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The Ulster Medical Journal Sep 2019
Topics: Biopsy, Needle; Colectomy; Colonic Polyps; Colonoscopy; Diagnosis, Differential; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Immunohistochemistry; Male; Rectal Diseases; Severity of Illness Index; Treatment Outcome; Young Adult
PubMed: 31619854
DOI: No ID Found -
Frontiers in Immunology 2021Colorectal cancer (CRC) is one of the most common cancer worldwide, with a growing impact on public health and clinical management. Immunotherapy has shown promise in... (Observational Study)
Observational Study
Colorectal cancer (CRC) is one of the most common cancer worldwide, with a growing impact on public health and clinical management. Immunotherapy has shown promise in the treatment of advanced cancers, but needs to be improved for CRC, since only a limited fraction of patients is eligible for treatment, and most of them develop resistance due to progressive immune exhaustion. Here, we identify the transcriptional, molecular, and cellular traits of the immune exhaustion associated with CRC and determine their relationships with the patient's clinic-pathological profile. Bioinformatic analyses of RNA-sequencing data of 594 CRCs from TCGA PanCancer collection, revealed that, in the wide range of immune exhaustion genes, those coding for , and were associated (Cramér's V=0.3) with MSI/dMMR tumors and with a shorter overall survival (log-rank test: 0.0004, =0.0014 and =0.0043, respectively), whereas high levels of expression of , , , and were associated with a shorter overall survival (log-rank test: =0.0003, =0.0188, =0.0004, =0.0303, =0.0052 and =0.0033, respectively), independently from the molecular subtype of CRC. Expression levels of , and were significantly correlated with each other and associated with genes coding for and T cell markers and cell markers, (OR >1.5, <0.05), which identify a subset of group 1 innate lymphoid cells, namely conventional (c)NK cells. Expression of and co-occurred with both T cell markers, , and B cell markers, and (OR >2, <0.05). Expression of was associated only with and T cell markers (odds ratio >2, <0.05). Expression of and was associated (OR >1.5, <0.05) only with cNK cell markers, whereas expression of and was associated (OR >2.5; <0.05) with B cell markers. Morphometric examination of immunostained CRC tissue sections, obtained from a validation cohort of 53 CRC patients, substantiated the biostatistical findings, showing that the highest percentage of immune exhaustion gene expressing cells were found in tumors from short-term survivors and that functional exhaustion is not confined to T lymphocytes, but also involves B cells, and cNK cells. This concept was strengthened by CYBERSORTx analysis, which revealed the expression of additional immune exhaustion genes, in particular and , by subpopulations of T, B and NK cells. This study provides novel insight into the immune exhaustion landscape of CRC and emphasizes the need for a customized multi-targeted therapeutic approach to overcome resistance to current immunotherapy.
Topics: Adult; Aged; Aged, 80 and over; B-Lymphocytes; Biomarkers, Tumor; Colon; Colorectal Neoplasms; Computational Biology; Datasets as Topic; Female; Follow-Up Studies; Gene Expression Regulation, Neoplastic; Humans; Immunity, Innate; Intestinal Mucosa; Kaplan-Meier Estimate; Killer Cells, Natural; Lymphocyte Count; Lymphocytes, Tumor-Infiltrating; Male; Middle Aged; RNA-Seq; Rectum; T-Lymphocytes; Time Factors
PubMed: 34975867
DOI: 10.3389/fimmu.2021.778329 -
Gastroenterology Nursing : the Official...The incidence of COVID-19 gastrointestinal manifestations has been reported to range from 3% to 61%. There are limited data on the incidence rates and risk factors... (Review)
Review
The incidence of COVID-19 gastrointestinal manifestations has been reported to range from 3% to 61%. There are limited data on the incidence rates and risk factors associated with gastrointestinal bleeding (GIB) in patients with COVID-19. A rapid review has been designed to investigate whether there is a relationship between COVID-19 and GIB in adult patients. PubMed, CINAHL, EMBASE, Cochrane Library, and Scopus databases have been analyzed. A total of 129 studies were found; 29 full texts were analyzed, and of these, 20 were found to be relevant to the topic. The key findings of the included studies present an overall GIB rate in COVID-19 patients ranging from 1.1% to 13%. The bleeding involves mucosal damage of the duodenum, stomach, colon, and rectum. The management of gastrointestinal bleeding could be conservative. The use of fecal diversion systems for the management of diarrhea in COVID-19 patients should be minimized and closely evaluated for the risk of rectal mucosal damages and erosions. It is recommended to provide an accurate nutritional assessment; an early setting up of enteral nutrition, if not contraindicated, can help protect the gut mucosa of patients and restore normal intestinal flora. Larger cohort studies are needed to increase the information about this topic.
