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Gastro-gastric intussusception in the setting of a neuroendocrine tumor: A case report

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World Journal of Clinical Cases 2019年第21期7卷 3517-3523页

作者： Alex Zhornitskiy Long Le Serene Tareen Gezman Abdullahi Deepthi Karunasiri James H Tabibian Department of Internal Medicine Olive View-UCLA Medical CenterSylmarCA 91342United States Department of Pathology and Laboratory Medicine Olive View-UCLA Medical CenterSylmarCA 91342United States Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCA 91342United States

BACKGROUND While in children intussusception is often idiopathic,in adults it is commonly caused by a pathologic condition functioning as a lead *** is important to note that a variety of pathologic conditions may trigger intussusception,with malignancy being a relatively frequent culprit in adults;this should be considered high on the differential diagnosis during *** SUMMARY This is a case of a 40-year-old female presenting to the emergency department(ED)with three days of acute on chronic,peri-umbilical abdominal pain described as waxing and waning,and pressure-like in *** computed tomography(CT)of the abdomen and pelvis with contrast in the ED(after her pain had resolved)re-demonstrated a previously noted 13 mm lesion in the gastric antrum but no clear cause of the *** ultrasound was pursued,and the mass lesion was sampled via fine needle ***-procedure the patient experienced another episode of severe pain which prompted a repeat stat CT abdomen and pelvis with contrast;this re-demonstrated the 13 mm antral lesion and in addition was remarkable for a gastro-gastric *** upper gastrointestinal gastrograffin series was ordered(completed only after the pain had subsided)and showed resolution of the *** was consistent with a diagnosis of low-grade neuroendocrine tumor(NET).Surgery was initially deferred during the hospitilization given the low grade pathology of the lesion;however further multidisciplinary discussion between Surgery,Oncology,and Gastroenterology recommended resection given the patient’s recurrent abdominal pain with the NET functioning as a lead point for further intussusception,and the patient thus underwent robotically-assisted wedge *** We present a unique case of severe,intermittent,peri-umbilical pain related to gastro-gastric intussusception caused by an antral NET lead *** case highlights the importance of considering neoplasms as t

关键词： Abdominal pain Gastro-gastric intussusception Neuroendocrine tumor Case report

Machine learning models compared to existing criteria for noninvasive prediction of endoscopic retrograde cholangiopancreatography-confirmed choledocholithiasis

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Liver Research 2021年第4期5卷 224-231页

作者： Camellia Dalai John M Azizian Harry Trieu Anand Rajan Formosa C Chen Tien Dong Simon W Beaven James H.Tabibian ucla-olive view Internal Medicine Residency Program Department of MedicineOlive View-UCLA Medical CenterSylmarCAUSA Keck School of Medicine University of Southern CaliforniaLos AngelesCAUSA Department of Surgery David Geffen School of Medicine at UCLALos AngelesCAUSA Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLALos AngelesCAUSA Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCAUSA

Background and aims:Noninvasive predictors of choledocholithiasis have generally exhibited marginal performance *** aimed to identify noninvasive independent predictors of endoscopic retrograde cholangiopancreatography(ERCP)-confirmed choledocholithiasis and accordingly developed predictive machine learning models(MLMs).Methods:Clinical data of consecutive patients undergoing first-ever ERCP for suspected chol-edocholithiasis from 2015 to 2019 were abstracted from a prospectively-maintained *** logistic regression was used to identify predictors of ERCP-confirmed *** were then trained to predict ERCP-confirmed choledocholithiasis using pre-ERCP ultrasound(US)imaging only as well as using all available noninvasive imaging(US,computed tomography,and/or magnetic reso-nance cholangiopancreatography).The diagnostic performance of American Society for Gastrointestinal Endoscopy(ASGE)“high-likelihood”criteria was compared to ***:We identified 270 patients(mean age 46 years,62.2%female,73.7%Hispanic/Latino,59%with noninvasive imaging positive for choledocholithiasis)with native papilla who underwent ERCP for suspected choledocholithiasis,of whom 230(85.2%)were found to have ERCP-confirmed *** regression identified choledocholithiasis on noninvasive imaging(odds ratio(OR)¼3.045,P¼0.004)and common bile duct(CBD)diameter on noninvasive imaging(OR¼1.157,P¼0.011)as predictors of ERCP-confirmed *** the various MLMs trained,the random forest-based MLM performed best;sensitivity was 61.4%and 77.3%and specificity was 100%and 75.0%,using US-only and using all available imaging,*** high-likelihood criteria demonstrated sensitivity of 90.9%and specificity of 25.0%;using cut-points achieving this specificity,MLMs achieved sensitivity up to 97.7%.Conclusions:MLMs using age,sex,race/ethnicity,presence of diabetes,fever,body mass index(BMI),total bilirubin,maximum CBD di

