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Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location

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World Journal of Gastroenterology 2019年第4期25卷 498-508页

作者： Fabian Emura Rene Gomez-Esquivel Carlos Rodriguez-Reyes Petros Benias Javier Preciado Michael Wallace Luis Giraldo-Cadavid Division of Gastroenterology Universidad de La Sabana Advanced Gastrointestinal Endoscopy EmuraCenter LatinoAmerica Emura Foundation for the Promotion of Cancer Research Unidad de Endoscopia Digestiva Clínica Pediátrica Colsanitas Division of Digestive Diseases and Nutrition Morsani College of Medicine University of South Florida Division of Gastroenterology North Shore-Long Island Jewish Medical Center Unidad de Exploraciones Digestivas Clinica Universitaria Colombia department of Gastroenterology and Hepatology Mayo Clinic Department of Internal Medicine. Universidad de La Sabana Division of Interventional Pulmonology Fundacion Neumologica Colombiana

AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.METHODS Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound(EUS) in 25 consecutive patients to confirm the findings.The scope orientation throughout the exam was maintained at the natural axis,where the left esophageal quadrant corresponds to the area between 6 and 9 o'clock. When an anatomical landmark was identified, it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined. The reference points to obtain the distances and radial orientation were as follows: the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium. With the video processor system set to moderate insufflation, measurements were obtained at the end of the patients' air expiration.RESULTS The left main bronchus and left atrium esophageal landmarks were identified using white light in 99% and 100% of subjects at a mean distance of 25.8 cm(SD2.3), and 31.4 cm(SD 2.4) from the incisors, respectively. The left main bronchus landmark was found to be a tubular, concave, non-pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. The left atrium landmark was identified as a round, convex, pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. Both landmarks were identified using white light on the anterior esophageal quadrant. In the substudy, the left main bronchus was identified in 24(92%) patients at 25.4 cm(SD2.1) and 26.7 cm(SD 1.9) from the incisors, by white light and EUS, respectively.The left atrium was recognized in all patients at 30.5 cm(SD 1.9), and 31.6 cm(SD2.3) from the incisors, by both white light and EUS, respectively. EUS confi

关键词： Esophagus Natural landmark Radial orientation Longitudinal orientation Four-quadrants Left main bronchus Left atrium

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Safety of the Patient from the Medication

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Journal of Pharmacy and Pharmacology 2017年第1期5卷 13-19页

作者： Julio Cesar Garcia Casallas Clinical Pharmacology department Clinica Universidad de La Sabana Investigation Group Evidencia Terapeutica Universidad de La Sabana Chia 250001 Colombia

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Gastrointestinal tuberculosis:An autopsy-based study

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Infectious medicine 2023年第2期2卷 122-127页

作者： Julio Cesar Mantilla Juan JoséChaves Ferney Africano-Lopez Néstor Blanco-Barrera Marta Juliana Mantilla department of Pathology Universidad Industrial de SantanderBucaramanga 680002Colombia department of Pathology Hospital Universitario de SantanderBucaramanga 680002Colombia department of Pathology Fundación Universitaria de Ciencias de la SaludBogotá111411Colombia department of Gastroenterology Gastrocenter and Medical SpecialitiesIpiales 524061Colombia department of Gastroenterology Universidad Militar Nueva GranadaBogotá250240Colombia department of Rheumatology Universidad de la SabanaChía 250001Colombia

Background:Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide.Gastrointestinal tuberculosis is an unusual presentation.It is defined as the involvement of any segment of the digestive tract,associated viscera,and peritoneum.The study’s main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia.Methods:This is a retrospective and descriptive study of autopsy reports.A total of 4,500 autopsies were performed between January 2004 and december 2020.The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization.Results:Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study.Most of the patients were male(n=35,72.9%)with a median age of 40.5 years old.Human immunodeficiency virus infection history was reported in 28 cases(58.33%).The most affected gastrointestinal tract site was the terminal ileum.Ulcers and thickened epithelium were common autopsies macroscopic findings.Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis.Conclusions:Gastrointestinal tuberculosis is a disease of great importance,being its diagnosis a clinical challenge.Underdiagnosis can be reported in a high percentage of cases,so autopsy diagnosis can help reveal more accurate data about this condition.

