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1.
Acta Medica (Hradec Kralove) ; 59(3): 84-90, 2016.
Article in English | MEDLINE | ID: mdl-27638962

ABSTRACT

Double balloon enteroscopy (DBE) was introduced 15 years ago. The complications of diagnostic DBE are rare, acute pancreatitis is most redoubtable one (incidence about 0.3%). Hyperamylasemia after DBE seems to be a rather common condition respectively. The most probable cause seems to be a mechanical straining of the pancreas. We tried to identify patients in a higher risk of acute pancreatitis after DBE. We investigated several laboratory markers before and after DBE (serum cathepsin B, lactoferrin, E-selectin, SPINK 1, procalcitonin, S100 proteins, alfa-1-antitrypsin, hs-CRP, malondialdehyde, serum and urine amylase and serum lipase). Serum amylase and lipase rose significantly with the maximum 4 hours after DBE. Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients values before DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. There was a trend for an association between the number of push-and-pull cycles and procalcitonin and urine amylase 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin, cathepsin and hs-CRP; and between E-selectin and malondialdehyde 4 hours after DBE. We found no laboratory markers determinative in advance those patients in a higher risk of acute pancreatitis after DBE.


Subject(s)
Double-Balloon Enteroscopy/adverse effects , Pancreatitis/blood , Pancreatitis/etiology , Acute Disease , Amylases/blood , Amylases/urine , Biomarkers/blood , Biomarkers/urine , C-Reactive Protein/metabolism , Calcitonin/blood , Case-Control Studies , Cathepsins/blood , E-Selectin/blood , Female , Humans , Hyperamylasemia/blood , Hyperamylasemia/etiology , Lipase/blood , Male , Malondialdehyde/blood , Middle Aged , Risk Factors , alpha 1-Antitrypsin/blood
2.
Int J Surg Pathol ; 23(2): 165-9, 2015 Apr.
Article in English | MEDLINE | ID: mdl-24942897

ABSTRACT

Herein we present a case of a 65-year-old woman with enterocolic lymphocytic phlebitis (ELP) who presented with anemic syndrome and in whom severe stenosis of the right flexure of large bowel was detected. The microscopic examination revealed fibrosis of the submucosa and lymphoplasmacytic phlebitis of small veins and venules, whereas arteries were spared. There were 110 IgG4-positive and 160 IgG-positive plasma cells in 1 high-power field, respectively, with corresponding IgG4/IgG ratio of 0.69. The IgG4 serum level was 2.42 g/L. According to the currently proposed criteria, this ELP case is the first that may be diagnosed as definite IgG4-related disease (IgG4-RD). Although based on the sole case description, taken together with a recent review and a case report, we presume that a subset of ELPs is a manifestation of IgG4-RD.


Subject(s)
Enterocolitis/immunology , Immune System Diseases/complications , Immunoglobulin G/immunology , Phlebitis/immunology , Aged , Female , Humans
3.
Gastroenterol Res Pract ; 2013: 856873, 2013.
Article in English | MEDLINE | ID: mdl-24369458

ABSTRACT

Cronkhite-Canada syndrome is a rare disease characterised by diffuse polyposis of the gastrointestinal tract, diarrhoea, weight loss, abdominal pain, cutaneous hyperpigmentation, dystrophic changes of fingernails, and alopecia. The etiology is probably autoimmune and diagnosis is based on history, physical examination, endoscopic findings of gastrointestinal polyposis, and histology. The disease is very rare; about 450 cases have been described in the literature so far. We present a review of the literature with our own picture documentation of this rare condition.

4.
Gastroenterol Res Pract ; 2013: 918031, 2013.
Article in English | MEDLINE | ID: mdl-24369459

ABSTRACT

Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is an extremely rare illness characterised by chronic or relapsing subileus status resulting from multiple small intestinal fibrous strictures and multiple shallow ulcers of the small bowel. The etiology is unknown and pathogenesis is not fully understood. Therapy with systemic glucocorticosteroids is the treatment of choice. However, most patients develop corticosteroid dependence. Deep enteroscopy enables precise diagnostic work, possible endoscopic treatment of stenoses; may obviate the need for surgery and prevent excessive small bowel resections.

