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The American Journal of Case Reports Mar 2024BACKGROUND Pyloric obstruction after dichlorvos poisoning causes repeated vomiting and inability to eat. Choledocholithiasis and cholelithiasis are the common digestive...
BACKGROUND Pyloric obstruction after dichlorvos poisoning causes repeated vomiting and inability to eat. Choledocholithiasis and cholelithiasis are the common digestive diseases, with high morbidity and relapse in elderly patients. However, the complex situation of these diseases' coexistence is a clinically intractable problem, and literature on selecting optimal surgical planning is scarce. CASE REPORT A thin 79-year-old woman took dichlorvos due to family conflicts. She improved after being urgently sent to local hospital for gastric lavage and detoxification. Over the next 3 months, she presented with intermittent nausea, vomiting, epigastric pain, and mental apathy, and was readmitted. Gastroscopy showed extensive scarring in the antrum, pyloric obstruction, and gastric retention. Magnetic resonance cholangiopancreatography revealed gallstones and choledocholithiasis. Also, she presented with gastric retention, hypertension, moderate anemia, hypoproteinemia, and electrolyte disturbances. After hospitalization, conservative treatment was performed, without improving vomiting, followed by surgical treatment. Gastrojejunostomy, Braun anastomosis, and nasojejunal feeding tube placement were performed for pyloric stenosis; cholecystectomy for cholelithiasis; and choledochotomy, intraoperative choledochoscopy examination, basket stone extraction, and primary suture of common bile duct without indwelling T tube for choledocholithiasis. Patient recovered and was discharged 9 days after surgery. She was recovered well, without vomiting, at 2-month follow-up. CONCLUSIONS Gastrojejunostomy plus Braun anastomosis is effective treatment of elderly patients with pyloric obstruction formed after pesticide-induced corrosion. Careful selection of choledocholithotomy with primary suture without indwelling T tube reduced postoperative pain and accelerated recovery. This complex case of pyloric obstruction with gallbladder and bile duct stones provides useful considerations for clinical treatment.
Topics: Aged; Female; Humans; Cholangiopancreatography, Endoscopic Retrograde; Choledocholithiasis; Dichlorvos; Pyloric Stenosis; Vomiting
PubMed: 38532541
DOI: 10.12659/AJCR.943101 -
Clinical Endoscopy Mar 2024Helicobacter pylori infection-negative gastric cancer (HPNGC) has not been systematically investigated in consecutive patients. Hence, this study aimed to investigate...
BACKGROUND/AIMS
Helicobacter pylori infection-negative gastric cancer (HPNGC) has not been systematically investigated in consecutive patients. Hence, this study aimed to investigate the clinicopathological and endoscopic features of HPNGC.
METHODS
This single-center retrospective study selected participants from patients with gastric cancer who were treated at the Fukuoka University Chikushi Hospital between January 2013 and December 2021. Only patients diagnosed with HPNGC were enrolled, and their clinicopathological and endoscopic features were analyzed in detail.
RESULTS
The prevalence of HPNGC in the present study was 2.6% (54/2112). The types of HPNGC observed in each gastric region were as follows: advanced gastric cancer was observed in the cardia; gastric adenocarcinoma of fundic-gland differentiation, gastric adenocarcinoma of foveolar-type presenting with whitish elevation and raspberry-like foveolar-type gastric adenocarcinoma, gastric adenocarcinoma arising in polyposis, and gastric adenocarcinoma with autoimmune gastritis were observed in the fundic gland region ranging from the gastric fornix to the gastric body; signet-ring cell carcinoma was observed in the gastric-pyloric transition region ranging from the lower gastric body to the gastric angle; and well-differentiated tubular adenocarcinoma with low-grade atypia was observed in the antrum.
CONCLUSIONS
This study revealed that tumors from each gastric region exhibited distinct macroscopic and histological types in HPNGC.
