Background: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasms of the gastrointestinal (GI)
tract, occupying 0.2% of all digestive tract cancer cases. The main affected site is the stomach (50% cases). The vast majority (95%) have a mutation in the Kit gene. Surgery is the treatment of choice, with complete tumor resection with free margins, and no need for lymphadenectomy. Minimal invasive surgery may be an option, mainly for small tumors and patients with localized disease. The emergence of molecular targeted therapy has brought great advances in the treatment of unresectable metastatic tumors, and in cases of recurrence after surgical treatment.
Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases.Dr./ Ihab Samy
Amr H. Sleema MD; Ihab S. Fayeka MD; Hany F. Habashyb MD;Amany Saberc MD;Alfred E. Namourd MD;Nevine F. Habashye MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University – Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University – Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University – Egypt.
Kasr el-aini journal of surgery Volume 15, No.2, May 2014
Abstract
Metastatic gastric tumors (MGTs) mean the tumor cells that attack the stomach and grow there through blood vessel, lymph vessel, and other pathway, consistent with the primary tumor in phenotype, which are clinically uncommon, and information on MGTs is generally limited to single case reports. Here we present a clinical series of 8 cases with MGTs, in attention to discuss the clinical characteristics, diagnosis and treatment, and prognosis of MGTs. Our data showed that MGTs are rare, with a male predominance, and the cause of death was multiple organ metastases in most cases. Heterochromous MGTs showed a significantly better prognosis than simultaneous MGTs, and a long interval between initial radical excision of the primary tumor and appearance of gastric metastasis was found to be associated with good prognosis.
Adjuvant therapy protocols for liver cancer in patients undergoing liver tran...hr77
Many patients undergo liver transplantation for a liver cancer in a setting of liver cirrhosis. When is it possible to consider chemotherapy in such patients? Is it even possible? Is there a role?
Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases.Dr./ Ihab Samy
Amr H. Sleema MD; Ihab S. Fayeka MD; Hany F. Habashyb MD;Amany Saberc MD;Alfred E. Namourd MD;Nevine F. Habashye MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University – Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University – Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University – Egypt.
Kasr el-aini journal of surgery Volume 15, No.2, May 2014
Abstract
Metastatic gastric tumors (MGTs) mean the tumor cells that attack the stomach and grow there through blood vessel, lymph vessel, and other pathway, consistent with the primary tumor in phenotype, which are clinically uncommon, and information on MGTs is generally limited to single case reports. Here we present a clinical series of 8 cases with MGTs, in attention to discuss the clinical characteristics, diagnosis and treatment, and prognosis of MGTs. Our data showed that MGTs are rare, with a male predominance, and the cause of death was multiple organ metastases in most cases. Heterochromous MGTs showed a significantly better prognosis than simultaneous MGTs, and a long interval between initial radical excision of the primary tumor and appearance of gastric metastasis was found to be associated with good prognosis.
Adjuvant therapy protocols for liver cancer in patients undergoing liver tran...hr77
Many patients undergo liver transplantation for a liver cancer in a setting of liver cirrhosis. When is it possible to consider chemotherapy in such patients? Is it even possible? Is there a role?
Gastric neuroendocrine carcinomas are rare and have a poor prognosis. The present case concerns with a 55 year old female who presented with complaints of recurrent vomiting on and off, hematemesis and weight loss and history of lumbar stenosis. Esophagogastroduedenostomy (EGD) showed a large ulcerated growth in the antrum. Computed tomography abdomen revealed an ill defined soft tissue density in the gastric antrum, a partial gastrectomy was performed. Microscopic evaluation revealed a neuroendocrine neoplasm. Immunohistochemically positive for Chromogranin A and Non Specific Enolase (NSE). A diagnosis of Neuroendocrine carcinoma of the stomach was given based on recent WHO classification of Neuroendocrine carcinoma of the stomach and on mitotic index with reference to grading scale.
Symptomatic Correlation with site of Colorectal Canceriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract
OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders.
DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors.
RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combina- tions of them.
CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clini- cal trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.
