BACKGROUND Secondary rectal linitis plastica(RLP)from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread,characterized by a desmoplastic response and concentric rectal wall infiltration...BACKGROUND Secondary rectal linitis plastica(RLP)from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread,characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation.This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies.This case series underscores the critical role of magnetic resonance imaging(MRI)in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.CASE SUMMARY Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features.The first patient,a 76-year-old man with advanced prostate cancer,had rectal pain and incontinence.MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic"target sign"pattern.The second,a 57-year-old asymptomatic man with elevated prostatespecific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI,with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread.The third patient,an 80-year-old post-radical prostatectomy,presented with refractory constipation.MRI revealed a neoplastic mass infiltrating the rectal wall.In all cases,MRI consistently showed stratified thickening,concentric signal changes,restricted diffusion,and contrast enhancement,which were essential for diagnosing secondary RLP.Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.CONCLUSION Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.展开更多
AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature.
Endoscopic ultrasound (EUS) provides relevant information when an ampullary or periampullary tumor is suspected.Early detection, T and N staging and Fine Needle Aspiration plus cithologic confirmation, are some of the...Endoscopic ultrasound (EUS) provides relevant information when an ampullary or periampullary tumor is suspected.Early detection, T and N staging and Fine Needle Aspiration plus cithologic confirmation, are some of the expected benefits. Exclusion of benign findings like choledocholithiasis or chronic pancreatitis is also important. A correct understanding of the complex ampullary and periampullary anatomy is needed. Knowledge of the individual clinical history and other previous diagnostic images all contribute to a successful EUS examination. Radial and lineal EUS images are uniquely detailed and, at the moment, it seems to be the best way to exclude or confirm malignant or benign findings. We propose a procedural algorithm, including EUS,for suspected ampullary or periampullary tumors. This review summarizes the vast amount of information to be found spread in the literature, and recognizes this small anatomic area as the origin for a clinical entity with proper clinical presentation, proper imaging and proper therapeutic resolutions. The benefits of performing EUS for its study are highlighted.展开更多
AIM To propose several alternatives treatment of type 1 hepatorenal syndrome(HRS-1) what is the most severe expression of circulatory dysfunction on patients with portal hypertension.METHODS A group of eleven gastroen...AIM To propose several alternatives treatment of type 1 hepatorenal syndrome(HRS-1) what is the most severe expression of circulatory dysfunction on patients with portal hypertension.METHODS A group of eleven gastroenterologists and nephrologists performed a structured analysis of available literature.Each expert was designated to review and answer a question.They generated draft statements for evaluation by all the experts.Additional input was obtained from medical community.In order to reach consensus,a modified three-round Delphi technique method was used.According to United States Preventive Services Task Force criteria,the quality of the evidence and level of recommendation supporting each statement was graded.RESULTS Nine questions were formulated.The available evidence was evaluated considering its quality,number of patients included in the studies and the consistency of its results.The generated questions were answered by the expert panel with a high level of agreement.Thus,a therapeutic algorithm was generated.The role of terlipressin and norepinephrine was confirmed as the pharmacologic treatment of choice.On the other hand the use of the combination of octreotide,midodrine and albumin without vasoconstrictors was discouraged.The role of several other options was also evaluated and the available evidence was explored and discussed.Liver transplantation is considered the definitive treatment for HRS-1.The present consensus is an important effort that intends to organize the available strategies based on the available evidence in the literature,the quality of the evidence and the benefits,adverse effects and availability of the therapeutic tools described.CONCLUSION Based on the available evidence the expert panel was able to discriminate the most appropriate therapeutic alternatives for the treatment of HRS-1.展开更多
Background: The epidemiology of stroke in Latin- American populations and va riation of subtypes between communities are unclear. Our aim was to ascertain pr ospectively the incidence of first- ever stroke in the pred...Background: The epidemiology of stroke in Latin- American populations and va riation of subtypes between communities are unclear. Our aim was to ascertain pr ospectively the incidence of first- ever stroke in the predominantly Hispanic- Mestizo population of Iquique, a city in the northern desert region of Chile. M ethods: We prospectively identified all possible cases of stroke and transient i schaemic attacks between July 1, 2000, and June 30, 2002, from several overlappi ng sources. Patients were rapidly assessed by two field neurologists. Standard d efinitions for incident cases, stroke, transient ischaemic attack, pathological type, and infarction subtype were used. All cases identified were adjudicated by at least two stroke neurologists and followed up at 6 months. Incidence rates o f first- ever strokes were calculated from the population of Iquique (214 526) according to the national census of 2002. Findings: Of 380 cases of stroke ident ified, 292 were incident. CT scans were done in 267 (91% ) patients and the mea n time to scan was 2.2 days. The hospital admission rate was 71% (207/292). Th e overall age- adjusted incidence rate of first- ever stroke was 140.1 per 100 000 (95% CI 124.0- 156.2). The incidence rates per 100 000 according to path ological type were: infarcts 87.3, intracerebral haemorrhage 27.6, and subarachn oid haemorrhage 6.2. The 30 day and 6- month case- fatality rates were 23.3% and 33.0% , respectively. Interpretation: Our results show incidence rates of stroke similar to those reported in other community studies. Although the propor tion of intracerebral haemorrhages was higher than reported in previous studies, the overall incidence was not, which could indicate a slightly lower incidence of ischaemic strokes in this population than in other countries. The prognosis w as similar to that found in other population- based studies.展开更多
