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Ulcerated intussuscepted jejunal lipoma-uncommon cause of obscure gastrointestinal bleeding: A case report

World Journal of Clinical Cases 2019年第22期7卷 3765-3771页

作者： Tudor Cuciureanu Laura Huiban stefan chiriac Ana-Maria Singeap Mihai Danciu Florin Mihai Carol Stanciu Anca Trifan Nutu Vlad Department of Gastroenterology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of Pathology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of Radiology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of General Surgery “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania

BACKGROUND Intestinal lipomas are rare benign gastrointestinal(GI)tumors,usually asymptomatic,but may become symptomatic as the result of some complications such as intussusception,intestinal obstruction,volvulus or *** can occur at any site along the entire GI tract,more frequent in colon and rarely in small *** patient reported here is a very rare case of jejunal lipoma,ulcerated and intussuscepted,diagnosed in an adult investigated for a chronic iron deficiency anemia(IDA),and successfully managed by segmental jejunal *** SUMMARY A 63-year-old male was referred to“***”Hospital,Institute of Gastroenterology and Hepatology,Iasi,to investigate an obscure GI bleeding with an *** upper GI endoscopy and colonoscopy were performed,excluding potentially bleeding lesions,videocapsule endoscopy was then carried out,revealing fresh blood and a protruding lesion in proximal jejunum,findings confirmed by a single-balloon *** biopsies were taken from the lesion,but histological results were ***,contrast-enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density,suggestive for lipoma.A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected enbloc,and sent for further histopathologic *** patient made an uneventful recovery and was discharged seven days later,and at six months follow-up he had no complains and his hemoglobin returned to normal *** Lipomas are very rarely located in the jejunum,usually asymptomatic,but they may lead to complications such as intussusception and *** resection remains the treatment of choice.

关键词： Lipoma Intussusception Computed tomography Video capsule endoscopy Gastrointestinal bleeding Case report

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Role of ammonia in predicting the outcome of patients with acuteon- chronic liver failure

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World Journal of Clinical Cases 2021年第3期9卷 552-564页

作者： stefan chiriac Carol Stanciu Camelia Cojocariu Ana-Maria Singeap Catalin Sfarti Tudor Cuciureanu Irina Girleanu Razvan Alexandru Igna Anca Trifan Department of Gastroenterology “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology "St.Spiridon"Emergency HospitalIasi 700111Romania Intensive Care “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania

BACKGROUND High venous ammonia(VA)values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis(LC)as well as acute ***,VA has been associated with poor prognosis and high mortality in these clinical ***,the role of ammonia in acuteon-chronic liver failure(ACLF)has not yet been clearly *** To assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care *** We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites,hepatic encephalopathy(HE),upper gastrointestinal bleeding,or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver(APASL)criteria for *** study was conducted in“***”University Hospital,Iasi,Romania,a tertiary care center,between January 2017 and January *** APASL ACLF Research Consortium(AARC)score was calculated and ACLF grade was established ***-haven classification was used for *** analysis was performed using IBM SPSS version *** Four hundred and forty-six patients were included,aged 59(50-65)years,57.4%***-Pugh,model for end-stage liver disease(MELD)and AARC scores were 11(10-12),19.13±6.79,and 7(6-8),respectively.66.4%had ACLF grade I,31.2%ACLF grade II,and 2.5%ACLF grade *** was diagnosed in 83.9%,34%grade I,37.2%grade II,23.5%grade III,and 5.3%grade *** mortality was 7.8%.VA was 103(78-148)μmol/*** operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score[Area under the curve(AUC)=0.886],MELD score(AUC=0.816),VA(AUC=0.812)and a fair accuracy for the Child-Pugh score(AUC=0.799).Subsequently,a cut-off value for the prediction of mortality was identified for VA(152.5μmol/L,sensitivity=0.706,1-specificity=0.190).Univariate analysis found acute kidney in

关键词： Venous ammonia Hepatic encephalopathy Acute-on-chronic liver failure Asian Pacific Association for the Study of the Liver Acute-on-chronic Liver Failure Research Consortium score Cirrhosis Mortality

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Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

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World Journal of Gastroenterology 2017年第35期23卷 6500-6515页

作者： Anca Trifan Carol Stanciu Irina Girleanu Oana Cristina Stoica Ana Maria Singeap Roxana Maxim stefan Andrei chiriac Alin Ciobica Lucian Boiculese Institute of Gastroenterology and Hepatology “St.Spiridon”Hospital“Grigore T.Popa”University of Medicine and Pharmacy Institute of Gastroenterology and Hepatology “St.Spiridon”Hospital Department of Research Faculty of Biology“Alexandru Ioan Cuza”University of Iasi Department of Preventive Medicine and Interdisciplinarity “Grigore.T.Popa”University of Medicine and Pharmacy

AIM To perform a systematic review and meta-analysis on proton pump inhibitors(PPIs) therapy and the risk of Clostridium difficile infection(CDI). METHODS We conducted a systematic search of MEDLINE/Pub Med and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios(ORs) estimates with 95% confidence intervals(CIs) were calculated using the random effect. Heterogeneity was assessed by I^2 test and Cochran's Q *** publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale(NOS). RESULTS Fifty-six studies(40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI(pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control(OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort(OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted(OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted(OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter(OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter(OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years(OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years(OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses(test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant hetero

关键词： Proton pump inhibitors Clostridium difficile infection Risk Systematic review Meta-analysis

