Association of metabolic syndrome with erosive esophagitis and Barrett’s esophagus in a Chinese population

AbstractBackgroundMetabolic syndrome has been highlighted as a risk factor for several gastrointestinal diseases, including gastroesophageal reflux disease and Barrett’s esophagus (BE). The aim of this study was to investigate the association of metabolic syndrome with erosive esophagitis (EE) and BE.MethodsData were retrospectively collected from patients who visited the Medical Screening Center at Taichung Veterans General Hospital, Taichung, Taiwan from January 2006 to December 2009. All patients underwent an open-access transoral upper gastrointestinal endoscopy, and serum laboratory data were collected. The exclusion criteria included prior gastric surgery, or presence of esophageal varices or peptic ulcers. These patients were assigned to groups according to their endoscopic findings as follows: (1) normal group; (2) EE group; and (3) BE group. Metabolic syndrome was diagnosed based on the International Diabetes Federation criteria.ResultsThere were 560/6499 (8.6%) patients, 214/1118 (9.6%) patients, and 19/95 (20%) patients with metabolic syndrome in the normal, EE, and BE groups, respectively. There was a significantly higher percentage of cases with hypertriglyceridemia in the EE group (67%) compared with the other groups. The BE group had significantly higher rates of central obesity (33%) and hypertension (29.5%) compared with rates in the normal and EE groups. After adjusting for confounders, the positive association with metabolic syndrome still existed in both the EE group (adjusted odds ratio=2.43; 95% confidence interval=1.02–3.44) and the BE group (adjusted odds ratio=2.82; 95% confidence interval=2.05–3.88).ConclusionOur research indicated that in fact there is a greater risk of concurrent metabolic syndrome in patients with EE or BE

Consecutive Tumor Lysis Syndrome and Hepatic Failure after Transarterial Chemoembolization for Treatment of Hepatocellular Aarcinoma: A Case Report and Literature Review

Introduction: Acute tumor lysis syndrome (ATLS) and hepatic failure are fatal complications that can occur in patients with hepatocellular carcinoma (HCC) who undergo transarterial chemoembolization (TACE).Presentation of Case: We report the case of a 78-year-old man with HCC who had successive ATLS and hepatic failure after the first course of TACE. He succumbed due to rapid deterioration of his condition.Conclusion: We therefore concluded that awareness of the risks of ATLS and hepatic failure before administration of TACE is crucial in patients with HCC

Calcifying Fibrous Pseudotumor of the Esophagus

Calcifying fibrous pseudotumor is an uncommon lesion and has recently been recognized as a distinctive fibrous lesion. Esophageal calcifying fibrous pseudotumor is extremely rare and, to the best of our knowledge, has never been reported before. A 54-year-old woman underwent upper gastrointestinal endoscopy and endoscopic ultrasound because of intermittent dysphagia. The results showed 1 isoechoic esophageal submucosal tumor over the deep mucosa and submucosal layers, with calcifications inside. The patient underwent tumor excision, and the diagnosis was confirmed by pathological features, with abundant collagen, calcification and inflammatory cell infiltration. She received regular follow-up at the clinic and no evidence of tumor recurrence was found

An Unusual Case of Metastatic Small Intestinal Tumor Due to Prostate Cancer

Prostate cancer is a common cancer in men, and its clinical behavior ranges from microscopic tumors to aggressive cancer with metastatic potential. We report the case of an 81-year-old man with primary prostate cancer, AJCC stage T2 and Gleason's score 10, which was diagnosed in March 2007. The patient received upper endoscopy due to symptoms of abdominal fullness and body weight loss, and a soft tumor in the secondary portion of the duodenum was found. Biopsy demonstrated a poorly differentiated carcinoma with positive prostate specific antigen cytoplasmic stain. The pathologic appearance was consistent with prostate cancer metastatic to the small bowel. Abdominal computed tomography also showed multiple liver tumors with enlarged retroperitoneal lymph nodes. This case should help raise clinical awareness of the possibility of unusual metastatic sites in patients with primary prostate cancer

Association of virological breakthrough and clinical outcomes in entecavir-treated HBeAg-positive chronic hepatitis B.

Background & aimsTo evaluate virological breakthrough (VBT) and the risk of hepatocellular carcinoma (HCC) in HBeAg-positive chronic hepatitis B (CHB) patients receiving entecavir (ETV) treatment.MethodsA retrospective cohort study was conducted in a tertiary referral hospital and a total of 228 HBeAg-positive CHB patients treated with ETV for more than 48 weeks were enrolled. Clinical outcome measures included HBeAg seroclearance, maintained virological response and the development of HCC.ResultsDuring a median follow-up period of 197 weeks, VBT developed in 26 (11.4%) patients (VBT group), and the other 202 patients without VBT (non-VBT group). The overall cumulative rate of HBeAg seroclearance in the VBT group and non-VBT group were 23.1% and 23.8%, 27.1% and 37.9%, 27.1% and 55.1%, 27.1% and 74.1%, 27.1% and 76.7% from week 48 to 240, respectively(p = 0.013). The cumulative probability of maintained virological responses from week 48 to 240 were 7.69% and 21.78%, 7.69% in the VBT groups and 36.85%, 7.69% and 51.68%, 7.69% and 64.97%, 7.69% and 72.1% in the non-VBT groups, respectively (pConclusionsVBT was associated with adverse clinical outcomes, including a low probability of HBeAg seroclearance, failure to achieve maintained virological responses, and a risk of developing HCC. Patients, particularly with cirrhosis, who had experienced VBT during ETV treatment, more likely developed HCC

Peripheral T-cell lymphoma of the colon associated with hemophagocytic lymphohistiocytosis

Peripheral T-cell lymphoma (PTCL) of the colon is classified as a subtype of intestinal T-cell lymphoma, which usually has multiple ulcerations. Herein, we report a case of multiple ulcers in the large intestine of a 55-year-old male, who presented to us with symptoms of abdominal pain and watery diarrhea for a month. In addition, results of his endoscopic biopsy revealed crypt abscess with dense inflammatory cells infiltrated in the lamina propria of the colon. One week later, he presented with pancytopenia and jaundice, and results of a biopsy of the bone marrow showed the appearance of hemophagocytosis. Unfortunately, colon perforation occurred during the 10th day of hospitalization, and a histopathological analysis of the colonic resection revealed PTCL. Finally, the patient died of sepsis on the 29th day of hospitalization. The endoscopic character of ulcerative colon T-cell lymphoma is easily confused with Crohn's disease, tuberculosis colitis, and viral colitis. In addition, it is also difficult to distinguish between lymphoma cells and dense inflammatory cells while performing endoscopic biopsy of the mucosa in colon lymphoma. Once a typical geographic and punched out ulcers of the colon are found accompanying the presentation of hemophagocytic lymphohistiocytosis, the diagnosis of PTCL involving the colon should be highly suspected, even if the initial endoscopic biopsy has failed to confirm it