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Emergency Radiology Jun 2024Ectopic varices account for 5% of variceal bleedings and occur outside the gastro-esophageal region. This review evaluates the efficacy of transjugular intrahepatic... (Review)
Review
Ectopic varices account for 5% of variceal bleedings and occur outside the gastro-esophageal region. This review evaluates the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for ectopic variceal management. A comprehensive search through PubMed, Scopus, Web of Science, and Embase was conducted until January 16, 2023, using relevant keywords. Case reports and case series with fewer than 10 patients on TIPS for ectopic variceal management were included. The quality assessment followed the Joanna Briggs Institute checklist for case reports. This systematic review evaluated 43 studies involving 50 patients with ectopic varices undergoing TIPS. Patients had a mean age of 54.3 years, half were female, and two were pregnant. Alcoholic liver disease (48%) and hepatitis C infection (26%) were common causes of portal hypertension. Ascites and splenomegaly were reported in 32% and 28% of the patients, respectively. Rectal, oral, and stomal variceal bleeding accounted for 62%, 16%, and 22% of the patients, respectively. Ectopic varices were mainly located in the duodenum (28%) and rectum (26%) regions. Complications affected 42% of the patients, re-bleeding in eleven and hepatic encephalopathy in seven. The follow-up lasted 12 months on average, and finally, 5 received a liver transplant. Mortality post-TIPS was 18%. Despite complications and a notable mortality rate, favorable outcomes were observed in almost half of the patients with ectopic variceal bleeding managed with TIPS. Further research is warranted to refine strategies and improve patient outcomes.
PubMed: 38935315
DOI: 10.1007/s10140-024-02258-6 -
Journal of Inflammation Research 2024Significant gastrointestinal hemorrhages, resulting from long-term compression of the duodenum by a hepatic pseudoaneurysm (HAPA), is an extremely rare condition. In...
AIM
Significant gastrointestinal hemorrhages, resulting from long-term compression of the duodenum by a hepatic pseudoaneurysm (HAPA), is an extremely rare condition. In fact, when the pseudoaneurysm is small in diameter, diagnosis can be particularly challenging. Timely and effective diagnosis and treatment is therefore of great significance, and in this case, endoscopy, combined with intravascular therapy, can provide an effective approach, especially since it removes the need for surgery while yielding favorable outcomes.
CASE SUMMARY
A 75-year-old old man presented to the hospital's emergency department with hematemesis and black stool. Despite conservative treatments such as "acid suppression, fluid resupply, hemostasis and blood transfusion", no significant improvement was noted. Emergency gastroscopy subsequently revealed an ulcer in the duodenal bulb (Figure 1), with an exposed thrombotic head and active bleeding on the surface. In addition, abdominal computed tomography (Figure 2) showed no obvious HAPA manifestations. After unsuccessful endoscopic hemostasis, angiography was performed (Figure 3) and a pseudotumor-like dilatation measuring 5.56 mm in diameter was found at the distal end of the proximal branch vessel of the common hepatic artery. Following spring coil embolization (Figure 4), the patient's condition improved and he was discharged from the hospital, with a follow-up after six months showing no signs of recurrence or complications.
CONCLUSION
Duodenal ulcer hemorrhages due to small hepatic pseudoaneurysms are very rare, with endoscopic intervention being effective for such cases.
PubMed: 38933359
DOI: 10.2147/JIR.S467969 -
Frontiers in Immunology 2024Chronic inflammatory enteropathy (CIE) is a common condition in dogs causing recurrent or persistent gastrointestinal clinical signs. Pathogenesis is thought to involve...
Chronic inflammatory enteropathy (CIE) is a common condition in dogs causing recurrent or persistent gastrointestinal clinical signs. Pathogenesis is thought to involve intestinal mucosal inflammatory infiltrates, but histopathological evaluation of intestinal biopsies from dogs with CIE fails to guide treatment, inform prognosis, or correlate with clinical remission. We employed single-cell RNA sequencing to catalog and compare the diversity of cells present in duodenal mucosal endoscopic biopsies from 3 healthy dogs and 4 dogs with CIE. Through characterization of 35,668 cells, we identified 31 transcriptomically distinct cell populations, including T cells, epithelial cells, and myeloid cells. Both healthy and CIE samples contributed to each cell population. T cells were broadly subdivided into GZMA (putatively annotated as tissue resident) and IL7R (putatively annotated as non-resident) T cell categories, with evidence of a skewed proportion favoring an increase in the relative proportion of IL7R T cells in CIE dogs. Among the myeloid cells, neutrophils from CIE samples exhibited inflammatory (SOD2 and IL1A) gene expression signatures. Numerous differentially expressed genes were identified in epithelial cells, with gene set enrichment analysis suggesting enterocytes from CIE dogs may be undergoing stress responses and have altered metabolic properties. Overall, this work reveals the previously unappreciated cellular heterogeneity in canine duodenal mucosa and provides new insights into molecular mechanisms which may contribute to intestinal dysfunction in CIE. The cell type gene signatures developed through this study may also be used to better understand the subtleties of canine intestinal physiology in health and disease.
