colorectal neoplasm were *** consent was obtained and the ethics committee approved this *** analysis was performed using Student's t-test and χ2 test,with a P value ≤ 0.05 being considered statistically ***:Of 258 patients,129 had MS;51% males;mean-age 67.1 years(50-87).Among the MS group,94% had high blood pressure,91% had increased waist circumference,60% had diabetes,55% had low high-density lipoprotein cholesterol level,50% had increased triglyceride level,and 54% were obese [body mass index(BMI) 30 kg/m2].51% presented 4 criteria of *** was associated with increased prevalence of adenomas(43% vs 25%,P = 0.004) and colorectal cancer(13% vs 5%,P = 0.027),compared with patients without *** was also positively associated with multiple(≥ 3) adenomas(35% vs 9%,P = 0.024) and sessile adenomas(69% vs 53%,P = 0.05).No difference existed between location(P = 0.086),grade of dysplasia(P = 0.196),or size(P= 0.841) of *** addition,no difference was found between BMI(P = 0.078),smoking(P = 0.146),alcohol consumption(P = 0.231),and the presence of ***:MS is positively associated with adenomas and colorectal ***,there is not enough information in western European countries to justify screening in

关键词： Metabolic syndrome Colorectal cancer Colorectal adenomas Obesity Western countries

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Systemic mastocytosis: A rare cause of non-cirrhotic portal hypertension

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World Journal of Gastroenterology 2016年第28期22卷 6559-6564页

作者： Cláudio Martins Cristina Teixeira Suzane Ribeiro daniel trabulo Cláudia Cardoso Joao Mangualde Ricardo Freire élia Gamito Ana Luísa Alves Isabelle Cremers Cecília Alves Anabela Neves Ana Paula Oliveira Department of Gastroenterology Setubal Hospital Center - Sao Bernardo Hospital 2910 Setubal Portugal Department of Pathology Setubal Hospital Center - Sao Bernardo Hospital 2910 Setubal Portugal Department of Hematology Setubal Hospital Center - Sao Bernardo Hospital 2910 Setubal Portugal

Mastocytosis is a clonal neoplastic disorder of the mast cells(MC) that can be limited to the skin(cutaneous mastocytosis) or involve one or more extracutaneous organs(systemic mastocytosis). The clinical manifestations of mastocytosis are heterogeneous ranging from indolent disease with a long-term survival to a highly aggressive neoplasm with survival of about 6 mo. Although liver involvement in aggressive systemic mastocytosis(ASM) is relatively common, the development of portal hypertension with or without cirrhosis is rare. We report a case of ASM without skin involvement in a 72-year-old caucasian male who presented with non-cirrhotic portal hypertension based on clinical, analytical, imagiological and endoscopic findings. Given the hematological picture, the correct diagnosis was established based on ancillary tests for MC using bone marrow aspirates and biopsy. Extensive involvement of the liver and gastrointestinal tract was histologically documented. The disease progressed rapidly and severe pancytopenia and recurrent upper gastrointestinal bleeding became the dominant problem. This case illustrates the challenge in establishing a diagnosis of ASM especially when the clinical picture is atypical and without skin involvement. Gastroenterologists should consider infiltrative disease, particularly systemic mastocytosis, as a differential diagnosis in a clinical case of portal hypertension of unknown etiology.

关键词： Systemic mastocytosis Mast cells Non-cirrhotic portal hypertension Upper gastrointestinal bleeding Cladribine

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