ABSTRACT
We present the case of a 59-year-old man with acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Two years later, he consulted for diarrhea and steatorrhea of 2-3 months of evolution with significant weight loss. Stool cultures and study of parasites were negative. Thyroid and celiac profile, cytomegalovirus viremia and colonoscopy, were normal. Fecal calprotectin and fecal clearance of alpha-1-Antitrypsin were normal but with almost undetectable fecal elastase (<15 ug/g). Pancreatic magnetic resonance reveals a generalized atrophy of the pancreas without other parenchymal or ductal alterations. The patient had no risk factors for chronic pancreatitis and was diagnosed with exocrine pancreatic insufficiency (EPI) associated with chronic graft-versus-host disease (GVHD). GVHD is caused by an immune-mediated reaction by donor T cells recognizing foreign antigens from the recipient. GVHD occurs in 80% of patients after allo-HSCT. Diarrhea is one of the most frequent manifestations, most often due to intestinal damage, opportunistic infections or chemoradiation effects.
Subject(s)
Cytomegalovirus Infections , Exocrine Pancreatic Insufficiency , Graft vs Host Disease , Male , Humans , Middle Aged , Exocrine Pancreatic Insufficiency/etiology , T-Lymphocytes , Diarrhea , Graft vs Host Disease/etiologyABSTRACT
BACKGROUND & AIMS: Management of delayed (within 30 days) postpolypectomy bleeding (DPPB) has not been standardized. Patients often undergo colonoscopies that do not provide any benefit. We aimed to identify factors associated with therapeutic intervention and active bleeding after DPPB. METHODS: We performed a retrospective study of 548 patients with bleeding within 30 days after an index polypectomy (DPPB; 71.9% underwent colonoscopy, 2.6% underwent primary angiographic embolization, and 25.5% were managed without intervention) at 6 tertiary centers in Spain, from January 2010 through September 2018. We collected demographic and medical data from patients. The primary outcomes were the need for therapeutic intervention and the presence of active bleeding during colonoscopy. RESULTS: A need for therapeutic intervention was associated independently with the use of antithrombotic agents, hemoglobin decrease greater than 2 g/dL, hemodynamic instability, and comorbidities (P < .05). The bleeding point during colonoscopy was identified in 344 patients; 74 of these patients (21.5%) had active bleeding. Active use of anticoagulants (odds ratio [OR], 2.6; 95% CI, 1.5-4.5), left-sided polyps (OR, 1.95; 95% CI, 1-3.8), prior use of electrocautery (OR, 2.6; 95% CI, 1.1-6.1), and pedunculated polyp morphology (OR, 1.8, 95% CI, 1-3.2) significantly increased the risk of encountering active bleeding. We developed a visual nomogram to estimate the risk of active bleeding. Overall, 43% of the cohort did not require any hemostatic therapy. Rebleeding (<6%) and transfusion requirements were low in those managed without intervention. CONCLUSIONS: In a study of patients with DPPB, we found that almost half do not warrant any therapeutic intervention. Colonoscopy often is overused for patients with DPPB. We identified independent risk factors for active bleeding that might be used to identify patients most likely to benefit from colonoscopy.
Subject(s)
Colonic Polyps , Cohort Studies , Colonic Polyps/surgery , Colonoscopy , Gastrointestinal Hemorrhage , Humans , Postoperative Hemorrhage , Retrospective StudiesABSTRACT
BACKGROUND: drug-induced pancreatitis is an unexplored entity. METHODS: a retrospective cohort study was performed at a referral center. Patients with drug-induced acute pancreatitis between 2008 and 2018 were included. Baseline patient characteristics, involved drugs, clinical course and recurrence were analyzed. RESULTS: drug-induced pancreatitis represented 2.8 % of acute pancreatitis (47/1,665) and 18 different drugs were involved (thiopurines 61.8 %). The latency period was less than one month in 87.2 % of cases. Pancreatitis was mild in 89.3 % and recurrence risk was 2.3 %. CONCLUSION: drugs are a rare cause of pancreatitis, which mostly occurs within the first month of treatment, is usually mild and is associated with a low risk of recurrence.
