Scipedia: Documents published in 2017

Pulmonary hypertension: prevalence and risk factors

Scipedia content — Fri, 19 May 2017 11:20:08 +0200

Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving hemodialysis. It is a major problem due to its high prevalence and morbidity and mortality. Its pathophysiological mechanism is just known and the strategies for its supported not yet defined. To determine the prevalence of PAH in our hemodialysis patients and its risk factors. Single center descriptive and analytical cross-sectional study, including 111 hemodialysis patients who had benefit from a trans-thoracic cardiac Doppler ultrasound during 2014. A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and severe pulmonary hypertension (> 70 mm Hg). Patients with a high probability of secondary PAH, especially those with the following history: chronic obstructive pulmonary disease, pulmonary embolism, were not included. The mean age was 44.3 ± 14.2 years. Among the 111 patients, 18 had pulmonary arterial pressure above 35 mm Hg corresponding to 16.22% of PAH prevalence. The average pressure was 45 mm Hg. Of these 18 patients, 11.8% had mild PAH, 3.4% moderate PAH and 0.8% severe PAH. The average hemodialysis duration was significantly associated with PAH (p = 0.003), as well as valvular calcification (p = 0.000), mitral regurgitation (p = 0.001) and tricuspid regurgitation (p = 0.002). Primary pulmonary hypertension is a major problem among our hemodialysis because of its high prevalence and its risk factors.

Left atrial geometry and pump function in ischemic cardiomyopathy

Scipedia content — Fri, 19 May 2017 11:20:01 +0200

Many of the factors that are known to alter left atrial (LA) contractility are present in patients with ischemic cardiomyopathy (ICM). Nevertheless, preservation of LA contractile function in this group of patients was reported in previous studies. The aim of this study was to assess the changes in LA size, geometry and contractile function in ICM. 60 subjects (age: 49 ± 12 years, 53% males) in sinus rhythm undergoing coronary angiography (CA), were enrolled in this study, 15 subjects as a control group, 30 patients with reduced ejection fraction (EF) and significant coronary artery disease, as the ICM group, and 15 with reduced EF and normal CA, as the dilated cardiomyopathy (DCM) group. LA dimensions, volume, active emptying fraction (ACTEF) and eccentricity index (LAEi) as well as late diastolic velocities of the mitral annulus (a′) and LA free wall (A3) were measured. Compared with the control group, ICM patients had larger LA volume and reduced ACTEF, a′ and A3, with no significant difference between patients with ICM and DCM in any of these parameters. LA eccentricity was, non-significantly, higher in both cardiomyopathy groups than in the control group. Patients with ICM have increased LA volume and reduced LA contractile function in comparison with normal controls. LA enlargement, LA contractile dysfunction and LA geometric changes in ICM are similar to that occurring in DCM. LA size, contractile function and eccentricity may not be reliable in differentiating ischemic from idiopathic dilated cardiomyopathy.

Identification of nonlinear kinematic hardening parameters for sheet metal from biaxial loading tests

Benjamin Söhngen — Wed, 17 May 2017 13:09:13 +0200

In this work an anisotropic material model at finite strains with nonlinear mixed (isotropic and kinematic) hardening is used for the identification of the hardening parameters of sheet steel. The algorithmic system is thereby reduced to a single equation return mapping. For the identification, a cruciform specimen is loaded biaxially in an alternating shear test to provoke the kinematic hardening behavior and prevent the sheet from buckling. The material parameters are found through an optimization strategy by comparing the deformation field from the experiment to that from a finite element (FE) simulation. The resulting cost function is minimized by means of a gradient-based method.

Time domain simulation of coupled sloshing-seakeeping problems by coupling PFEM-2 and SeaFEM

Jonathan Colom Cobb — Tue, 16 May 2017 12:18:13 +0200

The aim of this work is to be able to cope with complex sloshing-seakeeping problems in an effective manner. For this purpose, two different solvers will be integrated into one coupled tool to take advantage of their characteristics.

The Particle Finite Element Method is a versatile framework for the analysis of fluid-structure interaction problems. The latest development within the framework of the PFEM is the X-IVAS (eXplicit Integration along the Velocity and Acceleration Streamlines) scheme. It is a semi-implicit scheme built over a Semi-Lagrangian (SL) formulation. This new scheme was named PFEM-2 and will be used in this work to solve the fluid dynamics (sloshing) inside the tanks.

The PFEM-2 will be coupled in the time domain with SeaFEM, a solver developed for seakeeping problems. SeaFEM solves the second-order diffraction-radiation equations by using the Finite Element Method (FEM) and will be used in this work to simulate the interaction between waves and a floating body.

The coupling of the two tools will be accomplished by using an effective coupling algorithm and a communication technique that allows simulations to be computed without affecting the global compute time and the accuracy of the solvers. This new tool has been validated against experimental benchmarks carried out in a model basin at model scale.

Hydrodynamic analysis of fishing farms.

José Enrique Gutiérrez Romero — Tue, 16 May 2017 12:02:02 +0200

There is no question about the relevancy of the blue growth concept, as a long term strategy to support sustainable growth in the marine sector. One of the sectors that has a higher potential for sustainable growth in this field is the aquaculture. This work is focused on the development of a time domain hydrodynamic solver for analysis and assessment of floating fishing farms. The paper also presents a demonstration case based on typical configuration of fishing farms used in the Mediterranean Sea. It is composed by a set of individual circular fishing cages. Several arrangements of fishing cages are also analysed subject to wind waves and currents. Different fishing cages are used in the performed simulations: circular, square and hexagonal.

The influence of several configurations on fishing farm mooring behaviour in different sea states is studied. The analysis is focused in the dynamic behaviour of fishing cages. In particular mean drift and slow drift motions, including the second order-effects, will be studied, since they have important role on the behaviour of fishing farm in seaway. The results lead to final discussion about the best performance in fishing farm layout.

Regulatory challenges for preventing firearms smuggling into Mexico

Scipedia content — Mon, 15 May 2017 13:09:43 +0200

The recent surge in illegal firearms trafficking from the U.S. into Mexico has helped empower Mexican criminal groups to adopt highly confrontational strategies, contributing to a surge of violence throughout the country. This article addresses the regulatory asymmetries between Mexico and the U.S. with respect to the production, import, export, sales and possession of firearms. It reviews several important gun laws and explores why this asymmetry limits bilateral cooperation and encourages gray market activity. It also examines the autonomy of U.S. states to regulate firearms, as this creates a diverse regulatory map that complicates any effort to stem smuggling. The results are flourishing gray markets on one side of the border and violent criminal activity on the other.

Regulating Mexican biobanks for human biomedical research: What can be learned from the european experience?

Scipedia content — Mon, 15 May 2017 13:09:39 +0200

Biobanking presents significant governance challenges. This is especially evident in Mexico, where the legal framework has not kept up with significant industry expansion. Twenty years ago, Europe was in a similar position. More recently, Europe has developed a comprehensive framework for addressing biobank expansion within ever-growing scientific and biomedical research communities. Based on this experience, we can draw many lessons, including those involving the implementation of laws, procedures and stakeholders’ consensus to ethically maximize the potential of samples. Mexican biobanking raises many issues, requiring solutions that are sensitive to its own particular needs. This article analyses the flaws of current biobanking regulations in Mexico by drawing comparisons with Europe. It pays special attention to informed consent, sample/data sharing systems, ethical tissue treatment and classification, governance models, best practices and the role of ethics committees. It argues that several European provisions regarding data protection and sharing can serve as guidelines for international research collaboration currently taking place between Mexico and Europe.

How Mexican principals deal with teacher underperformance: A study of how public middle school principals in Mexico City manage underperforming teachers

Scipedia content — Mon, 15 May 2017 13:09:31 +0200

This study, based on thirty-eight interviews of principals from public middle schools in Mexico City, analyzes the criteria and methods used by these school officials to identify underperforming teachers, as well as how they wield discretionary authority. The study also proposes several measures that can be implemented by educational authorities to improve how these cases are handled. These measures include improving both principals’ training and the mechanisms used to evaluate teacher performance in the classroom.

THE EXCESSIVE USE OF FORCE BY MEXICO CITY LAW ENFORCEMENT AGENCIES: CORRUPTION, NORMAL ABUSE AND OTHER MOTIVES

Scipedia content — Mon, 15 May 2017 13:09:26 +0200

Mexican-American studies in tucson, arizona and the acosta v. huppenthal decision

Scipedia content — Mon, 15 May 2017 13:09:22 +0200

This note examines the political context surrounding the banning of the Mexican American Studies program in Tucson, Arizona and the Acosta v. Huppenthal decision, which leaves the ban largely intact. The convergence of economic crisis and partisan politics contributed to the rise in anxiety over the demographic shifts of the state of Arizona, for which Mexican American Studies became a symbolic target for Republicans. Mexican American Studies was declared in violation of a new law passed by the Republican dominated legislature, A.R.S. § 15-112, by Arizona Superintendent John Huppenthal, despite the conclusion by an independent audit he ordered which concluded otherwise. This left leaders within the Mexican American community and civil rights organizations with the conclusion that the ban on Mexican American Studies was politically motivated. This note explores the motivations by individual political actors, such as the current Attorney General of Arizona Tom Horne, and how he rose to power on a platform centered on the ban against Mexican American Studies.

ASSESSING ATTITUDES TOWARD MUNICIPAL POLICE IN MEXICO DURING DEMOCRATIC TIMES: A CASE STUDYING

Scipedia content — Mon, 15 May 2017 13:09:17 +0200

The objective international responsibility of states in the Inter-American human rights system

Scipedia content — Mon, 15 May 2017 13:09:06 +0200

The international responsibility of States is based on two legal precepts: first, a State must be subject to international obligations, and second, a State must be responsible for noncompliance with such obligations. Specific and concrete damages are not required for the allocation of international responsibility to a State. Given these elements, the Inter-American Human Rights System, through the Inter-American Court, will not hear disputes involving a State’s international responsibility without the existence of a specific and concrete human rights violation. While this seems appropriate, rulings by the Inter-American Court have subsequently opened the door to States’ objective in ternational responsibility, i.e., responsibility under the American Convention on Human Rights that require no showing of a specific violation. In the author’s view, the international responsibility of States, similar to Public International Law, should be based on noncompliance without the need for a victim –especially in human rights cases. For this reason, the Inter-American Court is correct in holding States responsible for domestic laws that contravene its own human rights commitments under international treaties– regardless of whether or not these norms have been enforced.

THE NULL-VOTE: A DESPERATE CRY FOR DEMOCRACY IN MEXICO

Scipedia content — Mon, 15 May 2017 13:08:59 +0200

Investor-state tribunals and constitutional courts: The Mexican sweeteners saga

Scipedia content — Mon, 15 May 2017 13:08:53 +0200

This article tackles the complex question of the relationship between international and domestic adjudicatory bodies. It does so by analyzing the debate between liberals and developmentalists over the effects of investor-state arbitration tribunals on domestic courts. For liberals, investor-state tribunals are a positive complement to domestic judicial institutions for their ability to “de-politicize” investment disputes, leading to economic policy stability that encourages foreign investment. For developmentalists, the same international alternatives reduce institutional quality by allowing powerful actors such as powerful corporations to skirt local judicial institutions. Through a comprehensive analysis of the negotiations of Chapter Eleven of NAFTA and the recent cases in the sweeteners conflict between Mexico and the United States, this article attempts to address how investor-state arbitration tribunals and constitutional courts interact and affect each other. The case study reveals two important lessons to this debate: i) scholars arguing against investor-state arbitration on the grounds of “circumvention” of domestic courts may do well to calibrate the debate of the use of remedies as one of added remedial possibilities in complex litigation, ii) those defending investor-state arbitration on the grounds of “de-politicization” of investment disputes may do well to consider the veto power wielded by international adjudicatory bodies that impact the judiciary and political systems of the host country.

WHAT IS “CONSTITUTIONAL EFFICACY”?: CONCEPTUAL OBSTACLES FOR RESEARCH ON THE EFFECTS OF CONSTITUTIONS

Scipedia content — Mon, 15 May 2017 13:08:48 +0200

International support for justice reform: Is it worthwhile?