Radical Resection HPB Tumors Presenting as Metastatic Lesions: Report of 2 Ca...CrimsonpublishersMedical
60 yr old lady referred to department of GI and HPB surgery for management for GB with ascetic, who underwent diagnostic laparoscopy for supposed to be metastatic ca GB at oncology hospital. Presenting features-Pain and distension abdomen, vomiting, generalized edema for 10 days. Diagnostic laparoscopy and biopsy findings of which were-diffuse ascitis with frozen subheptic region with GB not visualized, was biopsy negative for malignancy (exact site not mentioned). O/E- pt ASA GR3 pedal edema+, ascetic +, abdomen soft no s/o icterus/Lymphadenopathy/peritonitis /Mets Investigations-Hb-9.8gm/dl-, TLC-12700, DLC-N-74%, L-22%, E-2%, M-2%, urea-17 creatinine-0.6, HIV, HBS Ag, anti HCV -ve, serum bilirubin- 0.3, SGOT-98, SGPT-78, ALP-327, alb -2.3 CXR-B/L pleural effusion, tapping done. USG-CBD normal, mass in GB lumen not involving liver, liver normal, moderate ascitis. Ascetic cytologyve CTSCAN - Mass in GB lumen localized to GB wall filling the lumen with no Mets /LNs, ascetic+ ca 19-9 -3u/ml. Management -She was treated for gastritis, hyponatremia, hypoprotinemia with PPIs, high protein diet, albumin infusion &TPN for 7 days. After nutritional build up reevaluation showed serum albumin- 3.1gm/ dl, CECT findings same with resolution of ascitis. The ascitis was a result of hypoprotinemia as ascetic cytology was negative which disappeared after protein replacement. So decision was taken to proceed with diag. lap &radical cholecystectomy. Intraoperative Findings: Diag. lap-no free fluid, no Mets.
Il ruolo dell'ecoendoscopia nella diagnosi delle lesioni solide pancreatiche ...Gastrolearning
Gastrolearning II modulo/4a lezione
Il ruolo dell'ecoendoscopia nella diagnosi delle lesioni solide pancreatiche
Prof. A. Larghi - Università Cattolica Sacro Cuore (Roma).
Cholangiocarcinoma occur in cholangiocytes, either in the intrahepatic, peri-hilar or distal bile duct locations. The three, command distinct attention due to difference in presentation and management. The current 5 years survival for localized intrahepatic cholangiocarcinoma is estimated to be at 24%. With the advent of molecular diagnostics and targeted therapy the field has seen some changes. Surgical resection is still the mainstay of therapy, although transplantation has been proposed in selected patients that have shown disease stability. Localized therapy for intra-hepatic and hilar tumors with neoadjuvant chemotherapy has also been used with some success for smaller tumors.
Transgastric ERCP with Rendezvous Technique by Mikkel Jessen in Gastroenterology Medicine & Research
Two patients with gastric bypass Roux-en-Y (GBY) presented symptoms of post-prandial upper abdominal pain. Both patients had elevated liver enzyme levels and hyperbilirubinemia. MRCP was performed on both patients demonstrating cholecystolithiasis and gallstones in the common bile duct (CBD). A combined procedure was planned for both patients with laparoscopic cholecystectomy and perioperative Transgastric Rendezvous ERCP.
10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Presentada en el marco del Primer Simposiso de Cáncer Gastrointestinal - ACHO. Hotel Sonesta, Bogotá, 29.07.2017.
Se corrigen slides 3, 11 y 16; se adiciona slide de metastásico, que se ubica antes de la sección de antiangiogénicos.
Gemcitabine and Cisplatin In Metastatic Carcinoma Gallbladder. A Single Insti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Gastric neuroendocrine carcinomas are rare and have a poor prognosis. The present case concerns with a 55 year old female who presented with complaints of recurrent vomiting on and off, hematemesis and weight loss and history of lumbar stenosis. Esophagogastroduedenostomy (EGD) showed a large ulcerated growth in the antrum. Computed tomography abdomen revealed an ill defined soft tissue density in the gastric antrum, a partial gastrectomy was performed. Microscopic evaluation revealed a neuroendocrine neoplasm. Immunohistochemically positive for Chromogranin A and Non Specific Enolase (NSE). A diagnosis of Neuroendocrine carcinoma of the stomach was given based on recent WHO classification of Neuroendocrine carcinoma of the stomach and on mitotic index with reference to grading scale.