关键词： Gastrointestinal tuberculosis Autopsy Forensic pathology Infections Colombia

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A comprehensive review of genetic causes of obesity

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World Journal of Pediatrics 2024年第1期20卷 26-39页

作者： Marcio Jose Concepcion-Zavaleta Juan Eduardo Quiroz-Aldave Maria del Carmen Durand-Vasquez Elman Rolando Gamarra-Osorio Juan del Carmen Valencia de la Cruz Claudia Mercedes Barrueto-Callirgos Susan Luciana Puelles-Leon Elena de Jesus Alvarado-Leon Frans Leiva-Cabrera Francisca Elena Zavaleta-Gutierrez Luis Alberto Concepcion-Urteaga Jose Paz-Ibarra universidad Cientifica del Sur Bolivar 2150 AvenuePueblo Libre15084LimaPeru Division of medicine Hospital de Apoyo ChepénChepenPeru Division of Family medicine Hospital de Apoyo ChepénChepenPeru Division of Endocrinology Hospital Victor Lazarte EchegarayTrujilloPeru Division of Pediatrics Hospital de Apoyo ChepenChepenPeru Division of internal medicine Hospital de Apoyo ChepenChepenPeru Division of Genetics Universidad Nacional de TrujilloTrujilloPeru Division of Neonatology Hospital Belen de TrujilloTrujilloPeru Division of internal medicine Universidad Nacional de TrujilloTrujilloPeru department of medicine School of MedicineUniversidad Nacional Mayor de San MarcosLimaPeru

Background Obesity is a multifactorial chronic disease with a high,increasing worldwide prevalence.Genetic causes account for 7%of the cases in children with extreme obesity.Data sources This narrative review was conducted by searching for papers published in the PubMed/MEDLINE,Embase and SciELO databases and included 161 articles.The search used the following search terms:"obesity","obesity and genetics","leptin","Prader-Willi syndrome",and"melanocortins".The types of studies included were systematic reviews,clinical trials,prospective cohort studies,cross-sectional and prospective studies,narrative reviews,and case reports.Results The leptin-melanocortin pathway is primarily responsible for the regulation of appetite and body weight.However,several important aspects of the pathophysiology of obesity remain unknown.Genetic causes of obesity can be grouped into syndromic,monogenic,and polygenic causes and should be assessed in children with extreme obesity before the age of 5 years,hyperphagia,or a family history of extreme obesity.A microarray study,an analysis of the melanocortin type 4 receptor gene mutations and leptin levels should be performed for this purpose.There are three therapeutic levels:lifestyle modifications,pharmacological treatment,and bariatric surgery.Conclusions Genetic study technologies are in constant development;however,we are still far from having a personalized approach to genetic causes of obesity.A significant proportion of the affected individuals are associated with genetic causes;however,there are still barriers to its approach,as it continues to be underdiagnosed.

关键词： Leptin Melanocortin Obesity Prader-Willi syndrome Precision medicine

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Areas of research and clinical approaches to the study of liver abscess

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World Journal of Gastroenterology 2017年第2期23卷 357-365页

作者： Gregorio González-Alcaide Jorge Peris José Manuel Ramos department of History of Science and Documentation University of Valencia deparment of internal medicine Hospital Universitario Sant Joan d’Alacant departament of Clinical medicine Universidad Miguel Hernández de Elche department of internal medicine Hospital General Universitario de Alicante

