https://www.theskygallerypattaya.com/hcg A Heighpubs Open Access Journal en-us 04/07/2020 https://www.theskygallerypattaya.com/hcg/acgh-aid1016.php <h2>Abstract</h2> <p>Celiac disease affects 1% of the world population; however it is under diagnosed in UAE. The disease has many clinical manifestations, ranging from severe malabsorption to minimally symptomatic or non-symptomatic presentation. Hypocalcaemia is a common finding in celiac disease and could be the only presentation of the disease; however hypercalcemia has been previously reported in patients with celiac disease either due to primary hyperparathyroidism or tertiary hyperparathyroidism due to prolonged hypocalcaemia. A normal calcium level on the other hand in patients with untreated celiac disease who also have primary hyperparathyroidism can be due to interplay of these two conditions and may delay the diagnosis of primary Hyperparathyroidism. We report the very first case from our practice in UAE with untreated celiac disease and normal calcium level at presentation, where a diagnosis of primary hyperparathyroidism was not entertained initially. Patient went on gluten free diet which then caused normalization of intestinal abnormalities and likely calcium absorption manifesting as hypercalcemia on subsequent labs. This led to further work up and finally the diagnosis of Primary hyperparathyroidism due to parathyroid adenoma.</p> 04/06/2020 https://www.theskygallerypattaya.com/hcg/acgh-aid1015.php <h2>Abstract</h2> <p><strong>Introduction:</strong> Pancreatic pseudocysts (PPs) are mostly delayed complications of acute or chronic pancreatitis and trauma. Pancreatic pseudocysts are usually managed by supportive medical treatment without surgical procedure. All the surgical interventions (percutaneous, endoscopic or surgical approaches) are based on the location, size, symptoms, complications of the pancreatic pseudocyst and medical condition of the patients. Recently, laparoscopic cystogastrostomy has become most appropriate approach especially for retrogastric pancreatic pseudocysts. In this study, we would like to report results of laparoscopic anterior transgastric cystogastrostomy by using linear articulated endo GIA stapler (Covidien medium thick purple) and versa-lifter (versa lifter®, laparoscopic retractor, manufactured by protomedlabs, France) in 14 pancreatic pseudocysts patients.</p> <p><strong>Methods:</strong> We retrospectively analyzed data of patients with pancreatic pseudocysts treated by laparoscopic anterior transgastric cystogastrostomy from September 2010 to October 2014. All of the patients were controlled for the recurrence of pancreatic pseudocysts in February 2017.</p> <p><strong>Results:</strong> 14 patients with pancreatic pseudocysts were managed by laparoscopic anterior transgastric cysto-gastrostomy. Conversion was performed in only one patient (7%). There were no symptoms and signs of recurrence of pancreatic pseudocyst during on average 43.6 months follow up time.</p> <p><strong>Conclusion:</strong> Laparoscopic cystogastrostomy by using articulated linear endo-GIA stapler and versa-lifter is a safe and effective method for management of appropriate retro-gastric pancreatic pseudocysts.</p> 02/05/2020 https://www.theskygallerypattaya.com/hcg/acgh-aid1014.php <h2>Abstract</h2> <p>Heterotopic gastric mucosa (HGM) is an islet of gastric mucosa within the esophageal mucosa. These lesions can sit throughout the digestive tract and rarely in the upper third of the esophagus. The pathophysiology of HGM remains poorly understood.</p> <p>Our study aims to estimate the prevalence of HGM, clinical signs, endoscopic, microscopic aspects and different epidemiological factors associated.</p> <p>All patients from a single endoscopy center with HGM of the upper third of the esophagus were included over a 5-month evaluation period. All lesions seen in endoscopy were confirmed by histological analysis.</p> <p>The prevalence was 1.3% with a clear male predominance. 80% of patients were symptomatic and received medical treatment, clinical evolution was good. No case of dysplasia was identified and no complication was observed.