Symptomatic Correlation with site of Colorectal Canceriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract
OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders.
DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors.
RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combina- tions of them.
CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clini- cal trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.
Radical Resection HPB Tumors Presenting as Metastatic Lesions: Report of 2 Ca...CrimsonpublishersMedical
60 yr old lady referred to department of GI and HPB surgery for management for GB with ascetic, who underwent diagnostic laparoscopy for supposed to be metastatic ca GB at oncology hospital. Presenting features-Pain and distension abdomen, vomiting, generalized edema for 10 days. Diagnostic laparoscopy and biopsy findings of which were-diffuse ascitis with frozen subheptic region with GB not visualized, was biopsy negative for malignancy (exact site not mentioned). O/E- pt ASA GR3 pedal edema+, ascetic +, abdomen soft no s/o icterus/Lymphadenopathy/peritonitis /Mets Investigations-Hb-9.8gm/dl-, TLC-12700, DLC-N-74%, L-22%, E-2%, M-2%, urea-17 creatinine-0.6, HIV, HBS Ag, anti HCV -ve, serum bilirubin- 0.3, SGOT-98, SGPT-78, ALP-327, alb -2.3 CXR-B/L pleural effusion, tapping done. USG-CBD normal, mass in GB lumen not involving liver, liver normal, moderate ascitis. Ascetic cytologyve CTSCAN - Mass in GB lumen localized to GB wall filling the lumen with no Mets /LNs, ascetic+ ca 19-9 -3u/ml. Management -She was treated for gastritis, hyponatremia, hypoprotinemia with PPIs, high protein diet, albumin infusion &TPN for 7 days. After nutritional build up reevaluation showed serum albumin- 3.1gm/ dl, CECT findings same with resolution of ascitis. The ascitis was a result of hypoprotinemia as ascetic cytology was negative which disappeared after protein replacement. So decision was taken to proceed with diag. lap &radical cholecystectomy. Intraoperative Findings: Diag. lap-no free fluid, no Mets.
Il ruolo dell'ecoendoscopia nella diagnosi delle lesioni solide pancreatiche ...Gastrolearning
Gastrolearning II modulo/4a lezione
Il ruolo dell'ecoendoscopia nella diagnosi delle lesioni solide pancreatiche
Prof. A. Larghi - Università Cattolica Sacro Cuore (Roma).
Cholangiocarcinoma occur in cholangiocytes, either in the intrahepatic, peri-hilar or distal bile duct locations. The three, command distinct attention due to difference in presentation and management. The current 5 years survival for localized intrahepatic cholangiocarcinoma is estimated to be at 24%. With the advent of molecular diagnostics and targeted therapy the field has seen some changes. Surgical resection is still the mainstay of therapy, although transplantation has been proposed in selected patients that have shown disease stability. Localized therapy for intra-hepatic and hilar tumors with neoadjuvant chemotherapy has also been used with some success for smaller tumors.
Transgastric ERCP with Rendezvous Technique by Mikkel Jessen in Gastroenterology Medicine & Research
Two patients with gastric bypass Roux-en-Y (GBY) presented symptoms of post-prandial upper abdominal pain. Both patients had elevated liver enzyme levels and hyperbilirubinemia. MRCP was performed on both patients demonstrating cholecystolithiasis and gallstones in the common bile duct (CBD). A combined procedure was planned for both patients with laparoscopic cholecystectomy and perioperative Transgastric Rendezvous ERCP.
10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Presentada en el marco del Primer Simposiso de Cáncer Gastrointestinal - ACHO. Hotel Sonesta, Bogotá, 29.07.2017.
Se corrigen slides 3, 11 y 16; se adiciona slide de metastásico, que se ubica antes de la sección de antiangiogénicos.