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Update on adrenal insufficiency in patients with liver cirrhosis

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World Journal of Gastroenterology 2013年第4期19卷 445-456页

作者： Anca Trifan stefan chiriac Carol Stanciu "Gr.T.Popa" University of Medicine and Pharmacy Institute of Gastroenterology and Hepatology"St.Spiridon" University Hospital

Liver cirrhosis is a major cause of mortality worldwide,often with severe sepsis as the terminal *** the last two decades,several studies have reported that in septic patients the adrenal glands respond inappropriately to stimulation,and that the treatment with corticosteroids decreases mortality in such *** cirrhosis and septic shock share many hemodynamic abnormalities such as hyperdynamic circulatory failure,decreased peripheral vascular resistance,increased cardiac output,hypo-responsiveness to vasopressors,increased levels of proinflammatory cytokines [interleukine(IL)-1,IL-6,tumor necrosis factor-alpha] and it has,consequently,been reported that adrenal insufficiency(AI) is common in critically ill cirrhotic *** may also be present in patients with stable cirrhosis without sepsis and in those undergoing liver *** term hepato-adrenal syndrome defines AI in patients with advanced liver disease with sepsis and/or other complications,and it suggests that it could be a feature of liver disease per se,with a dif-ferent pathogenesis from that of septic *** AI is the term given to inadequate cortisol response to *** recently,another term is used,namely "critical illness related corticosteroid insufficiency" to define "an inadequate cellular corticosteroid activity for the severity of the patient's illness".The mechanisms of AI in liver cirrhosis are not completely understood,although decreased levels of high-density lipoprotein cholesterol and high levels of proinflammatory cytokines and circulatory endotoxin have been *** prevalence of AI in cirrhotic patients varies widely according to the stage of the liver disease(compensated or decompensated,with or without sepsis),the diagnostic criteria defining AI and the methodology *** effects of corticosteroid therapy on cirrhotic patients with septic shock and AI are *** review aims to summarize the existing published information rega

关键词： Liver cirrhosis Adrenal insufficiency Septic shock Corticosteroid therapy

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Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

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World Journal of Clinical Cases 2021年第33期9卷 10180-10188页

作者： Camelia Cojocariu Irina Girleanu Anca Trifan Andrei Olteanu Cristina Maria Muzica Laura Huiban stefan chiriac Ana Maria Singeap Tudor Cuciureanu Catalin Sfarti Carol Stanciu Department of Gastroenterology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”University HospitalInstitute of Gastroenterology and HepatologyIasi 700115Romania

BACKGROUND Clostridium difficile infection(CDI)has increased in prevalence during the last *** coronavirus disease 2019(COVID-19)pandemic has negatively influenced patient *** majority of the severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2)-infected patients received antibiotics during *** To analyze the factors that influenced CDI development after SARS-CoV-2 *** Between March 2020 to December 2020,we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university *** diagnosis of CDI was based on the presence of diarrhea(≥3 watery stools within 24 h)associated with Clostridium difficile toxins A or *** excluded patients with other etiology of acute *** Among the total 447(12.5%)patients with CDI,most were male(54.3%)and mean age was 59.7±10.8 ***-six(17.0%)had history of COVID-19,most being elderly(COVID-19:62.6±14.6 years vs non-COVID-19:56.8±17.6 years,P=0.007),with history of alcohol consumption(43.4%vs 29.4%,P=0.017),previous hospitalizations(81.6%vs 54.9%,P<0.001)and antibiotic treatments(60.5%vs 35.5%,P<0.001),requiring higher doses of vancomycin and prone to recurrent disease(25.0%vs 13.1%,P=0.011).Age over 60 years[odds ratio(OR):2.591,95%confidence interval(CI):1.452-4.624,P=0.001],urban residence(OR:2.330,95%CI:1.286-4.221,P=0.005),previous antibiotic treatments(OR:1.909,95%CI:1.083-3.365,P=0.025),previous hospitalizations(OR:2.509,95%CI:1.263-4.986,P=0.009)and alcohol consumption(OR:2.550,95%CI:1.459-4.459,P=0.001)were risk factors of CDI in *** CDI risk is unrelated to history of SARS-CoV-2 ***,previous COVID-19 may necessitate higher doses of vancomycin for CDI.

关键词： COVID-19 infection Clostridium difficile infection Risk factors Antibiotic use Pandemic Recurrence

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Split-dose or hybrid nonsteroidal anti-inflammatory drugs and Nacetylcysteine therapy for prevention of post-retrograde cholangiopancreatography pancreatitis

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World Journal of Clinical Cases 2019年第3期7卷 300-310页

作者： Laura Pavel Gheorghe Gh Balan Alexandra Nicorescu Georgiana Emmanuela Gilca-Blanariu Catalin Sfarti stefan chiriac Smaranda Diaconescu Vasile Liviu Drug Gheorghe Balan Gabriela stefanescu Gastroenterology "Grigore T.Popa" University of Medicine and Pharmacy Endocrinology "Grigore T. Popa" University of Medicine and Pharmacy Department of Mother and Child Medicine "Grigore T. Popa" University of Medicine and Pharmacy

BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been *** To evaluate efficacy of three pharmacologic prophylactic methods for prevention of *** In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP *** Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)*** The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.

关键词： Endoscopic retrograde cholangiopancreatography Prophylaxis Postendoscopic retrograde cholangiopancreatography pancreatitis Nonsteroidal antiinflammatory drugs N-acetylcysteine

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