</p> <p>Due to insufficient data in the evolutionary literature, the management of HGM remains debated and could resemble that of Barett’s esophagus for monitoring and therapeutic management, particularly in the event of symptoms or dysplasia.</p> 12/05/2019 https://www.theskygallerypattaya.com/hcg/acgh-aid1013.php <h2>Abstract</h2> <p><strong>Introduction:</strong> Fluid management is the cornerstone of treatment for acute pancreatitis (AP), but the proper rate and volume is still controversial. We aim to evaluate the role of aggressive hydration in AP patients.</p> <p><strong>Methods:</strong> We retrospectively reviewed and analyzed 279 hospitalized patients of AP. Severity was determined by the Revised Atlanta classification; validated clinical scores were also calculated based on clinical information upon presentation. We extracted amount of fluid received by at 6, 12, 24 and 48 hours after presentation. Aggressive hydration was defined as amount higher than 10 ml/kg bolus followed by infusion at 1.5 ml/kg/h. After direct comparison between aggressive versus non-aggressive hydration groups, propensity-score match was performed to control severity, APACHE II and BISAP score. Post-match comparison as well as a subgroup comparison were conducted.</p> <p><strong>Results: </strong>At 24 hours, 125 (44.8%) patients received aggressive hydration averaged at 5.1 L (2-18 L), while 154 (55.2%) patients received non-aggressive hydration averaged at 2.5 L. Post-match comparison showed that aggressive hydration group had longer hospital stay (MAP: 5.3 vs 4.5, <em>p</em> = 0.145, MSAP/SAP: 8.3 vs 4.8 d, <em>p</em> = 0.007), and higher rate of intensive care unit admission (mild: 12.9% vs 4.4%, <em>p</em> = 0.042, moderately severe or severe: 36.8% vs 3.1%, <em>p</em> = 0.001), while showed no difference in rate of mortality or re-admission by 1 year. In patients who presented without organ failure, aggressive hydration did not change the rate of development of organ failure (14.1% vs 12.5%, <em>p</em> = 0.731), but the aggressive hydration group had a trend towards longer hospital stay (5.5 vs 4.6 d, <em>p</em> = 0.083) and higher rate of MICU admission (12.1% vs 4.8%,<em> p</em> = 0.051).</p> <p><strong>Conclusion:</strong> Our study did not find mortality or morbidity benefit in patients who received aggressive hydration. The optimal strategy for fluid hydration in AP remains to be elucidated and studies focusing on early non-invasive accurate hemodynamic assessment and fluid resuscitation responsiveness prediction are needed.</p> 11/27/2019 https://www.theskygallerypattaya.com/hcg/acgh-aid1012.php <h2>Abstract</h2> <p><strong>Background:</strong> This article reviews current knowledge of Gaucher’s disease (GD) and liver involvement and reports our experience: how many patients with chronic liver disease of unknown origin could be affected by Gaucher’s disease.</p> <p><strong>Patients and methods:</strong> Over 24 months, we tested 75 sine causa chronic liver disease patients (30 women and 45 men, mean age 55 years, range 15 to 77).</p> <p><strong>Results:</strong> None of the 75 patients was affected by Gaucher’s disease.</p> <p><strong>Conclusion:</strong> We believe that the chronic liver disease patient is unlikely to be affected by Gaucher’s disease. Probably this disease is to be found in cases of coexistence of hepatic disease and other symptoms of Gaucher’s disease (bone, neurological, bone marrow involvement).</p> 11/13/2019 https://www.theskygallerypattaya.com/hcg/acgh-aid1011.php <h2>Summary</h2> <p>Hepatitis C Virus (HCV) infection is usually treated with direct acting antivirals (DAAs) for 12 weeks. In treatment naive patients with genotype (GT) 1 infection without cirrhosis and baseline viral load <6 million, 8 weeks of Ledipasvir/Sofosbuvir (LDV/SOF) is an option. Eight weeks with Glecaprevir/Pibrentasvir (GLE/PIB) is an option for patients with GT 1 through 6 without cirrhosis. Our objective was to evaluate achievement of Sustained Virologic Response (SVR) after 8 weeks of LDV/SOF or GLE/PIB in our HCV-infected veterans. Patients with HCV infection that received GLE/PIB or LDV/SOF for a planned 8 weeks of therapy in the past four years were reviewed (January 2015-September 2018). Treatment outcomes were evaluated through medical record review.