AIM To analyze the research activity on liver abscess(la) and identify the main topic clusters in the area. METHODS We identified all documents using the medical subject heading "la" indexed in the MEDLINE database between 2001 and 2015. We performed a descriptive bibliometric analysis, characterizing the evolution of scientific activity, the publication types of the documents, the document categories of clinical interest(case reports, clinical trials, evaluation studies, meta-analysis, observational studies, practice guidelines and validation studies) and the geographic distribution of the research. We also carried out an analysis of networks and research clusters in order to identify the main topic areas of research.RESULTS Our search yielded a total of 1278 documents, showing a stable scientific production over the study period and a marked multidisciplinary nature. The research was dominated by case reports(65.9% of the documents analyzed). In terms of geographic distribution, researchers from the United States led in the number of signatures(n = 229), followed by those from Taiwan(n= 185), India(n = 145), Japan(n = 144), South Korea(n = 100), and China(n = 84). With regard to amebic la, the top-producing countries were India and Mexico(n = 69 each), followed by the United States(n = 29). In the case of pyogenic la, Taiwan Residents researchers led scientific production(n = 71), followed by the United States(n = 39) and China(n = 29). The most active areas of research in the field are diagnosis via computerized tomography scan, differential diagnosis with regard to liver cancer, treatment with antimicrobial agents, and Klebsiella infections(including bacteremia).CONCLUSION Clinical case reports associated with diagnosis and treatment are the main topic of study, highlighting the importance of this document type in advancing knowledge.

关键词：肝脓肿聚类分析阿米巴的脓肿 Pyogenic 脓肿 Bibliometrics

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Serum biomarkers and risk of hepatocellular carcinoma recurrence after liver transplantation

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World Journal of Hepatology 2019年第1期11卷 50-63页

作者： Maria J Citores Jose L Lucena Sara de la Fuente Valentin Cuervas-Mons department of internal medicine Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana Liver Transplantation Unit Hospital Universitario Puerta de Hierro-Majadahonda department of Surgery Hospital Universitario Puerta de Hierro-Majadahonda Valentin Cuervas-Mons Department of Internal Medicine HospitalUniversitario Puerta de Hierro-Majadahonda department of medicine Universidad Autónoma de Madrid

Liver transplantation(LT) is the only potentially curative treatment for selected patients with cirrhosis and hepatocellular carcinoma(HCC) who are not candidates for resection. When the Milan criteria are strictly applied, 75% to85%of 3-to 4-year actuarial survival rates are achieved, but up to 20% of the patients experience HCC recurrence after transplantation. The Milan criteria are based on the preoperative tumor macromorphology, tumor size and number on computed tomography or magnetic resonance imaging that neither correlate well with posttransplant histological study of the liver explant nor accurately predict HCC recurrence after LT, since they do not include objective measures of tumor biology. Preoperative biological markers, including alpha-fetoprotein, desgamma-carboxiprothrombin or neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio, can predict the risk for HCC recurrence after transplantation.These biomarkers have been proposed as surrogate markers of tumor differentiation and vascular invasion, with varied risk magnitudes depending on the defined cutoffs. Different studies have shown that the combination of one or several biomarkers integrated into prognostic models predict the risk of HCC recurrence after LT more accurately than Milan criteria alone. In this review, we focus on the potential utility of these serum biological markers to improve the performance of Milan criteria to identify patients at high risk of tumoral Published online: January 27, 2019 recurrence after LT.Liver transplantation(LT) is the only potentially curative treatment for selected patients with cirrhosis and hepatocellular carcinoma(HCC) who are not candidates for resection. When the Milan criteria are strictly applied, 75% to85%of 3-to 4-year actuarial survival rates are achieved, but up to 20% of the patients experience HCC recurrence after transplantation. The Milan criteria are based on the preoperative tumor macromorphology, tumor size and number on computed tomography or magnetic resonance imaging that nei

关键词： Hepatocellular carcinoma Liver transplantation Recurrence Selection criteria Prognostic score Biomarker Alpha-fetoprotein Systemic inflammatory marker