Topics: Adult; COVID-19; Colon; Enteral Nutrition; Gastrointestinal Hemorrhage; Humans; Rectum
PubMed: 35833732
DOI: 10.1097/SGA.0000000000000676 -
Nigerian Journal of Clinical Practice Sep 2022Colonoscopy is an important procedure in the management of colorectal diseases. During a colonoscopy, one can visualize the mucosa of the large bowel and perform...
BACKGROUND
Colonoscopy is an important procedure in the management of colorectal diseases. During a colonoscopy, one can visualize the mucosa of the large bowel and perform therapeutic procedures.
AIM
The aim of this study is to review the indications and findings of colonoscopy in our center. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register.
PATIENTS AND METHODS
The study is a retrospective descriptive one and included all patients who underwent colonoscopy between June 2017 to December 2019 at the endoscopy unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) statistical software version 20.
RESULTS
One hundred and twenty-five patients had a colonoscopy during the period under review with a male to female ratio of 1.9:1. The age range of the patients was 3 to 85 years and the mean age was 46.7 ± 16.7 The most common indications for colonoscopy in our center were lower gastrointestinal bleeding (40 (32%)), followed by suspected colonic tumors (37 (29.6%)), and hemorrhoids (18 (14.4%)). The commonest findings were hemorrhoids (50 (40%)), colonic tumors (25 (20%)), and colitis (21 (16.8%)).
CONCLUSION
A colonoscopy is an effective tool in the management of colorectal diseases. Lower gastrointestinal bleeding was the commonest indication for colonoscopy in our center and hemorrhoids and colorectal tumors were the commonest findings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Colonic Diseases; Colonic Neoplasms; Colonoscopy; Colorectal Neoplasms; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Male; Middle Aged; Nigeria; Retrospective Studies; Young Adult
PubMed: 36149222
DOI: 10.4103/njcp.njcp_150_22 -
The American Journal of Gastroenterology Mar 2017Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is difficult, although studies have reported clinical, endoscopic, imaging, and laboratory... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is difficult, although studies have reported clinical, endoscopic, imaging, and laboratory findings that help to differentiate these two diseases. We aimed to produce estimates of the predictive power of these findings and construct a comprehensive model to predict the probability of ITB vs. CD.
METHODS
A systematic literature search for studies differentiating ITB from CD was conducted in MEDLINE, PUBMED, and EMBASE from inception until September 2015. Fifty-five distinct meta-analyses were performed to estimate the odds ratio of each predictive finding. Estimates with a significant difference between CD and ITB and low to moderate heterogeneity (I<50%) were incorporated into a Bayesian prediction model incorporating the local pretest probability.
RESULTS
Thirty-eight studies comprising 2,117 CD and 1,589 ITB patients were included in the analyses. Findings in the model that significantly favored CD included male gender, hematochezia, perianal disease, intestinal obstruction, and extraintestinal manifestations; endoscopic findings of longitudinal ulcers, cobblestone appearance, luminal stricture, mucosal bridge, and rectal involvement; pathological findings of focally enhanced colitis; and computed tomographic enterography (CTE) findings of asymmetrical wall thickening, intestinal wall stratification, comb sign, and fibrofatty proliferation. Findings that significantly favored ITB included fever, night sweats, lung involvement, and ascites; endoscopic findings of transverse ulcers, patulous ileocecal valve, and cecal involvement; pathological findings of confluent or submucosal granulomas, lymphocyte cuffing, and ulcers lined by histiocytes; a CTE finding of short segmental involvement; and a positive interferon-γ release assay. The model was validated by gender, clinical manifestations, endoscopic, and pathological findings in 49 patients (27 CD, 22 ITB). The sensitivity, specificity, and accuracy for diagnosis of ITB were 90.9%, 92.6%, and 91.8%, respectively.
CONCLUSIONS
A Bayesian model based on the meta-analytic results is presented to estimate the probability of ITB and CD calibrated to local prevalence. This model can be applied to patients using a publicly available web application.