Subject(s)
Pancreatitis , Pharmaceutical Preparations , Acute Disease , Humans , Pancreatitis/chemically induced , Pancreatitis/epidemiology , Recurrence , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Epidermal Cyst/diagnosis , Epidermal Cyst/pathology , Adenocarcinoma/diagnosis , Appendicitis/surgery , Gardner Syndrome/diagnosis , Polyps/diagnosis , Colonoscopy , Appendicitis/radiotherapy , Metastasectomy/methods , Fluorouracil/administration & dosage , Diagnosis, Differential , Cell Nucleus/pathologyABSTRACT
BACKGROUND: Population aging and comorbidity are leading to an increase in patients unfit for cholecystectomy. AIMS: To evaluate whether endoscopic biliary sphincterotomy after a first episode of acute gallstone pancreatitis reduces the risk of pancreatitis recurrence and gallstone-related events in non-surgical candidates. METHODS: Retrospective study of patients admitted for a first episode of acute gallstone pancreatitis rejected for cholecystectomy between 2013-2018. The role of endoscopic sphincterotomy was evaluated by adjusting for age, severity of pancreatitis, and presence of choledocholithiasis. RESULTS: We included 247 patients (mean age 80⯱â¯12â¯years; Charlson index: 5; severity of pancreatitis: 72% mild). Sphincterotomy was performed in 23.9%. Recurrence of pancreatitis occurred in 17.4% patients (median follow-up: 426â¯days). The one-year cumulative incidence of a new episode of pancreatitis was 1.8% (95% confidence interval [CI]: 0.2-12%) and 23% (95% CI: 17-31%) in patients with and without sphincterotomy, respectively (pâ¯=â¯0.006). In multivariate analysis, sphincterotomy showed a protective role for recurrence of pancreatitis (adjusted hazard ratio [HR]: 0.29, 95% CI: 0.08-0.92, pâ¯=â¯0.037) and for any gallstone-related event (HR 0.46, 95% CI: 0.21-0.98, pâ¯=â¯0.043). CONCLUSIONS: Endoscopic biliary sphincterotomy reduced the risk of gallstone pancreatitis recurrence and other biliary-related disorders in patients with a first episode of pancreatitis non-candidates for cholecystectomy.
Subject(s)
Gallstones/surgery , Pancreatitis/surgery , Sphincterotomy, Endoscopic/methods , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Choledocholithiasis/etiology , Choledocholithiasis/surgery , Female , Gallstones/etiology , Humans , Incidence , Male , Pancreatitis/epidemiology , Pancreatitis/etiology , Proportional Hazards Models , Recurrence , Retrospective Studies , Risk Factors , Spain/epidemiology , Tertiary Care Centers , Time Factors , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Liver Abscess, Amebic/diagnostic imaging , Liver Abscess, Amebic/drug therapy , Enzyme-Linked Immunosorbent Assay , Immunoglobulin G/analysis , Entamoeba histolytica/microbiology , Entamoeba histolytica/isolation & purification , Metronidazole/administration & dosageSubject(s)
Epidermal Cyst/pathology , Neoplastic Syndromes, Hereditary/diagnosis , Skin Diseases/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/genetics , Adenocarcinoma/therapy , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Appendectomy , Appendiceal Neoplasms/diagnosis , Appendiceal Neoplasms/genetics , Appendiceal Neoplasms/therapy , Asymptomatic Diseases , Carcinoid Tumor/diagnosis , Carcinoid Tumor/genetics , Carcinoid Tumor/therapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Diagnosis, Differential , Endoscopy, Digestive System , Epidermal Cyst/genetics , Epidermal Cyst/surgery , Fluorouracil/administration & dosage , Gardner Syndrome/diagnosis , Gardner Syndrome/genetics , Head , Hepatectomy , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Male , Neoadjuvant Therapy , Neoplastic Syndromes, Hereditary/pathology , Oxaliplatin/administration & dosage , Rectal Neoplasms/diagnosis , Rectal Neoplasms/genetics , Rectal Neoplasms/surgery , Skin Diseases/genetics , Skin Diseases/surgerySubject(s)
Liver Abscess, Amebic/diagnostic imaging , Adult , Female , Humans , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Stomach Volvulus/diagnostic imaging , Abdomen, Acute/etiology , Epigastric Arteries/physiopathology , Endoscopy, Digestive System/methods , Radiography, Abdominal/methods , Tomography, X-Ray Computed/methodsABSTRACT
No disponible