Epidermolysis bullosa (EB) is an inherited connective tissue disease causing blisters in the skin and mucosal membranes. In severe cases, EB may be associated with renal damage through several mechanisms, mainly immun...Epidermolysis bullosa (EB) is an inherited connective tissue disease causing blisters in the skin and mucosal membranes. In severe cases, EB may be associated with renal damage through several mechanisms, mainly immunological ones. The present case described a young male with dystrophic recessive EB who developed an advanced chronic renal damage secondary to tubulointerstitial nephritis that was demonstrated by a renal biopsy. Unpublished previously, this complication should be considered among the possible causes of renal damage in EB. Also it is recommended a protocoled surveillance of renal and urinary tract complications in children with EB.展开更多
Background The characteristics of patients with acute ischaemic stroke(AIS)and their management vary across regions,which may influence outcomes.We examined for differential patterns of outcome between China and non-C...Background The characteristics of patients with acute ischaemic stroke(AIS)and their management vary across regions,which may influence outcomes.We examined for differential patterns of outcome between China and non-China participants of the ENhanced Control of Hypertension And Thrombolysis strokE stuDy(ENCHANTED),which tested different alteplase doses in AIS.Methods ENCHANTED was an international,multicentre,open,blinded-endpoint trial of the effects of low-dose(0.6 mg/kg)versus standard-dose(0.9 mg/kg)intravenous alteplase on 90-day disability outcomes and symptomatic intracerebral haemorrhage(sICH)in 3310 patients with AIS.Results Participants(n=1419,48%)in China were younger,and more often male,hypertensive and with prior stroke and coronary artery disease,but less likely to have atrial fibrillation and use antihypertensive,antithrombotic and lipid-lowering agents,compared with non-China patients with AIS.Although China participants had more AIS due to large artery occlusion,were treated later and had differing ancillary management,there was no significant difference in 90-day modified Rankin scale scores 2–6(55.6% vs 47.8%;OR,adjusted for baseline and management factors 0.87(95%CI 0.71 to 1.07;p=0.20))and risk of sICH(Safe Implementation of Thrombolysis in Stroke-Monitoring Study criteria:1.4% vs 1.8%;p=0.12)compared with non-China participants.There was no heterogeneity in the treatment effects of low-dose versus standard-dose alteplase between China and non-China participants.Conclusion Patients with AIS recruited to the ENCHANTED trial in China had similar outcomes in response to thrombolysis treatment despite significantly differing demographic,clinical and management factors to patients with AIS in other regions.展开更多
Gallbladder cancer is considered a rare disease associatedwith a dismal prognosis(1-3).However,since the irruptionof laparoscopic cholecystectomy,incidental cases haveincreased and prognosis improved.The main reason f...Gallbladder cancer is considered a rare disease associatedwith a dismal prognosis(1-3).However,since the irruptionof laparoscopic cholecystectomy,incidental cases haveincreased and prognosis improved.The main reason forthis improvement is the detection of unapparent tumorscorresponding to mucosal and muscular lesions.展开更多
Objectives:Despite many publications describing sheep models for functional endoscopic sinus surgery(FESS)procedures,accurate endoscopic anatomical studies are lacking.There are no publications correlating computed to...Objectives:Despite many publications describing sheep models for functional endoscopic sinus surgery(FESS)procedures,accurate endoscopic anatomical studies are lacking.There are no publications correlating computed tomography(CT)and 3D models with endoscopic anatomical descriptions.This study evaluates and describes the endoscopic anatomy of a sheep model.Methods:Ten live sheep(20-sides)were included.Two cadaveric specimens,imaged using thin slice CT for 3D reconstruction correlation were also included.Using endoscopy,anatomical structures were measured and described.Measurement of the same structures was carried out using the 3D imaging model.Results:Three sets of turbinates were identified at 2.3,5.1 and 8.5 cm from the anterior nasal sill.Frontal recess and uncinate process were identified at 12.7 cm.The septum has a bony and cartilaginous component and measures 10.5 cm.The sphenopalatine foramen was measured at 12.1 cm.All anatomical measurements were correlated with the measurements on the CT scan 3D volume-rendering model,thereby allowing for an accurate description of the sheep sinonasal anatomy.Conclusion:This study describes the endoscopic sinonasal anatomical measurements of the adult sheep.It is the first study to evaluate the sheep CT and endoscopic anatomy in order to determine its feasibility as an animal model for research in FESS.展开更多
文摘BACKGROUND Secondary rectal linitis plastica(RLP)from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread,characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation.This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies.This case series underscores the critical role of magnetic resonance imaging(MRI)in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.CASE SUMMARY Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features.The first patient,a 76-year-old man with advanced prostate cancer,had rectal pain and incontinence.MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic"target sign"pattern.The second,a 57-year-old asymptomatic man with elevated prostatespecific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI,with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread.The third patient,an 80-year-old post-radical prostatectomy,presented with refractory constipation.MRI revealed a neoplastic mass infiltrating the rectal wall.In all cases,MRI consistently showed stratified thickening,concentric signal changes,restricted diffusion,and contrast enhancement,which were essential for diagnosing secondary RLP.Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.CONCLUSION Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.