Topics: Ascites; Bayes Theorem; Constriction, Pathologic; Crohn Disease; Diagnosis, Differential; Endoscopy, Digestive System; Fever; Gastrointestinal Hemorrhage; Granuloma; Humans; Ileocecal Valve; Interferon-gamma Release Tests; Intestinal Obstruction; Models, Theoretical; Rectum; Sensitivity and Specificity; Sex Factors; Sweating; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Ulcer
PubMed: 28045023
DOI: 10.1038/ajg.2016.529 -
World Journal of Gastroenterology Mar 2017To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer. (Review)
Review
AIM
To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.
METHODS
A review of the databases MEDLINE and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.
RESULTS
This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.
CONCLUSION
A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
Topics: Blood Loss, Surgical; Decision Making; Electrocoagulation; Hemostasis; Hemostasis, Surgical; Humans; Hydrodynamics; Metals; Pelvis; Prostheses and Implants; Rectal Neoplasms; Rectum; Sacrum; Veins
PubMed: 28321171
DOI: 10.3748/wjg.v23.i9.1712 -
Journal of Comparative Effectiveness... Jul 2021Hemorrhoidal disease (HD) is common in adults. Treatment is largely conservative, although more invasive procedures may be required. Venoactive drugs such as micronized... (Review)
Review
Hemorrhoidal disease (HD) is common in adults. Treatment is largely conservative, although more invasive procedures may be required. Venoactive drugs such as micronized purified flavonoid fraction (MPFF) are widely used, but a recent and comprehensive review of supporting evidence is lacking. In acute HD, MPFF can reduce HD symptoms such as bleeding, pain, anal discomfort, anal discharge and pruritus. In patients undergoing surgery, postoperative adjunct MPFF consistently reduces pain, bleeding duration and use of analgesia. MPFF treatment is appropriate and effective both as a first-line conservative treatment and as a postoperative adjunct treatment. MPFF reduces the duration of hospital stay following surgery, facilitating a return to normal activity and improving quality of life. MPFF may also prevent HD recurrence.
Topics: Acute Disease; Adult; Flavonoids; Hemorrhage; Hemorrhoids; Humans; Quality of Life; Treatment Outcome
PubMed: 33928786
DOI: 10.2217/cer-2021-0038 -
Techniques in Coloproctology Dec 2017The transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to... (Review)
Review
BACKGROUND
The transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to assess the clinical efficacy and the satisfaction of patients in a large series treated with THD and to review the relevant literature.
METHODS
In this retrospective, single-institution, study consecutive patients with grade 2, 3, or 4 hemorrhoidal disease were treated with the THD Doppler procedure. Dearterialization was performed in all cases and mucopexy in case of prolapse. The dearterialization procedure evolved from "proximal artery ligation" to "distal Doppler-guided dearterialization." Follow-up was scheduled at 15 days, 1, 3, 12 months, and once a year thereafter. Complications were recorded. Clinical efficacy was assessed comparing both frequency of symptoms and disease grading (Goligher's classification) at baseline versus last follow-up. Uni-/multivariate analysis evaluated factors affecting the outcome.
RESULTS
There were 1000 patients (619 men; mean age: 48.6 years, range 19-88 years). Acute postoperative bleeding was observed in 14 patients (1.4%), pain/tenesmus in 31 patients (3.1%), and urinary retention in 23 patients (2.3%). At mean follow-up duration of 44 ± 29 months, the symptomatic recurrence rate was 9.5% (95 patients; bleeding in 12 (1.2%), prolapse in 46 (4.6%), and bleeding and prolapse in 37 (3.7%) patients). The recurrence rate was 8.5, 8.7, and 18.1% in patients with grade 2, 3, and 4 hemorrhoids, respectively. Seventy out of 95 patients with recurrence needed surgery (reoperation rate: 7.0%). At final follow-up and taking into account the reoperations, 95.7% of patients had no hemorrhoidal disease on examination. Younger age, grade 4 disease, and high artery ligation affected the outcome negatively.