Topics: Animals; Dogs; Duodenum; Single-Cell Analysis; Dog Diseases; Transcriptome; Gene Expression Profiling; Intestinal Mucosa; Chronic Disease; Male; Female; T-Lymphocytes
PubMed: 38933260
DOI: 10.3389/fimmu.2024.1397590 -
Anatomy & Cell Biology Jun 2024Anticipating a wide range of morphological variations of arterial anatomy of foregut derivatives beyond the classical pattern, a precise understanding is pertinent to...
Anticipating a wide range of morphological variations of arterial anatomy of foregut derivatives beyond the classical pattern, a precise understanding is pertinent to preoperative diagnosis, operative procedure and to avoid potentially devastating post-operative outcome during various traumatic and non-traumatic vascular insult of foregut. The study aimed to revisit the morphological details and update unusual configurations of arteries of foregut to establish clinico-anatomical correlations. This study described the detailed branching pattern of coeliac trunk (CT) as principal artery of foregut with source & course of hepatic, gastric, duodenal and pancreatic branches in 58 cadaveric dissections. Based on morphology, different types and subtypes were made. The descriptions were explained using figures and pertinent tables. Among classical branches of CT, splenic artery was found as most stable whereas other two branches were found to be most variable with missing common hepatic artery in 11 cases. In addition to classical trifurcation (65.52%), different types of bifurcation (12.07%) and tetrafurcations (22.41%) of CT were observed. Regarding variations of hepatic arteries (27.59%), both non-classical origin and accessory hepatic branches were found. In case of gastric branches, more variant origins were seen with right gastric (50%) as compared to left gastric artery (34.48%). Other morphological variations included non-classical origin of gastro-duodenal artery (18.96%) along with presence of accessory pancreatic (17.13%) and duodenal arteries (6.38%). Awareness of anatomical variations regarding circulatory dynamics of foregut is worth knowing in order to facilitate successful planning of surgery involving upper abdominal organs with least complications.
PubMed: 38932617
DOI: 10.5115/acb.24.078 -
The American Journal of Case Reports Jun 2024BACKGROUND When people in their 60s experiences abdominal pain, vomiting, and unexplained weight loss without a history of abdominal surgery, the usual diagnosis is...
BACKGROUND When people in their 60s experiences abdominal pain, vomiting, and unexplained weight loss without a history of abdominal surgery, the usual diagnosis is obstruction caused by a neoplastic mass. Nevertheless, in exceptionally rare cases, these symptoms arise from complications linked to a visceral artery aneurysm. CASE REPORT We present a case of a 60-year-old man with immunodeficiency and Sneddon-Wilkinson disease (a rare subcorneal pustular dermatosis), who developed a pancreaticoduodenal aneurysm of uncertain origin, associated with pancreatic mass, retroperitoneal hematoma, and duodenal obstruction. The treatment approach included transcatheter arterial coil embolization with supportive measures such as parenteral nutrition, a nasogastric tube, octreotide administration, and antiemetics. Despite these interventions, persistence gastrointestinal symptoms prompted an endoscopic ultrasound fine-needle aspiration to rule out malignancy. The biopsy confirmed localized fibro-inflammation. Although he was initially considered for a gastro-jejunal bypass, conservative management effectively improved the pancreatic lesion and duodenal obstruction, leading to discontinuation of parenteral nutrition. The patient was able to resume a regular diet 4 weeks after embolization. CONCLUSIONS Pancreaticoduodenal artery aneurysm is a rare visceral aneurysm with multiple etiologies and potentially fatal consequences. We report an unusual case of a pancreaticoduodenal artery aneurysm associated with pancreatic mass and duodenal obstruction. This diagnosis warrants consideration when an immunodeficient patient presents symptoms of abdominal pain and vomiting. Early endovascular embolization, combined with conservative approaches, effectively alleviated the symptoms in our patient.