Scipedia content — Mon, 15 May 2017 13:08:44 +0200

Over the last twenty-five years, a number of justice reform projects funded by international actors have been implemented in Latin America. No less than 2 billion US dollars were disbursed for this purpose. Several questions on this issue are addressed in this article: How does international aid work in the field of justice and what is the rationale used? What is the relationship between and the dynamics of the actors who participate in international aid? What are the results of the funded projects and what limits have been encountered? Has international support for justice reform been worthwhile? The author elaborates on the central argument that international actors underperform their role mainly for two reasons. One, the approach used in the recipient country seriously restricts the proper comprehension of the root causes of the problems country faces. Two, international actors lack serious interest in learning. In the predominant approach, bureaucratic criteria prevail: projects are designed and promoted according to the aid agency’s blueprint, evaluation is usually poor and money is readily available. If in a given country there are no strong national actors, international agencies establish asymmetrical relationships with their counterparts, tend to import recipes that hardly suit the conditions in the country, and impose paths to reform that are difficult for local actors to appropriate. Cooperation agencies have disseminated an ideological construct based on a non-proven causal relationship between justice systems and economic growth as the driving force for reform. International actors could do better were they to develop a capacity for learning, but this goal seems difficult for them to reach.

ANTITRUST IN THE NEW ECONOMY CASE GOOGLE INC. AGAINST ECONOMIC COMPETITION ON WEB

Scipedia content — Mon, 15 May 2017 13:08:39 +0200

The role of China and the brics project

Scipedia content — Mon, 15 May 2017 13:08:34 +0200

BRICS is an exogenous invention that was institutionalized as a convenient geopolitical market strategy, which favored each of the five BRICS countries to a greater or a lesser degree. As such, it is now a political group without deep roots and its future will be conditioned by any dividends it might yield over the coming years as a result of political, economic and social correlations and divergences.

THE BECOMING-OTHER OF LAW: PRELIMINARIES FOR A CITIZEN'S CONCEPTUALIZATION OF LAW

Scipedia content — Mon, 15 May 2017 13:08:30 +0200

THE DIGITAL DIVIDE IN MEXICO: A MIRROR OF POVERTY

Scipedia content — Mon, 15 May 2017 13:08:20 +0200

CRIMINALS AND ENEMIES? THE DRUG TRAFFICKER IN MEXICO'S POLITICAL IMAGINARY

Scipedia content — Mon, 15 May 2017 13:08:15 +0200

A Comparative-Empirical analysis of administrative courts in Mexico

Scipedia content — Mon, 15 May 2017 13:08:10 +0200

The main function of administrative courts in Mexico is to resolve disputes between administrative agencies and citizens. Mexico is a federal system with 31 states and a Federal District. Twenty-nine states and the Federal District have administrative courts of this type. Most of these courts follow the French model of reviewing administrative actions in bodies that do not form part of the regular justice system. However, almost half of the states have deviated from this model and ascribed these administrative courts to the judicial branch. How does this change in the institutional framework influence the way administrative court judges review administrative action disputes? In order to answer this question we analyzed the rulings of judges from the different types of courts empirically. The Mexican federal court structure made this experiment possible because there are both administrative courts incorporated into the judiciary and autonomous courts. We used a database of more than 4, 000 cases from over twenty local administrative courts. We analyzed the influence of the branch to which the court belongs, the procedures of appointment for judges, the length of a judge’s term in office, and the protection of judges’ salaries over their actual decisions. We classified decisions into two broad categories: pro-government decisions and case dismissals. The results point toward evidence that the branch to which the court belongs, the length of a judge’s term in office and governor intervention in the appointment of judges affect judges’ decisions.

Mexicos attempt to extend its continental shelf beyond 200 nautical miles serves as a model for the international community

Scipedia content — Mon, 15 May 2017 13:08:06 +0200

In June 2000, the United States and Mexico signed a treaty for the delimitation of the continental shelf in the western Gulf of Mexico beyond 200 nautical miles. When the treaty was signed, both countries realized that the interpretation and implementation of the treaty depended on the scientific and legal certainty of determinations regarding how far their respective submarine continental shelves extended. On 13 December 2007, Mexico submitted information to the Commission on the Limits of the Continental Shelf regarding the limits of the continental shelf beyond 200 nautical miles from the baselines from which the breadth of the territorial sea is measured in relation to the Western Polygon in the Gulf of Mexico. Mexico sought an extension of its continental shelf in the Western Polygon based on international law, UNCLOS, and bilateral treaties with the United States, in accordance with Mexicos domestic legislation. Peaceful delimitation of maritime borders is essential to maintaining world order. Mexico is a country of peace, and has attempted to use international law as a tool to represent its interests. Mexico has meticulously adhered to a series of international precedents and treaties to support its claim. Moreover, Mexico has gathered significant scientific evidence to verify its sovereign authority over its maritime areas. In the authors opinion, the United States should recognize these claims and show the world that the U.S. stands for fairness, equity and the rule of law.

Migration of responsibility: The trust doctrine and the tohono o’odham nation

Scipedia content — Mon, 15 May 2017 13:08:01 +0200

This article discusses the impact of the influx of migrants from Mexico and Central America on the American Southwest. Specifically, it discusses how Native American tribes of the Southwest, especially the Tohono O’odham Nation, have become a magnet for illegal border crossings due to lax enforcement policies on tribal land. As a result, the tribe has encountered a surge in drug-trafficking, violence, and environmental destruction on its reservation. The article first analyzes the trust doctrine between the Native American tribes and the United States federal government. It concludes with a discussion of the monetary and equitable relief available to the Tohono O’odham Nation in the form of damage awards and increased border protection.

The role of shocks and social pressures in the development of citizenship rights: Great britain and Mexico’s divergent paths

Scipedia content — Mon, 15 May 2017 13:07:56 +0200

Drawing on T.H. Marshall’s classic analysis of how civil, political and social rights evolved in Great Britain, this article follows authors, like Rose and Shin, who used a “social pyramid” to illustrate how the inverted development of such citizenship rights in other nations may weaken liberal democracy. In contrast, I argue that this sequence varies depending on a society’s own unique history, and that no one single path can define the development of liberal democracy. In Mexico, the development of citizenship rights (mainly social, political and civil, following T.H. Marshall’s categorization) was catalyzed by a series of economic and security-related crises that impacted a broad cross-section of Mexican society. The result of these pressures —both from above (organized elites) and below (organized popular groups)— has been greater enforcement of already existing political rights. This major change eventually led to competitive ballot elections (since the late 1990s) which in turn has forced politicians to focus on reshaping social rights (e.g., making their application universal rather than selective). Since President Felipe Calderon’s (2006-2012) “war on drugs, ” there has also been notable legislation —backed by widespread public support— to strengthen civil rights (e.g., 2008 criminal justice reform, 2011 reforms to the amparo and human rights).

Global politics

Scipedia content — Mon, 15 May 2017 13:07:51 +0200

This article is about the great changes that have happened in recent years in international politics as well as the challenges that these thorough transformations imply. Some examples of great significance are the fall of the Berlin Wall (1989), the attack on the New York World Trade Centers twin towers and the Pentagon (2001), and the crash of Wall Street (2008). These are historical events that have had practical and theoretical repercussions for different humanistic disciplines like political science, law and international studies. The authors purpose is to analyze both practically and theoretically the new paradigms of global politics. The impact of globalization on Latin America is given special attention. The author concludes by presenting some alternatives in order to resolve the dilemmas posed by globalization.

Legal challenges of biometric immigration control systems

Scipedia content — Mon, 15 May 2017 13:07:45 +0200

This article analyzes the deployment of biometric systems in immigration control. It argues that public policy for biometric data collection and processing must be based on legal principles and involve the participation of diverse actors, including civil society organizations, industry associations, special privacy advocates and government officials. Such deployments must also involve control mechanisms that help ensure transparency and accountability. Based on a comparative study of biometric immigration control system deployment in four countries (Australia, Mexico, New Zealand and Spain), two types of asymmetries stand out: first, notable differences in the types of information collected, stored, processed, retrieved, updated, analyzed and exchanged, Second, the purposes for which biometric systems are currently used. In the latter case, wide divergence exists in areas for which these systems are employed, such as border control strategies and the use of travel documents, revealing that each nation chooses to use these systems at different points in the immigration process. These asymmetries pose both short and long-term challenges for international cooperation.

Transitional justice, human rights and the restoration of credibility: Reconstructing Mexico’s social fabric

Scipedia content — Mon, 15 May 2017 13:07:40 +0200

Mexico is entering a phase of transitional justice. This can be observed in the numerous reforms and measures that are being taken to adapt the legal system to international standards, particularly those related to human rights and criminal justice. Some examples show an increased tendency to adhere to and enforce the rule of law and human rights, to recognize the official truth of authorized misconduct that took place in the past, to punish perpetrators, and above all, to ensure victims’ rights to truth and reparation. If these tendencies continue, it could potentially lead to the restoration of public trust in the authorities and pave the way for reconciliation between society and the State. While many experiences of traditional transitional justice have taken place in post-authoritarian contexts, the convergence of the main elements used in those traditional cases lead us to suggest that these models could also apply to societies in transition, not from a particular form of government to another, but from a developing democracy into a law-abiding society. In this sense, a bottom-up approach that aims at attaining truth, reform and change will be necessary to break a cycle of impunity and develop social and government institutions that respect and enforce the rule of law and human rights.

The development of the media and the public sphere in Mexico

Scipedia content — Mon, 15 May 2017 13:07:36 +0200

This article reviews the development of the Mexican media, both broadcast and print, through an analysis of their current legal framework, culture, ownership structure and common practices. It is based on archival research, interviews and a review of the available literature. Its analytical framework is based on concepts of the theory of deliberative democracy developed by contemporary philosophers such as Jürgen Habermas, James Bohman, Jane Mans-bridge and Joshua Cohen. Within this framework, it argues that the major obstacles to democracy in Mexico, which include social and economic inequalities, patronage and a weak rule of law, also constitute obstacles to the deliberative development of the Mexican media.

ONE NORM, TWO MODELS. LEGAL ENFORCEMENT OF HUMAN RIGHTS IN MEXICO AND THE UNITED STATES

Scipedia content — Mon, 15 May 2017 13:07:30 +0200

Why has the transition to democracy led the Mexican presidential system to political instability? A proposal to enhance institutional arrangements

Scipedia content — Mon, 15 May 2017 13:07:26 +0200

Over the past two decades, Mexico has gone from an authoritarian regime to an electoral democracy. Although this change is undoubtedly positive, the institutional engineering in place and the balance of power among institutions has led to increased political instability and a latent risk of political paralysis. There is substantial literature asserting that these problems may be connected to the core characteristics of presidential systems, however, I demonstrate that in the Mexican case, it is also due to the electoral rules derived from the reforms of the 1990s and the subsequent electoral results. To substantiate this claim, I present the historical conformation of the presidential, political and electoral systems, as well as the balance of power derived from later system structures and the problems that can trigger instability. Finally, in response to the vast amount of literature that asserts that presidential systems generally shift to a parliamentary or semi-presidential system to perform better, I present an original formula based on relatively simple and feasible political reforms that can enhance the Mexican presidential system and prevent political paralysis.

Massive post-polypectomy hemorrhage: Successful tulip-bundle technique with endoloop for hemostasis

Scipedia content — Mon, 15 May 2017 12:55:06 +0200

Colonoscopic polypectomy is a common procedure for removing colonic polyps to prevent subsequent development of colon cancer. Hemorrhage is the most common complication following polypectomy, with a reported rate of 0.3% to 6.0%. The risk increases to 12.5% when the size of the polyp stalk exceeds 1 cm. The most commonly used endoscopic preventive techniques, such as injection therapy, prophylactic use of endoclip, or endoloop, were found to decrease the rate of post-polypectomy hemorrhage, and repeated use of these techniques is useful for controlling bleeding. Here, we reported a case of a 65-year-old man with refractory post-polypectomy hemorrhage for a 2-cm adenomatous polyp. Application of an endoloop using the tulip-bundle technique achieved successful hemostasis. To our knowledge, this is the first report of this technique being used to treat refractory acute post-polypectomy hemorrhage.