Gemcitabine and Cisplatin In Metastatic Carcinoma Gallbladder. A Single Insti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football athlete experienced acute posterior leg pain while pushing off on the line of scrimmage. Ultrasound (US) showed a midsubstance plantaris tendon rupture, an injury that, to our knowledge, has only been described once before in the medical literature [1]. US was also used to assist with rehab progression and return to previous level of activity, which was achieved three weeks after the injury. While there currently are no guidelines regarding return to sport after this injury, this case demonstrates that once pain is controlled and ROM restored, progression through rehabilitation and return to elite level sport is simply based on symptoms.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
Kratom is an herbal product that is derived from Southeast Asian Mitragyna speciose tree leaves [1-10]. This compound is used for many purposes such as stimulation, euphoria, or analgesia [1-10]. It has been recently identified as a drug of abuse by the United States Drug Enforcement Administration [2,8]. Side-effects from this compound have not been well documented. We describe a case of a 36-year-old female who develop nephrotoxicity after taking an herbal supplement. She took kratom as an adjunctive therapy for back pain management. She developed right upper quadrant pain and nausea. Laboratory tests showed elevated liver enzymes without evidence of bile duct obstruction. Liver enzymes normalized several weeks after Kratom discontinuation. We advise clinicians to be vigilant about Kratom’s hepatotoxic potential on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with
suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical,hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using SPSS version 21.
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Introduction
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Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
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MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
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Structure and Function of Taste Buds:
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Location of Taste Buds:
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Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
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Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
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Abnormalities of Taste Detection:
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Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Cite this Article: Barchi LC, Zilberstein B. Current Status on
Gastric Stromal Tumor.Int J Hepatol Gastroenterol. 2015;1(1):
005-008.
SCIRES Literature - Volume 1 Issue 1 - www.scireslit.com Page - 006
International Journal of Hepatology & Gastroenterology
KEYWORDS: GIST, imatinib, gastrectomy, laparoscopic
resection, stomach neoplasm, c-Kit
INTRODUCTION
Gastrointestinal Stromal Tumor (GIST) is the most common
mesenchymal neoplasms of the gastrointestinal (GI) tract, occupying
0.2% of all digestive tract cancer cases. It has an estimated incidence
of 14.5 inhabitants / million / year and prevalence of 129 / million
inhabitants / year. In the US the annual incidence is 5-6 thousand
cases / year with a 3-year survival rate of 73% [1].
The mean age is 58 years, with no gender preference. The main
affected site is the stomach (50% cases), followed by small intestine
(25%), colon (10%), and other locations such as the rectum,
esophagus, mesenteric and retroperitoneal (15%) [2]. Of 2,583 cases
of malignancies of the stomach treated at Hospital das Clínicas –
University of São Paulo School of Medicine (HCFMUSP) from 1971
and 2006, the GIST accounted for only 2% and adenocarcinoma
accounts for 93% of cases [4].
Itisbelievedthatthesetumorsareoriginatedintheinterstitialcells
of Cajal (1893). These cells, which are present in all gastrointestinal
tract, work as true pacemakers integrating the smooth muscles of the
digestive tract with the autonomic nervous system in its peristalses
activity [5].
The term gastrointestinal stromal tumor was introduced by
Mazur and Clark in 1983 as a reference to the main group of
mesenchymal tumors of the gastrointestinal tract, which could not
be distinguished from smooth muscle or neurogenic origin [6]. To
date, it is now known that GIST is a distinct cancer and it is estimated
that 72% of these tumors diagnosed today were wrongly classified in
the past as leiomyomas, leiomyossarcomas or tumors of neural origin
between schwannomas or neurilenomas [7]. This differentiation has
been possible only due to the emergence of immunohistochemical
staining techniques (1980) that are essential for diagnosis.
HISTOLOGY AND IMUNOHISTOCHEMICAL
ASPECTS
This distinct group of mesenchymal neoplasms are consisted of
spindle cell, i.e., elongated nuclei present in 70% of cases, epithelioid
cells with rounded nuclei and abundant cytoplasm (20%) or mixed
(10%) and has mutation in the tirosinakinase (TK) receiver [8].
The vast majority (95%) have a mutation in the Kit gene. This
gene encodes a transmembrane receptor with tyrosine kinase
activity immunologically recognized as CD-117 (c-kit) [9,10]. The
human proto-oncogene c-kit has been described by Yarden et al. in
1987, however was Hirota et al. in 1998 that, although interestingly
did not mention Yarden’s work, proposed to be the origin of GIST
the interstitial cells of Cajal and that Kit mutation leads to the
development of this neoplasia [11,12]. Kit is a TK transmembrane
receptor and is responsible for various cell functions, among which
proliferation, adhesion, apoptosis, and cell differentiation. The
mutation that occurs in the Kit gene leads to a constitutive activation
in Kit protein causing unopposed cell proliferation stimulus. This
entails the development of tumor [13]. Most of positive c-Kit GIST
also express positivity for other receptor, the CD-34 (70% of cases),
which are more common in the esophagus and rectum. S-100 protein
and Desmin are rarely positive. Nonetheless, Vimentin and Smooth
Muscle Actin (1A 4) marker may be positive in 15-60% of cases. A
small percentage shows no mutation in c-Kit, but in the growth factor
receptor alpha derived from platelets (PDGRFa) [14].
