BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histolog...BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.展开更多
AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The ...AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation,electrocardiogram(ECG) changes,transthoracic echocardiographic findings,cardiac magnetic resonance findings,microbiology cultures,Salmonella species,inflammatory markers(erythrocyte sedimentation rate and C-reactive protein),cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases(defined as < 18 years old) and adult cases(defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics(Windows,Version 20.0. Armonk,NY: IBM Corp.) for demographic characteristics,presenting symptoms,microbiology,diagnostic methods,treatment modalities and outcome.RESULTS: From the selected articles,we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years(range 1 mo-67 years),16% of cases were children aged < 18 years. Most patients presented with chest pain,fever,and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia(40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group(100% vs 63.1%). Eightythree percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.展开更多
Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are t...Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.展开更多
Colorectal cancer(CRC) is a major public health concern being the third leading cause of cancer mortality in the United States. The availability of better therapeutic options has led to a decline in cancer mortality i...Colorectal cancer(CRC) is a major public health concern being the third leading cause of cancer mortality in the United States. The availability of better therapeutic options has led to a decline in cancer mortality in these patients. Surgical resection should be considered in all stages of the disease. The use of conversion therapy has made surgery a potentially curative option even in patients with initially unresectable metastatic disease. In this review we discuss the role of various antiangiogenic agents in patients with metastatic CRC(m CRC). We describe the mechanism of action of these agents, and the rationale for their use in combination with chemotherapy. We also review important clinical studies that have evaluated the safety and efficacy of these agents in m CRC patients. Despite the discovery of several promising anti-angiogenic agents, m CRC remains an incurable disease with a median overall survival of just over 2 years in patients exposed to all available treatment regimens. Further insights into tumor biology and tumor microenvironment may help improve outcomes in these patients.展开更多
文摘BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.
文摘AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation,electrocardiogram(ECG) changes,transthoracic echocardiographic findings,cardiac magnetic resonance findings,microbiology cultures,Salmonella species,inflammatory markers(erythrocyte sedimentation rate and C-reactive protein),cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases(defined as < 18 years old) and adult cases(defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics(Windows,Version 20.0. Armonk,NY: IBM Corp.) for demographic characteristics,presenting symptoms,microbiology,diagnostic methods,treatment modalities and outcome.RESULTS: From the selected articles,we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years(range 1 mo-67 years),16% of cases were children aged < 18 years. Most patients presented with chest pain,fever,and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia(40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group(100% vs 63.1%). Eightythree percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.
文摘Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.
文摘Colorectal cancer(CRC) is a major public health concern being the third leading cause of cancer mortality in the United States. The availability of better therapeutic options has led to a decline in cancer mortality in these patients. Surgical resection should be considered in all stages of the disease. The use of conversion therapy has made surgery a potentially curative option even in patients with initially unresectable metastatic disease. In this review we discuss the role of various antiangiogenic agents in patients with metastatic CRC(m CRC). We describe the mechanism of action of these agents, and the rationale for their use in combination with chemotherapy. We also review important clinical studies that have evaluated the safety and efficacy of these agents in m CRC patients. Despite the discovery of several promising anti-angiogenic agents, m CRC remains an incurable disease with a median overall survival of just over 2 years in patients exposed to all available treatment regimens. Further insights into tumor biology and tumor microenvironment may help improve outcomes in these patients.
