Intestinal Bleeding Research Articles

Idiopathic Thrombocytopenic Purpura: Current Limitations and Management.

Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenia, is a blood disorder characterized by a reduction in the number of platelets. A reduction in the number of platelets beyond the normal levels leads to several consequences. A severe reduction in blood platelet levels leads to a rash of purple spots on the skin, joints, etc.due to leakage in the small blood vessels, easy bruising, bleeding gums, intestinal bleeding, and hemorrhage. Suppose a case of ITPresolves in fewer than six months. In that case, it is an acute case of ITP. Still, if a case settles in more than six months, it is a case of ITP. The cause of a reduced platelet count can be increased peripheral destruction or impaired production; this is termed an autoimmune condition in which the body's immune system attacks platelets thinking it to be a foreign antigen. ITP in children occurs commonly following a previous viral attack. Even though evaluating patients' reports is useful for understanding and guiding the treatment, these estimates might not be regularly evaluated in clinical settings. First-line drugs in the treatment of ITP are corticosteroids, and long-term use of these drugs has several side effects, such as excessive increase in weight, mental health disturbances, and sleep disturbances; additional therapies to treat hemorrhage are usually momentary. As a result, it is essential to recognize the flaws in current procedures and adopt innovative measures for the management and minimization of difficulties.

LARGE INTESTINES COMPLICATED DIVERTICULITIS MODERN TREATMENT TACTICS USING VIDEOENDOSCOPIC EQUIPMENT

Abstract. Colonic diverticular disease (CDD) is an important problem in abdominal surgery for the majority countries of the world. The incidence of CDD is, unfortunately, progressing. The CDD relevance is determined by medical and economic aspects taking into account the disease frequent cases in working age persons. The tactics of CDD treatment is considered to be traditional and is determined according to the generally accepted modifi ed disease classifi cation according to E. J. Hinchey. Using daily the tactics of a personalized approach to patients we agree with the opinion of our colleagues and consider the choice of sigmoid colon acute diverticulitis and its complications optimal method of diagnosis and surgical treatment to be still arguing. Having considerable experience and treating patients with CDD for a long time, we try to use mostly the laparoscopic approach in surgical tactics the eff ectiveness of which we intend to summarize.The purpose. To determine the eff ectiveness of the laparoscopic method of surgical treatment of patients with CDD complicated clinical manifestation. Research material and methods. The treatment of 221 patients with 263 surgical interventions due to CDD and its complications was analyzed. CDD complicated forms were diagnosed in 186 (84.5 %) patients. 164 (62.4 %) operations were performed urgently, 102 (61.7 %) of which were performed using videoendoscopic equipment, 62 (38.3 %) were performed using the traditional open method. Open operations performed under urgent indications. Special attention was attracted to patients with bleeding as CDD complication. 9 patients (in 6 with initial intestinal bleeding and in 3 with CDD complicated by profuse bleeding) underwent operative treatment. All patients were treated in one stage.Results and their discussion. According to planned indications, 26 laparoscopic and 31 open resections of the large intestine were performed due to CDD. The source of infl ammation was localized in the sigmoid colon in all patients. Infl ammation of one diverticulum occurred in 56 (98.4 %) cases, two diverticulies – in 1 (1.6 %) observation. 49 patients were treated in 2 stages. Perforation of the diverticulum wall was detected in 79 (51.6 %) patients. The duration of operative treatment of patients with complicated CDD using videoendoscopic equipment was 73.4±6.2 min. The index of bed days duration with laparoscopic operations was 6.1±0.7. The patients’ stay in the hospital after scheduled videoendoscopic operations was 6.3±1.6 days. From 9 patients with bleeding in the absence of conservative therapy effi cacy and under the condition of the patient’s stable condition, 4 patients underwent laparoscopic left-sided hemicolectomy. Open surgical interventions were performed in 5 patients, mostly elderly and with severe concomitant pathology.Conclusions. In case of patients with a CDD complicated course treatment we consider a two-stage treatment preferable, when the second stage (left-sided hemicolectomy) is performed in a planned manner within 9 days to 6 months after the operation for urgent indications. Patients with complicated CDD operative treatment is better to be performed with the use of videoendoscopic equipment. It is better to perform repeated planned radical operations for CDD laparoscopically, which is evidenced by a lower number of complications. The use of laparoscopic technologies in case of colonic bleeding treatment as CDD complication is a promising direction in abdominal surgery and requires its e ffi ciency further study.