Medical utilization by liver cancer patients under the National Health Insurance program in Taiwan: A population-based cross-sectional study

Scipedia content — Mon, 15 May 2017 12:55:00 +0200

Taiwan implemented a comprehensive and universal National Health Insurance (NHI) program to cover all inhabitants. This study aimed to assess the medical utilization by liver cancer patients under the NHI. This retrospective cross-sectional study used a sampled NHI research database, which contained 1 million beneficiaries. The claims of liver cancer patients in 2009 were analyzed. The other beneficiaries without liver cancer who used medical services in 2009 served as the control patients. Among the 2335 identified liver cancer patients, 2178 (93.3%) patients used outpatient services and 1193 (51.1%) patients used inpatient services. Liver cancer accounted for 1.8% of the NHI’s total cost. The cost per visit was United States dollars (US$)59.30 for outpatient care and US$2070.30 for inpatient care. The annual cost per patient was US$4746.60, US$1951.00 were for outpatient care and US$2795.60 for inpatient care. Patients who were female, in their 60s, had a lower income, and lived in southern Taiwan had a higher cost per patient (p

Pravastatin inhibits tumor growth through elevating the levels of apolipoprotein A1

Scipedia content — Mon, 15 May 2017 12:54:53 +0200

Statins are a class of drugs used to lower cholesterol levels, accompanying increased high-density lipoprotein (HDL) levels. Previous studies have suggested that statins can inhibit inflammation, and also reduce tumor proliferation. We therefore hypothesized that pravastatin, a member of the statins, mediating the inhibitory functions in tumor growth may be associated with the upregulated HDL constituent, apolipoprotein A1 (ApoA1). Pravastatin-induced inhibition in tumor proliferation in vitro and in xenografts was investigated. Reduced ApoA1 expressions were detected in the tumor regions in specimens from tumor patients as well in xenografts using Western Blotting. Moreover, ApoA1 was administered to inhibit tumor proliferation, and pravastatin was given to enhance the chemotherapeutic efficacy of doxorubicin (DOX). We found a significant statistical reduction of ApoA1 in the tumor regions of specimens from gastric cancer and colorectal cancer patients. MKN45 cells proliferation was inhibited by 18% under the growing medium containing pravastatin. ApoA1 levels were elevated in liver Clone 9 cells administered pravastatin, but not in MKN45 cells. In vitro studies revealed that ApoA1 can reduce MKN45 tumor proliferation. Moreover, the tumor volume was significantly reduced in in vivo xenografts after the administration of pravastatin. Combined treatments of pravastatin with DOX significantly minimized the size of tumors, leading to a better therapeutic efficacy. This study demonstrated that pravastatin elevated ApoA1, an HDL major constituent with anti-inflammatory characteristics, which displayed strong adversary associations with tumor developments and growth. Increasing the amounts of ApoA1 by pravastatin coupled with DOX may improve the therapeutic efficacy for cancer treatment.

Reticulocyte production index as a predictor of clinically significant anemia in chronic hepatitis C patients receiving pegylated interferon combination therapy

Scipedia content — Mon, 15 May 2017 12:54:47 +0200

This work was conducted to study the relationship of reticulocyte production index to clinically significant anemia in chronic hepatitis C patients receiving pegylated interferon combination therapy. A total of 69 chronic hepatitis C patients receiving pegylated interferon combination therapy were included. Clinically significant anemia was defined as a hemoglobin level of 60 years [odds ratio (OR), 2.94, 95% confidence interval (CI), 1.09–7.93], pretreatment hemoglobin level

Unexpected and unintentional fish bone ingestion causing acute abdomen and uncommon small intestinal perforation

Scipedia content — Mon, 15 May 2017 12:54:43 +0200

Perforation of the mesenteric small bowel is an uncommon cause of acute abdomen in the emergency department. Early diagnosis is difficult owing to unspecific clinical presentations. The most common causes of perforation are tumor, trauma, Crohns disease, ischemia, and foreign body ingestion. Currently, computed tomography (CT) is often the initial modality used to assess patients with acute abdomen, and the excellent anatomic details it provides, including segmental bowel wall thickening, mesenteric air bubbles, and fatty infiltration, may help the clinician to diagnose earlier and with greater ease. Here, we present a case of acute abdomen diagnosed as small bowel perforation due to unintentional fish bone ingestion using multidetector CT. The multiplanar reconstruction images from multidetector CT helped locate the perforation site before surgical intervention.

The clinical efficacy and safety of EUS-FNA for diagnosis of mediastinal and abdominal solid tumors – A single center experience

Scipedia content — Mon, 15 May 2017 12:54:36 +0200

Many tumors are small and located around the gastrointestinal (GI) tract, and they are difficult to obtain tissue from for pathological diagnosis by the guidance of conventional methods (sonography or computed tomography. The aim of this study was to analyze the efficacy and benefit of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the clinical diagnosis of solid tumors in the mediastinum and abdomen. Data from 233 patients with solid tumors on or around the GI tract were reviewed. They had received successful EUS-FNA without on-site cytopathology study. The lesions were classified according to the anatomic location as pancreatic tumors (Group A, n = 91), mediastinal tumors (including lymph nodes) (Group B, n = 38), abdominal tumors (including lymph nodes) (Group C, n = 49), focal transmural thickening of the GI tract (Group D, n = 6), and submucosal tumors of the GI tract (Group E, n = 49). The accuracies of pathological diagnosis of malignancy were 79.2%, 76.9%, 93.2%, and 80% for Groups A–D, respectively. The overall accuracy for malignancy was 82.9%. For the submucosal tumors of the GI tract in Group E, FNA cytopathology provided evidence of specific diagnosis all were GI stromal tumor in 47% of the cases, 14% were diagnosed as suspicious (most were of a spindle cell tumor nature), and 39% were considered negative of tumor or non-diagnostic. There were three episodes (1.3%) of complication (GI bleeding, n = 1, septic fever, n = 1, gallbladder puncture, n = 1) which occurred among all patients in this study, and all of them were treated appropriately, with no occurrence of life-threatening events. EUS-FNA appears to be a very useful tool for obtaining tissue diagnosis for lesions that are inaccessible by the conventional methods and was shown to be a safe and effective technique in the hands of experienced operators. Pathological diagnosis can be obtained for the guidance of clinical management to avoid the more invasive ways, such as surgery or mediastinal scope.

Young man with chronic anemia

Scipedia content — Mon, 15 May 2017 12:54:30 +0200

Advanced hepatocellular carcinoma treated by a combination of sorafenib and radiotherapy

Scipedia content — Mon, 15 May 2017 12:54:24 +0200

Advanced hepatocellular carcinoma has a poor therapeutic outcome and treatment options are limited. Sorafenib, an orally active multikinase inhibitor, is the only systemic drug that has been shown to provide survival benefits in randomized control studies. However, the gains in survival are modest and new treatment strategies are needed. We report here the case of a patient with advanced hepatocellular carcinoma who had an impressive response to a combination of sorafenib and radiotherapy. The treatment was well tolerated with no unexpected toxicities. Post-treatment imaging showed a satisfactory partial response with regression of the tumor by more than 50%.

Early endoscopic finding of esophageal thermal injury after having spicy hot pot

Scipedia content — Mon, 15 May 2017 12:54:18 +0200

We herein present the case of a woman who had esophageal thermal injury after having a spicy hot pot. The patient came to us with complaints of odynophagia, dysphagia, and burning sensation at the throat and upper chest while eating or drinking for 1 day. An upper endoscopy was conducted 1 day after the onset of symptoms, which showed a linear, disrupted bullae-like lesion with a thin detached membrane. Our report depicts the early endoscopic finding of esophageal thermal injury following the ingestion of hot food. The finding is different from what has been often reported as the “candy-cane” appearance of esophageal injury, which results from the ingestion of hot liquid.

Analysis of ascitic fluid lactoferrin levels in the diagnosis of spontaneous bacterial peritonitis after systemic antibiotic treatment

Scipedia content — Mon, 15 May 2017 12:54:14 +0200

Spontaneous bacterial peritonitis (SBP) is one of the most frequent complications of liver cirrhosis. Ascitic fluid lactoferrin has been proved to be a good diagnostic tool for SBP. However, lactoferrin in ascites may be checked after antibiotic treatment in these patients. Our study aims to assess the utility of ascitic fluid lactoferrin levels for the diagnosis of SBP after antibiotic treatment. Twenty-two ascites samples were collected from patients with cirrhosis. Samples were examined for bacterial culture, lactoferrin concentration, and polymorphonuclear leukocyte count. Clinical symptoms and indications for ascitic paracentesis were obtained from medical records. The diagnosis of SBP was based on an elevated ascitic fluid polymorphonuclear leukocyte count of ≥250 cells/mm3 . Four (18.1%) samples fulfilled the diagnostic criteria for SBP. Three ascites samples showed a positive result for bacterial culture. Patients who received antibiotics for treatment of SBP constituted Group B (n = 9), whereas those who did not receive any antibiotics comprised Group A (n = 9). Lactoferrin concentration was significantly elevated (mean: 261.69 ± 145.5 ng/mL) in the three cases with a positive bacterial culture compared to those without SBP, in both Group A (mean: 19.64 ± 6.32 ng/mL, p = 0.002) and Group B (mean: 23.64 ± 9.53 ng/mL, p = 0.001). After systemic antibiotic treatment, elevated lactoferrin levels in the ascites of cirrhotic patients appear to be a promising predictor for the presence of SBP having positive ascitic bacterial culture.

Multipolar radiofrequency ablation with non-touch technique for hepatocellular carcinoma ≤ 3 cm: A preliminary report

Scipedia content — Mon, 15 May 2017 12:54:09 +0200

Conventional monopolar radiofrequency ablation (RFA) bears the risks of incomplete ablation and tumor seeding. This study aimed to evaluate the effectiveness and safety of multipolar RFA with non-touch technique for hepatocellular carcinoma (HCC) ≤ 3 cm. Fifteen cirrhotic patients (9 men, 6 women, age 51–83 years, mean 64.4 years, Child-Pugh score: A = 10 and B = 5) with 17 HCCs of ≤ 3 cm (mean: 26 mm), which were diagnosed based on typical radiologic findings were enrolled. Two or three Celon Prosurge Bipolar electrodes with 3-cm active tip were deployed with non-touch technique via percutaneous approach under ultrasound guidance. Complete ablation was achieved in all 17 lesions. This is defined as no enhanced part around the ablated index tumors according to dynamic computed tomography or magnetic resonance imaging at least 1 month after ablation. No local tumor progression was detected at follow-up (range, 3–21.5 months, mean, 10 months). No track seeding was observed. There was one distant recurrence 15.4 months after ablation. One patient had procedure-related biliary stricture and died of pneumonia 3.5 months after tumor ablation. Multipolar RFA with non-touch technique is an effective method to achieve complete tumor ablation and an adequate safety margin. This method has low complication rate and bears minimal risk of tumor seeding.

Delayed healing of gastric ulcer is associated with downregulation of connexin 32 in the gastric mucosa

Scipedia content — Mon, 15 May 2017 12:53:59 +0200

Most benign gastric ulcers are healed through suppression of gastric acid by a proton pump inhibitor (PPI). Despite prolonged use of a PPI, some gastric ulcers still do not heal. The primary goal of this study is to investigate the relationship between the expression of connexin 32 (Cx32), a major gap junction protein expressed in the gastric mucosa, and the healing response of gastric ulcers. Patients with endoscopically verified gastric ulcer were treated with a standard dose of PPI for 12 weeks. Histological studies were performed to exclude malignancy. In total, 10 patients having endoscopically verified gastric ulcers with delayed healing at the end of the PPI course were included in this study. The control group consisted of 11 patients with gastric ulcers that healed normally. The expression of Cx32 in the gastric mucosa of the ulcer margin was analyzed by immunoblotting. Patients with gastric ulcer showing delayed healing had significantly reduced Cx32 expression in the gastric mucosa compared with the patients in whom the ulcers healed normally (i.e., controls). Age, sex, presence of duodenal ulcers, location and size of gastric ulcer, ulcer staging, Helicobacter pylori infection, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, smoking, and alcohol consumption were similar in both the control and delayed healing groups. H. pylori infection, use of NSAIDs, smoking, and alcohol consumption all had no significant impacts on the expression of Cx32. Age and expression of Cx32 were not correlated. Downregulation of Cx32 in the gastric mucosa of the ulcer margin may predict delayed healing in patients with gastric ulcer following acid-suppression therapy.