Topics: Humans; Male; Middle Aged; Aneurysm, False; Pancreas; Duodenal Obstruction; Duodenum; Embolization, Therapeutic
PubMed: 38932438
DOI: 10.12659/AJCR.943879 -
Nutrients Jun 2024The hawthorn fruit is an interesting medicinal plant that has several biological features, especially related to anti-inflammatory, antioxidant and immune-modulating...
The hawthorn fruit is an interesting medicinal plant that has several biological features, especially related to anti-inflammatory, antioxidant and immune-modulating actions, and boosting general health. In this study, we aimed to clarify the immunological effects of hawthorn vinegar on immunity and general health. We also focused on three different production processes to improve the antioxidant activity of hawthorn vinegar (2) Methods: In the study, besides the traditional production of hawthorn vinegar (N), thermal pasteurization (P) and ultrasound (U) techniques were applied to vinegars. A total of 56 female adult Wistar albino rats were randomly allocated into seven groups; Control, N0.5 (regular vinegar; 0.5 mL/kgbw), N1 (regular vinegar; 1 mL/kgbw), P0.5 (pasteurized vinegar; 0.5 mL/kgbw), P1 (pasteurized vinegar; 1 mL/kgbw), U0.5 (ultrasound treated vinegar; 0.5 mL/kgbw), and U1 (ultrasound treated vinegar; 1 mL/kgbw). Vinegars were administered by oral gavage daily. The average weight gains, body mass index, and blood hematological parameters were measured, and the Neutrophil Lymphocyte ratio was calculated. The plasma IL-1β and TNF-α values, and MDA, IL-1β and TNF-α values of intestinal tissue, were determined. Also, the streptavidin-biotin-peroxidase complex method was applied to determine the expressions of TNF-α and IL-1β in duodenum. (3) Results: There was a decreasing tendency in the average weight gains in all vinegar groups compared to the control group. In addition, there was an increase in NL ratio in all vinegar groups, although not significant. There were no statistical differences among all vinegar groups, although decreases were observed in plasma IL-1β. Also, the plasma TNF-α values showed slight increases in high-dose-of-vinegar groups (N1, P1 and U1), although not significant. In addition, the intestinal tissue IL-1β value tended to increase in groups N0.5, N1 and P0.5, while it tended to decrease in P1, U0.5 and U1. On the other hand, there were slight increases in the TNF-α values of intestinal tissue in all groups compared to control, although these were not significant. Furthermore, the intensive expressions of TNF-α and IL-1β were determined in groups U0.5 and U1. (4) Conclusions: The results suggest that either high doses or ultrasound applications of hawthorn vinegar have positive effects on intestinal health, boosting immunity and general health.
Topics: Animals; Female; Acetic Acid; Rats, Wistar; Crataegus; Rats; Antioxidants; Interleukin-1beta; Tumor Necrosis Factor-alpha; Fruit
PubMed: 38931223
DOI: 10.3390/nu16121868 -
Medicina (Kaunas, Lithuania) Jun 2024Hyperprolactinemia, as a potential side-effect of some antipsychotic medications, is associated with decreased bone density and an increased risk of fractures. This...
Hyperprolactinemia, as a potential side-effect of some antipsychotic medications, is associated with decreased bone density and an increased risk of fractures. This study investigates whether calcium and vitamin D supplementation affects prolactin receptor ( gene expression in the duodenum, vertebrae, and kidneys of female rats with sulpiride-induced hyperprolactinemia. Twenty-one-week-old female Wistar rats were assigned to three groups: Group S consisted of ten rats who received sulpiride injections (10 mg/kg) twice daily for 6 weeks; Group D (10 rats) received daily supplementation of 50 mg calcium and 500 IU vitamin D along with sulpiride for the last 3 weeks; and Group C consisting of seven age-matched nulliparous rats serving as a control group. Real-time PCR was used to assess gene expression in the duodenum, vertebrae, and kidneys. In Group S, Prlr gene expression was notably decreased in the duodenum ( < 0.01) but elevated in the vertebrae and kidneys compared to Group C. Conversely, Group D exhibited significantly increased Prlr expression in the duodenum ( < 0.01) alongside elevated expression in the vertebrae and kidneys. In sulpiride-induced hyperprolactinemia, decreased Prlr gene expression in the duodenum may lead to reduced intestinal calcium absorption. Consequently, prolactin may draw calcium from the skeletal system to maintain calcium balance, facilitated by increased Prlr gene expression in the vertebrae. However, vitamin D supplementation in sulpiride-induced hyperprolactinemia notably enhances Prlr gene expression in the duodenum, potentially ameliorating intestinal calcium absorption and mitigating adverse effects on bone health.