文摘AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature.
文摘Endoscopic ultrasound (EUS) provides relevant information when an ampullary or periampullary tumor is suspected.Early detection, T and N staging and Fine Needle Aspiration plus cithologic confirmation, are some of the expected benefits. Exclusion of benign findings like choledocholithiasis or chronic pancreatitis is also important. A correct understanding of the complex ampullary and periampullary anatomy is needed. Knowledge of the individual clinical history and other previous diagnostic images all contribute to a successful EUS examination. Radial and lineal EUS images are uniquely detailed and, at the moment, it seems to be the best way to exclude or confirm malignant or benign findings. We propose a procedural algorithm, including EUS,for suspected ampullary or periampullary tumors. This review summarizes the vast amount of information to be found spread in the literature, and recognizes this small anatomic area as the origin for a clinical entity with proper clinical presentation, proper imaging and proper therapeutic resolutions. The benefits of performing EUS for its study are highlighted.
基金Supported by The Sociedad Chilena de Gastroenterología(SCHGE)the Asociación Chilena de Hepatología(ACHHEP)
文摘AIM To propose several alternatives treatment of type 1 hepatorenal syndrome(HRS-1) what is the most severe expression of circulatory dysfunction on patients with portal hypertension.METHODS A group of eleven gastroenterologists and nephrologists performed a structured analysis of available literature.Each expert was designated to review and answer a question.They generated draft statements for evaluation by all the experts.Additional input was obtained from medical community.In order to reach consensus,a modified three-round Delphi technique method was used.According to United States Preventive Services Task Force criteria,the quality of the evidence and level of recommendation supporting each statement was graded.RESULTS Nine questions were formulated.The available evidence was evaluated considering its quality,number of patients included in the studies and the consistency of its results.The generated questions were answered by the expert panel with a high level of agreement.Thus,a therapeutic algorithm was generated.The role of terlipressin and norepinephrine was confirmed as the pharmacologic treatment of choice.On the other hand the use of the combination of octreotide,midodrine and albumin without vasoconstrictors was discouraged.The role of several other options was also evaluated and the available evidence was explored and discussed.Liver transplantation is considered the definitive treatment for HRS-1.The present consensus is an important effort that intends to organize the available strategies based on the available evidence in the literature,the quality of the evidence and the benefits,adverse effects and availability of the therapeutic tools described.CONCLUSION Based on the available evidence the expert panel was able to discriminate the most appropriate therapeutic alternatives for the treatment of HRS-1.
文摘Background: The epidemiology of stroke in Latin- American populations and va riation of subtypes between communities are unclear. Our aim was to ascertain pr ospectively the incidence of first- ever stroke in the predominantly Hispanic- Mestizo population of Iquique, a city in the northern desert region of Chile. M ethods: We prospectively identified all possible cases of stroke and transient i schaemic attacks between July 1, 2000, and June 30, 2002, from several overlappi ng sources. Patients were rapidly assessed by two field neurologists. Standard d efinitions for incident cases, stroke, transient ischaemic attack, pathological type, and infarction subtype were used. All cases identified were adjudicated by at least two stroke neurologists and followed up at 6 months. Incidence rates o f first- ever strokes were calculated from the population of Iquique (214 526) according to the national census of 2002. Findings: Of 380 cases of stroke ident ified, 292 were incident. CT scans were done in 267 (91% ) patients and the mea n time to scan was 2.2 days. The hospital admission rate was 71% (207/292). Th e overall age- adjusted incidence rate of first- ever stroke was 140.1 per 100 000 (95% CI 124.0- 156.2). The incidence rates per 100 000 according to path ological type were: infarcts 87.3, intracerebral haemorrhage 27.6, and subarachn oid haemorrhage 6.2. The 30 day and 6- month case- fatality rates were 23.3% and 33.0% , respectively. Interpretation: Our results show incidence rates of stroke similar to those reported in other community studies. Although the propor tion of intracerebral haemorrhages was higher than reported in previous studies, the overall incidence was not, which could indicate a slightly lower incidence of ischaemic strokes in this population than in other countries. The prognosis w as similar to that found in other population- based studies.