Barretts esophagus and risk of esophageal adenocarcinoma: A retrospective analysis

Scipedia content — Mon, 15 May 2017 12:53:54 +0200

Barretts esophagus (BE) is the most common cause or precursor of esophageal adenocarcinoma (EAC), a condition with a poor prognosis. This study aimed to investigate the clinical characteristics and risk of EAC in patients with BE. From January 2001 to December 2012, a total of 425 patients with histologically proven BE were identified and analyzed retrospectively. Patients' personal data (smoking, alcohol consumption), underlying systemic disease data (diabetes mellitus and hypertension), endoscopic findings (hiatal hernia, peptic ulcer, endoscopically suspected esophageal metaplasia, severity of reflux esophagitis, rapid urease test), and pathological findings (degree of dysplasia, Helicobacter pylori infection) were collected for further analysis. In this retrospective study, 15 patients were diagnosed with EAC. Only one patient was found to have EAC during endoscopic surveillance for BE. The majority of patients (14/15 patients) suffered alarm symptoms and were diagnosed to have BE and EAC concurrently. Meanwhile, EAC is already relatively at an advanced stage. The mean age for diagnosis of EAC in a patient with BE was 67.67 ± 9.92 years old. All patients were male. From a total of 15 patients, 33.3% (5 patients) demonstrated erosive esophagitis under endoscopy and 60% (3 of 5 patients) of these were classified as Los Angeles grade C or D disease. Our study found that BE-associated EAC mostly occurred in older men. In the group with BE-associated EAC, the majority of patients were discovered due to alarm symptoms, at the same time as esophageal adenocarcinoma had already developed. Further prospective study is needed to stratify the risk of disease progression in BE patients.

Evolution of esophageal function testing in achalasia: Linking new technology to treatment outcome

Scipedia content — Mon, 15 May 2017 12:53:50 +0200

A rare presentation of clinically intractable hypertension: Pancreatic paraganglioma

Scipedia content — Mon, 15 May 2017 12:53:45 +0200

Paraganglioma is a rare extra-adrenal pheochromocytoma which originates from chromaffin cells within the ganglia of the sympathetic trunk and of the celiac, renal, suprarenal, and hypogastric plexuses. Pancreatic paragangliomas are rarer still. And even then, paragangliomas are mostly reported to be nonfunctional. We report a case of a 64-year-old woman with underlying disease of hypertension who presented with biliary colic. Contrast-enhanced computer tomography showed an enhancing mass in the uncinate process of the pancreas. Pylorus-sparing Whipple procedure was performed for complete tumor excision. Hypertensive crisis developed after Whipple, which improved after continuous intravenous nicardipine infusion. Pathology revealed a paraganglioma. A 24-h catecholamine urine test showed increased norepinephrine and vanillylmandelic acid level. Functional paraganglioma was diagnosed.

Recurrent abdominal pain after an episode of acute diverticulitis

Scipedia content — Mon, 15 May 2017 12:53:39 +0200

Endoscopic balloon-based radiofrequency ablation for long-segment early esophageal squamous cell neoplasia

Scipedia content — Mon, 15 May 2017 12:53:34 +0200

Esophageal cancer is a common and highly lethal disease. In the Asia-Pacific region, esophageal squamous cell neoplasias are the major forms of the disease. Recent advances in endoscopic therapy enable curative treatment of early esophageal squamous cell neoplasias, however, the technique is complicated and requires a high level of expertise, especially for those with long-segment lesions. Endoscopic radiofrequency ablation is a rapidly evolving treatment modality and has been shown to have good efficacy and safety for the treatment of dysplasia in cases of Barrett’s esophagus. Theoretically, it can also be used to treat squamous dysplasia. We report a case of a 48-year-old man with an 8-cm-long circumferential squamous high-grade dysplasia over the esophagus (from 21 cm to 29 cm below the incisor) that was treated successfully and safely with balloon-based radiofrequency ablation. The procedure took only around 30 minutes to complete. There were no major adverse events during and after the procedure. In addition, we examined the histology of the esophageal coagulum, which showed an extensive cauterization effect with focal dysplasia within the ablated epithelium. Follow-up endoscopy at 1 month, 3 months, and 6 months showed no residual lesion, and biopsies also confirmed complete remission.

Analgesic effect of premedication with meperidine in patients undergoing colonoscopy without sedation

Scipedia content — Mon, 15 May 2017 12:53:30 +0200

Colonoscopy is a standard and useful examination in the diagnosis of colorectal diseases, however, it usually causes pain to patients. Some patients receive narcotic drugs, e.g., meperidine, for pain relief if a colonoscopy is carried out without sedation. Whether the administration of such analgesic drugs to patients without sedation facilitates the performance of the colonoscopy or reduces pain remains to be elucidated. The aim of this study was to evaluate the analgesic effect of meperidine as premedication for patients undergoing a colonoscopy without sedation. A total of 217 patients (109 men, 108 women) undergoing a diagnostic colonoscopy without sedation were analyzed prospectively. The procedures were carried out by three experienced endoscopists in a medical center. The patients could opt to receive analgesic drugs, with 25 mg of meperidine being given intramuscularly prior to the procedure if requested by either the doctor or patient. The colonoscopic examination was performed by one person using the short-axis method. Questionnaires to evaluate abdominal pain during or after colonoscopy without sedation were collected and analyzed for patients who used meperidine as premedication (Group A) and for those who did not receive meperidine (Group B). Abdominal pain was evaluated using a visual analog scale from 0 to 10. The cecal intubation rate, total insertion time, and the patients willingness to receive another colonoscopy in the future if needed were also analyzed. In both groups, the cecal intubation rate was more than 99% with no significant difference between groups. The mean ± standard deviation insertion time was 7.14 ± 5.45 minutes in Group A and 6.24 ± 4.24 minutes in Group B (p = 0.309). The visual analog pain score was 3.54 ± 3.13 in Group A and 2.46 ± 2.75 in Group B (p = 0.009). After adjusting for age and sex, the pain score was 3.51 ± 3.21 in Group A (p = 0.055). Multivariate analysis showed that female sex and the individual endoscopist performing the colonoscopy were associated with abdominal pain during the examination. In our study, premedication with meperidine or no premedication was not associated with a reduction in abdominal pain during colonoscopy without sedation. The insertion time and cecal intubation rate showed no difference between patients with or without additional analgesic drugs prior to the procedure. However, as self-selection bias could not be ruled out, further randomized, placebo-controlled trials are needed to confirm our findings.

Clinical factors associated with the survival of patients with intrahepatic cholangiocarcinoma

Scipedia content — Mon, 15 May 2017 12:53:21 +0200

Intrahepatic cholangiocellular carcinoma (ICC) is an uncommon but lethal cancer. The aim of this study is to assess the factors affecting the survival of ICC patients and to evaluate the benefit of these factors when various therapeutic modalities are used. Between October 2007 and June 2012, 66 ICC cases among 2255 liver cancer patients were identified by pathology and divided into two groups: Group I (surgery group, n = 17) and Group II (nonsurgery group, n = 49). Group II was further divided into Group IIa (those receiving palliative treatment, n = 19) and Group IIb (no treatment received, n = 30). Factors affecting patient survival over the study period were assessed (3- and 6-month results were reported) and therapeutic benefits identified within each of the groups were evaluated. Of the 66 patients identified (male/female = 36/30), 10.6% (7/66) were in the early stages of illness. Overall, the mean patient survival duration was 3.50 ± 0.92 months (1.69–5.31 months). The mean survival duration of Group I patients was 10.50 ± 2.84 months (4.94–16.06 months). The mean survival duration of Group II patients was 3.50 ± 0.65 months (2.24–4.76 months) with Group IIa patients surviving on average 9.50 ± 3.27 months (3.10–15.90 months) and Group IIb patients surviving on average 1.50 ± 0.12 months (1.26–1.74 months). Better survival outcomes were observed in the groups receiving treatment, Group I and Group IIa, than in Group Iib, which did not receive treatment [9.50 ± 1.73 months (6.12–12.89 months) vs. 1.50 ± 0.12 months (1.26–1.74 months), p

IL28B polymorphism and early anemia predict the rapid null response in genotype-1 chronic hepatitis C with dual therapy

Scipedia content — Mon, 15 May 2017 12:53:15 +0200

Rapid null response (rNR), defined as less than one log decline of Hepatitis C virus (HCV-RNA) at Week 4 of treatment with pegylated interferon-α and ribavirin (PegIFN/RBV), is highly correlated with treatment failure in patients with chronic hepatitis C (CHC), genotype-1 (GT-1). In this study, we investigate the possible predictors of rNR. We retrospectively analyzed a cohort of 199 GT-1 CHC naive patients who had been treated with a dual therapy of PegIFN/RBV. Clinical parameters and genotypes of rs12979860, the single nucleotide polymorphisms (SNPs) of interleukin-28B (IL28B ) were analyzed for their relationship with rNR. Of the patients analyzed, 41.7% did not exhibit a rapid virological response (RVR). Only 13.1% of patients who experienced a rNR showed an RVR. The treatment failure rate was 36.2%. High baseline viral load (OR: 5.74, p = 0.028), nonrapid virological response (non-RVR, OR: 4.32, p = 0.004) and rNR (OR: 51.82, p

An unusual polynodular liver disease: Multiple biliary hamartoma

Scipedia content — Mon, 15 May 2017 12:53:08 +0200

We report a 73-year-old male patient who suffered from right upper abdominal dull pain, fever, and chills for 2 days. Gall bladder stones and acute cholecystitis were diagnosed, and parenteral antibiotics were used. The abdominal ultrasonography showed multiple tiny hyperechoic nodules over both lobes of the liver. His computed tomography scan revealed low-density lesions without contrast enhancement. Magnetic resonance imaging and magnetic resonance cholangiopancreatography further revealed lesions that were hypointense on T1-weighted images and hyperintense on T2-weighted images. Laparoscopic cholecystectomy and liver biopsy were performed, and biliary hamartoma was diagnosed based on the pathology. This report describes an unusual case of multiple biliary hamartomas and reviews the literature regarding the incidence, pathogenesis, and diagnosis of this disease.

Younger age and female sex predict a better therapeutic response in HBeAg-positive chronic hepatitis B patients to entecavir therapy

Scipedia content — Mon, 15 May 2017 12:53:03 +0200

Clinical trials and real-world data confirm the efficacy of entecavir treatment for chronic hepatitis B (CHB), however, the factors associated with a favorable response remain unknown. In a retrospective multicenter study, 132 treatment-naïve hepatitis B e antigen (HBeAg)-positive CHB patients (71% male, median age, 40.2 years) received entecavir therapy for >2 years. At baseline, 15% of these patients had cirrhosis. The primary endpoint was HBeAg loss at 2 years of entecavir treatment. The rates of serum alanine aminotransferase (ALT) normalization at treatment Year 1 and Year 2 were 86% and 88%, respectively. The cumulative rate of HBeAg loss at treatment Year 1 and Year 2 were 17% and 33.3%, respectively. The rates of undetectable levels of serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) at treatment Year 1 and Year 2 were 64% and 80.8%, respectively. In univariate analysis, HBeAg loss at 2 years was associated with a young age (≤35 years, p = 0.007) and a high baseline ALT level (p 5 times the upper limit of normal (ULN)] showed that a young age (odds ratio, 2.66, 95% confidence interval, 1.2–5.92) and male sex (odds ratio, 0.36, 95% confidence interval, 0.16–0.83) were independent factors associated with HBeAg loss at 2 years of therapy. Two-year entecavir therapy has good biochemical and virologic responses, however, the rate of HBeAg loss is modest in HBeAg-positive CHB patients. A young age (i.e., ≤35 years) and female sex were also associated with a better serologic response.

Pseudomelanosis duodeni in a female adult with chronic renal failure

Scipedia content — Mon, 15 May 2017 12:52:57 +0200

Pseudomelanosis duodeni is a rare endoscopic finding that manifests as dark speckled spots in the duodenum. It is considered a benign condition and is associated with certain diseases and the use of certain medications. This study reports a case of a 74-year-old woman, with end-stage renal disease under maintenance hemodialysis, hypertension under regular medical control, iron deficiency anemia under oral iron supplement, and progressive anemia with suspicious occult gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed multiple tiny brownish-black pigmentation throughout the proximal second portion of the duodenum. The histopathological examination showed pigment-laden macrophages with positive iron stain and negative melanin stain in the lamina propria of the mucosal villi.

Ileal ulcers in a patient with Henoch-Schönlein purpura

Scipedia content — Mon, 15 May 2017 12:52:51 +0200

Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized by a classic tetrad of nonthrombocytopenic palpable purpura, arthritis, gastrointestinal, and renal involvement. The most common gastrointestinal complaint is abdominal pain. The characteristic endoscopic findings are ulcers seen in the second portion of the duodenum. We present the case of a 45-year-old man suffering from abdominal pain. Erythematous purpura over bilateral lower extremities and soreness of the joints developed 3 days before abdominal pain. An abdominal computed tomography showed an edematous change of the intestinal wall and the distal part of the ileum. A retrograde single balloon enteroscopy revealed several discrete ulcers and hyperemic mucosa in the distal ileum. The middle, proximal, and terminal ileum and ileocecal valve to the rectum were not affected. Under the impression of HSP, nonsteroidal anti-inflammatory drugs and prednisolone were administered. We concluded that balloon-assisted enteroscopy is helpful for differential diagnosis of small bowel lesions in adult patients with HSP.