THE EFFECTIVENESS OF CEFTRIAXONE AND MEROPENEM IN THE TREATMENT OF ENTERIC FEVER IN CHILDREN- EXPERIENCE IN A TERTIARY CARE HOSPITAL IN PAKISTAN

Objectives: To determine the effectiveness of ceftriaxone and Meropenem in the treatment of Enteric Fever in the Pediatric Department of Khyber Teaching Hospital Peshawar. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted at the Department of Child Health Khyber Teaching Hospital Peshawar Pakistan from June 2020 to June 2022. The sample size included 392 patients. Keeping in view 392 blood samples were taken and sent for blood culture. Both positive and negative cultures were incorporated in the study. The patients were started empirically on ceftriaxone and then in case of no response, the patients were shifted to Meropenem based on the sensitivity of the culture report. The response was defined as when the patient is afebrile for 72 hours after the treatment and the absence of complications like peritonitis, intestinal hemorrhage, and obtundation. Data was analyzed using SPSS version 21.0. RESULTS: In our study, out of 392 patients, 64% were males while 36% were females. Among blood cultures sent, 16.8% were positive and 83.2% were negative. Among the culture positive, 10.5% of patients were sensitive to Meropenem, 3.6% were sensitive to ceftriaxone and 2.8% were sensitive to other drugs. 60.7% of patients responded to Meropenem. Ceftriaxone-responsive patients were 11.7%, while 27.6% showed a response to other drugs. CONCLUSION: The efficacy of Meropenem was significantly high (in 2/3rd patients) while Ceftriaxone showed 11.73% efficacy. KEYWORDS: Enteric fever, ceftriaxone, Meropenem

DNase I targeted degradation of neutrophil extracellular traps to reduce the damage on IgAV rat.

In the past two years, studies have found a significant increase in neutrophil extracellular traps (NETs) in patients with IgA vasculitis (IgAV), which is correlated with the severity of the disease. NETs have been reported as an intervention target in inflammatory and autoimmune diseases. This study aimed to investigate the effect of targeted degradation of NETs using DNase I in IgAV rat model. Twenty-four Sprague-Dawley rats were randomly divided into three groups: the IgAV model group, the DNase I intervention group and the normal control group, with an average of 8 rats in each group. The model group was established by using Indian ink, ovalbumin, and Freund's complete adjuvant. In the intervention group, DNase I was injected through tail vein 3 days before the end of established model. The circulating cell free-DNA (cf-DNA) and myeloperoxidase-DNA (MPO-DNA) were analyzed. The presence of NETs in the kidney, gastric antrum and descending duodenum were detected using multiple fluorescences immunohistochemistry and Western blots. Morphological changes of the tissues were observed. After the intervention of DNase I, there was a significant reduction in cf-DNA and MPO-DNA levels in the intervention group compared to the IgAV model group (all P<0.001). The presence of NETs in renal, gastric, and duodenal tissues of the intervention group exhibited a significant decrease compared to the IgAV model group (P < 0.01). Moreover, the intervention group demonstrated significantly lower levels of renal MPO and citrullinated histone H3 (citH3) protein expression when compared to the IgAV model group (all P < 0.05). The HE staining results of intervention group demonstrated a significant reduction in congestion within glomerular and interstitial capillaries. Moreover, there was a notable improvement in gastric and intestinal mucosa necrosis, congestion and bleeding. Additionally, there was a substantial decrease in inflammatory cells infiltration. The degradation of NETs can be targeted by DNase I to mitigate tissue damage in IgAV rat models. Targeted regulation of NETs holds potential as a therapeutic approach for IgAV.