A calcium-regulated chloride channel protein was identified from
transcriptional gene expression profiling studies on GIST [15,16].
This protein is known as DOG1 (discovered on GIST-1) and has high
specificity and sensitivity for GIST and is expressed strongly on their
cell surface. The polyclonal antibodies against this protein have been
found to label GIST independently of c-KIT/PDGFRA mutational
status [17, 18].
For histological and immunohistochemistry GIST diagnosis is
recommended by the National Institute of Health (NIH) studying
CD-117, CD-34, 1A 4, Desmin and Ki-67 (cell proliferation antigen),
which does not help in the diagnosis but has strong influence on
prognosis [19].
DIAGNOSIS AND TREATMENT APPROACH
Most patients with GIST are diagnosed due to symptoms caused
by the tumor size, leading to abdominal pain and hemorrhage (50%
of cases) [20]. One third of patients has already liver and peritoneum
metastasis at the diagnosis [21]. The diagnostic evaluation is based on
imaging methods, with significant role of endoscopy and endoscopic
ultrasound (EUS). These methods provide the location, consistency
and tumor size, as well the aspect of the submucosal and mucosal
integrity. Biopsies have low sensitivity because they can not reach the
submucosal layer. But the biopsy with fine-needle aspiration by EUS
is useful for the differential diagnosis [22,23]. Ultrasonography can
be helpful, but CT scan is necessary for the location and assessment
of tumor, usually showing solid mass with calcification area, central
necrosis, and to identify possible metastasis sites [24]. Magnetic
resonance imaging can provide insight on specific cases, but usually
is not required.
Surgery is the treatment of choice, with complete tumor resection
with free margins. There is no need for lymphadenectomy, because
these tumors very rarely lead to lymphatic spread. DeMatteo et al.
ABSTRACT
Background: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasms of the gastrointestinal (GI)
tract, occupying 0.2% of all digestive tract cancer cases. The main affected site is the stomach (50% cases). The vast majority (95%)
have a mutation in the Kit gene. Surgery is the treatment of choice, with complete tumor resection with free margins, and no need
for lymphadenectomy. Minimal invasive surgery may be an option, mainly for small tumors and patients with localized disease. The
emergence of molecular targeted therapy has brought great advances in the treatment of unresectable metastatic tumors, and in cases
of recurrence after surgical treatment.
3. Cite this Article: Barchi LC, Zilberstein B. Current Status on
Gastric Stromal Tumor.Int J Hepatol Gastroenterol. 2015;1(1):
005-008.
SCIRES Literature - Volume 1 Issue 1 - www.scireslit.com Page - 007
International Journal of Hepatology & Gastroenterology
(2000) published a review of 200 cases of GIST, which 94 of them
already had metastasis at diagnosis. There were only 6% of lymph
node involvement in patients with metastatic disease [25]. Miettinem
et al. (2005) reported another review of 1,765 cases of gastric GIST
with long follow up and stated “... the fact of GIST does not develop
lymph node metastasis should avoid lymph node dissection [26].
Exceptionally neoplastic lymph node invasion may occur, however,
in general, is due to invasion by contiguity. Enucleation should be
avoided and, if necessary, adjacent organs must be removed with
the tumor, in order to reach R0 resection. Incisional biopsies (pre
or intraoperative) should also be avoided because it can lead to
neoplastic cells dissemination.
The type of surgery and the type of approach will depend on
the tumor’s size, characteristics and location. For small tumors
located on the greater curvature the first option is the laparoscopy
wedge resection. For small tumors located in gastric antrum,
laparoscopic or conventional distal gastrectomy should be preferred.