Intraobserver and interobserver agreement for identifying extraluminal manifestations of Crohns disease with magnetic resonance enterography

Scipedia content — Mon, 15 May 2017 12:52:44 +0200

Magnetic resonance (MR) enterography has emerged as a new imaging modality in evaluating patients with Crohns disease. However, whether interpretations of MR enterography findings are consistent among radiologists has not yet been fully investigated. The purpose of this study is to evaluate the intraobserver and interobserver agreement for identifying extraluminal manifestations of Crohns disease with MR enterography. MR enterography was performed with a 3-tesla system. We retrospectively enrolled patients with Crohns disease that had MR enterography between November 2011 and March 2013. Three radiologists reviewed the images independently. Extraluminal findings of these patients were recorded and described. Intraobserver and interobserver agreement were calculated using the kappa statistic. A total of 22 sessions of MR enterography were performed on 15 patients (12 men and 3 women) with Crohns disease. The mean age was 38.7 ± 11.4 years. We identified extraluminal manifestations such as engorged vasa recta, enlarged mesenteric lymph nodes, fibrofatty proliferation, fistulas, and abscesses. In addition, avascular necrosis of the femoral head as a complication of long-term steroid treatment was also depicted. The intraobserver agreement was almost perfect (κ = 0.83, p

Gastroprotective effect of bezafibrate, a peroxisome proliferator activated receptor α agonist and its mechanism in a rat model of aspirin-induced gastric ulcer

Scipedia content — Mon, 15 May 2017 12:52:38 +0200

The aim of the present study was to demonstrate the antiulcer activity and mechanism of bezafibrate in a rat model of aspirin-induced gastric ulcer. We used an aspirin-induced gastric ulcer model. Bezafibrate was administered orally in graded doses (10 mg/kg, 25 mg/kg, 50 mg/kg, 100 mg/kg, and 200 mg/kg) to detect the best effective antiulcer dose of bezafibrate. The parameters measured were: ulcer index, histopathological scoring of gastric ulcer, gastric juice analysis, gastric mucosal lipid peroxidation parameters, estimation of NO metabolite in blood, mRNA expression of inducible NO synthase iNOS and constitutive NO synthase (cNOS) in gastric mucosa, and gastric mucosal DNA fragmentation. The dose-dependent antiulcer activity of bezafibrate was shown by the ulcer index and histopathological score. Bezafibrate (100 mg/kg) significantly reduced total acidity, free acidity, and pepsin activity, and increased total hexoses and total proteins. Bezafibrate (100 mg/kg) also significantly reduced lipid peroxidation, inhibited iNOS expression, preserved cNOS expression, and inhibited DNA fragmentation. Bezafibrate can decrease aspirin-induced gastric mucosal injury via reducing lipid peroxidation, inhibiting iNOS expression, preserving cNOS expression, and decreasing DNA fragmentation.

Liver cirrhosis as a predisposing factor for esophageal candidiasis

Scipedia content — Mon, 15 May 2017 12:52:33 +0200

Esophageal candidiasis (EC) often occurs in human immunodeficiency virus (HIV)-infected patients, but is uncommon in non-HIV-infected patients. It is known that malignancy, diabetes mellitus, previous gastric surgery, and medications (antibiotics, proton pump inhibitors, and steroids) are risk factors for esophageal candidiasis in non-HIV-infected patients. However, the relationship between liver cirrhosis and esophageal candidiasis was unclear. This study aimed to elucidate the role of liver cirrhosis in esophageal candidiasis. A retrospective chart review study was conducted on non-HIV-infected patients with esophageal candidiasis who presented to Tri-Service General Hospital from January 2009 to December 2012. The diagnosis of EC was primarily based on endoscopic findings. The incidence of EC in cirrhotic and noncirrhotic patients was compared. Furthermore, differences in baseline characteristics, clinical variables, and mortality after antifungal treatment between the two groups were analyzed. In this study, 43, 217 non-HIV-infected patients were enrolled, 3017 of whom had liver cirrhosis. The incidence of EC in cirrhotic patients was higher than that in noncirrhotic patients (0.8% vs. 0.36%, relative risk = 2.2, p

Immunoglobulin G4-related disease presenting with obstructive jaundice

Scipedia content — Mon, 15 May 2017 12:52:27 +0200

A 48-year-old male presented with diffuse abdominal fullness for 1 month and tea-colored urine for 10 days. Abdominal computed tomography/magnetic resonance cholangiopancreatography revealed diffuse enlargement of the pancreas and unusual soft tissue density around the left ureter. Endoscopic retrograde cholangiopancreatography demonstrated lumen narrowing of the distal common bile duct and irregularity of the pancreatic duct. Markedly elevated serum immunoglobulin G4 (IgG4) was also noted. Biopsy of soft tissue from the area surrounding the left ureter identified lymphoplasmacytic infiltration with high concentrations of IgG4-positive plasma cells accompanied by obliterative phlebitis, compatible with IgG4-related disease. The patient was administered steroid therapy and his symptoms improved. Clinicians should be aware of possible IgG4-related disease in a patient presenting with obstructive jaundice and diffuse pancreatic enlargement because glucocorticoid administration can achieve good response.

Bile aspiration enhances the diagnostic accuracy of Clonorchis sinensis : A case report

Scipedia content — Mon, 15 May 2017 12:52:21 +0200

Clonorchis sinensis is endemic to Southeast Asia, Japan, China, and Taiwan. Those infected often have a history of consumption of raw fresh fish. Its manifestations can be asymptomatic of cholangitis, biliary stones, or cholangiocarcinoma. A 69-year-old male living in Chishan, Taiwan visited our hospital with obstructive jaundice. Noninvasive analyses, such as stool examination, abdominal ultrasound, and an abdominal computed tomography scan did not reveal clues of clonorchiasis. As the obstructive jaundice was unexplained, endoscopic retrograde cholangiopancreatography (ERCP) was then performed and a hepatic fluke was seen via aspiration of bile. Subsequently, the ova of C. sinensis were detected via microscopic examination of bile samples. Bile aspiration is not routine during an ERCP procedure, however, we suggest the bile aspiration can be diagnostically accurate for clonorchiasis, especially for patients with a suspicious infection.

Refractory gastric variceal bleeding secondary to splenic vein occlusion associated with abdominal lymphadenopathy

Scipedia content — Mon, 15 May 2017 12:52:15 +0200

Splenic vein occlusion caused by abdominal lymphadenopathy is rare. We herein present the case of a 80-year-old man with refractory isolated gastric variceal bleeding in the absence of pancreatic or liver disease. Left-sided portal hypertension was confirmed by angiography, and para-aortic lymphadenopathy compressing the splenic vein was identified by serial abdominal computed tomography. Endoscopic sclerosing therapy failed to treat the recurring gastric variceal hemorrhage. Therefore, splenectomy was suggested and the patient was successfully treated. The patient had been variceal bleeding free for 12 months since the surgery. In patients with isolated gastric varices but without advanced liver disease, a variety of diagnostic techniques should be attempted to elucidate the nature of portal hypertension, and left-sided portal hypertension should be suspected. For those cases in which endoscopic treatment failed to treat refractory gastric variceal bleeding, splenectomy can be an effective option.

A man with abdominal fullness

Scipedia content — Mon, 15 May 2017 12:52:09 +0200

Risk factors for 1-year mortality in patients with intermediate-stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization

Scipedia content — Mon, 15 May 2017 12:52:04 +0200

Transcatheter arterial chemoembolization (TACE) is a main therapy for patients with intermediate-stage hepatocellular carcinoma (HCC). The purpose of our study was to determine the risk factors for 1-year mortality in patients treated solely with TACE. A total of 123 patients with intermediate-stage HCC treated solely with TACE were recruited from Ren-ai Branch, Taipei City hospital during the period from January 1998 to June 2013. Baseline characteristics and factors associated with 1-year mortality were analyzed. There were 94 men (76.4%) and 29 women (23.6%) among 123 newly diagnosed intermediate-stage HCC patients treated solely with TACE. The mean age was 63 ± 11 years (range, 31–92 years). The 1–5-year overall cumulative survival rates were 65.9%, 46%, 33.2%, 22%, and 18.4% [median: 23 months, 95% confidence interval (CI): 16.4–29.6 months], respectively. Of these, 42 (34.1%) and 81 (65.9%) patients had survival time shorter (Group 1) and longer (Group 2) than 1 year, respectively. There were no significant differences in sex, age, hepatitis B virus/hepatitis C virus positive rate and tumor number between Group 1 and Group 2 patients. Compared to Group 2, Group 1 patients had a significantly larger mean maximum tumor size (6.8 ± 3.2 cm vs. 5.3 ± 3.1 cm, p = 0.024), lower serum albumin level (3.4 ± 0.45 g/dL vs. 3.6 ± 0.46 g/dL, p = 0.011), higher serum bilirubin level (1.52 ± 1.07 mg/dL vs. 1.07 ± 0.59 mg/dL, p = 0.023), higher ratio of serum alpha-fetoprotein (AFP) > 400 ng/mL (52.4% vs. 24.7%, p = 0.003), and higher ratio of Child-Turcotte-Pugh (CTP) class B cirrhosis (26.2% vs. 6.2%, p = 0.003). Multivariate analysis revealed that AFP level > 400 ng/mL [hazard ratio (HR): 2.663, 95% CI: 1.143–6.205, p = 0.023], CTP class B cirrhosis (HR: 4.69, 95% CI: 1.399–15.715, p = 0.012) and tumor size (HR: 1.153 for each 1 cm increase, 95% CI: 1.015–1.310, p = 0.029) were independently associated with 1-year mortality. One-year mortality in patients with intermediate-stage HCC treated solely with TACE is not uncommon. High serum AFP level (> 400 ng/mL), CTP class B cirrhosis, and tumor size are independent risk factors for 1-year mortality in those patients.

Clinical and endoscopic features of gastric pyogenic granuloma

Scipedia content — Mon, 15 May 2017 12:51:58 +0200

Pyogenic granuloma (PG) is a polypoid form of capillary hemangioma. This study aimed to analyze the clinical and endoscopic features of gastric PG. We retrospectively reviewed nine patients with gastric PGs who were evaluated by esophagogastroduodenoscopy and diagnosed by pathological study at the Chang Gung Medical Center (Taoyuan, Taiwan) between 2000 and 2009. Demographic data, clinical presentations, endoscopic findings, treatment, and outcome were collected and analyzed. The median age of the study patients was 62 years (range, 40–73 years) with a female preponderance. The most common symptom at presentation was overt gastrointestinal bleeding, followed by anemia and epigastralgia. Two patients were asymptomatic at diagnosis. The most common underlying diseases were liver cirrhosis [5 (56%) patients] and hypertension [5 (56%) patients]. Five (56%) cases of gastric PGs originated at the site of prior ulcer lesions. Most gastric PGs were solitary [7 (78%) patients] and located in the antrum [8 (89%) patients]. The gastric PGs typically appeared morphologically as smooth protruding hyperemic lesions with adherent white or yellow deposits. One patient received an endoscopic mucosal resection with complete excision of the lesion. Another patient received surgical intervention. Four gastric PG lesions were stationary or regressed with conservative management. Overt gastrointestinal bleeding was the most common clinical presentation in patients with gastric PG. Gastric ulcers were the most common precursors of PG with the antrum being the most frequent site involved. Gastric PGs were characteristically protruding hyperemic lesions with adherent exudates. Conservative treatment may be considered for asymptomatic PG patients with major comorbidities. Endoscopic resection may be offered to patients with symptoms.

A man with progressive abdominal distension

Scipedia content — Mon, 15 May 2017 12:51:53 +0200

Gallbladder perforation in cholecystitis with liver abscess formation and septic thrombophlebitis of portal vein mimicking presentation of liver malignancy

Scipedia content — Mon, 15 May 2017 12:51:47 +0200

Gallbladder perforation is a rare complication of cholecystitis. Similarly, septic thrombophlebitis of the portal vein, also called pylephlebitis, is another rare complication of intra-abdominal infections including cholecystitis. Both gallbladder perforation and pylephlebitis are associated with significantly higher morbidity and mortality. Herein, we report a patient with an atypical presentation of gallbladder perforation and liver abscess formation. A 68-year-old man suffered from malaise, poor appetite, and body weight loss for 1 month. Liver mass lesion and portal vein thrombosis were detected by ultrasound at a local clinic. He was referred to our institution under the tentative diagnosis of hepatocellular carcinoma. He underwent abdominal ultrasound and computed tomography examinations at our hospital. Cholecystitis with gallbladder perforation was highly suspected. Broad-spectrum antibiotics were administered immediately. Percutaneous transhepatic gallbladder drainage was performed in this case, and pigtail drainage for liver abscess was done later. The patients condition—cholecystitis, liver abscess, and pylephlebitis (followed by ultrasound)—improved after treatment. Furthermore, the patient recovered his appetite and his body weight increased.