Hubungan Tingkat Pengetahuan Ibu Dengan Penanganan Demam Thypoid Pada Anak Di Rsu Mayjen H.A Thalib Kota Sungai Penuh

Complications that often occur in typhoid fever are intestinal bleeding and perforation. Intestinal bleeding and perforation are serious complications and need to be watched out for. About 5 percent of people with typhoid fever experience this complication. Other, less common complications include swelling and inflammation of the heart muscle (myocarditis), pneumonia, inflammation of the pancreas (pancreatitis), kidney or bladder infections, infection and swelling of the lining of the brain (meningitis), and psychiatric problems such as delirium, hallucinations, and paranoid psychosis. This study uses an analytic descriptive design using a cross sectional approach. The sample in this study were 43 respondents and the sample in this study used the Total Sampling technique. By using the chi-square test with the SPSS program. The results of this study found that the p value = 0.000 (p value≤0.05) which means that Ha is accepted and H0 is rejected, which means there is a relationship between the level of knowledge of the mother and the handling of typhoid fever in children at the General Hospital of Major General H.A Thalib City Full River. It is expected that parents can always maintain children's sanitary hygiene, especially the food consumed by children and the condition of their hands when they are going to touch food.

Lasso peptide MccY alleviates non-typhoidal salmonellae-induced mouse gut inflammation via regulation of intestinal barrier function and gut microbiota.

Non-typhoidal salmonellae-induced zoonotic intestinal bleeding infections are a crucial threat to public health worldwide, and the development of new medications is required to prevent and treat non-typhoid Salmonella (NTS) infections. MccY, a class of lasso peptide, is effective in biological sterilization against Salmonella and Shigella. In this study, the therapeutic effect of MccY on S. Typhimurium-infected BALB/c mice has been discussed. specific pathogen free (SPF) mice were infected with the ST53 strain with bacterial loads of 106 and 103 CFU/mL, respectively, and then treated with 9.92 mg/kg BW MccY. Results revealed that MccY significantly reduced mouse mortality by 20%-40% and effectively alleviated weight loss and diarrhea. The integrity of the intestinal structure was protected, and the expression of TNF-α, IL-6, IL-10, and IL-18 was inhibited. Particularly, MccY exerted multiple effects on gut microbiota ecology, including direct elimination of Salmonella, showing promise in limiting infection to the gut level and thereby halting the transmission of NTS. MccY indirectly inhibited other opportunistic pathogens and partially restored the microbiota, promoting an increase in Bacteroidetes, Lactobacillus, Muribaculum, and Clostridium. Consequently, this work provides an understanding of the link between host infection and therapeutic application of MccY. IMPORTANCE Diseases caused by Enterobacteriaceae multidrug-resistant strains have become increasingly difficult to manage. It is necessary to verify the new antibacterial drug MccY effect on non-typhoid Salmonella infection in mice since it is regarded as a promising microcin. The results demonstrated that MccY has a potential therapeutic application value in the protection against Salmonella-induced intestinal damage and alleviating related intestinal dysbiosis and metabolic disorders. MccY could be a promising candidate as an antimicrobial or anti-inflammatory agent for treating infectious diseases.

Is laparoscope surgery feasible for upper gastrointestinal cancer patients with a history of abdominal surgery?