5.
Gastroenterol Res Pract ; 2013: 478349, 2013.
Article in English | MEDLINE | ID: mdl-23843784

ABSTRACT

Whipple's disease is a chronic infectious systemic disease caused by the bacterium Tropheryma whipplei. Nondeforming arthritis is frequently an initial complaint. Gastrointestinal and general symptoms include marked diarrhoea (with serious malabsorption), abdominal pain, prominent weight loss, and low-grade fever. Possible neurologic symptoms (up to 20%) might be associated with worse prognosis. Diagnosis is based on the clinical picture and small intestinal histology revealing foamy macrophages containing periodic-acid-Schiff- (PAS-) positive material. Long-term (up to one year) antibiotic therapy provides a favourable outcome in the vast majority of cases. This paper provides review of the literature and an analysis of our 5 patients recorded within a 20-year period at a tertiary gastroenterology centre. Patients were treated using i.v. penicillin G or amoxicillin-clavulanic acid + i.v. gentamicin for two weeks, followed by p.o. doxycycline (100 mg per day) plus p.o. salazopyrine (3 g per day) for 1 year. Full remission was achieved in all our patients.

7.
Acta Medica (Hradec Kralove) ; 53(1): 25-9, 2010.
Article in English | MEDLINE | ID: mdl-20608229

ABSTRACT

Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare condition characterised by chronic or relapsing moderate ileous episodes resulting from multiple small intestinal strictures, multiple shallow ulcers of the small bowel and favourable therapeutical effect of glucocorticosteroids. The aim of this paper was to evaluate three cases of CMUSE diagnosed within 10 years at a tertiary gastroenterology centre. Three females (35, 50, 60 years) were presented with colicky pain, repeated moderate ileous episodes and weight loss. Multiple fibrous strictures and ulcers of the small bowel were found. All three patients responded to glucocorticosteroid treatment. Tandem tight jejunal stenoses were dilated endoscopically by means of double balloon enteroscopy. In conclusion, CMUSE should always be considered when chronic moderate ileous episodes and multiple small intestinal strictures and ulcers of uncertain aetiology are found. Double balloon enteroscopy enables precise diagnostic work, possible endoscopic treatment of stenoses, may obviate the need for surgery and prevent excessive small bowel resections.


Subject(s)
Enteritis/complications , Intestinal Obstruction/complications , Ulcer/complications , Adult , Enteritis/pathology , Female , Humans , Intestinal Obstruction/pathology , Intestine, Small/pathology , Middle Aged , Ulcer/pathology
8.
World J Gastroenterol ; 16(19): 2331-40, 2010 May 21.
Article in English | MEDLINE | ID: mdl-20480517

ABSTRACT

Double balloon enteroscopy (DBE) is a new technique, first published and introduced into clinical practice in 2001 by Yamamoto, the inventor of this outstanding method. DBE allows complete visualization, biopsy and treatment of the small bowel. Nowadays, we have some experience of this method for evaluation of the complication rate. Severe complications are described in 1%-1.7% of patients. Acute pancreatitis is a rare complication of the investigation. The incidence of acute pancreatitis after diagnostic DBE is 0.3% in most studies. More than 50 cases of acute pancreatitis have been described in the literature so far. On the contrary, hyperamylasemia after DBE seems to be a rather common condition. Association with acute pancreatitis is supposed to be possible, but not obligatory. The causal mechanism of post-DBE acute pancreatitis is uncertain, and there are several theories in the literature. The most probable cause seems to be a mechanical straining of the endoscope with over-tube on the pancreas or in the papillary area.