</p> <p>Two hundred sixty-five veterans were initiated on 8 weeks of therapy with either GLE/PIB or LDV/SOF. Of these, 231 (87%) were initiated on 8 weeks of LDV/SOF and 34 (13%) were initiated on 8 weeks of GLE/PIB. The majority of patients had GT 1 (93%) infection. One hundred and ninety-five veterans who completed 8 weeks of LDV/SOF and 30 veterans on GLE/PIB had follow-up viral loads. The overall SVR was 95%. Treatment with GLE/PIB resulted in a higher SVR rate (100%) compared to LDV/SOF (95%). Elderly patients had similar SVR rates. Treatment with 8 weeks of DAA is effective in our veteran population and showed an SVR rate similar to literature reports. The SVR for patients treated with 8 weeks LDV/SOF was slightly lower than the SVR for GLE/PIB; however, the GLE/PIB population was smaller.</p> 09/20/2019 https://www.theskygallerypattaya.com/hcg/acgh-aid1010.php <h2>Summary</h2> <p><strong>Background:</strong> Even with current standard treatment after variceal bleeding which includes combination of nonselective b-blockers and repeated endoscopic variceal ligation, the risk of rebleeding and mortality are high. Statins exhibit an antifibrotic effect and improves HVPG. We evaluated whether addition of simvastatin to carvedilol plus EVL therapy reduces variceal rebleeds or death in patients with cirrhosis.</p> <p><strong>Method:</strong> Patients with a variceal bleed 5 to 10 days before were randomly assigned to groups A [carvedilol (n = 69)] or group B [carvedilol (maximum dose - 12.5mg), and simvastatin (40mg/day) (n = 65)]. Primary end points were variceal rebleeding or death. Secondary end points were new complications of portal hypertension and serious adverse effects of drugs.</p> <p><strong>Results:</strong> During a mean follow-up of 49.05 ± 25.74 weeks, composite end point i.e. rebleeding or death developed in 23 patients (33.3%) in group A and 12 patients (18.5%) in group B [HR for simvastatin = 0.512; 95% CI: 0.254 – 1.030; <em>p</em> = 0.06]. In subgroup analysis by excluding patients of Child C class, 18 patients (34.6%) in group A and 7 patients (13.6%) in group B developed composite end point [HR for simvastatin = 0.369; 95% CI: 0.154 – 0.887; <em>p</em> = 0.026]. 17.4% and 15.4% patients in group A and B developed additional secondary complication [HR = 0.86; 95% CI: 0.345-2.161; <em>p</em> = 0.75). No simvastatin induced significant adverse effects were found.</p> <p><strong>Conclusion:</strong> Addition of simvastatin to carvedilol and EVL may reduce the rebleeding and death in patients with less advance liver disease.</p> <p> </p> 07/08/2019 https://www.theskygallerypattaya.com/hcg/acgh-aid1009.php <h2>Abstract</h2> <p>Treatments via the minor papilla is effective where the deep cannulation via the major papilla is impossible in such cases as [1] the Wirsung’s duct is inflammatory narrowed, bent or obstructed by impacted stones [2] pancreatic duct divisum (complete or incomplete) [3], maljunction of pancreatico-biliary union with stones [4], pancreatic stones in the Santorini’s duct. In [1,2] cases, the pancreatic juice flow via the major papilla decreases, while that of the minor papilla increases. Then the size of minor papilla and its orifice shows corresponding enlargement. This substitutional mechanism is an advantage when undertaking our new method. Since the pancreatic juice flow is maintained via the minor papilla in these cases, accurate and careful endoscopic skills are necessary to prevent pancreatitis due to the occlusion of the Santorini’s duct after this procedure. We have experienced 135 cases treated via minor papilla in these 27 years, so we would like to report about its safety and efficacy.