To investigate the feasibility of laparoscopic abdominal mobilization in patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery. A total of 132 patients who underwent resection for cancers of the esophagus or gastroesophageal junction from August 2018 to March 2022 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, were selected (66 patients with a history of abdominal surgery (observation group) and 66 patients without a history of abdominal surgery (control group)). All patients were treated with preoperative neoadjuvant therapy, based on the clinical stage. Thoracoscopic and laparoscopic resection was performed under general anesthesia. The intraoperative and postoperative conditions and surgical complications were compared between the two groups. No significant differences were found in baseline data between the observation group and the control group (p > 0.05). Laparoscopic abdominal mobilization was completed in both groups, and there were no significant differences between the two groups in the total operation time [(272.50 ± 86.45) min vs. (257.55 ± 67.96) min], abdominal mobilization time [(25.03 ± 9.82) min vs. (22.53 ± 3.88) min], blood loss [(119.09 ± 72.17) ml vs. (104.39 ± 43.82) ml], and postoperative time to first flatus [(3.44 ± 0.73) d vs. (3.29 ± 0.60) d] (p > 0.05). The abdominal mobilization time was longer in observation group than that in control group (p = 0.057). After excluding the patients (31/66) with a history of simple appendectomy from the observation group, the abdominal mobilization time was significantly longer in observation group than that in control group [(27.97 ± 12.16) min vs. (22.53 ± 3.88) min] (p < 0.05). There were significantly fewer dissected abdominal lymph nodes in the observation group than in the control group [(18.44 ± 10.87) vs. (23.09 ± 10.95), p < 0.05]. After excluding the patients (15/66) with a history of abdominal tumor surgery from the observation group, there was no significant difference in the number of dissected abdominal lymph nodes between the two groups [(20.62 ± 10.81) vs. (23.09 ± 10.95)] (p > 0.05).In addition, no postoperative complications, such as intestinal obstruction, abdominal infection and bleeding, occurred in either group. Patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery are suitable for minimally invasive laparoscopic mobilization.

Massive Gastro Intestinal Bleeding Revealing an Ileal GIST: A Case Report and Literature Review

Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions of the gastro-intestinal tract, they can be difficult to diagnose and have a varied clinical outcome. We report the case of a 70-year-old man who presented a recurrent and severe gastro intestinal bleeding revealing an ileal GIST. Upper GI endoscopy and colonoscopy showed no abnormalities, meanwhile abdominal CT scan revealed the tumor. The patient underwent surgery and the diagnosis of an ileal GIST was confirmed by histopathological evaluation.

Morphological anomalies of tadpoles from a contaminated stream in the state of Tlaxcala, Mexico

The contamination of aquatic systems by anthropogenic activities may impact amphibian populations by causing malformation and death in tadpoles. However, there often needs to be more information regarding environmental pollutants' effects on amphibians, such as contaminated systems from the state of Tlaxcala in Mexico. This study reports on morphological abnormalities observed in Lithobates spectabilis tadpoles found in a stream of three sites monitored in Tlaxcala. The tadpoles presented swollen heads, edema, intestinal hemorrhage, anomalies in the mouth, a deviated tail, and underdeveloped tail fins. We hypothesise that these abnormalities have been caused by exposure to contamination from nearby communities, including garbage and sewage pumped directly into the stream. This research provides the first report on the potential adverse effects of contaminant exposure on tadpole development and morphology in this region. Identifying malformations in tadpoles could help detect contaminants in aquatic systems for further analysis. Keywords: Lithobates spectabilis, pollutants, anthropogenic, edema, abnormalities

Surgical approaches to the treatment of complicated ulcers of the stomach and duodenum