关键词： Machine learning models(MLMs) Endoscopic retrograde cholangiopancreatography(ERCP) Noninvasive imaging Bile duct disorders Common bile duct stones Gallstones

Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices

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World Journal of Gastrointestinal Surgery 2022年第4期14卷 286-303页

作者： Anand Rajan Peerapol Wangrattanapranee Jonathan Kessler Trilokesh Dey Kidambi James H Tabibian Department ofGastroenterology Olive View-UCLA Medical CenterSylmarCA 91342United States Department ofGastroenterology City of Hope Medical CenterDuarteCA 91010United States Department ofMedicine Keck School of Medicine of USCLos AngelesCA 90033United States Department ofInterventional Radiology City of Hope Medical CenterDuarteCA 91010United States Department ofGastroenterology UCLA-Olive View Medical CenterSylmarCA 91342United States

Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication *** evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events(AEs).Appropriate indications,contraindications,ethical considerations,and comorbidities of patients referred for gastrostomy placement should be weighed and ***,endoscopist should consider either a transoral or transabdominal approach is appropriate,and radiologic or surgical gastrostomy tube placement is ***,medical history,physical examination,and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.

关键词： Gastrostomy Gastropexy Enterostomy Decompression Enteral nutrition Endoscopy

Place of technosphere inhaled insulin in treatment of diabetes

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World Journal of Diabetes 2016年第20期7卷 599-604页

作者： Nasser Mikhail Department of Medicine Olive View-UCLA Medical Center

Technosphere insulin(TI), Afrezza, is a powder form of short-acting regular insulin taken by oral inhalation with meals. Action of TI peaks after approximately 40-60 min and lasts for 2-3 h. TI is slightly less effective than subcutaneous insulin aspart, with mean hemoglobin A1c(Hb A1c) reduction of 0.21% and 0.4%, respectively. When compared with technosphere inhaled placebo, the decrease in HbA 1c levels was 0.8% and 0.4% with TI and placebo, respectively. Compared with insulin aspart, TI is associated with lower risk of late postprandial hypoglycemia and weight gain. Apart from hypoglycemia, cough is the most common adverse effect of TI reported by 24%-33% of patients vs 2% with insulin aspart. TI is contraindicated in patients with asthma and chronic obstructive pulmonary disease. While TI is an attractive option of prandial insulin, its use is limited by frequent occurrence of cough, need for periodic monitoring of pulmonary function, and lack of long-term safety data. Candidates for use of TI are patients having frequent hypoglycemia while using short-acting subcutaneous insulin, particularly late postprandial hypoglycemia, patients with needle phobia, and those who cannot tolerate subcutaneous insulin due to skin reactions.

关键词： Afrezza Efficacy Safety Technosphere insulin Cough

Primary sclerosing cholangitis:A review and update

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Liver Research 2017年第4期1卷 221-230页

作者： James H.Tabibian Christopher L.Bowlus Division of Gastroenterology and Hepatology University of California DavisSacramentoCAUSA Division of Gastroenterology Olive View-UCLA Medical CenterSylmarCAUSA

Primary sclerosing cholangitis(PSC)is a rare,chronic,cholestatic liver disease of uncertain etiology characterized biochemically by cholestasis and histologically and cholangiographically by fibroobliterative inflammation of the bile *** a clinically significant proportion of patients,PSC progresses to cirrhosis,end-stage liver disease,and/or hepatobiliary cancer,though the disease course can be highly *** clinical trials of numerous pharmacotherapies over several decades,safe and effective medical therapy remains to be *** transplantation is an option for select patients with severe complications of PSC,and its outcomes are generally *** surveillance testing for pre-as well as post-transplant patients is a cornerstone of preventive care and health *** we provide an overview of PSC,including its epidemiology,etiopathogenesis,clinical features,associated disorders,surveillance,and emerging potential therapies.

关键词： Bile duct diseases Primary sclerosing cholangitis(PSC) Cholestasis Cholangiocarcinoma Magnetic resonance imaging Cholangiography Natural history

Foreign object ingestion and esophageal food impaction:An update and review on endoscopic management

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World Journal of Gastrointestinal Endoscopy 2019年第3期11卷 174-192页

作者： Brian M Fung Seth Sweetser Louis M Wong Kee Song James H Tabibian ucla-olive view Internal Medicine Residency Program Division of Gastroenterology and Hepatology Mayo Clinic Division of Gastroenterology Olive View-UCLA Medical Center

Foreign body ingestion encompasses both foreign object ingestion(FOI) and esophageal food impaction(EFI) and represents a common and clinically significant scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life-threatening, depending on the ingested substance,its location, patient fitness, and time to appropriate therapy. This article reviews the FOI and EFI literature and highlights important considerations and implications for pediatric and adult patients as well as their providers. Where published literature is insufficient to provide evidence-based guidance, expert opinion is included to supplement the content of this comprehensive review.