PubMed: 38514987
DOI: 10.5946/ce.2023.258 -
Journal of Gastroenterology Jun 2024Nodular gastritis (NG) is characterized by marked antral lymphoid follicle formation, and is a strong risk factor for diffuse-type gastric cancer in adults. However, it...
BACKGROUND
Nodular gastritis (NG) is characterized by marked antral lymphoid follicle formation, and is a strong risk factor for diffuse-type gastric cancer in adults. However, it is unknown whether aberrant DNA methylation, which is induced by atrophic gastritis (AG) and is a risk for gastric cancer, is induced by NG. Here, we analyzed methylation induction by NG.
METHODS
Gastric mucosal samples were obtained from non-cancerous antral tissues of 16 NG and 20 AG patients with gastric cancer and 5 NG and 6 AG patients without, all age- and gender-matched. Genome-wide methylation analysis and expression analysis were conducted by a BeadChip array and RNA-sequencing, respectively.
RESULTS
Clustering analysis of non-cancerous antral tissues of NG and AG patients with gastric cancer was conducted using methylation levels of 585 promoter CpG islands (CGIs) of methylation-resistant genes, and a large fraction of NG samples formed a cluster with strong methylation induction. Promoter CGIs of CDH1 and DAPK1 tumor-suppressor genes were more methylated in NG than in AG. Notably, methylation levels of these genes were also higher in the antrum of NG patients without cancer. Genes related to lymphoid follicle formation, such as CXCL13/CXCR5 and CXCL12/CXCR4, had higher expression in NG, and genes involved in DNA demethylation TET2 and IDH1, had only half the expression in NG.
CONCLUSIONS
Severe aberrant methylation, involving multiple tumor-suppressor genes, was induced in the gastric antrum and body of patients with NG, in accordance with their high gastric cancer risk.
Topics: Humans; DNA Methylation; Male; Female; Stomach Neoplasms; Middle Aged; Aged; Gastric Mucosa; CpG Islands; Gastritis, Atrophic; Proto-Oncogene Proteins; Promoter Regions, Genetic; Cadherins; Chemokine CXCL12; Chemokine CXCL13; Dioxygenases; Antigens, CD; Adult; DNA-Binding Proteins; Gastritis; Pyloric Antrum; Risk Factors
PubMed: 38499886
DOI: 10.1007/s00535-024-02094-y -
The Journal of Small Animal Practice Mar 2024A 6-year-old, female neutered Labrador retriever was presented with a chronic history of vomiting and anorexia. Abdominal ultrasound identified two large cavitated...
A 6-year-old, female neutered Labrador retriever was presented with a chronic history of vomiting and anorexia. Abdominal ultrasound identified two large cavitated structures with echogenic content in the gastric fundus and pyloric region. CT revealed the intraparietal nature of these structures, one in the greater curvature and another one extending from the lesser curvature to the pyloric antrum. Surgical exploration revealed two areas of thickened gastric wall with intramural purulent material. Debridement and partial resection of the abscess (deroofing) were performed via a routine gastrotomy approach. Histopathology of a gastric wall sample revealed neutrophilic inflammation with intralesional vegetal foreign body. The presence of intralesional foreign body with a positive bacterial culture and macroscopic absence of peritonitis may suggest an intramural migrating vegetal foreign body. Gastric wall abscess should be included in a differential diagnosis in dogs with a history of chronic vomiting and the presence of gastric wall cavitated structures. Surgical debridement through a routine gastrotomy opening alleviated the clinical signs related to the intramural gastric abscesses in this dog with no recurrence at 22 months.
PubMed: 38441150
DOI: 10.1111/jsap.13713 -
Zhonghua Wei Chang Wai Ke Za Zhi =... Feb 2024To investigate the clinicopathological factors and clinical significance of (micro)metastasis in No.12b lymph node in patients with gastric antrum cancer. This was a...