Surgical treatment of combined complications of peptic ulcer disease of the stomach and duodenum currently remains a complex and not fully resolved problem in abdominal surgery. Algorithms, surgical approaches and tactics of surgical treatment of patients with multiple combined complications have not been developed. The relative number of patients with a combination of complications has increased and is accompanied by significant mortality. The aim was to improve the results of surgical treatment of complicated gastroduodenal ulcers. The presented materials are the results of the analysis of the surgical treatment of patients with complicated gastroduodenal ulcer for the period from 2000 to 2022, which was carried out on the basis of the Kyiv City Clinical Hospital No.12 (Gastro Intestinal Bleeding Center of the city of Kyiv). 395 patients operated on for complicated gastroduodenal ulcers (combination of 2 or more complications) were analyzed. By time period, all patients were divided into 2 periods: group A (2000–2014) – 209 patients, group B (2015–2022) – 186 patients. Of which 299 (75.7%) patients had a combination of two complications in different combinations, 88 (22.3%) patients had a combination of three complications, and the remaining 8 (2.3%) had four complications. Gastrointestinal bleeding was observed in 164 (41.5%) of 395 patients, and ulcer perforation complications were observed in 353 (89.4%) patients. 352 (89.1%) emergency operations were performed, 43 (10.9%) early-term operations. The use of modern measures of endoscopic hemostasis made it possible to operate on patients with EDP, and their share increased 2.6 times (from 13 (6.2%) to 30 (16.1%)) and made it possible to perform radical operations in most cases (from 174 (83.2%) to 182 (97.8%)) both organ-preserving and organ-sparing. The total mortality in group A was 21 cases per 209 patients (10.1%), and in group B it decreased to 12 cases per 186 operated (6.5%). The highest rate of complications and mortality is associated with gastric resection – 42.9% (3 out of 7 patients). The lowest rate of mortality was among patients who underwent OSO, 3.3% (8 out of 245 operated on). Keywords: complicated gastroduodenal ulcer, perforation, bleeding, stenosis, penetration, early delayed period.

Discovery of Bacteroides uniformis F18-22 as a Safe and Novel Probiotic Bacterium for the Treatment of Ulcerative Colitis from the Healthy Human Colon.

Previous studies have demonstrated that the intestinal abundance of Bacteroides uniformis is significantly higher in healthy controls than that in patients with ulcerative colitis (UC). However, what effect B. uniformis has on the development of UC has not been characterized. Here, we show for the first time that B. uniformis F18-22, an alginate-fermenting bacterium isolated from the healthy human colon, protects against dextran-sulfate-sodium (DSS)-induced UC in mice. Specifically, oral intake of B. uniformis F18-22 alleviated colon contraction, improved intestinal bleeding and attenuated mucosal damage in diseased mice. Additionally, B. uniformis F18-22 improved gut dysbiosis in UC mice by increasing the abundance of anti-inflammatory acetate-producing bacterium Eubacterium siraeum and decreasing the amount of pro-inflammatory pathogenetic bacteria Escherichia-Shigella spp. Moreover, B. uniformis F18-22 was well-tolerated in mice and showed no oral toxicity after repeated daily administration for 28 consecutive days. Taken together, our study illustrates that B. uniformis F18-22 is a safe and novel probiotic bacterium for the treatment of UC from the healthy human colon.

Non-O1/O139 Vibrio cholerae causes severe intestinal disease in bullfrogs (Rana catesbeiana)

Bullfrogs (Rana catesbeiana) are amphibians with high economic value, but in recent years, bullfrog farming has encountered serious threats of bacterial diseases, and the “bullfrog economy” is facing a continuous decline. In this study, the dominant strain was isolated from diseased bullfrogs in a bullfrog farm in Nanning, Guangxi, and based on its morphological, physiological, and biochemical characteristics and analysis of 16S rRNA gene sequences, the strain was identified as a non-O1/O139 group Vibrio cholerae and named TC1. Three virulence factors were identified in this strain, including hemolysin, outer membrane protein, and toxin-coregulated pili. Drug susceptibility testing showed that the strain resisted gentamicin, florfenicol, nitrofural, oxytetracycline, neomycin, penicillin, amoxicillin, doxycycline, and sulfamonomethoxine. The results of artificial infection experiments showed that TC1 caused serious pathologies such as abdominal swelling and anal prolapse in bullfrogs, especially severe intestinal bleeding. Histopathological observations revealed that the bullfrog intestine exhibited obvious pathological lesions. These results provide an essential epidemiological basis for controlling V. cholerae infections in aquatic animals and demonstrate the promise of bullfrogs as an amphibian model for studying the pathogenesis of V. cholerae.

