ABSTRACT
Objective: capsule endoscopy [CE] has revolutionized the evaluation of small bowel disorders, particularly obscure gastrointestinal bleeding [OGIB]. The aim of this study was to determine the findings and the diagnostic yield of CE in a large series of patients with suspected small bowel disease mainly OGIB; as well as to compare our results to that of other reported centers
Methods: data on 230 patients who underwent capsule endoscopy for suspected small bowel related symptoms and/ or signs mainly overt [81 patients] or occult [66 patients] OGIB were obtained by retrospective chart review and review of an internal computer database of capsule endoscopy patients. Data presented as percentages, p value used to show differences whenever relevant
Results: out of 230 patients investigated for small bowel related symptoms and /or signs, 7 patients excluded mainly due to improper preparation, of the remaining 223, 128 [57.3%] had some lesion detected by CE,80 [35.8%] had definite lesions detected that could unequivocally explain patients' complaints. Patients with overt GI bleeding had the highest diagnostic yield [64.1%], this was significantly greater [P < 0.001] compared to that in patients with occult bleeding [43.9%] as well as those with abdominal pain and/or diarrhea [33.3%]. Angiodysplasia is the most common cause of OGIB [26.5%]
Conclusions: the yield of clinically important findings on CE in patients with OGIB is 55% and is greater in patients with obscure-overt than obscure-occult GI bleeding. Angiodysplasia account for the majority of significant lesions in both groups
ABSTRACT
Background: renal cell carcinoma [RCC] represent 2-3% of all malignant tumors in adults. Clear cell carcinoma is the most frequent histological type, and 25-30% of renal carcinoma have metastasis at the time of diagnosis. RCC very rarely metastasize to the colon. The objective of the present study is to report synchronous haematogenous solitary colonic metastasis that presented as severe recurrent lower gastrointestinal haemorrhage which required right hemicoloectomy and right nephrectomy plus chemotherapy
Clinical Case: we report the case of a 46-year old male patient who presented with multiple episodes of severe haemotochezia and anemia. He had a right flank mass. CT scan of the abdomen showed a large right kidney mass together with a lesion in the ascending colon, not connected to the renal mass. It also showed hepatic metastasis, lung metastasis and ascites. Colonoscopy revealed an ascending colonic mass. The patient was managed by right nephrectomy and right hemicolectomy. The pathology report of the colonic mass showed clear cell carcinoma with involvement of the colon from serosa to mucosa. It indicated the presence of haematogenous spread of the RCC as the mechanism of metastasis. The colonic haemorrhage did not recur. the patient survived close to a year after surgery
Conclusion: RCC metastasis to the colon is very rare and can be synchronous with the primary renal tumor and can be metachronous after nephrectomy. Also, it can be the result of direct invasion, haematogenous spread or after local recurrence following nephrectomy. Metastatic RCC requires surgery, immunotherapy, tyrosine kinase inhibitors, and mammalian target rapamycin inhibitors. Surgery is the first step for disease control and control bleeding from colonic metastasis. Metastectomy is indicated in localized disease and when surgically accessible
ABSTRACT
Since the extent of elevation of liver transaminases in type 2 diabetics in Jordan and most of the Middle East is unknown, we estimated the prevalence of elevated liver transaminase levels among patients with type 2 diabetes and determined associated risk factors. This study was performed on 1014 consecutive type 2 diabetic outpatients who attended the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. The patients' age ranged between 26-85 years with a mean age of 56.8 [+9.8]. Three- hundred and fifty three [54.5%] were males with a median age of 58 years [ranging between 26-82 years], and four hundred and sixty one [45.5%] were females with a median age of 57 years [ranging between 28-85 years]. Body mass index, waist circumference, lipid profile, and hepatic transaminase levels were recorded. Ultraonography was performed in those with elevated alanine transaminase levels. Overall, the prevalence of elevated alanine transaminase [ALT] level was 10.4% [n=105] with the gender-wise prevalence being 12.8% [n=71] in men and 7.4% [n=34] in women. The prevalence of elevated aspartate transaminase [AST] levels was 5.4% [n=56] with the gender-wise prevalence being 5.6% [n=31] in men and 5.4% [n=25] in women. Only 4.5% [n=44] showed elevated levels of both ALT and AST. Male gender [OR=2.35, Cl: 1.5-3.8] and high waist circumference [OR=1.9, Cl: 1.2-3.2] were associated with increased risk of elevated ALT levels. Younger patients had a higher tendency to have elevated ALT compared to those over 65 years [OR=12.4 for patients aged 25-45years, and OR=5.8 for those who were 45-65 years old]. Non-insulin use was associated with a high odds ratio for elevated ALT levels [OR=1.7, Cl: 1.1 -2.9]. Elevated ALT and AST levels are found in 10.4% and 5.4% of our type 2 diabetic patients respectively. Male gender, younger age, higher waist circumference; as an indicator of central obesity, as well as non insulin use are independent predictors of elevated liver transaminase levels
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Prevalence , Diabetes Mellitus, Type 2/blood , Sex Factors , Age Factors , Waist CircumferenceABSTRACT
To obtain normal values of gastric emptying in normal Jordanian individuals using a simple and standardized method. The study was performed during 2005-2007 at Jordan University Hospital. Gastric emptying in 36 normal healthy subjects without gastrointestinal symptoms was assessed using standardized radioisotope scintigraphy with egg-based meal. Measured points were obtained at one hour, two hours and three hours. Lag phase and half time were calculated using a modified power exponential function. Results were analyzed for correlation of gastric retention with gender, body mass index and smoking. Median gastric retention at the first, second and third hour was 67%, 30% and 11.7% respectively. The median for lag phase and T1/2 was 15.7 minutes and 89.3 minutes respectively. For all variables examined smoking was the only factor that affected significantly gastric emptying; however its effect was limited to the first and second hours [P value 0.007, 0.026 respectively]. We obtained normal gastric emptying parameters using a simple standardized technique in Jordanian population. Our results represent the basis for future clinical and research studies in this part of the world
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Radionuclide Imaging , Reference ValuesABSTRACT
Nonalcoholic steatohepatitis [NASH] is a chronic liver disease that is attracting increasing significance characterized by diffuse fatty infiltration and inflammation.The exact prevalence of NASH is unclear, but it is becoming more evident that the disease is much more common than previously thought, although originally believed to be a benign clinical entity, NASH is now recognized as a cause of progressive fibrotic liver disease with adverse clinical sequelae. Clinical characteristics associated with NASH include obesity, hyperlipidemia, and diabetes mellitus, all of which have been associated with underlying insulin resistance. Typically, this disease becomes evident in the fourth or fifth decade of life with an equal sex predilection. NASH is thought to be caused, in part, by impaired insulin signaling, leading to elevated circulating insulin levels and subsequent altered lipid homeostasis. This process is likely multifactorial and includes both genetic and environmental factors. Treatment options to date are limited and are based on very small clinical trials. Current investigations are focusing on improving the underlying insulin resistance that has been associated with NASH as well as other therapies that decrease oxidative stress or improve hepatocyte survival