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Conservative management of razor blade ingestion

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gastroenterology Report 2014年第2期2卷 158-159页

作者： Mazen Albeldawi Sigurbjorn Birgisson gastroenterology and Hepatology Cleveland ClinicClevelandOH 44195USA

A 30-year-old woman presented to the emergency department complaining of abdominal *** abdominal radiograph was done,revealing ten rectangular razor blades measuring 52 *** patient was taken to the operating room and a flexible esophago-gastroduodenoscopy was *** at retrieval,using both a gastric overtube and an inverted hood,were unsuccessful due to the shape and size of the *** was transferred to a regular medical floor and managed conservatively with serial abdominal *** the next week,she passed the razor blades transanally without further event—all were still wrapped in paper and chewing gum—and was cleared to be discharged home.

关键词： Foreign body ingestion endoscopy razor blades

Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

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World Journal of clinical Cases 2018年第16期6卷 1087-1093页

作者： Shiro Hayashi Mamoru Takenaka Makoto Hosono Tsutomu Nishida Department of gastroenterology and Internal Medicine Hayashi Clinic Department of gastroenterology Toyonaka Municipal Hospital Department of gastroenterology and Hepatology Kindai University Faculty of Medicine Department of Radiology Kindai University Faculty of Medicine

Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.

关键词： Quality indicator Fluoroscopic procedures Endoscopic retrograde cholangiopancreatography Diagnostic reference levels Radiation exposure

Drivers and breaks in the cholangiocarcinoma immune microenvironment

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Hepatobiliary Surgery and Nutrition 2022年第2期11卷 320-323页

作者： Caitlin B.Conboy Sumera I.Ilyas Gregory J.Gores Division of Medical Oncology Mayo ClinicRochesterMinnesotaUSA Division of gastroenterology and Hepatology Mayo ClinicRochesterMNUSA

clinically effective immune checkpoint inhibitors(ICI)have transformed cancer treatment over the last *** progress was built on a foundation of understanding tumor immunology,immune checkpoint biology,and biomarkers for sensitivity to ICI(1).Monoclonal antibodies disrupting the PD-L1/PD-1 axis or CTLA-4 are highly effective in tumors that are primed for an anti-tumor immune response but suppressed by immune checkpoints(1).This is the case for cancer types with abundant neoantigens,such as melanoma and lung cancer,and in tumors regardless of histology that have elevated tumor mutation burden(TMB)or microsatellite instability(MSI)due to mismatch repair deficiency(dMMR).Elevated expression of PD-L1 is a biomarker of immunosuppression and predicts sensitivity to PD-(L)1 blockade in several tumor types,including lung and gastroesophageal *** cholangiocarcinoma(CCA),the immune landscape and factors predicting response to immunotherapy are less well understood(2).

关键词： lung elevated landscape

Primary sclerosing cholangitis and the risk of colon neoplasia in patients with Crohn’s colitis

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gastroenterology Report 2016年第3期4卷 226-231,I0002页

作者： Udayakumar Navaneethan Tarun Rai Preethi GK Venkatesh Ravi P Kiran Department of gastroenterology Digestive disease InstituteThe Cleveland ClinicClevelandOHUSA Department of Colorectal Surgery Digestive disease InstituteThe Cleveland ClinicClevelandOHUSA

Background and aim:Crohn’s colitis(CC)is associated with primary sclerosing cholangitis(PSC).However the risk of colon cancer or dysplasia in CC and PSC is *** aim was to study the risk of colon neoplasia in CC in patients with and without ***:This is a nested,case-control cohort study of all patients diagnosed with concurrent CC and PSC,seen at the Cleveland clinic between 1985 and ***-three patients with both CC and PSC were compared with a random sample of 159 CC controls without PSC during the same ***:Seven(16.3%)of 43 CC patients with PSC developed colon cancer or dysplasia,compared with 22(13.8%)of 159 controls(P=0.98).Of seven colon neoplasia cases in the PSC group,100%occurred proximal to the splenic flexure,compared with 50%(11/22)cases of colon neoplasia in controls occurring in the proximal colon(P=0.001).Based on Cox regression analysis,male gender independently increased the risk of neoplasia[hazard ratio(HR)=2.68;95%confidence interval(CI)1.30-5.54;P=0.008],as did age at CC diagnosis(HR=1.29;95%CI 1.14-1.47;P<0.001),while the use of azathioprine/6-mercaptopurine was protective(HR=0.30;95%CI 0.13-0.70;P=0.005).The presence of PSC did not increase the risk for colon neoplasia(HR=0.45;95%CI 0.18-1.13;P=0.09).Conclusions:CC patients with PSC appear not to be at increased risk of developing colon *** patients in our cohort with colon neoplasia and concurrent PSC,the neoplasia occurred in the proximal colon in all cases.