</p> 06/07/2019 https://www.theskygallerypattaya.com/hcg/acgh-aid1008.php <h2>Abstract</h2> <p><strong>Background:</strong> Transcatheter arterial embolization can be used for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic treatment. Our aim to identify the clinical and technical factors that influenced the outcome of transcatheter embolization for therapy of upper gastrointestinal bleeding after failed surgery or after failed endoscopic treatment in high risk surgical patients.</p> <p><strong>Methods:</strong> We performed a prospective study to analysis of the 15 patients who underwent Transcatheter arterial embolization for nonvariceal upper gastrointestinal bleeding at Alshifa hospital from January 2015 to March 2019.</p> <p>The following variables were recorded: demographic data, time from bleeding start to TAE, units of packed red cells before TAE and units of packed plasma before Transcatheter arterial embolization and we analysis 30 days rebleeding rates and mortality</p> <p><strong>Results:</strong> Patients treated with Transcatheter arterial embolization (median age: 62 years, range: 14–79 years).The technical success rate of the embolization procedure was 100%. Time from bleeding start to TAE was 2.1 (1-4) days , units of packed red cells before Transcatheter arterial embolization was 12.8 (4-22) packed and units of packed plasma was 3.2 (2-5) packed. Following 30 days after embolization, 2 (13%) patients had repeated bleeding and 3 (20.0%) patients died.</p> <p><strong>Conclusion:</strong> In our experience, arterial embolization is a safe and effective treatment method for upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.</p> 04/26/2019 https://www.theskygallerypattaya.com/hcg/acgh-aid1007.php <h2>Summary</h2> <p>Pseudomyxoma peritonei or Gelatinous Peritoneal Disease is a rare disease. We report a case treated in the department of Hepato-Gastroenterology at Ibn Sina Hospital in Rabat, of a 64-year-old male who presented with an abdominal pain and an increased volume of the abdomen corresponding to ascites. Imaging and anatomopathological study made it possible to diagnose the disease. However, given the general state of the patient, he is under palliative care.</p> 07/11/2018 https://www.theskygallerypattaya.com/hcg/acgh-aid1006.php <h2>Abstract</h2> <p>43-year-old lady presented with incidentally discovered liver lesions while she was being managed for her complaints of menorrhagia. CT and MRI showed hepatomegaly with multiple lesions in both lobes of the liver with vascular element in the background of diffuse fatty infiltration. Patient underwent laparoscopic core biopsy. Histopathology showed extensive steatosis, intracytoplasmic giant mitochondria and absence of portal tracts, features highly suggestive of hepatic adenomatosis. IHC staining showed membranous and cytoplasmic positivity in hepatocytes for B-catenin consistent with multiple hepatic adenomatosis. Hepatic adenomatosis is a new clinical entity in the hepatological practice characterized by the presence of 10 or more nodules in the liver known for its major complication of bleeding. Hepatic adenomatosis is managed by regular imaging and resection of large (> 5cm) superficial and painful adenomas along with liver function tests and tumor markers to rule out malignant transformation. However, the potential cure being the liver transplantation.</p> 01/19/2018 https://www.theskygallerypattaya.com/hcg/acgh-aid1005.php <h2>Abstract</h2> <p><strong>Background:</strong> Pyogenic liver abscesses (PLA) are frequent in immunosuppressed patients. We review the characteristics of patients with PLA at a tertiary academic Spanish hospital in Asturias.</p> <p><strong>Methods:</strong> A retrospective observational study for 10 years, between 2006-2015. Epidemiological, clinical, analytical characteristics, treatment and hospital stay of the patients with PLA were analyzed.</p> <p><strong>Results:</strong> 99 patients, 62 (62.6%) men, with age ≥65 years (72.7%). The most frequent etiology was: Biliary (40%), postsurgical (15%) and intestinal origin (11%). The most frequent clinical signs were fever, showing significant differences, abdominal pain (p=0.001) and nausea (p=0.02) between biliary PLA and the rest of the PLA. Microbiological results were confirmed in 63% (62 cases). All were treated with antibiotic therapy, along with percutaneous drainage (44.4% (44 cases)); and surgical drainage (12.1% (12 cases)). The overall mean stay was 23.1 days without significant differences between those treated with percutaneous drainage or surgical drainage.