Celastrol as an intestinal FXR inhibitor triggers tripolide-induced intestinal bleeding: Underlying mechanism of gastrointestinal injury induced by Tripterygium wilfordii

BackgroundTripterygium wilfordii has been widely used for the treatment of rheumatoid arthritis, which is frequently accompanied by severe gastrointestinal damage. The molecular mechanism underlying the gastrointestinal injury of Tripterygium wilfordii are yet to be elucidated. MethodsTransmission electron microscopy, and pathological and biochemical analyses were applied to assess intestinal bleeding. Metabolic changes in the serum and intestine were determined by metabolomics. In vivo (time-dependent effect and dose-response) and in vitro (double luciferase reporter gene system, DRATs, molecular docking, HepG2 cells and small intestinal organoids) studies were used to identify the inhibitory role of celastrol on intestinal farnesoid X receptor (FXR) signaling. Fxr-knockout mice and FXR inhibitors and agonists were used to evaluate the role of FXR in the intestinal bleeding induced by Tripterygium wilfordii. ResultsCo-treatment with triptolide + celastrol (from Tripterygium wilfordii) induced intestinal bleeding in mice. Metabolomic analysis indicated that celastrol suppressed intestinal FXR signaling, and further molecular studies revealed that celastrol was a novel intestinal FXR antagonist. In Fxr-knockout mice or the wild-type mice pre-treated with pharmacological inhibitors of FXR, triptolide alone could activate the duodenal JNK pathway and induce intestinal bleeding, which recapitulated the pathogenic features obtained by co-treatment with triptolide and celastrol. Lastly, intestinal bleeding induced by co-treatment with triptolide and celastrol could be effectively attenuated by the FXR or gut-restricted FXR agonist through downregulation of the duodenal JNK pathway. ConclusionsThe synergistic effect between triptolide and celastrol contributed to the gastrointestinal injury induced by Tripterygium wilfordii via dysregulation of the FXR-JNK axis, suggesting that celastrol should be included in the quality standards system for evaluation of Tripterygium wilfordii preparations. Determining the mechanism of the FXR-JNK axis in intestinal bleeding could aid in the identification of additional therapeutic targets for the treatment of gastrointestinal hemorrhage diseases. This study also provides a new standard for the quality assessment of Tripterygium wilfordii used in the treatment of gastrointestinal disorders.

Peutz-Jeghers Syndrome Causing Gastroduodenal Intussusception : A Rare Case Report

Peutz-Jeghers syndrome (PJS) is a rare disease characterized by melanotic macular lesions over the pulp of fingers, in oral cavity mucosa, lips, and hamartomatous gastric and intestinal polyps. They usually present with intestinal intussusception or intestinal bleeding; gastroduodenal intussusception is an infrequent presentation. Endoscopic resection or complete surgical excision of the polyp is the treatment of choice. We here present a case of a seven year male with multiple gastric polyps presenting as gastric outlet obstruction.

Ascaridia galli infection in chicken: Pathobiology and immunological orchestra.

Ascaridia galli is the largest gut-dwelling helminth of chickens, which confers adverse effects on meat and egg production; thus, on the animal protein supply and the economy. Both adult and immature parasites affect gut health, but larval stages play a major role in pathology. Here, we present immunology and pathology of A. galli in chickens. Literatures were surveyed through online platforms such as PubMed, Google Scholar and Researchgate. The larvae cause excessive mucus production, damage to the intestinal gland, hemorrhage, anemia, diarrhea, and malnutrition. The adult worms can cause death by intestinal obstruction and intussusception. Although both cellular and humoral immunity are involved in fighting against ascariasis, the role of naturally acquired immunity is poorly defined. In cellular immunity, Th-2 cytokines (IL-4, IL-5, IL-9, and IL-13), goblet cells (mucin), gut-associated lymphoid tissues, CD8α+ intraepithelial cells, TCRγδ + T cells, and TGF-β4 form a protective band. Type 2 immunity provides protection by forming a network of endogenous damage-associated molecular patterns, chitin, and parasitic antigens. Among antibodies, IgY is the most prominent in chickens and provides temporary humoral protection. During parasitic infection, infiltration of various immune cells is evident, especially in the intestinal epithelium, lamina propria, and crypts of the duodenum and jejunum. In chickens older than 12 weeks, gradual reduction of worm burden is more successful than the younger birds. Female chickens exert a short-lived but higher level of protection by passing IgY to chicks in the form of egg yolk antibodies. In laying conditions, immunity differs between breeds. This review provides an overview of the silent but inevitable pathological changes induced by A. galli and the interaction of host immunity with the parasite.