Severe diarrhea caused by cytomegalovirus in an elderly man

Scipedia content — Mon, 15 May 2017 12:51:42 +0200

Modified endoscopic mucosal resection of gastric heterotopic pancreas: Report of two cases

Scipedia content — Mon, 15 May 2017 12:51:36 +0200

Heterotopic pancreas is a congenital anomaly characterized by the presence of ectopic pancreatic tissue far from the pancreas. The treatment of heterotopic pancreas may include expectant observation, endoscopic resection, or surgery. The aim of this study was to describe the technique of cap-assisted endoscopic mucosal resection for the management of heterotopic pancreas of the stomach. Two patients, a 41-year-old woman and a 31-year-old man, were referred to us for the management of gastric subepithelial lesions. Endoscopic ultrasound was used in the female patient to disclose two small hypoechoic lesions arising from the submucosal layer. Cap-assisted endoscopic mucosal resection was performed in both patients without complications. Histopathological examination of the resected specimens showed heterotopic pancreatic tissue in the submucosal layer. Our technique is a suction, snaring, and cut method. This method does not need a special cap with a shallow circumferential lip on the inside and the snare does not need to be pre-looped. This technique allowed a histopathological confirmation of the suspected diagnosis in both patients.

Assessment of esophageal motor function using combined multichannel intraluminal impedance and manometry in patients with achalasia

Scipedia content — Mon, 15 May 2017 12:51:29 +0200

Achalasia is characterized by esophageal aperistalsis and a failure of lower esophageal sphincter (LES) relaxation. Combined multichannel intraluminal impedance and manometry (MII-EM) allows the simultaneous recording of esophageal peristalsis and bolus transport patterns. The aim of this study was to evaluate the feasibility of MII-EM for the assessment of esophageal motility and to characterize patterns of esophageal bolus transport in patients with achalasia with or without Heller myotomy. A total of nine patients (2 men and 7 women, age range 25–46 years) were enrolled in this study. Two of the patients had previously undergone Heller myotomy. All patients underwent combined MII-EM with a nine-channel esophageal function testing catheter containing four impedance measuring segments and five solid-state pressure transducers. Each patient received 10 liquid and 10 viscous swallows in a sitting position. All tracings were recorded and analyzed for esophageal contractions and bolus transit. None of the patients with achalasia, whether they had undergone a Heller myotomy or not, had manometrically normal esophageal peristalsis during saline or viscous swallowing. They had a normal LES resting pressure, incomplete LES relaxation, and lower distal esophageal contraction. The LES relaxation percentages in the patients who had undergone Heller myotomy (97% and 51%) were higher than those of the untreated patients (mean 47%). All patients demonstrated a low baseline impedance level in the distal esophagus. Air trapping in the proximal esophagus was also detected in nearly all of the patients. None of the patients in either group had complete bolus transit with either saline or viscous swallows. Patients with achalasia are characterized by poor esophageal contraction and absent esophageal bolus clearance and such abnormalities are still noticeable after Heller myotomy. Although combined MII-EM can provide additional information regarding esophageal bolus transit, a low baseline impedance level and air trapping in the proximal esophagus may limit its utility in the diagnosis of esophageal dysmotility in patients with achalasia.

A case of massive lower gastrointestinal bleeding from a rectal Dieulafoy lesion

Scipedia content — Mon, 15 May 2017 12:51:24 +0200

A Dieulafoy lesion is an uncommon and sometimes life-threatening cause of gastrointestinal hemorrhage. Typically, it presents as a tiny mucosal defect with an exposed protruding artery with normal surrounding mucosa. An 84-year-old woman developed sudden massive hematochezia and had an unstable hemodynamic status. The source of bleeding was found to be an exposed vessel in the rectum without surrounding ulceration. The patient was treated successfully with an epinephrine injection given endoscopically, followed by hemostatic clipping.

Serum hepatitis B surface antigen level might predict cirrhosis and hepatocellular carcinoma in older patients with chronic hepatitis B

Scipedia content — Mon, 15 May 2017 12:51:19 +0200

Distinguishing inactive hepatitis B surface antigen (HBsAg) carriers from hepatitis B e antigen-negative hepatitis remains difficult but is important because patients with active hepatitis may develop severe complications. Long-term follow-up data with stringent criteria are required for the identification of inactive HBsAg carriers. A single serum HBsAg level may be used to solve this difficult diagnostic issue, however, very few studies on its application in older patients have been published. This study was designed to evaluate the clinical significance of a single serum HBsAg level in older patients with chronic hepatitis B (CHB). From January 2012 to December 2012, the clinical manifestations of 1749 HBsAg-positive patients were analyzed including 412 patients aged ≥ 60 years (mean age at enrollment, 68.6 ± 6.9 years, range, 60–90 years, 262 males and 150 females). We investigated the possibility of using a single serum HBsAg level to predict cirrhosis and hepatocellular carcinoma (HCC) in older patients with CHB. Of the 1749 HBsAg-positive patients, those aged ≥ 60 years tended to have lower serum HBsAg levels than the younger patients. In fact, all patients aged ≥ 60 years had a serum HBsAg level ≤ 10, 000 IU/mL. Of the 412 patients aged ≥ 60 years, 122 (29.6%) had cirrhosis and 59 (14.3%) developed HCC. When an HBsAg-titer

A young female with alternating diarrhea and constipation

Scipedia content — Mon, 15 May 2017 12:51:14 +0200

Outcome for self-expandable metal stents in patients with malignant gastroduodenal obstruction: A single center experience

Scipedia content — Mon, 15 May 2017 12:51:08 +0200

Malignant gastric outlet obstruction causes significant malnutrition and morbidity. The implantation of a metallic stent is an alternative palliative treatment to allow the intake of food in these patients. Thirty-eight consecutive patients with malignant gastric outlet obstruction who had received an uncovered metallic stent placement in our department from April 2010 to April 2012 were enrolled for analysis. The mean follow-up time was 6.3 months. Food intake, measured by the Gastric Outlet Obstruction Scoring System, complications, duration of stent patency, and survival were evaluated. The technical and clinical success rates of the procedure were 100% and 94.7%, respectively. The Gastric Outlet Obstruction Scoring System scores were significantly improved at 1 day, 7 days, and 30 days after the implantation compared with those prior to the procedure (p

Comparison of the efficacy of esomeprazole and famotidine against stress ulcers in a neurosurgical intensive care unit

Scipedia content — Mon, 15 May 2017 12:51:03 +0200

To compare the efficacy of esomeprazole and famotidine against stress ulcers and the association of these prophylactic agents with ventilator-associated pneumonia in patients admitted to neurosurgical intensive care unit (ICU). Sixty patients were randomly allocated into two groups (the esomeprazole and famotidine groups, n = 30 each) to receive prophylaxis medication for 7 days within 24 hours of admission in a neurosurgical ICU. Patients in the esomeprazole group received esomeprazole (40 mg) dissolved in water once a day through a nasogastric tube, whereas patients in the famotidine group received an intravenous infusion of famotidine (20 mg) every 12 hours. We then compared the occurrence of overt upper gastrointestinal bleeding and ventilator-associated pneumonia between these two groups. One patient in the famotidine group had overt upper gastrointestinal bleeding (3.3%), whereas the bleeding was not observed in patients in the esomeprazole group. Ventilator-associated pneumonia occurred in one patient (3.3%) from each group. One patient died within 30 days (3.3%) in the esomeprazole group and three patients (10%) died in the famotidine group. There was no difference in the occurrence of overt upper gastrointestinal bleeding (p = 1.000), ventilator-associated pneumonia (p = 1.000), and 30-day mortality (p = 0.612) between these two groups. In this small-scale study, the effect of administration of esomeprazole through a nasogastric tube on stress ulcer was similar to that of intravenous famotidine infusion in neurosurgical ICU patients. In addition, the association between prevalence of ventilator-associated pneumonia and administration of esomeprazole was also similar to that observed with famotidine infusion.

Acute hepatitis with nontyphoidal salmonella and hepatitis E virus coinfection

Scipedia content — Mon, 15 May 2017 12:50:59 +0200

A 65-year-old Taiwanese man presented with dark urine for 5 days before admission to hospital and with fever on the 2nd day of admission to hospital. Laboratory studies showed acute hepatitis with hyperbilirubinemia. Acute hepatitis with nontyphoidal salmonella and hepatitis E virus coinfection was diagnosed. The fever subsided after treatment with ceftriaxone and cefepime. His serum bilirubin reached its peak value on the 3rd week after admission to hospital and then gradually returned to the normal range. To the best of our knowledge, acute hepatitis E coinfection with nontyphoidal salmonella has not been reported previously.

Risk factors of incomplete response to proton pump inhibitor therapy in patients with mild erosive esophagitis

Scipedia content — Mon, 15 May 2017 12:50:54 +0200

Incomplete symptom resolution to proton pump inhibitor (PPI) therapy is a common problem in the treatment of gastroesophageal reflux disease (GERD). The aims of this study were (1) to examine the rate of incomplete symptom response following 8-week PPI therapy in patients with mild erosive esophagitis (Los Angeles Grade A/B erosive esophagitis) and (2) to determine the independent factors predicting incomplete symptom response in patients with mild erosive esophagitis. From January 2010 to July 2012, symptomatic GERD patients with endoscopic findings of Los Angeles Grade A or B erosive esophagitis were recruited for the study and received esomeprazole 40 mg daily for 8 weeks. The characteristics of eligible patients including clinical factors, endoscopic findings, Helicobacter pylori status, and CYP2C19 (cytochrome P450 2C19) genotype were checked on enrollment. Patients were asked to record symptoms with diary cards during the follow-up period. The major outcome measurement was incomplete symptom response. In total, 232 patients (male/female, 126/106) participated in this study. Following 8-week esomeprazole therapy, 50 (21.6%) of the patients had incomplete symptom response. Univariate analysis showed that sex, alcohol consumption, underlying diseases, regurgitation of food, chest pain, globus, and insomnia were associated with incomplete symptom response (p = 0.049, p = 0.006, p = 0.023, p = 0.010, p = 0.013, p = 0.009, and p

Different schedules of bowel preparation with sodium phosphate lead to different bowel cleansing effects and adenoma detection rates at colonoscopy

Scipedia content — Mon, 15 May 2017 12:50:47 +0200

Adequate bowel preparation is an important quality indicator of colonoscopy. This study validated whether the bowel cleansing quality and adenoma detection rate (ADR) could be different between two bowel preparation schedules in individuals receiving health examinations. We enrolled individuals who had received a colonoscopy as part of the regimen for their health checkup program with split-dose phosphosoda for bowel preparation. Prior to December 31, 2012, the second dose of phosphosoda was administered at 10:00 pm before the day of the colonoscopy and the individuals were defined as the 10-pm group. After January 1, 2013, the schedule was changed to 4:00 am the same day as the colonoscopy and was defined as the 4-am group. The bowel cleansing quality was assessed using the Aronchick scale. A total of 431 individuals were included, 259 in the 10-pm group and 172 in the 4-am group. The 4-am group individuals had a higher rate of excellent or good bowel cleansing quality as compared with the 10-PM group (77.3% vs. 22%, respectively, p

Ectopic sebaceous gland in the esophagus—Case reports and review of the literature

Scipedia content — Mon, 15 May 2017 12:50:40 +0200

Ectopic sebaceous glands (ESGs) are benign esophageal lesions that have a lower detection rate than malignant lesions because most patients are asymptomatic. However, this rate can be increased by the widespread use of endoscopes and an increasing awareness of the disease. Through esophagogastroduodenoscopy, ESGs often appear in the middle and lower esophagus in numbers ranging from 1 to more than 100 yellowish plaques measuring 1–2 mm in diameter. Histopathological examination of ESGs would reveal small lobular cluster glands in the lamina propria. Diagnosis is usually confirmed through an endoscopic biopsy. ESGs are best distinguished from other yellowish lesions such as xanthoma via endoscopy. These lesions tend to appear singly scattered, whereas xanthomas tend to be clustered. We present three cases of ESGs in the esophagus. Although their etiologies are still unclear, we present related theories in our review.

