Calcium Channel Blockers and Esophageal Sclerosis: Should We Expect Exacerbation of Interstitial Lung Disease?

Esophageal sclerosis is the most common visceral manifestation of systemic sclerosis, resulting in impaired esophageal clearance and retention of ingested food; in addition, co-existence of lung fibrosis with esophageal scleroderma is not uncommon. Both the progression of generalized connective tissue disorders and the damaging effect of chronic aspiration due to esophageal dysmotility appear to be involved in this procedure of interstitial fibrosis. Nifedipine is a widely prescribed calcium antagonist in a significant percentage of rheumatologic patients suffering from Raynaud syndrome, in order to inhibit peripheral vasospasm. Nevertheless, blocking calcium channels has proven to contribute to exacerbation of gastroesophageal reflux, which consequently can lead to chronic aspiration. We describe the case of severe exacerbation of interstitial lung disease in a 76-year-old female with esophageal sclerosis who was treated with oral nifedipine for Raynaud syndrome

Study of the impact of bacterial translocation in the postoperative course and the overall survival of colorectal cancer patents

Introduction: Bacterial translocation is defined as the passage of live bacteria or theirconstituents from the gastrointestinal tract in extraintestinal sites. The importance ofbacterial translocation in colorectal cancer patients remains controversial. This studyinvestigates the association of bacterial translocation with long-term prognosis ofpatients with colorectal cancer. Additionally this study examines the predictive valueof serum procalcitonin measurement in patients with colorectal cancer.Material and Methods: This prospective study enrolled 54 consecutive patients withhistologically confirmed colorectal cancer. After receipt of patient's consent patientdemographics and clinical and pathological features of the disease were documented.Moreover, the value of serum procalcitonin, WBC, ESR and CRP were measured in ablood sample. In the operating room, immediately after laparotomy and before anysurgical manipulation irrigation of the peritoneal cavity with 100cc N / S 0.9% wasperformed and the washing was collected and sent for culture to determine thepossible presence of bacteria.Postoperatively, patients were followed for 60 days, during which all postoperativecomplications were recorded. Furthermore, long term overall survival and diseasefreesurvival were recorded.All statistical analyzes were performed with the statistical package SPSS. The p-value<0.05 was determined as statistically significant level of difference but we alsorecorded marginally significant statistical differences (0.05 <P <0.1).Results: The study included 32 men and 22 women with a mean age of 71 ± 11.02years . The median duration of hospitalization was 11 days , 35 % had complicationsduring hospitalization and 4% resulted in death. The cultures of the peritoneal lavagefluid was positive in 11% of patients with isolation Gram positive in 67% and Gramnegative pathogenic microorganism in 33%. Statistical analysis revealed no significant correlation between the culture of the peritoneal fluid and patientcharacteristics, clinical course, characteristics of the tumors and the levels of whiteblood cells , ESR , CRP, PCT and CEAThe analysis showed a significant positive correlation between the PCT andinflammatory markers (WBC, CRP, TKE) and the tumor marker CEA (p <0.05).Patients with distant metastases had significantly higher levels of PCT (0.074compared to 0.043 mg / L) compared to patients without metastases (p <0.05).Marginal statistical significance was found between the PCT and the degree ofdifferentiation (p = 0.09) The median follow up was 46 [ 22, 55 ] months . Duringfollow-up of patients 45.5 % had disease recurrence and 43.6 % died.The statistical analysis did not show the presence of significant correlation betweenthe result of the culture of the peritoneal fluid, and the overall and disease-freesurvival. The Kaplan-Meier survival showed a trend towards a shorter overallsurvival in patients with elevated levels of PCT No statistically significant correlationbetween the levels PCT and disease-free survival of patients was foundConclusion: The results of this study showed that bacterial translocation is relativelyfrequent in colorectal cancer and Procalcitonin is a useful biomarker for theinvestigation of patients with colorectal cancer. The clinical significance of bacterialtranslocation in patients with colorectal cancer is minimal as is not correlated withprognosis

Rare Case of Hepatic Endometriosis as an Incidental Finding: Difficult Diagnosis of a Diagnostic Dilemma

Endometriosis is the abnormal existence of functional uterine mucosal tissue outside the uterus. It is a usual disorder of women in reproductive age which is mainly located in the female genital tract. Hepatic endometriosis is one of the rarest disorders characterised by the presence of ectopic endometrium in the liver. It is often described as cystic mass with or without solid component. Preoperative diagnosis is difficult via cross-sectional imaging and histopathologic evaluation remains the gold standard for diagnosis. We report an asymptomatic 40-year-old female with a large cystic mass involving the left hepatic lobe. She underwent laparoscopic removal of the cyst. The diagnosis of hepatic endometriosis was established by the histopathological analysis of the surgical specimen

Adhesive Ileus Complicating Recurrent Intestinal Pseudo-Obstruction in a Patient with Myasthenia Gravis

Intestinal pseudo-obstruction is considered to be one of the most frequent gastrointestinal manifestations of myasthenia gravis, accompanied by the presence of neoplasia of the thymus gland in the vast majority of the cases presented in the international literature. Despite the fact that myasthenia gravis has been implicated to be the cause of recurrent episodes of intestinal pseudo-obstruction, adhesive ileus has never been reported to complicate this – in any sense rare – condition. We present a unique case of a patient with myasthenia gravis, free of thymus neoplasia, who was submitted to emergency surgery due to the presence of extended adhesive ileus as a complication of chronic intestinal functional obstruction

Mesentery lymphoma in a patient with Crohn's disease: An extremely rare entity

AbstractINTRODUCTIONLymphoma is a rare complication of long-standing Crohn's disease. We report a rare case of a diffuse, B-cell non-Hodgkin's lymphoma of the mesentery in a patient receiving treatment for Crohn's disease.PRESENTATION OF CASEA 52 year-old patient presented with abdominal pain, anorexia and postprandial fullness. Abdominal examination revealed a firm mass, extending from the epigastrium to the right iliac fossa. CT scan showed a large intra-abdominal mass with air-fluid levels within, and soft tissue density along its walls, surrounded by distended bowel loops. The patient was scheduled for surgery due to clinical assumption of an intra-abdominal abscess. At laparotomy an ill-defined, lobulated mass with cystic areas was noted rising from the mesentery. Frozen section biopsy of the cystic mass revealed a non-Hodgkin follicle center B-cell lymphoma of the mesentery.DISCUSSIONTo the best of our knowledge, this is an extremely rare case of lymphoma development in the mesentery, in a patient receiving treatment for Crohn's disease. Although the development of abdominal lymphomas can be justified as a possible consequence of the chronic immune-modulating therapy, their location can lead to diagnostic pitfalls.CONCLUSIONAlthough mesentery has scarcely been presented as a potential site of occurrence of abdominal lymphomas in the process of treatment of inflammatory bowel diseases, this rare entity should be considered in the differential diagnosis of intra-abdominal lymphomas in patients with inflammatory bowel disease. In cases where imaging techniques do not provide definitive answers, surgical intervention can safely pose the accurate diagnosis

Recurrent erythema multiforme after alcohol ingestion in a patient receiving ciprofloxacin: a case report

The incidence of cutaneous adverse reactions to quinolones is low; moreover their development in patients with concomitant alcohol consumption is a phenomenon that has been scarcely reported. We present a case of 46-year-old male who developed erythema multiforme after ingestion of alcohol, while being treated with ciprofloxacin. The lesion was self-limiting and abstinence from alcohol permitted the completion of the course of therapy without any other adverse reaction