Interesting surgical cases of mesenteric cystic lymphangioma

Mesenteric cystic lymphangioma involving the gastrointestinal tract is uncommon in infants and children. It is a benign tumor due to abnormal formation lymphatic system. These tumors exhibit symptoms varying in site and size of localization. Usually, symptoms are manifested by acute abdominal pain, intestinal obstruction, rising body temperature, and diarrhea. Lymphangioma can easily misdiagnose with other conditions like intestinal obstruction, acute appendicitis, or ovarian cyst in a female child. Therapeutic interventions such as fibrin glue, steroids, bleomycin, OK-432, and laparoscopic-assisted surgery are available. From 2018 to 2022, the Regional Paediatrics Hospital of Grodno, Belarus has recorded two cases of mesenteric lymphangioma. Both were emergency cases. In this scientific paper, we have described a surgical approach with improved outcomes. In both cases, surgical resection of lymphangioma that was rooted alongside the ileum was done. We used laparotomy in our surgical procedure, however, the approach was different, one being lower median laparotomy and another being a transrectal approach. Post-operatively patients were in satisfactory condition. Even though mesenteric lymphangioma is a benign condition, it should be immediately diagnosed and surgically managed to avoid morbidity, and mortality due to an increase in size that can fatally compress the adjacent organs impairing the function of an organ and complications like intestinal obstruction and bleeding. Our approaches with case-1 and case-2, both resulted in effective surgical and post-surgical outcomes. But more data is required to make a population-based influence depending on our approach.

Risk Stratification in Egyptian Patients with Upper Gastro Intestinal Bleeding

Abstract Introduction Acute upper gastrointestinal bleeding is a common and life-threatening condition. It remains a common cause of visits to the emergency department with an estimated incidence of about 100 per 100000 hospitalizations and being associated with significant morbidity, 30 day mortality and health-care costs. Urgent triage in emergency departments and risk stratification can help to identify patients who warrant urgent diagnostic and therapeutic procedures. We aimed to assess the correlation between Glasgow-Blatchford Bleeding Score, the AIMS65 score and Rockall score in sixty Egyptian patients with upper gastrointestinal bleeding, and to evaluate the best scoring system for risk stratification in these patients. Methods This prospective study included 60 Egyptian patients presented to Ain shams university hospital with upper gastrointestinal bleeding. All patients underwent emergency endoscopic evaluation within 12 hours of presentation. Surgical and radiological interventions were considered for patients who failed or were not feasible for endoscopic therapy. Rockall score, Glascow-Blatchford and AIMS65 were calculated for each patient. Results the age of the studied patients ranging between 20 and 81 years old with a mean age of 55.57 ± 13.14, of them 66.7% were males and 33.3% were females. Most of the patients (90%) had co-morbidities in the form of hepato-billiary diseases (70%), HTN (30%), DM (26.7%), cardiac disease (8.3%), and GIT related disorders (6.7%). Portal hypertension gastropathy was the most common finding in UGIT endoscopy (58.3%) followed by esophageal varcies (56.7%), then gastritis (30%), then peptic ulcer (20%) and lastly gastric mass (6.7%). Rockall score had significant association with altered mental status and liver cirrhosis. Rockall score was found to be the most effective predictor for mortality (sensitivity 100%, specificity 67.92% and AUC 91.0%). Conclusion complete Rockall score is the most effective scoring system for prediction of in hospital mortality in patients with upper gastrointestinal bleeding.