</p> <p><strong>Conclusion:</strong> PLA predominate in patients ≥65 years. Biliary PLA are the most frequent, diagnosed at an older age than the intestinal PLA (p=0.005).<br /> <br /> - The treatment is based on systemic antibiotherapy and percutaneous drainage, especially in PLA only >5cm (p=0.019).<br /> <br /> - There are no significant differences in average stay of patients treated with percutaneous drainage or surgical drainage.</p> 12/29/2017 https://www.theskygallerypattaya.com/hcg/acgh-aid1004.php <h2>Abstract</h2> <p><strong>Purpose:</strong> The purpose of the study is to access the prevalence of accessory right inferior hepatic veins and their relevant significance in liver transplantation.</p> <p><strong>Materials and Methods:</strong> A retrospective study was done in which the CT of 82 potential liver transplant candidates between January 2012 and March 2013 were reviewed. The presence of the accessory right inferior hepatic vein was examined; the diameters of the accessory inferior hepatic veins and the distance between the point where they open into the inferior vena cava on the coronal plane and to the right hepatic vein-inferior vena cava junction was measured.</p> <p><strong>Results:</strong> Out of 82 patients, 42 (51%) had accessory right inferior hepatic veins. Right accessory inferior hepatic veins larger than 3 mm were detected in 23 (28%) patients. The distance of these veins to the right hepatic vein-inferior vena cava junction was more than 4 cm in 13 (15%) patients.</p> <p><strong>Conclusion:</strong> The precise preoperative knowledge of accessory right inferior hepatic veins is essential in living donor liver transplantation.</p> 08/25/2017 https://www.theskygallerypattaya.com/hcg/acgh-aid1003.php <h2>Abstract</h2> <p><strong>Aim:</strong> To identify the possibility of correction of motor function of the gastro-intestinal tract in experimental pancreatitis with the administration of infliximab.</p> <p><strong>Material and methods:</strong> Pancreatitis was modeled by the administration of picrylsulfonic acid retrogradely into the pancreatic duct of rat (n=5) and 4 animals were control. Electromyogram (EMG) of the pancreatic duct was monitored immediately after the administration of picrylsulfonic acid and on the 15th day of pancreatitis simulation before and after the administration of infliximab. The morphological investigation of pancreas was conducted on the 15th day of development of pancreatitis and on the 15th day of treatment of pancreatitis with infliximab.</p> <p><strong>Results:</strong> Infliximab restores the motor function of pancreatic duct and structure of pancreas during acute pancreatitis.</p> <p><strong>Conclusion:</strong> Protective action of infliximab during acute pancreatitis was shown.</p> 07/14/2017 https://www.theskygallerypattaya.com/hcg/acgh-aid1002.php <h2>ABSTACT</h2> <p>Anemia due to gastrointestinal blood loss can occur due to many conditions and rarely to bowel structural anomalies. We report a 12 years old girl with anemia due to small bowel duplication cyst, posing diagnostic challenge intra operatively. Surgery offered cure without recurrence of bleeding. Common symptoms can be due to a rare surgical condition in practice.</p> 07/10/2017 https://www.theskygallerypattaya.com/hcg/acgh-aid1001.php <h2>ABSTRACT</h2> <p>Obstructive jaundice in children is not uncommon and has diverse etiologies. We report a rare cause of obstructive jaundice, cholangitis and pancreatic mass in a young boy due to eosinophilic cholangiopathy who responded to oral steroids. Presence of peripheral eosinophilia, elevated serum IgE level, radiological imaging and tissue eosinophilia helped in diagnosis. Eosinophilic cholangiopathy with pancreatitis is a benign treatable cause of obstructive jaundice though it can masquerade as malignancy.</p>