To investigate the clinicopathological factors and clinical significance of (micro)metastasis in No.12b lymph node in patients with gastric antrum cancer. This was a retrospective cohort study of data of 242 patients with gastric adenocarcinoma without distant metastasis, complete follow-up data, and no preoperative anti-tumor therapy or history of other malignancies. All study patients had undergone radical gastrectomy (at least D2 radical range) + No.12b lymph node dissection in the Department of Gastric Surgery of Liaoning Cancer Hospital from January 2007 to December 2012. Immunohistochemical staining with antibody CK8/18 was used to detect micrometastasis to lymph nodes. Patients with positive findings on hematoxylin and eosin stained specimens and/or CK8/18 positivity in No.12b lymph node were diagnosed as having No.12b (micro)metastasis and included in the No.12b positive group. All other patients were classified as 12b negative. We investigated the impact of No.12b (micro)metastasis by comparing the clinicopathological characteristics and recurrence free survival (RFS) of these two groups of patients and subjecting possible risk factors to statistical analysis. Traditional hematoxylin-eosin staining showed that 15/242 patients were positive for No.12b lymph nodes and 227 were negative. A total of 241 negative No. 12b lymph nodes were detected. Immunohistochemical testing revealed that seven of these 241 No.12b lymph nodes (2.9%) were positive for micrometastasis. A further seven positive nodes were identified among the 227 nodes (3.1%) that had been evaluated as negative on hematoxylin-eosin-stained sections. Thus, 22 /242 patients' (9.1%) No.12b nodes were positive for micrometastases, the remaining 220 (90.9%) being negative. Factor analysis showed that No.12b lymph node (micro) metastasis is associated with more severe invasion of the gastric serosa (HR=3.873, 95%CI: 1.676-21.643, =0.006), T3 stage (HR=1.615, 95%CI: 1.113-1.867, =0.045), higher N stage (HR=1.768, 95%CI: 1.187-5.654, =0.019), phase III of TNM stage (HR=2.129, 95%CI: 1.102-3.475, =0.046), and lymph node metastasis in the No.1/No.8a/No.12a groups (HR=0.451, 95%CI: 0.121-0.552, =0.035; HR=0.645, 95%CI:0.071-0.886, =0.032; HR=1.512, 95%CI: 1.381-2.100, =0.029, respectively). Survival analysis showed that the 5-year RFS of patients in the No.12b positive group was worse than that of those in the No.12b negative group (18.2% vs. 34.5%, <0.001). Independent predictors of RFS were poorer differentiation of the primary tumor (HR=0.528, 95%CI:0.288-0.969, =0.039), more severe serous invasion (HR=1.262, 95%CI:1.039-1.534, =0.019), higher T/N/TNM stage (HR=4.880, 95%CI: 1.909-12.476, <0.001; HR=2.332, 95%CI: 1.640-3.317, <0.001; HR=0.139, 95%CI: 0.027-0.713, =0.018, respectively), and lymph node metastasis in the No.12a/No.12b group(HR=0.698, 95%CI:0.518-0.941, =0.018; HR=0.341, 95%CI:0.154-0.758,=0.008, respectively). Detection of micrometastasis can improve the rate of positive lymph nodes. In patients with gastric antrum cancer, dissection of group No.12b lymph nodes may improve the prognosis of those with intraoperative evidence of tumor invasion into the serosa, more than two lymph node metastases, and suspicious lymph nodes in groups No.1 / No.8a / 12a.