Giant colonic lipoma arising from the ileocecal valve and causing cecal-transverse colonic intussusception

Scipedia content — Mon, 15 May 2017 12:50:34 +0200

Intussusception is rare in adults, representing only 1% of bowel obstruction and 5% of all intussusceptions. Previous reports have shown that > 90% of adults diagnosed with intussusception had an identifiable pathological leading point—a malignant tumor in 43–63% of the cases. Colonic lipomas are rare nonepithelial neoplasms, but represent the most common benign tumors in the large intestine. Most colonic lipomas present as submucosal, sessile polypoid masses with intact mucosa, and they rarely produce symptoms when 4 cm in diameter. As the clinical presentations of adult intussusception are not pathognomonic and the image study may not provide a typical presentation, a precise preoperative diagnosis of whether a benign or malignant tumor is causing the colon intussusception can be difficult. Here, we report the case of a 50-year-old man who presented with abdominal pain and lower gastrointestinal bleeding and was diagnosed postoperatively with ileocecal valve lipoma with cecal-transverse colon intussusception. This report emphasizes colonic lipomas > 4 cm in diameter should receive surgical resection before intussusception develops. However, if the nature of the tumor causing colon intussusception cannot be identified before the operation, en bloc resection is recommended as there is a high risk of malignancy spreading.

Primary duodenal Burkitt lymphoma presenting as sessile, button-like bleeding polyps

Scipedia content — Mon, 15 May 2017 12:50:29 +0200

Primary gastrointestinal (GI) lymphoma accounts for 30–50% of all extranodal non-Hodgkin’s lymphomas, making the GI tract the most common site of extranodal non-Hodgkin’s lymphomas. Most GI lymphomas belong to the B cell lineage. Burkitt lymphoma (BL) is a highly aggressive mature B cell neoplasm that occurs in three forms: endemic, sporadic, and immunodeficiency-associated. Sporadic BL accounts for 1–2% of all adult lymphomas and usually presents as an abdominal manifestation of extranodal disease involving the distal ileum or cecum. Primary BL of the duodenum is rare. However, this report emphasizes the importance of awareness of the malignancy potential of duodenal polyps. We report the case of a 70-year-old woman admitted to our ward with upper GI bleeding due to duodenal polyps. An upper GI endoscopic examination showed button-like polyps with central depression, and an immunohistochemical study of the polyps revealed a high-grade B cell malignancy (BL). Consequently, the patient was treated with aggressive chemotherapy. The tumors regressed after chemotherapy. Although primary duodenal Burkitt lymphoma is very rare, the possibility of malignancy should be considered if a patient presents with duodenal button-like polyps with a central depressed surface.

Establishing a risk scoring system for predicting erosive esophagitis

Scipedia content — Mon, 15 May 2017 12:50:23 +0200

This study aims to establish a noninvasive scoring system to predict the risk of erosive esophagitis (EE). From 2002 to 2009, a total of 34, 346 consecutive adults who underwent health check-ups and upper gastrointestinal endoscopy were retrospectively enrolled. Of the participants, 22, 892 in the earlier two-thirds period of examination were defined as the training set and the remaining 11, 454 as the validation set. EE was diagnosed by upper gastrointestinal endoscopy. Independent risk factors associated with EE were analyzed by multivariate analysis using a logistic regression model with the forward stepwise selection procedure in the training set. Subsequently, an EE risk scoring system was established and weighted by β coefficient. This risk scoring system was further validated in the validation set. In the training set, older age, male gender, higher body mass index, higher waist circumference, higher serum triglyceride, and lower high-density lipid cholesterol levels were independent risk factors for predicting EE. According to the β coefficient value of each independent risk factor, the total score ranging from 0 to 10 was established, and then low- (0–3), moderate- (4–6), and high-risk (7–10) groups were identified. In the validation set, the prevalence rates of EE in the low-, moderate-, and high-risk groups were 5.15%, 15.76% and 26.11%, respectively (p

Altered anorectal function in rotating shift workers: Association with autonomic dysfunction and sleep disturbance

Scipedia content — Mon, 15 May 2017 12:50:16 +0200

We aimed to investigate whether disruption of the circadian rhythm in rotating shift work (RSW) workers would change anorectal motility and cardiac autonomic function. We also determined whether sleep and psychological status (e.g., anxiety and depression) would affect anorectal motility in RSW workers. Sixteen RSW workers and 11 control individuals were involved in the study. All study participants underwent anorectal manometry and spectral analysis of heart rate variability. All participants completed three questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) questionnaire, and the Taiwanese Depression Questionnaire (TDQ). The RSW workers had a lower threshold volume for maximal urge (p = 0.006) and greater rectal compliance (p = 0.02), compared to the controls. The RSW workers had a greater PSQI score (p = 0.002) and TDQ score (p = 0.003), compared to the controls. The RSW workers had a significantly increased low-frequency power percentage (LF%), compared to the controls (p = 0.03). The RSW workers had a significant correlation between the resting anal sphincter pressure and high-frequency power percentage (HF%, r = –0.62, p = 0.01), and between the R-R interval and the threshold for maximal urge (r = 0.51, p = 0.04). The PSQI score was significantly correlated with the threshold volume for urge (r = 0.55, p = 0.03) and for compliance (r = 0.51, p = 0.04) in the RSW workers. Rotating shift workers have anorectal dysmotility and cardiac sympathetic hyperactivity. Anorectal dysmotility in RSW workers has a close relationship with cardiac autonomic dysfunction, sleep disturbance, and depression, but not with anxiety.

Oral sodium phosphate for bowel preparation in endoscopic submucosal dissection training in a pig model: A pilot study

Scipedia content — Mon, 15 May 2017 12:50:11 +0200

The technical complexity of endoscopic submucosal dissection (ESD) demands adequate training to lower the surgical risks. The diameter and mucosal structure of the porcine colon is similar to the human colon making the pig a good animal for colonoscopic procedure training. However, a standardized animal bowel preparation used in colonic ESD training has not been established. Colonoscopic procedures were performed in 12 pigs, divided into four groups. The control group (Group 1) fasted and received no preprocedure preparation. Group 2 received a single dose of sodium phosphate 2 mL/kg, Group 3 and Group 4 received split doses of sodium phosphate (2 mL/kg and 4 mL/kg, respectively). An experienced endoscopist, blinded to the preparation method, assigned a score from excellent (4 points) to poor (1 point) at five regions of the colon. The final mean bowle cleansing score was calculated from five regions in each pig. Serum biochemistry and electrolyte levels were analyzed. The different doses of sodium phosphate preparations did not change the serum glucose, creatinine, sodium, potassium, calcium, or phosphorus levels. The colonic cleansing scores in Group 1 (1.3 ± 0.4, mean ± standard deviation) and Group 2 (1.5 ± 0.2) were lower than those of Group 3 (2.6 ± 0.6) and Group 4 (3 ± 0.2). The use of oral sodium phosphate is easy and safe in porcine bowel preparation for ESD training. Bowel preparation using a split dose of 2 mL/kg or 4 mL/kg sodium phosphate produces an adequate bowel cleansing. The optimal dosage still needs to be established in a large-scale study.

Colon perforation after esophagogastroduodenoscopy in an asymptomatic diverticulitis patient

Scipedia content — Mon, 15 May 2017 12:50:06 +0200

Esophagogastroduodenoscopy (EGD) is regarded as a relatively safe procedure, however, it carries a very low incidence of severe adverse events. Perforation is a rare complication of EGD, and it may further lead to pneumoperitoneum or pneumoretroperitoneum. The occurrence of large bowel perforation after EGD is extremely rare, and it has never been reported in the international literature. Herein, we present a case of concurrence of pneumoperitoneum and pneumoretroperitoneum as a result of sigmoid perforation after EGD. In our case, the probable mechanism of the perforation may have stemmed from the excessive inflation of air that passed through the gastrointestinal tract to the sigmoid colon, causing the increased intraluminal pressure, and then prompting a healed asymptomatic diverticulitis leak again.

Gastritis cystica polyposa in an unoperated stomach

Scipedia content — Mon, 15 May 2017 12:50:00 +0200

Gastritis cystica polyposa is relatively rare and characterized by polypoid hyperplasia and cystic dilatation of the gastric glands in stomach. Most cases are related to previous gastric surgeries, but a few cases have been reported in unoperated stomachs. We present a 34-year-old man who had anemic symptoms with melena and exertional dyspnea for 3 weeks. He denied any surgical history. An esophagogastroduodenoscopy revealed diffuse giant folds extending from the lower to the upper body of the stomach with nodularity and no obvious bleeding site. A pathologic diagnosis of a punch biopsy specimen from the giant folds revealed only moderately active chronic inflammation with a high Helicobacter pylori density. After serial studies, the patient received a whole layer gastric biopsy during a laparoscopy. Gastritis cystica polyposa was diagnosed on the pathology report. Our present case highlights the rare clinical and endoscopic condition of gastritis cystica polyposa in an unoperated stomach.

A modified bowel preparation protocol improves the quality of bowel cleansing for colonoscopy

Scipedia content — Mon, 15 May 2017 12:49:55 +0200

Adequate colonic cleansing is essential for a high quality colonoscopy. Few studies have investigated the association between patient education and quality of bowel preparation. The control group comprised 165 participants who underwent colonoscopy after a standard bowel preparation protocol during the period September–October 2013 and the study group comprised 251 individuals who underwent colonoscopy after a modified bowel preparation protocol during the period January–February 2014. The modified bowel preparation protocol included an instructional video and leaflet, a dietician-designed 2-day low fiber diet, a follow-up phone message, and information to confirm stool characteristics. The Aronchick Bowel Preparation Scale was used to define the quality of bowel preparation. The endoscopists who performed the procedures were blinded to the preparation protocols. The percentage of participants with excellent bowel preparation quality was significantly higher in the study group than in the control group (35.9% vs. 21.8%, p = 0.002). Also, the percentage of participants with poorly prepared bowels was significantly higher in the control group than in the study group (3% vs. 0.8%, p = 0.042). Moreover, the adenoma detection rate was significantly higher in the study group (35.1% vs. 24.8%, p = 0.028). The results show that the quality of bowel cleansing can be improved by providing patients with a modified bowel preparation protocol.

Utility of balloon expulsion test in patients with constipation: Preliminary results in a single center

Scipedia content — Mon, 15 May 2017 12:49:50 +0200

Pelvic floor dyssynergia can be a cause of idiopathic constipation. Although pelvic floor dyssynergia can be diagnosed by rectal balloon expulsion (BE) and anorectal manometry, the utility of BE in the evaluation of constipation in clinical practice remains to be determined. To this end, we examined the role of BE among different body positions in Taiwanese people with constipation. Fourteen Taiwanese adults (age range, 19–61 years), including six healthy volunteers (4 male, 2 female) and eight patients with chronic constipation (1 male, 7 female) underwent solid-state anorectal manometry and BE. The demographic data of all individuals were recorded at enrollment. Compared to healthy volunteers, patients with chronic constipation had a numerically lower threshold for mean resting pressure (p = 0.052), squeeze pressure, maximal squeeze pressure, and lower threshold volumes for urge, but higher threshold pressures for compliance. Successful BE seemed to be associated with lower mean resting pressure (p = 0.061), lower mean threshold volumes for urge, and higher mean maximal squeeze pressure for compliance. Although patients with chronic constipation had a numerically lower successful rate of rectal BE than healthy controls, the differences did not reach statistical significance. In Taiwanese individuals, results of BE seems consistent with anorectal manometry parameters, and patients with chronic constipation have a trend of lower successful rate of rectal BE than healthy controls. However, future work to confirm the use of BE in differentiating subtypes of chronic constipation is needed.

An 86-year-old man with intermittent fever for 1 month

Scipedia content — Mon, 15 May 2017 12:49:45 +0200

Endoscopic submucosal tunnel dissection for a large esophageal subepithelial leiomyoma to prevent postprocedural stenosis

Scipedia content — Mon, 15 May 2017 12:49:37 +0200

A 27-year-old man with a huge esophageal leiomyoma, 4.5 cm in size, at the distal esophagus suffered from postprandial belching and chest discomfort. Endoscopic submucosal tunnel dissection was implemented to resect his leiomyoma. His symptoms resolved after tumor resection without any sequelae, such as luminal stricture that often occurs after large-size esophageal lesion resection. Endoscopic submucosal tunnel dissection has been reported to be a useful method for the resection of esophageal submucosal tumors, however, such large-size tumors are rare.

