RESUMEN
Malignancy can induce a hypercoagulable state and lead to an increased risk of thromboembolic events. The pathogenesis of the prothrombotic state in cancer is complicated but is thought to involve several mechanisms. Thrombosis predominantly affects the venous circulation and infrequently the arteries. Arterial occlusion as an initial manifestation of acute leukemia is unusual. This is a case of a 44-year-old male admitted with complete thrombotic occlusion of the superior mesenteric artery and treated with emergent thrombectomy. Hematologic work-up was consistent with a diagnosis of T-cell acute lymphoblastic leukemia. To our knowledge, this is the first case of complete occlusion of the superior mesenteric artery presenting as the initial manifestation of T-cell acute lymphoblastic leukemia.
RESUMEN
Although duodenal diverticula are relatively common, the bleeding complications from duodenal diverticula are exceedingly rare. We report 2 cases of obscure upper gastrointestinal bleeding secondary to angiodysplasias within a duodenal diverticula. These cases highlight the importance of considering duodenal diverticular angiodysplasias as a clinically significant etiology for upper gastrointestinal bleeding.
RESUMEN
OBJECTIVES: After subtotal colectomy, 40% of patients report chronic gastrointestinal symptoms and poor quality of life. Its etiology is unknown. We determined whether small intestinal bacterial overgrowth (SIBO) or small intestinal fungal overgrowth (SIFO) cause gastrointestinal symptoms after colectomy. METHODS: Consecutive patients with unexplained abdominal pain, gas, bloating and diarrhea (>1 year), and without colectomy (controls), and with colectomy were evaluated with symptom questionnaires, glucose breath test (GBT) and/or duodenal aspiration/culture. Baseline symptoms, prevalence of SIBO/SIFO, and response to treatment were compared between groups. RESULTS: Fifty patients with colectomy and 50 controls were evaluated. A significantly higher (p = 0.005) proportion of patients with colectomy, 31/50 (62%) had SIBO compared to controls 16/50 (32%). Patients with colectomy had significantly higher (p = 0.017) prevalence of mixed SIBO/SIFO 12/50 (24%) compared to controls 4/50 (8%). SIFO prevalence was higher in colectomy but not significant (p = 0.08). There was higher prevalence of aerobic organisms together with decreased anaerobic and mixed organisms in the colectomy group compared to controls (p = 0.008). Patients with colectomy reported significantly greater severity of diarrhea (p = 0.029), vomiting (p < 0.001), and abdominal pain (p = 0.05) compared to controls, at baseline. After antibiotics, 74% of patients with SIBO/SIFO in the colectomy and 69% in the control group improved (p = 0.69). CONCLUSION: Patients with colectomy demonstrate significantly higher prevalence of SIBO/SIFO and greater severity of gastrointestinal symptoms. Colectomy is a risk factor for SIBO/SIFO.
Asunto(s)
Bacterias/crecimiento & desarrollo , Colectomía/efectos adversos , Duodeno/microbiología , Hongos/crecimiento & desarrollo , Enfermedades Gastrointestinales/microbiología , Complicaciones Posoperatorias/microbiología , Dolor Abdominal/etiología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Pruebas Respiratorias , Diarrea/etiología , Enfermedades Gastrointestinales/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Factores de Riesgo , Vómitos/etiologíaRESUMEN
Endocytoscopy is a new imaging and magnification technology. It has been developed for observation of cellular structure and applied in the esophageal cancer. In this article we summarize the important aspects of this new modality.