Topics: Humans; Lymphatic Metastasis; Pyloric Antrum; Neoplasm Staging; Retrospective Studies; Neoplasm Micrometastasis; Clinical Relevance; Eosine Yellowish-(YS); Hematoxylin; Prognosis; Stomach Neoplasms; Lymph Node Excision; Lymph Nodes; Gastrectomy
PubMed: 38413085
DOI: 10.3760/cma.j.cn441530-20230412-00121 -
Endoscopy Dec 2024
Topics: Child; Humans; Endoscopy; Pyloric Antrum
PubMed: 38388949
DOI: 10.1055/a-2253-0879 -
Gan To Kagaku Ryoho. Cancer &... Dec 2023Cronkhite-Canada syndrome(CCS)is a rare non-inherited disease characterized by gastrointestinal polyposis and ectodermal abnormalities. We report a rare case of CCS... (Review)
Review
Cronkhite-Canada syndrome(CCS)is a rare non-inherited disease characterized by gastrointestinal polyposis and ectodermal abnormalities. We report a rare case of CCS associated with gastric cancer and gastric outlet obstruction with a review of the literature. A 75-year-old man was admitted because of frequent vomiting and hypoproteinemia. He was diagnosed with CCS due to typical clinical and laboratory findings including alopecia, nail atrophy, hypoproteinemia, and typical gastrointestinal polyposis. Upper endoscopic examination also pointed out a large gastric cancer mainly located in the antrum and the reversible pyloric obstruction caused by the gastric tumor. Biopsy of the tumor revealed tubular adenocarcinoma. Computed tomography demonstrated the dilated duodenum caused by packing of the gastric tumor. 1.5 months after prednisolone therapy, he underwent total gastrectomy with complete resection of the dilated duodenal bulb. Histological examination revealed gastric cancer(pap>tub1)classified into Stage ⅢC. Postoperative course was uneventful and he moved to another hospital. To our knowledge, including the present case, there were 20 reported cases of CCS associated with gastric cancer from Japan(1979-2022). Also, 7 cases of CCS associated with gastric outlet obstruction was reported.
Topics: Male; Humans; Aged; Stomach Neoplasms; Gastric Outlet Obstruction; Pyloric Stenosis; Intestinal Polyposis; Hypoproteinemia
PubMed: 38303218
DOI: No ID Found -
Gan To Kagaku Ryoho. Cancer &... Dec 2023An 82-year-old, male. He visited his local doctor with a chief complaint of dyspnea on exertion. Anemia was noted, and upper gastrointestinal endoscopy was performed,...
An 82-year-old, male. He visited his local doctor with a chief complaint of dyspnea on exertion. Anemia was noted, and upper gastrointestinal endoscopy was performed, which revealed an ulcerative lesion in the gastric antrum. A biopsy revealed Group 5, tub2, and HER2 negative, with PD-L1≥5%. cT3N1H1(M1 HEP), cStage ⅣB was diagnosed based on CT scan showing enlarged #8 lymph node and a single liver metastasis in the 2 cm range in S6 of the liver. The patient was deemed unresectable and was started on SOX plus nivolumab therapy. On day 11 after initiation, the patient had Grade 3 diarrhea by CTCAE v5.0, and S-1 was withdrawn for 3 days, but was administered for 2 courses. CT and MRI after chemotherapy showed shrinkage of both the primary tumor and liver metastases; R0 resection was deemed possible, and pyloric gastrectomy, D2 lymph node dissection, and partial hepatic S6 resection were performed. The histological evaluation of response to treatment was Grade 1b, and the patient was in ypStage ⅠA. The patient has been alive without recurrence for 6 months postoperatively while receiving S-1 monotherapy on an outpatient basis.
Topics: Humans; Male; Aged, 80 and over; Stomach Neoplasms; Nivolumab; Antineoplastic Combined Chemotherapy Protocols; Gastrectomy; Liver Neoplasms
PubMed: 38303216
DOI: No ID Found -
Journal of Clinical Anesthesia Jun 2024Interpretation of gastric ultrasound relies on the use of a clinical algorithm that combines qualitative analysis of the gastric antrum contents with the calculation of... (Observational Study)
Observational Study
Diagnostic accuracy of a simple qualitative ultrasound assessment for the diagnosis of high-risk gastric contents in the parturient. A prospective observational cohort study.