Clinical experience of large colorectal laterally spreading tumor in a regional hospital: 2-year results

Scipedia content — Mon, 15 May 2017 12:49:32 +0200

Nonpolypoid colorectal neoplasm has been widely recognized in the past few years. Among nonpolypoid colorectal neoplasms, laterally spreading tumor (LST) is a unique and distinct category in that the tumor grows horizontally with a size >1 cm. It may be easily overlooked during colonoscopy. If the size of the colorectal LST is >2 cm, achieving definite management is also another concerning issue. The aim of this study was to improve our understanding of LST by reviewing its clinical manifestations. All the large colorectal LSTs that were diagnosed and managed at our hospital in the past 2 years were reviewed. Basic demographic data were recorded. LSTs were divided into granular (G) and nongranular types (NG), then further subdivided into nodular mixed and homogeneous types for the G group and flat elevated and pseudodepressed types for the NG group. A total of 28 LST in 28 patients were enrolled, with males being more predominant than females (male/female: 18/10). Mean age of the patients and mean size of the LST were 62.6 ± 9.75 years and 3.4 ± 1.257 cm, respectively. Concerning morphology, 14 were diagnosed as NG and 14 as G group. The rate of malignant change was 28.6% (8/28). Twenty-three of our patients received endoscopic treatment (5 for endoscopic piecemeal mucosal resection 18 for endoscopic submucosal dissection) and five for laparoscopy-assisted colectomy. The cost and length of admission analysis between the endoscopic and operation treatment groups showed significant cost reduction (endoscopy/operation: NTD 28172/82516, p

Cytomegalovirus enteritis in immunocompetent patients: Report of two cases diagnosed using single-balloon enteroscopy

Scipedia content — Mon, 15 May 2017 12:49:26 +0200

Cytomegalovirus (CMV) infection of the gastrointestinal tract involves mostly the colon and rectum and mainly develops in immunocompromised patients. CMV infection in the small intestines has rarely been reported in immunocompetent patients. We report two cases of CMV enteritis that developed in immunocompetent patients and involved the ileum and jejunum, respectively. Both of them were diagnosed with single-balloon enteroscopy (SBE) and further confirmed with histopathology. The first case is a 71-year-old woman with a presentation of obscure gastrointestinal bleeding and severe anemia. Neither esophagogastroduodenoscopy nor colonoscopy identified any active bleeding. SBE and biopsy disclosed multiple scattered ulcers in the distal ileum and histopathology confirmed CMV ileitis. The hemorrhage subsided after conservative medical treatment. The second case is a 59-year-old woman with a presentation of progressive abdominal pain. SBE showed diffuse irregularly-shaped ulcers located from the upper to middle jejunum, and CMV jejunitis was confirmed with endoscopic biopsy and histopathological examination. Antiviral therapy was prescribed and her abdominal pain improved gradually. We discuss the clinical manifestations and management strategies of CMV infection that develops in the small intestines of immunocompetent patients. In addition, we highlight the endoscopic characteristics of CMV enteritis and the clinical utilities of SBE in the evaluation of patients with suspected CMV infection of the small intestines.

Outcomes of endoscopic submucosal dissection for early gastric cancer and precancer lesion: Experience from a center in Southern Taiwan

Scipedia content — Mon, 15 May 2017 12:49:20 +0200

Limited data are available on the interval of disease-free status after endoscopic submucosal dissection (ESD) for early gastric cancer and precancer lesion in Taiwan. In this long-term (2–105 months) follow-up study, we analyzed the risk factors that affect the local recurrence and noncurative resection (non-CR) of these lesions. We retrospectively studied 65 consecutive treatment-naïve patients with 69 EGC lesions who were selected to be treated by ESD. A total of 56 lesions (48 CR lesions and 8 non-CR lesions) were analyzed for local recurrence after ESD. ESD was curative for gastric epithelial tumors in 51 (73.9%) but not in 18 (26.1%) lesions. Unfortunately, five (8.93%) of these 56 lesions in 53 patients had local recurrence. None of the patients died from gastric cancer-associated diseases during follow-up. In our studies, the cumulative local recurrence rates were 5.3% in the CR group and 56.7% in the non-CR group (p = 0.0091). The disease-free status was high (94.7%) with CR. The risk factors that affect the non-CR were tumor location (p = 0.013), deeper invasion (p

A tubular polyp in the cecum during colonoscopic examination

Scipedia content — Mon, 15 May 2017 12:49:15 +0200

Liver cirrhosis as a predisposing risk factor for esophageal candidiasis: Bystander or culprit?

Scipedia content — Mon, 15 May 2017 12:49:10 +0200

Condoms used to assist difficult endoscopic removal of impacted upper esophageal foreign bodies

Scipedia content — Mon, 15 May 2017 12:49:05 +0200

The use of a homemade balloon dilator and protector hood composed of condoms for assisting the removal of sharp foreign bodies lodged in the upper esophagus in difficult cases is reported. A conventional endoscopic method failed to remove two sharp bones and two press-through packages became impacted in the upper esophagus. A condom was used to make a balloon dilator that was attached to a flexible endoscope in an attempt to dilate the upper esophageal sphincter to dislodge the impacted sharp bones. This handmade condom balloon dilator succeeded in dislodging the two tightly impacted sharp bones and assisted in removing the impacted objects in the upper esophagus. Additionally, a condom was tied to the distal end of the scope to act as a protector hood to protect the esophageal mucosa when removing the sharp packages. The two impacted press-through packages were pushed into the lower esophagus or stomach and removed uneventfully using the condom protector hood. Subsequent endoscopy disclosed no relevant mucosal damage after the successful removal and the patients did well after discharge from the emergency department. In conclusion, condom-based endoscopic balloon dilatation is a simple and accessible method for assisting the endoscopic removal of tightly impacted, sharp foreign bodies in the upper esophagus. A condom can also be used as a protector hood to avoid mucosal injury when removing impacted, sharp press-through packages when a commercial protector hood is not available.

Interleukin-23p19 expression in patients with ulcerative colitis and its relation to disease severity

Scipedia content — Mon, 15 May 2017 12:48:58 +0200

The purpose of this study was to determine whether the mucosal expression of interleukin (IL)-23p19 has a role in the pathogenesis of ulcerative colitis, and to determine its relation to disease severity. This study was performed on 50 patients with ulcerative colitis and 10 normal individuals as the controls. They were divided into Group I (27 patients with mild to moderate disease), Group II (23 patients with severe disease), and Group III (10 normal individuals). All patients and the controls were subjected to histopathological study, IL-23p19 immunohistochemical staining, IL-23R expression by flow cytometry, and serum IL-23 by enzyme-linked immunoassay. There was a significant increase in IL-23p19 gene expression and IL-23R level in patients with ulcerative colitis, compared to the controls. A significant positive correlation was detected between increased expression of the IL-23p19 gene, IL-23R, high serum IL-23, and the severity of the disease. Increased expression of the IL-23p19 gene has a role in the pathogenesis of ulcerative colitis. Targeted therapy directed against IL-23p19 may be effective in its treatment. Increased expression of the IL-23p19 gene and IL-23R with high serum IL-23 is correlated positively with disease severity.

High pre-operative serum aminotransferase levels predict local recurrence after curative resection of hepatocellular carcinoma

Scipedia content — Mon, 15 May 2017 12:48:52 +0200

Hepatocellular carcinoma is a common cancer with an increasing incidence worldwide because of the dissemination of hepatitis B and hepatitis C virus infection. Surgical resection is the most important therapeutic option with a curative intent. Early tumor detection through screening and improvements in surgical techniques have significantly improved the outcome of patients with hepatocellular carcinoma. However, local recurrence after curative hepatic resection is common and is the most frequent cause of death in these patients. In an attempt to identify the risk factors that predict tumor recurrence, we conducted this retrospective study in a single institution for a 6-year period. Of the 100 consecutive patients who underwent curative tumor resection, we analyzed age, sex, viral etiology (hepatitis B virus vs. hepatitis C virus), preoperative levels of aspartate aminotransferase and alanine aminotransferase, the α-fetoprotein level, underlying liver disease status (chronic hepatitis vs. cirrhosis), number and size of tumors, type of resection, and presence of microvascular invasion. In the median follow-up period of 36 months (range, 12–85 months), the 1-year, 3-year, and 5-year overall survival rates were 90%, 84%, and 73%, respectively, tumor recurrence occurred in 38 (38%) patients and was the leading cause of death among the patients who died (15 of 17 patients, 88%). On univariate analysis, the only factor significantly associated with a higher incidence of tumor recurrence was preoperative levels of aspartate aminotransferase greater than twice the upper normal value (p 2 years) was conducted and a preoperative aspartate aminotransferase level greater than twice the upper normal value was still significant in both groups (p = 0.02 and p = 0.044, respectively). Although this is a small-scale study, our findings could be easily applied clinically and used as readily available indicators to help the follow-up algorithm. We also suggest antiviral management as soon as possible for patients with hepatocellular carcinoma undergoing curative resection, especially those with a high preoperative aspartate aminotransferase level.

Stromal tumor presents as a large extragastrointestinal mass in the abdominal cavity

Scipedia content — Mon, 15 May 2017 12:48:45 +0200

Gastrointestinal stromal tumors are nonepithelial neoplasms of the gastrointestinal tract and have been increasingly recognized in recent years. In contrast, stromal tumor outside the gastrointestinal tract is not frequently found. Here, we present a 57-year-old male patient who had abdominal fullness for several months. It was caused by a 23-cm heterogeneous tumor mass that was successfully removed from the left upper abdominal cavity. The tumor adhered tightly to adjacent organs but postoperative histopathological analysis revealed no direct connection to the stomach, liver, pancreas, spleen, or kidneys. Immunohistochemical examination of the tumor revealed proliferative spindle-shaped cells stained positive for CD117 and CD34 and negative for smooth muscle actin and S-100. The patient received regular follow up. A suspected recurrent liver metastatic lesion was noted 2 years later and radiofrequency ablation of the liver tumor was performed followed by oral imatinib treatment. No tumor recurrence was detected at 3 years after radiofrequency ablation. This case reminds us that extragastrointestinal stromal tumors should be considered in the differential diagnosis when a large heterogeneous mass is present in the abdominal cavity. The characteristics of extragastrointestinal stromal tumor are described and the literature is reviewed in this report.

Short-term outcomes of endoscopic submucosal dissection for colorectal neoplasms in a single medical center

Scipedia content — Mon, 15 May 2017 12:48:39 +0200

Endoscopic submucosal dissection (ESD) is an emerging technique for treating superficial neoplasms of the gastrointestinal tract. Clinical experience of ESD for superficial colorectal neoplasms remains limited in Taiwan. The aim of this study was to assess ESD performed in a series of patients at our hospital and report the results. Thirty-three patients who underwent ESD were retrospectively analyzed for tumor size, rate of en bloc resection, complete resection, curative resection, technical results, and complications. The tumors treated using ESD were situated in the cecum (n = 6), ascending colon (n = 2), transverse colon (n = 2), descending colon (n = 4), sigmoid colon (n = 9), and rectum (n = 10). The median size of the tumors was 30 mm (range, 10–55 mm). The en bloc resection rate was 72.7%, and the complete resection rate was 66.7%. In patients with en bloc resection, the curative resection rate was 87.5%. Histopathological analysis revealed adenoma with low-grade dysplasia (n = 18), adenoma with high-grade dysplasia (n = 7), and adenocarcinoma (n = 8). Five patients experienced perforation, and the overall complication rate was 15.2%. None of these five patients received surgical treatment. ESD is a challenging but relatively safe procedure to treat large superficial colorectal neoplasms. However, additional experience is required to achieve higher en bloc resection, complete resection, and curative resection rates.

Immunoglobulin G4-related disease with recurrent obstructive jaundice

Scipedia content — Mon, 15 May 2017 12:48:34 +0200

A 51-year-old man was referred to our clinic for recurrent obstructive jaundice and underwent pylorus-preserving pancreaticoduodenectomy for a suspected malignancy. The pathology showed immunoglobulin G4 positive plasma cell infiltrated at the pancreas and the gallbladder. We discuss the cost-effectiveness of serum immunoglobulin G4 level prior to arranging for a pancreaticoduodenectomy, which would reduce the possibility of surgical complications as well as costs.