ABSTRACT
In the United States, 80%-90% of primary hepatic tumors are hepatocellular carcinomas and 10%-15% are cholangiocarcinomas (CCA), both with high mortality rate, particularly CCA, which portends a worse prognosis. Traditional management with surgery has good outcomes in appropriately selected patients; however, novel ablative treatment options have emerged, such as radiofrequency ablation (RFA), which can improve the prognosis of both hepatic and biliary tumors. RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode, with a goal to completely eradicate the tumor while preserving surrounding healthy tissue. Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.
ABSTRACT
Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.
ABSTRACT
A 32-year-old Hispanic woman at 23â weeks gestation presented with right-sided headache, associated with photophobia and right-sided numbness. She denied visual problems, menstrual irregularities and galactorrhoea. Examination revealed visual acuity 20/40 bilaterally with some blurriness on the left side, decreased right V1-V2 facial sensation and preserved 5/5 power, but decreased sensation over the entire right upper extremity (RUE) and right lower extremity (RLE) to touch and pinprick. Laboratories suggested normal pituitary function, but MRI of the brain revealed enlargement of the pituitary (1.7â cm), with layering haemorrhage posteriorly and mild compression of the optic nerve. The patient underwent emergent evacuation of a pituitary haematoma, and histology revealed minute fragments of adenohypophysis with haemorrhage and fibrosis.
Subject(s)
Hypesthesia/diagnosis , Intracranial Hemorrhages/diagnosis , Pituitary Apoplexy/diagnosis , Pituitary Gland/pathology , Pregnancy Complications , Pregnancy Trimester, Second , Adult , Female , Headache/diagnosis , Headache/etiology , Hematoma/etiology , Hematoma/surgery , Humans , Hypesthesia/etiology , Intracranial Hemorrhages/complications , Magnetic Resonance Imaging , Optic Nerve/pathology , Pituitary Apoplexy/etiology , Pituitary Neoplasms/complications , Pregnancy , Vision Disorders/diagnosis , Vision Disorders/etiology , Visual AcuitySubject(s)
Esophagus/pathology , Adenocarcinoma/drug therapy , Antineoplastic Agents/adverse effects , Endoscopy, Digestive System , Erlotinib Hydrochloride , Fatal Outcome , Female , Humans , Lung Neoplasms/drug therapy , Middle Aged , Multiple Organ Failure , Necrosis/diagnosis , Quinazolines/adverse effectsABSTRACT
AIM: Percutaneous endoscopic gastrostomy (PEG) tube is an important method of enteral feeding for patients who require temporary or long-term artificial nutritional support to prevent or correct disease-related malnutrition. However, there is paucity of data on the utility of short-term PEG tube placements in acute illnesses in cognitively intact older adults. METHODS: We present a series of seven, cognitively intact patients (age range 72-93 years), who had PEG tubes placed for short periods. These patients were diagnosed with "failure to thrive" and were managed by placing a PEG tube temporarily for nutritional management. None of these patients had terminal illness or hospice eligibility, and all of the patients were community dwellers. RESULTS: All of the elderly patients experienced good outcomes in terms of their functional status and nutritional support. CONCLUSIONS: Our series clearly supports the notion that short-term PEG tube placement in cognitively intact elderly patients could be a successful strategy to support them during an episode of acute illness, and to improve their nutritional deficits and survival.
Subject(s)
Algorithms , Gastroscopy , Gastrostomy/instrumentation , Gastrostomy/methods , Acute Disease , Aged , Aged, 80 and over , Clinical Decision-Making , Cognition , Female , Humans , Intubation, Gastrointestinal , Male , Time FactorsABSTRACT
Gastric varices (GVs) are notorious to bleed massively and often difficult to manage with conventional techniques. This mini-review addresses endoscopic management principles for gastric variceal bleeding, including limitations of ligation and sclerotherapy and merits of endoscopic variceal obliteration. The article also discusses how emerging use of endoscopic ultrasound provides optimism of better diagnosis, improved classification, innovative management strategies and confirmatory tool for eradication of GVs.
ABSTRACT
AVN is caused by a disease, or severe trauma that affects the blood supply to the bone or in many cases may be idiopathic, with no known cause. AVN pathophysiology is most closely linked to SLE literature, and there is a strong cause and effect relationship between corticosteroid intake and AVN development in SLE patients, and AVN is extremely rare in the absence of steroid use. Apart from few anecdotal reports, there is no data on exact pathophysiologic mechanisms responsible for AVN in the setting of vasculitis. We saw a 69-year-old man with femoral AVN and a possibility of vasculitis as the underlying cause was raised by the radiologist, and hence we present this literature search on vasculitis per se causing AVN of the bone.
Subject(s)
Femur Head Necrosis/etiology , Osteonecrosis/etiology , Vasculitis/complications , Aged , Humans , MaleABSTRACT
BACKGROUND/AIM: Clostridium difficile infection (CDI) can affect up to 8% of hospitalized patients. Twenty-five percent CDI patients may develop C. difficile associated diarrhea (CDAD) and 1-3% may progress to fulminant C. difficile colitis (FCDC). Once developed, FCDC has higher rates of complications and mortality. PATIENTS AND METHODS: A 10-year retrospective review of FCDC patients who underwent colectomy was performed and compared with randomly selected age- and sex-matched non-fulminant CDAD patients at our institution. FCDC (n=18) and CDAD (n=49) groups were defined clinically, radiologically, and pathologically. Univariate analysis was performed using Chi-square and Student's t test followed by multivariate logistic regression to compute independent predictors. RESULTS: FCDC patients were significantly older (77 ± 13 years), presented with triad of abdominal pain (89%), diarrhea (72%), and distention (39%); 28% had prior CDI and had greater hemodynamic instability. In contrast, CDAD patients were comparatively younger (65 ± 20 years), presented with only 1 or 2 of these 3 symptoms and only 5% had prior CDI. No significant difference was noted between the 2 groups in terms of comorbid conditions, use of antibiotics, or proton pump inhibitor. Leukocytosis was significantly higher in FCDC patients (18.6 ± 15.8/mm³ vs 10.7 ± 5.2/mm³; P=0.04) and further increased until the point of surgery. Use of antiperistaltic medications was higher in FCDC than CDAD group (56% vs 22%; P=0.01). CONCLUSIONS: Our data suggest several clinical and laboratory features in CDI patients, which may be indicative of FCDC. These include old age (>70 years), prior CDI, clinical triad of increasing abdominal pain, distention and diarrhea, profound leukocytosis (>18,000/mm³), hemodynamic instability, and use of antiperistaltic medications.