For tumors located in the lesser curvature an option would be to
conduct endogastric surgery or hybrid procedures (laparoscopic and
endoscopic) [27]. Tumors between 2 and 5 cm can be removed by
wedge resection or through partial or total gastrectomy depending
on the location, giving preference to the minimal invasive access.
Laparoscopic surgery has been demonstrated to have higher rate of
complete resection comparing to open surgery (97.5% vs. 85.2%),
as well as a lower, complication rate, operative time, morbidity and
length of hospitalization [28]. Notwithstanding, for tumors larger
than 5 cm each case must be evaluated individually, but the risk of
tumor’sperforationoftenoutweighsthebenefitsofminimallyinvasive
surgery. One option would be to perform video-assisted surgery.
Lesions smaller than 2 cm, due to its low degree of aggressiveness can
be followed up every 6/12 months, as long as they are asymptomatic
[29]. Hassan et al. (2008) demonstrated low mortality and overall
survival at 5 years was 65% for patients who underwent surgical
treatment [30].
Standard Chemotherapy is not effective in GIST treatment. For
unresectable metastatic large tumors, with high risk of aggressiveness
or recurrence after surgery (50% cases) [25], the treatment of choice
is the imatinib mesylate (STI571), approved in 2002 by FDA. This
gene therapy feature inhibits the TK activity of the Kit protein
by competitively interaction with ATP for the binding site on Kit.
Without ATP, which is the phosphorus source used for kinase
function, Kit molecule can not phosphorylate the substrate leading
to inhibiting cell proliferation and inducing apoptosis [13,31].
It should be noted that its antitumor activity depends on their
continuous administration. In 2008, the FDA approved imatinib as
adjuvant therapy for the treatment of c-KIT-positive GIST based on a
multicenter randomized, double-blind phase III, placebo-controlled
trial that showed better recurrence-free survival of 98% vs. 83% (HR
=0.35, 95% CI 0.22– 0.53; P < 0.0001). There was no difference in
overall survival [32]. There are reports of primary resistance (before
6 months) to this form of treatment in the range of 9 to 13%, and
secondary (after 6 months) of 40 to 50% [33]. In these cases, it is
suggested to double the dose of 400 mg / day to 800 mg or replace
the drug to sunitinib malate (SU11248), a second-line tirosinekinase
inhibitor (TKI) that’s indicated for patients with imatinib intolerance
or resistance [34,35]. In 2013, the FDA approved Regorafenib, a third-
line TKI for patients who previously failed imatinib and sunitinib
treatment. Failure was defined as either intolerance or progression
with imatinib and solely progression with sunitinib [36].
PROGNOSTIC VIEW
The potential aggressiveness of the tumor and disease free
survival after surgical resection depends mainly on the tumor size,
mitotic index and tumor location (Table 1). It is known that larger
tumors with high mitotic index and located in the small intestine has
higher probability of relapse. Even after complete resection, at least
40% of patients will relapse within 5 years [37].
Some other embodiments are also related to more or less tumor
aggressiveness such as tissues and surrounding organs invasion,
liver and peritoneum metastasis, necrosis, hemorrhage, cellular
polymorphism, DNA ploidy, c-Kit mutations and CD-34 positivity
[38].
Neoadjuvant treatment with imatinib may be applied in some
situations with the goal to decrease tumor size and to make initially
inoperable cases suitable for surgical treatment. In approximately
70% of cases there will be tumor mass reduction and the disease will
remain stable in approximately 15% of cases [39].There are no studies
to confirm their real advantage, but some case reports advocate that
this effort should be carried out for at least 1-2 years. Unfortunately,
only 25% of patients will be suitable to surgical resection after this
approach [40].
CONCLUSION
In recent years the diagnosis of GIST has become increasingly
common in everyday practice of surgeons and oncologists,
mainly due to advances in imaging diagnostic methods and
immunohistochemistry. In order to provide better outcomes and
long-term survival rates, quick and accurate diagnosis is essential.
The laparoscopic approach for small tumors and localized disease
is feasible and should be performed whenever possible. The
emergence of molecular targeted therapy has brought great advances
in the treatment of unresectable metastatic tumors, and in cases of
recurrence after surgical treatment.
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005-008.
SCIRES Literature - Volume 1 Issue 1 - www.scireslit.com Page - 008
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