文摘Epidermolysis bullosa (EB) is an inherited connective tissue disease causing blisters in the skin and mucosal membranes. In severe cases, EB may be associated with renal damage through several mechanisms, mainly immunological ones. The present case described a young male with dystrophic recessive EB who developed an advanced chronic renal damage secondary to tubulointerstitial nephritis that was demonstrated by a renal biopsy. Unpublished previously, this complication should be considered among the possible causes of renal damage in EB. Also it is recommended a protocoled surveillance of renal and urinary tract complications in children with EB.
基金Funding was principally received from the National Health and Medical Research Council(NHMRC)of AustraliaAdditional funding was from the Stroke Association of the United Kingdom,the National Council for Scientific and Technological Development of Brazil,and the Ministry for Health,Welfare and Family Affairs of the Republic of Korea(HI14C1985).
文摘Background The characteristics of patients with acute ischaemic stroke(AIS)and their management vary across regions,which may influence outcomes.We examined for differential patterns of outcome between China and non-China participants of the ENhanced Control of Hypertension And Thrombolysis strokE stuDy(ENCHANTED),which tested different alteplase doses in AIS.Methods ENCHANTED was an international,multicentre,open,blinded-endpoint trial of the effects of low-dose(0.6 mg/kg)versus standard-dose(0.9 mg/kg)intravenous alteplase on 90-day disability outcomes and symptomatic intracerebral haemorrhage(sICH)in 3310 patients with AIS.Results Participants(n=1419,48%)in China were younger,and more often male,hypertensive and with prior stroke and coronary artery disease,but less likely to have atrial fibrillation and use antihypertensive,antithrombotic and lipid-lowering agents,compared with non-China patients with AIS.Although China participants had more AIS due to large artery occlusion,were treated later and had differing ancillary management,there was no significant difference in 90-day modified Rankin scale scores 2–6(55.6% vs 47.8%;OR,adjusted for baseline and management factors 0.87(95%CI 0.71 to 1.07;p=0.20))and risk of sICH(Safe Implementation of Thrombolysis in Stroke-Monitoring Study criteria:1.4% vs 1.8%;p=0.12)compared with non-China participants.There was no heterogeneity in the treatment effects of low-dose versus standard-dose alteplase between China and non-China participants.Conclusion Patients with AIS recruited to the ENCHANTED trial in China had similar outcomes in response to thrombolysis treatment despite significantly differing demographic,clinical and management factors to patients with AIS in other regions.
文摘Gallbladder cancer is considered a rare disease associatedwith a dismal prognosis(1-3).However,since the irruptionof laparoscopic cholecystectomy,incidental cases haveincreased and prognosis improved.The main reason forthis improvement is the detection of unapparent tumorscorresponding to mucosal and muscular lesions.
文摘Objectives:Despite many publications describing sheep models for functional endoscopic sinus surgery(FESS)procedures,accurate endoscopic anatomical studies are lacking.There are no publications correlating computed tomography(CT)and 3D models with endoscopic anatomical descriptions.This study evaluates and describes the endoscopic anatomy of a sheep model.Methods:Ten live sheep(20-sides)were included.Two cadaveric specimens,imaged using thin slice CT for 3D reconstruction correlation were also included.Using endoscopy,anatomical structures were measured and described.Measurement of the same structures was carried out using the 3D imaging model.Results:Three sets of turbinates were identified at 2.3,5.1 and 8.5 cm from the anterior nasal sill.Frontal recess and uncinate process were identified at 12.7 cm.The septum has a bony and cartilaginous component and measures 10.5 cm.The sphenopalatine foramen was measured at 12.1 cm.All anatomical measurements were correlated with the measurements on the CT scan 3D volume-rendering model,thereby allowing for an accurate description of the sheep sinonasal anatomy.Conclusion:This study describes the endoscopic sinonasal anatomical measurements of the adult sheep.It is the first study to evaluate the sheep CT and endoscopic anatomy in order to determine its feasibility as an animal model for research in FESS.