Topics: Animals; Hyperprolactinemia; Sulpiride; Rats, Wistar; Female; Vitamin D; Rats; Calcium; Duodenum; Receptors, Prolactin; Gene Expression
PubMed: 38929559
DOI: 10.3390/medicina60060942 -
Medicina (Kaunas, Lithuania) May 2024Hepatobiliary ascariasis is caused by the entry of the nematode from the duodenum into the biliary duct. We report a case of an -induced extrahepatic biliary tract... (Review)
Review
Hepatobiliary ascariasis is caused by the entry of the nematode from the duodenum into the biliary duct. We report a case of an -induced extrahepatic biliary tract obstruction in a pediatric patient admitted to the hospital due to a wide spectrum of symptoms of biliary disease, which included abdominal pain in the upper abdominal quadrants, vomiting, and jaundice. Imaging tests-including ultrasound, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP)-were performed to confirm the diagnosis of biliary ascariasis. The tests did, in fact, demonstrate signs of this disease. Nevertheless, during the ERCP, only the remains of parasites in the form of tissue fragments were extracted. We also aim to discuss the prevalence of ascariasis in children, the causes of migration of parasites into the bile ducts, together with its clinical manifestations, as well as the diagnostic and treatment methods of this disease.
Topics: Humans; Ascariasis; Lithuania; Cholangiopancreatography, Endoscopic Retrograde; Child; Animals; Male; Ascaris lumbricoides; Cholangiopancreatography, Magnetic Resonance; Female
PubMed: 38929533
DOI: 10.3390/medicina60060916 -
Children (Basel, Switzerland) May 2024Ultrasound serves as a valuable tool for the early detection of fetal bowel dilatation, yet the correlation between fetal bowel dilatation and gastrointestinal...
BACKGROUND
Ultrasound serves as a valuable tool for the early detection of fetal bowel dilatation, yet the correlation between fetal bowel dilatation and gastrointestinal malformations remains to be further investigated. This study aims to explore the relationship by conducting a follow-up and analysis of fetuses with bowel dilation.
METHODS
A retrospective analysis was conducted on 113 fetuses with bowel dilatation at our center from July 2014 to December 2019. The location and degree of bowel dilatation were analyzed. ROC curves were constructed based on the diameter of the bowel and its ratio to fetal gestational age.
RESULTS
In total, 40 of 41 cases (97.6%) with upper gastrointestinal dilatation (double-bubble sign) and 46 of 72 cases (63.9%) with lower gastrointestinal dilatation were diagnosed with gastrointestinal malformations postnatally. The AUC of the dilatation diameter was 0.854 with a cutoff value of 18.05 mm in patients with lower gastrointestinal dilatation. The ratio of the diameter to gestational age (D/GA) showed a higher AUC of 0.906 with a cutoff value of 0.4931.
CONCLUSIONS
The presence of the double-bubble sign in fetuses indicates a close association with duodenal obstruction. The risk of gastrointestinal malformations increases when the bowel diameter exceeds 18.05 mm, particularly when the D/GA surpasses 0.4931.
PubMed: 38929249
DOI: 10.3390/children11060670 -
International Journal of Molecular... Jun 2024A family of bifunctional dihetarylmethanes and dibenzoxanthenes is assembled via a reaction of acetals containing a 2-chloroacetamide moiety with phenols and related...
A family of bifunctional dihetarylmethanes and dibenzoxanthenes is assembled via a reaction of acetals containing a 2-chloroacetamide moiety with phenols and related oxygen-containing heterocycles. These compounds demonstrated selective antitumor activity associated with the induction of cell apoptosis and inhibition of the process of glycolysis. In particular, bis(heteroaryl)methane containing two 4-hydroxy-6-methyl-2-pyran-2-one moieties combine excellent in vitro antitumor efficacy with an IC of 1.7 µM in HuTu-80 human duodenal adenocarcinoma models with a high selectivity index of 73. Overall, this work highlights the therapeutic potential of dimeric compounds assembled from functionalized acetals and builds a starting point for the development of a new family of anticancer agents.
Topics: Humans; Antineoplastic Agents; Apoptosis; Cell Line, Tumor; Methane; Cell Proliferation; Xanthenes
PubMed: 38928428
DOI: 10.3390/ijms25126724