关键词： Crohn’s colitis primary sclerosing cholangitis colon neoplasia

Common controversies in management of biliary strictures

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World Journal of gastroenterology 2017年第7期23卷 1119-1124页

作者： Mansour A Parsi Center for Endoscopy and Pancreatobiliary Disorders Department of Gastroenterology and HepatologyCleveland ClinicClevelandOH 44195United States

Biliary strictures are caused by a heterogeneous group of benign and malignant conditions, each requiring a specific treatment approach. Management of biliary strictures often involves endoscopy either for definite treatment, as a bridge to surgery or for palliative purposes. Endoscopic treatment of various types of biliary strictures is not standardized and there are multiple areas of controversy regarding the best treatment options. These controversies are mainly due to lack of well-designed comparative studies to support a specific therapy. This paper reviews three common areas of controversy in the endoscopic management of biliary strictures. The areas discussed in this editorial include the role of biliary drainage in resectable malignant strictures and whether such drainage should be performed routinely prior to surgery, the best endoscopic palliation for unresectable hilar strictures and whether unilateral or bilateral stenting should be attempted, and the optimal endoscopic management for dominant strictures in patients with primary sclerosing cholangitis. The goal of this editorial is twofold. The first is to review the current literature on management of the aforementioned strictures and offer recommendations based on available evidence. The second goal is to highlight the gaps in our knowledge which in turn can encourage future research on these topics.

关键词： Biliary stricture Benign Primary sclerosing cholangitis Malignant Controversy Biliary drainage Preoperative Hilar stricture

Short-and long-term outcome of interferon therapy for chronic hepatitis B infection

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World Journal of gastroenterology 2014年第37期20卷 13284-13292页

作者： Yasushi Seo Yoshihiko Yano Division of gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Internal Medicine and Ophthalmology clinic

Hepatitis B virus (HBV) infection is a serious clinical problem worldwide. Conventional interferon (IFN)-α has been approved for the treatment of chronic hepatitis B (CHB). Short-term studies have demonstrated that IFN-based therapy is moderately effective in inducing the loss of hepatitis e antigen (HBeAg) or seroconversion (30%-40%) in HBeAg-positive patients and also produces sustained HBV DNA suppression (20%-30%) in HBeAg-negative patients. Many studies have reported a correlation between the HBV genotype and response to IFN treatment. The highest response rate to IFN treatment was found in patients infected with HBV genotype A, followed by HBV genotypes B, C, and D. The long-term effect of IFN-α on CHB has not yet been elucidated. The ability of IFN-α treatment to prevent new cirrhosis, complications associated with cirrhosis, and development of hepatocellular carcinoma (HCC) is controversial. The beneficial effect of IFN-α treatment in reducing the development of HCC has mainly been observed in treatment responders who already have cirrhosis. These inconsistent findings may be attributed to the inevitable limitations of comparisons across studies, including differences in the baseline characteristics of the study and the moderate suppression of HBV replication by IFN-α relative to nucleoside/nucleos(t)ide analogs.

关键词： Chronic hepatitis B Hepatitis B virus Interferon α Long-term outcome Hepatocellular carcinoma

Metformin does not improve survival in patients with hepatocellular carcinoma

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World Journal of gastroenterology 2014年第42期20卷 15750-15755页

作者： Mamatha Bhat Roongruedee Chaiteerakij William S Harmsen Cathy D Schleck Ju Dong Yang Nasra H Giama Terry M Therneau Gregory J Gores Lewis R Roberts Division of gastroenterology and Hepatology Mayo Clinic College of Medicine Division of gastroenterology McGill University Health Centre Department of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Thai Red Cross Society Division of Biomedical Statistics and Informatics Mayo Clinic College of Medicine

AIM: To assess whether metformin, which has a chemopreventive effect in chronic liver disease, has any chemotherapeutic effect in hepatocellular carcinoma.

关键词： Hepatocellular carcinoma Metformin Diabetes Survival Liver disease Lactic acidosis

Recent advances in treatment of follicular lymphoma: efficacy of PI3Kα/δ inhibitor (TQ-B3525)

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Signal Transduction and Targeted Therapy 2024年第6期9卷 2341-2343页

作者： Takuya Watanabe Department of Internal Medicine and gastroenterology Watanabe Internal Medicine Aoyama ClinicNiigata-city 9502002Japan

The commented study reports the results of monotherapy using TQ-B3525,a novel phosphatidylinositol-3 kinase(PI3K)inhibitor developed in China,in patients with refractory/relapsed follicular lymphoma(r/r FL).

关键词： PI3K lymphoma treatment

Metastatic tumors to the pancreas: The role of surgery

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World Journal of Gastrointestinal Oncology 2014年第10期6卷 381-392页

作者： Cosimo Sperti Lucia Moletta Giuseppe Patanè Department of Surgery Oncology and Gastroenterology 3rd Surgical Clinic University of Padua 35128 Padova Italy

Pancreatic metastases from other primary malignancies are a rare entity. By far, the most common primary cancer site resulting in an isolated pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. Only few data on the surgical outcome of pancreatic resections performed for metastases from other primary tumor have been published, and there are no guidelines to address the surgical treatment for these patients. In this study, we performed a review of the published literature, focusing on the early and long-term results of surgery for the most frequent primary tumors metastasizing to the pancreas. Results for the Literature's analysis show that in last years an increasing number of surgical resections have been performed in selected patients with limited pancreatic disease. Pancreatic resection for metastatic disease can be performed with acceptable mortality and morbidity rates. The usefulness of pancreatic resection is mainly linked to the biology of the primary tumor metastasizing to the pancreas. The benefit of metastasectomy in terms of patient survival has been observed for metastases from renal cell cancer, while for other primary tumors, such as lung and breast cancers, the role of surgery is mainly palliative.

关键词： Pancreas Pancreatic neoplasms/second-ary Pancreatectomy Renal cell cancer Breast cancer Melanoma Sarcoma Lung carcinoma