Subject(s)
Catheterization/adverse effects , Endoscopy, Gastrointestinal/adverse effects , Intestine, Small , Pancreatitis/etiology , Acute Disease , Biopsy , Catheterization/instrumentation , Endoscopy, Gastrointestinal/methods , Equipment Design , Gastroscopes , Humans , Hyperamylasemia/etiology , Intestine, Small/pathology , Intestine, Small/surgery , Risk Assessment , Risk Factors
9.
J Gastrointest Surg ; 14(3): 578-81, 2010 Mar.
Article in English | MEDLINE | ID: mdl-19274480

ABSTRACT

INTRODUCTION: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. Authors present a 67-year-old woman treated for iron deficiency anemia for the past 5 years. Suddenly, her disease was presented with painless severe gastrointestinal bleeding (fresh melena). Inverted Meckel's diverticulum with ectopic pancreatic tissue as a source of severe gastrointestinal bleeding was diagnosed by intraoperative enteroscopy. CONCLUSION: A combination of inversion of Meckel's diverticulum with ectopic pancreatic tissue is extremely rare, particularly in elderly patient. Capsule endoscopy, double balloon enteroscopy, and ultimately intraoperative enteroscopy may be helpful in timely diagnosis.


Subject(s)
Capsule Endoscopy/methods , Choristoma/complications , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Meckel Diverticulum/complications , Pancreas , Aged , Biopsy, Needle , Blood Transfusion , Choristoma/pathology , Endoscopy, Gastrointestinal/methods , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/pathology , Humans , Ileal Diseases/diagnosis , Ileal Diseases/surgery , Immunohistochemistry , Meckel Diverticulum/diagnosis , Rare Diseases , Risk Assessment , Treatment Outcome
10.
Hepatogastroenterology ; 56(91-92): 629-35, 2009.
Article in English | MEDLINE | ID: mdl-19621669

ABSTRACT

BACKGROUND/AIMS: Pancreatic cystic neoplasms represent a heterogeneous group of tumors with varied malignant potential. The aim of this prospective study was to evaluate EUS, EUS-FNA and cyst fluid analysis in distinguishing serous cystadenomas (SCA) and mucinous cystic neoplasms (MCN). METHODOLOGY: Twelve patients with SCA (4 men, 8 women, mean age 58), 16 with MCN (3 men, 13 women, mean age 53) and 10 pancreatic non-tumorous cysts as controls (1 man, 9 women, mean age 43) were investigated by EUS-FNA from January 2003 to February 2006. Cyst fluid evaluation was done for cytology, amylase, CEA, CA 19-9, CA 72-4 and CA 15-3 (RIA). The final diagnosis was based on surgery & histology (14 patients) and/or follow-up after EUS-FNA (mean 15 months). RESULTS: In the MCN-group 13 mucinous cystadenomas, 2 cystadenocarcinomas and 1 malignant IPMT were found. EUS-FNA results: cytology (including staining for mucin) was diagnostic in 2/12 SCA (17%), 10/16 MCN (63%) and negative in all controls. Fluid CEA in MCN-group (mean 9487, 95%CI 0-23637) was significantly higher compared both with SCA-group (mean 22, 95%CI 0-54, p<0.001) and controls (mean 4, 95%CI 0.5-8, p<0.001). Similar results were found in fluid CA72-4 and fluid CA19-9. Accuracy of EUS-FNA with final diagnosis was 93%. CONCLUSIONS: EUS-FNA with cyst fluid CEA, CA72-4, CA19-9 and cytology are useful tools in differentiating SCA, MCN and non-tumorous cysts.


Subject(s)
Cystadenoma, Mucinous/pathology , Cystadenoma, Serous/pathology , Endosonography , Pancreatic Cyst/pathology , Pancreatic Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle , Cohort Studies , Cystadenoma, Mucinous/diagnostic imaging , Cystadenoma, Mucinous/metabolism , Cystadenoma, Serous/diagnostic imaging , Cystadenoma, Serous/metabolism , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Pancreatic Cyst/diagnostic imaging , Pancreatic Cyst/metabolism , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/metabolism , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Young Adult
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