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Neutral protamine hagedorn/regular insulin in the treatment of inpatient hyperglycemia: Comparison of 3 basal-bolus regimens

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World Journal of Diabetes 2017年第10期8卷 455-463页

作者： Dania Lizet Quintanilla-Flores JoséGerardo González-González Guillermo García-de la Cruz Héctor Eloy Tamez-Pérez department of internal medicine 'Dr. José Eleuterio González' University HospitalUniversidad Autónoma de Nuevo León Endocrinology Service 'Dr. José Eleuterio González' University HospitalUniversidad Autónoma de Nuevo León School of medicine Universidad Autónoma de Nuevo León Research Division School of MedicineUniversidad Autónoma de Nuevo León

AIM To compare the safety and efficacy or 3 basal-bolus regimens of neutral protamine hagedorn(NPH)/regular insulin in the management of inpatient hyperglycemia.METHODS We randomized 105 patients with blood glucose levelsbetween 140 and 400 mg/dL to a basal-bolus regimen of NPH insulin given once(n = 30), twice(n = 40) or three times(n = 35) daily, in addition to pre-meal regular insulin. Major outcomes included were differences in glycemic control, frequency of hypoglycemia and total insulin dose.RESULTS NPH insulin given in a once-daily regimen was associated with better glycemic control(58.3%) compared to twice daily(42.4%) and three times daily(48.9) regimens(P = 0.031). The frequency of hypoglycemia was similar between the three groups(2.0%, 0.7% and 1.2%, P = 0.21). The mean insulin dose at discharge was 0.48 ± 0.14 U/kg in the once-daily group compared to 0.69 ± 0.28 in the twice-daily, and 0.65 ± 0.20 in the three times daily regimens(P lar rates of hypoglycemia compared to a twice-daily and a three times-daily regimen. Further studies are needed to evaluate whether this regimen could be implemented in all hospitalized patients with hyperglycemia.

关键词：中立鱼精朊 hagedorn 胰岛素医院多糖症基础大丸药的政体打 2 糖尿病 mellitus 住院病人照顾单位

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Review on the management of cardiovascular risk factors in the elderly

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Journal of Geriatric Cardiology 2022年第11期19卷 894-927页

作者： Magali González-Colaço Harmand María del Mar García-Sanz Antònia Agustí Pablo César Prada-Arrondo Alberto Domínguez-Rodríguez Beatriz Grandal-Leirós David Peña-Otero Natalia Negrín-Mena Jesús Javier López-Hernández Pablo Díez-Villanueva department of internal medicine.Geriatric medicine Hospital Universitario Nuestra Señora de CandelariaSanta Cruz de TenerifeSpain universidad Europea de Canarias Faculty of Health SciencesLa OrotavaSpain Clinical Pharmacology department Hospital Universitario Marqués de ValdecillaSantanderSpain Clinical Pharmacology department.Hospital Vall d'Hebron BarcelonaSpain Cardiac Surgery department Hospital Universitario de CanariasLa LagunaTenerifeSpain Cardiology department Hospital Universitario de CanariasLa LagunaTenerifeSpain Ortogeriatric department.Hospital Universitario de Canarias La LagunaTenerifeSpain Subdepartment of Health Care Hospital Universitario Marqués de ValdecillaServicio Cántabro de SaludSantanderSpain Instituto de Investigación Sanitaria Gregorio Marañón(liSGM)y Valdecilla(IDIVAL) Spain Hospital Universitario de Canarias Sistema Canario de SaludTenerifeSpain Primary Care Management Servicio Cántabro de SaludSpain Cardiology department Hospital de la PrincesaMadridSpain

Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this population.The objective of this work is to offer a review of the current evidence in the management of CVRF in the elderly population.The search strategy was executed in PubMed,*** and Embase,to search for clinical trials,observational cohort or cross-sectional studies,reviews,and clinical practice guidelines focused or including elderly population.The results provided were refined after reading the title and abstract,as well as elimination of duplicates,and were finally identified and assessed following the GRAde methodology.A total of 136 studies were obtained for all predefined risk factors,such as sedentary lifestyle,smoking,obesity and metabolic syndrome,hypertension,diabetes mellitus,dyslipidemia and alcohol.We described the results of the studies identified and assessed according to their methodological quality in different recommendation sections:diagnostic and prevention,intervention,or treatment in the elderly population.As the main limitation to the results of this review,there is the lack of quality studies whose target population is elderly patients.This issue limits the recommendations that can be made in this population.Due to this reason,comprehensive geriatric assessment seems the best tool currently available to implement the most appropriate treatment plans based on the baseline situation and comorbidity of each elderly patient.

关键词： prevention elderly finally

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Skin problems in children under five years old at a rural hospital in Southern Ethiopia

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Asian Pacific Journal of Tropical Biomedicine 2016年第7期6卷 625-629页

作者： José Manuel Ramos Paula Moles-Poveda Dalu Tessema Mubarack Kedir Gamadi Safayo Abraham Tesfasmariam Francisco Reyes Isabel Belinchon department of Paediatrics and General medicine Gambo General Rural Hospital department of internal medicine Hospital General Universitario de Alicante department of Clinical medicine Universidad Miguel Hernandez de Elche department of dermatology Hospital Arnau de Vilanova department of dermatology Hospital General Universitario de Alicante

Objective: To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia.Methods: A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia.Results: A total of 324 children were included(59.6% male) whose median age was 16.4months. In total, 147 children [45.4%; 95% confidence interval(CI): 40.0%–50.8%]under 5 years had a skin problem, of which 101(68.7%) consulted for that reason. The other 46(31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children(28.7%; 95% CI:20%–33.8%), it was the main disease, and in 54 children(16.5%; 95% CI: 13.0%–21.1%)it was concomitant with other diseases. The most common dermatological disease was scabies(n = 44, 13.6%; 95% CI: 10.3%–17.7%). Impetigo was diagnosed in 32 children(9.9%; 95% CI: 7.1%–13.3%), of which 23(71.9%) had complicated impetigo. Nineteen children(5.9%; 95% CI: 3.8%–9.0%) had eczema, 10(3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea(n = 9; 2.8%),infected wound and ulcer(n = 7; 2.2%), and burns(n = 6; 1.9%).Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.

关键词： Children Under five years Skin problem Scabies Impetigo

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Sarcomatoid carcinoma of the pancreas—a rare tumor with an uncommon presentation and course:A case report and review of literature

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World Journal of Clinical Cases 2021年第15期9卷 3716-3725页

作者： Paulina F Toledo Zoltan Berger laura Carreño Gonzalo Cardenas Jaime Castillo Omar Orellana department of Gastroenterology Hospital Clinico Universidad de ChileSantiago 834456IndependenciaChile department of internal medicine Section GastroenterologyHospital Clinico Universidad de ChileSantiago 834456IndependenciaChile department of Pathology Hospital Clínico de la Universidad de ChileSantiago 834456IndependenciaChile department of Radiology Hospital Clínico Universidad de ChileSantiago 834456IndependenciaChile department of Surgery Hospital Clínico Universidad de ChileSantiago 834456IndependenciaChile

BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP)is a rare type of pancreatic neoplasm,and only a few cases have been described in the literature.Histologically,it is composed mostly of atypical spindle cells with apparent sarcomatous features.CASE SUMMARY This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain.Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy.En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor.Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion.After surgery,the patient did not receive chemotherapy.Previous studies indicate a poor prognosis for this type of malignancy.However,our patient has survived for 35 mo with no recurrence to date.CONCLUSION The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.

关键词： Pancreatic neoplasms Sarcomatoid carcinoma Pancreatic ductal carcinoma Survival Abdominal pain Case report

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