Chronic kidney disease in a giant panda (Ailuropoda melanoleuca): a case report

BackgroundChronic kidney disease (CKD) is a common cause of morbidity and mortality in captive wildlife species. However, CKD has been rarely documented in giant pandas.Case presentationThe following report describes a case of an eight-year-old female giant panda showing clinical signs of epistaxis, bloody diarrhea, polyuria, azotemia and anemia. The animal died despite of supportive treatments. Necropsy was performed. Grossly, both kidneys were shrunken and scarred with pallor. Subcutis edema and petechia on the epicardium of the heart were observed. The tissue samples were made into paraffin sections and stained by H.E and special staining including Periodic Acid-Schiff (PAS), von Kossa, Masson’s trichrome, Phosphotungstic acid-hematoxylin (PTAH), and Congo red. Histopathology examination revealed severe chronic tubulointerstitial nephritis with marked interstitial fibrosis, glomerulosclerosis, tubular atrophy and calcification in kidneys, and acute necrotizing hemorrhagic myocarditis with calcification in heart. Other lesions included intestinal hemorrhage, hepatic fatty degeneration and necrosis with hemosiderin, and splenic hemosiderin.ConclusionsIn summary, chronic kidney disease was finally diagnosed based on the association of clinical, gross, and histopathological findings. Heart failure secondary to CKD is the leading cause of death in this giant panda. The potential cause of CKD in this animal is possibly due to long term and uncontrolled hypertension. Blood pressure monitoring is essential in establishing the diagnosis and management of hypertension in giant panda.

Analysis of two cases of small bowel diverticulum misdiagnosisand its comorbidities: A report of two cases

To discuss and analyze the diagnosis and treatment methods of small bowel diverticulum to improve the level of diagnosis and treatment. The clinical data of two patients with small bowel diverticulum found by intraoperative exploration in our hospital were analyzed, and the preoperative and postoperative diagnoses were compared, as well as the causes and treatment methods of misdiagnosis. The two patients could not be clearly diagnosed before surgery, but they were clearly diagnosed during surgical exploration, and they were discharged after surgical treatment. Small intestinal diverticulum has no specific clinical manifestations; preoperatively, it is not easy to diagnose and is often diagnosed in autopsies or other operations. Patients with acute abdomen and gastrointestinal bleeding, such as small intestinal bleeding and acute appendicitis, should be vigilant for small bowel diverticula to avoid delaying the condition and causing serious consequences.

Hepatic Venous Pressure Gradient Predicts Further Decompensation in Cirrhosis Patients with Acute Esophageal Variceal Bleeding.

The role of hepatic venous pressure gradient (HVPG) in predicting further decompensation in cirrhosis patients with acute variceal bleeding (AVB) is not known. We aimed to evaluate the role of HVPG in predicting further decompensation in cirrhosis patients with AVB Methods: In this prospective study, 145 patients with cirrhosis with esophageal or gastric AVB were included. HVPG was measured on the day of the AVB. Decompensating events occurring after 42-days of AVB were considered further decompensation. The median age of the study cohort was 44 years; 88.3% males. The predominant etiology of cirrhosis was alcohol (46.2%). Overall, 40 (27.6%) patients developed further decompensation during median follow-up of 296 days following AVB. Gastro intestinal bleeding n = 27 (18.6%) and new-onset/worsening ascites n = 20 (13.8%) were the most common decompensating events. According to the multivariate model, HVPG was an independent predictor of any further decompensation in esophageal AVB patients but not in gastric variceal bleeding patients. HVPG cut-off of ≥16 mmHg predicted further decompensation in the esophageal AVB. However, HVPG was not an independent predictor of mortality. HVPG measured during an episode of acute variceal hemorrhage from esophageal varices predicts further decompensating events in cirrhosis patients.