CONCLUSIONS
Our results show that the THD Doppler procedure is safe and effective in patients with hemorrhoidal disease and associated with low morbidity and recurrence rates and a high rate percentage of treatment success.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Arteries; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction; Postoperative Hemorrhage; Proctoscopes; Recurrence; Retrospective Studies; Severity of Illness Index; Symptom Assessment; Transanal Endoscopic Surgery; Treatment Outcome; Urinary Retention; Young Adult
PubMed: 29170839
DOI: 10.1007/s10151-017-1726-5 -
Journal of Visceral Surgery Apr 2015The transanal hemorrhoidal de-arterialization (THD) procedure is an effective treatment of hemorrhoidal disease. The ligation of hemorrhoidal arteries... (Review)
Review
PURPOSE
The transanal hemorrhoidal de-arterialization (THD) procedure is an effective treatment of hemorrhoidal disease. The ligation of hemorrhoidal arteries ("de-arterialization") can provide a significant reduction of arterial blood flow to the hemorrhoidal tissues. Plication of redundant rectal mucosa/submucosa ("mucopexy") can reposition prolapsing tissue to its original anatomical site. In this paper the surgical technique using a specific device (THD(®) Doppler) and peri-operative patient management are illustrated.
METHODS
After appropriate clinical assessment, patients undergo the THD procedure under general or spinal anesthesia, in either the dorsal lithotomy or prone jackknife position. A specifically designed device is used. In all patients, THD is performed, consisting of selective ligation of hemorrhoidal arteries identified by Doppler and marked with a mucosal stitch overlying the artery. In patients with hemorrhoidal or mucosal prolapse, a mucopexy is also performed using continuous suture(s) that include the redundant prolapsing mucosa and submucosa.
RESULTS
In long-term follow-up, THD results in resolution of symptoms in the majority of patients. The most common complication is transient but sometimes-painful tenesmus. Rectal bleeding occurs in only a very limited number of patients. There is little or no risk of fecal incontinence or chronic pain. Ano-rectal manometry and endo-anal ultrasound show no evidence of injury to physiologic sphincteric function.
CONCLUSIONS
THD is a safe procedure and is, at present, one of the most effective treatments of hemorrhoidal disease.
Topics: Hemorrhoids; Humans; Ligation; Rectum; Transanal Endoscopic Microsurgery; Treatment Outcome; Ultrasonography, Doppler; Ultrasonography, Interventional
PubMed: 25262549
DOI: 10.1016/j.jviscsurg.2014.08.003 -
Journal of Visceral Surgery Sep 2014The aim of this study was to compare the efficacy between stapled hemorrhoidopexy (Longo technique) and transanal hemorrhoidal artery ligation with mucopexy (THDm) in... (Comparative Study)
Comparative Study
AIM
The aim of this study was to compare the efficacy between stapled hemorrhoidopexy (Longo technique) and transanal hemorrhoidal artery ligation with mucopexy (THDm) in the treatment of hemorrhoidal disease.
PATIENTS AND METHODS
From June 2009 to January 2011, 81 patients having grade II or III hemorrhoidal disease underwent prospective evaluation followed by surgery at two centers (27 Longo and 54 THDm). Symptoms (bleeding, tenesmus, prolapse, fecal incontinence, pain) and the satisfaction score were compared on the first post-operative day and at 1, 6, 12, and 24 months thereafter. The follow-up was 24 months.
RESULTS
There was no difference in mean length of stay. One complication (recto-vaginal fistula) was observed after Longo. The prolapse score was significantly lower after THDm than after Longo on the first post-operative day (P < 0.0015). Bleeding score after THDm was significantly lower on the first post-operative day (P = 0.04), but higher thereafter (P = 0.03 and P = 0.04). Tenesmus score after THDm was significantly lower for the first three months (P < 0.06 and 0.001). On the first post-operative day and at one month, the visual analog pain score was significantly lower after THDm than that after Longo (P < 0.0003 et P < 0.01). On the first post-operative day and at one month, the satisfaction score was higher after THDm than after Longo (P < 0.001).
CONCLUSION
THDm was safe and effective. Short-term outcomes after THDm were better than after Longo but long-term results seemed to be similar.
Topics: Adolescent; Adult; Aged; Arteries; Chi-Square Distribution; Cohort Studies; Female; Follow-Up Studies; Hemorrhoidectomy; Hemorrhoids; Humans; Intestinal Mucosa; Length of Stay; Ligation; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pain, Postoperative; Prospective Studies; Rectum; Severity of Illness Index; Surgical Stapling; Treatment Outcome; Ultrasonography; Young Adult
PubMed: 24726856
DOI: 10.1016/j.jviscsurg.2014.03.009