STUDY OBJECTIVE
Interpretation of gastric ultrasound relies on the use of a clinical algorithm that combines qualitative analysis of the gastric antrum contents with the calculation of the volume of fluid contents. This reference method may be difficult to apply in the parturient. We therefore aimed to assess the diagnostic accuracy of a simple qualitative assessment in the supine position for the diagnosis of high-risk gastric contents in the parturient. We also assessed the diagnostic accuracy of a composite scale and another clinical algorithm based on a mathematical model different to that used in the reference method.
DESIGN
Prospective observational cohort study.
SETTING
University hospital, Lyon, France.
PATIENTS
Adult women admitted to the delivery room.
INTERVENTIONS
Qualitative and quantitative gastric ultrasound examination within the first hour following admission.
MEASUREMENTS
With respect to the reference method, the diagnostic accuracy of a simple qualitative assessment for the diagnosis of high-risk gastric contents was assessed. The diagnostic accuracy of a composite scale and another clinical algorithm, and the agreement between each approach were also assessed.
MAIN RESULTS
A total of 235 parturients were included and analyzed. The simple qualitative assessment led to conclusive ultrasound assessment in 233 (99%) women, while the reference method led to conclusive assessment in 213 (91%) women (P < 0.05). The sensitivity and the specificity of the simple qualitative assessment were 97% (95%CI: 93 to 99%) and 96% (95%CI: 90 to 99%), respectively. These were not significantly different from those of the composite scale and the clinical algorithm. The four approaches showed almost perfect agreement with each other.
CONCLUSIONS
These results suggest that simple qualitative assessment may be useful in clinical practice to help the anesthesiologist in the assessment of gastric contents status and risk of aspiration.
Topics: Adult; Humans; Female; Male; Prospective Studies; Stomach; Pyloric Antrum; Ultrasonography; Respiratory Aspiration
PubMed: 38290374
DOI: 10.1016/j.jclinane.2024.111404 -
Molecular Biology Reports Jan 2024Helicobacter pylori (H. pylori) colonizes human gastric mucosa and is classified as class one carcinogenic bacteria. In this regard, this study aimed to detect major...
BACKGROUND
Helicobacter pylori (H. pylori) colonizes human gastric mucosa and is classified as class one carcinogenic bacteria. In this regard, this study aimed to detect major virulence factors in H. pylori strains recovered from gastric biopsy in patients referred to Aras Clinique in Ardabil, northwest of Iran (2019-2021).
MATERIALS AND METHODS
In this descriptive-cross sectional study, 287 dyspeptic patients were included. For bacterial isolation, gastric biopsy specimens (n=287) were taken from gastric antrum, then aseptically were cultured on the selective medium and incubated at 37C in microaerophilic conditions for 3-5 days.
RESULTS
25.18% of all (n = 70) patients were found to be infected with H. pylori upon endoscopy. Of them, 9 patients (12.857%) and 2 patients (2.875%) had peptic ulcer disease and gastric cancer respectively. According to the different patterns of virulence factors, 57 virutypes were identified in which oipA-vacAs1-vacAm2 (3, 4.28% n =) and oipA-vacAs1-vacAs2-vacAm2 (3, 4.28% n =) were the most common patterns. The simultaneous presence of vacAS2, vacAm2 and hopQ2 genes was observed in both patients with gastric cancer. OipA (n = 562.5%), VacAs1 (n = 6.75%), VacAs2 (n = 6.75%), and VacAm2 (n = 787.5%) were found to be the most prevalent virulence factor.
CONCLUSION
According previous studies, it is confirmed that the cagPAI gene cluster and vacA gene alleles are strongly correlated with gastritis and gastrointestinal tract adenocarcinomas. Our study indicated that 50% of the indigenous strains of H. pylori harbor these oncogenic genes and they are hypervirulent.
Topics: Humans; Helicobacter pylori; Stomach Neoplasms; Cross-Sectional Studies; Biopsy; Pyloric Antrum
PubMed: 38270789
DOI: 10.1007/s11033-023-09075-z