关键词： Foreign bodies Endoscopy Gastrointestinal emergency medical management Dysphagia

Place of sodium-glucose co-transporter type 2 inhibitors for treatment of type 2 diabetes

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World Journal of Diabetes 2014年第6期5卷 854-859页

作者： Nasser Mikhail Department of Medicine Endocrine DivisionOlive View-UCLA Medical CenterSylmar

Inhibitors of sodium-glucose co-transporter type 2(SGLT2), such as canagliflozin and dapagliflozin, are recently approved for treatment of type 2 diabetes. These agents lower blood glucose mainly by increasing urinary glucose excretion. Compared with placebo, SGLT2 inhibitors reduce hemoglobin A1c(Hb A1c) levels by an average of 0.5%-0.8% when used as monotherapy or add-on therapy. Advantages of this drug class include modest weight loss of approximately 2 kg, low risk of hypoglycemia, and decrease blood pressure of approximately 4 mm Hg systolic and 2 mm Hg diastolic. These characteristics make these agents potential add-on therapy in patients with Hb A1 c levels close to 7%-8.0%, particularly if these patients are obese, hypertensive, and/or prone for hypoglycemia. Meanwhile, these drugs are limited by high frequency of genital mycotic infections. Less common adverse effects include urinary tract infections, hypotension, dizziness, and worsening renal function. SGLT2 inhibitors should be used with caution in the elderly because of increased adverse effects, and should not be used in chronic kidney disease due to decreased or lack of efficacy and nephrotoxicity. Overall, SGLT2 inhibitors are useful addition for treatment of select groups of patients with type 2 diabetes,but their efficacy and safety need to be established in long-term clinical trials.

关键词： Type 2 diabetes Canagliflozin dapagliflozin Weight loss Hypoglycemia Chronic kidney disease Genital infection

Postmortem CT in decedents with SARS-CoV-2 infection.A single institution experience

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Forensic Sciences Research 2022年第2期7卷 255-260页

作者： Mariam Thomas Fereidoun Abtin Antoinette Roth Catherine Yim Anokh Pahwa Jeremy Paige Odey Ukpo Radiology UCLA Medical Center Olive ViewLos AngelesCAUSA University of California Los Angeles Los AngelesCAUSA Los Angeles medical Examiner-Coroner’s Office Los AngelesCAUSA

Coronavirus disease 2019(COVID-19)caused by SARS-CoV-2 produced a global pandemic with significant *** autopsies are not routinely performed on all decedents with SARS-CoV-2 infection,postmortem CT(PMCT)may be valuable to provide additional information on the cause of death and risk factors known to be associated with an increased mortality in *** purpose of this manuscript is to review the PMCT findings in a series of 42 decedents with SARS-CoV-2 infection from our *** analysis of 42 decedents who had a positive postmortem nasopharyngeal swab for SARS-CoV-2 and had a PMCT were included in this *** were reviewed for pulmonary findings seen in COVID-19 and other organ *** the 42 decedents,although the majority had imaging findings in the lungs that would be consistent with COVID-19 and acute respiratory distress syndrome,in 14%of the decedents the SARS-CoV-2 infection was likely coincidental and the PMCT findings suggested that they died from other *** half of the decedents that died from COVID-19 had PMCT findings of vascular *** is useful to identify pulmonary and extra pulmonary findings in decedents with SARS-CoV-2 infection that can provide additional information,which may be useful for the forensic pathologist to help determine the underlying cause of death.

关键词： Forensic sciences postmortem CT COVID-19 virtual autopsy SARS-CoV-2

Endoscopic ultrasound in chronic liver disease

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World Journal of Hepatology 2020年第6期12卷 262-276页

作者： Brian M Fung Alexander P Abadir Armen Eskandari Michael J Levy James H Tabibian Department of Medicine Olive View-UCLA Medical CenterSylmarCA 91342United States Department of Medicine University of California Irvine Medical CenterOrangeCA 92868United States Division of Gastroenterology and Hepatology University of California Davis Medical CenterSacramentoCA 95817United States Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCA 91342United States

Endoscopic ultrasound(EUS)is a minimally invasive diagnostic and therapeutic modality with a number of established as well as evolving uses in patients with chronic liver *** to other diagnostic tools such as cross-sectional imaging or conventional endoscopy,EUS has been shown to increase diagnostic sensitivity and therapeutic success for many clinical scenarios and applications with a low rate of adverse *** this review,we discuss and focus on the current and growing role of EUS in the evaluation and/or treatment of hepatobiliary masses,hepatic parenchymal disease,portal hypertension,esophageal and other varices,and indeterminate biliary strictures.

关键词： Endoscopy Cirrhosis Liver mass Liver biopsy Variceal bleeding