Gastrointestinal stromal tumor masquerading as a lung neoplasm. A case presentation and literature review

Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract. Their incidence in the esophagus is 1%–3%. Never has a GIST been documented to directly invade the lung. We report a primary esophageal GIST with direct invasion into the lung parenchyma, presenting predominantly with respiratory symptoms. We include a retrospective literature review. Although the principle 'common things are common' usually guides our everyday clinical practice, this case emphasizes that rare entities can mimic common pathologies and underlines the importance of having a clearly defined differential diagnostic list which should be meticulously scrutinized

Prognostic factors affecting survival after surgical resection of gastrointestinal stromal tumours: a two-unit experience over 10 years

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) tract which has only been recently described based on their specific immunohistochemistry and the presence of particular KIT-related mutations which potentially make them targets for tyrosine kinase inhibition. METHODS: Sixty-one patients (29 M; 32 F, median age 60 years; range: 23–86 years) between June 1994 and March 2005, were analyzed from two allied institutions. Patient, tumour, and treatment variables were analyzed to identify factors affecting survival. RESULTS: Of the 61 patients, 55 (90%) underwent complete surgical resection of macroscopic disease. The 5-year overall survival (OS) rate in the 61 patients was 88% and the 5-year disease-free survival (DFS) in the 55 cases completely resected was 75%. Univariate analysis revealed that R0 resection was strongly associated with a better OSrate (p < 0.0001). Likewise, univariate analysis also showed high mitotic count of > 10 mitoses/per 50 HPF was a significant variable in worse prognosis for OS (≤ 10 mitoses/per 50 HPF 95% 5-year OS vs. > 10 mitoses/per 50 HPF 74% 5-year OS, respectively; p = 0.013). On subsequent multivariate analysis, only high mitotic count remained as a significant negative prognostic variable for OS (p = 0.029). Among patients resected for cure, there were 8 recurrences during follow-up. The mean time to recurrence was 21 ± 10 months (range: 4–36 months). Univariate analysis revealed that mitotic count of > 10 mitoses per 50 high power fields, intratumoural necrosis, and pathological tumour size (> 10 cm in maximal diameter) significantly correlated with DFS (p = 0.006, 0.002 and 0.02, respectively), with tumour necrosis and high mitotic count remaining as independent predictive variables affecting prognosis on subsequent multivariate analysis. CONCLUSION: Most GISTs are resectable with survival principally dependent upon mitotic count and completeness of resection. Future metabolic and genetic analyses will define the role of and resistance to induction or postoperative adjuvant targeted kinase inhibition therapy

Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective

A substantial volume of the consultations requested of gastroenterologists are directed towards the evaluation of anemia. Since iron deficiency anemia often arises from bleeding gastrointestinal lesions, many of which are malignant, establishment of a firm diagnosis usually obligates an endoscopic evaluation. Although the laboratory tests used to make the diagnosis have not changed in many decades, their interpretation has, and this is possibly due to the availability of extensive testing in key populations. We provide data supporting the use of the serum ferritin as the sole useful measure of iron stores, setting the lower limit at 100 μg/l for some populations in order to increase the sensitivity of the test. Trends of the commonly obtained red cell indices, mean corpuscular volume, and the red cell distribution width can provide valuable diagnostic information. Once the diagnosis is established, upper and lower gastrointestinal endoscopy is usually indicated. Nevertheless, in many cases a gastrointestinal source is not found after routine evaluation. Additional studies, including repeat upper and lower endoscopy and often investigation of the small intestine may thus be required. Although oral iron is inexpensive and usually effective, there are many gastrointestinal conditions that warrant treatment of iron deficiency with intravenous iron

Perioperative erythropoietin administration in patients with gastrointestinal tract cancer - Prospective randomized double-blind study

Objective To investigate the effect of recombinant human erythropoietin (r-HuEPO) administration on perioperative hemoglobin concentrations and on the number of blood transfusions in patients undergoing surgery for gastrointestinal tract malignancies. Summary Background Data Erythropoietin has been shown to improve the yield of autologously predonated blood and to reduce the subsequent requirements for homologous blood transfusions in cancer patients. Methods In this double-blind placebo-controlled study, 31 cancer patients received subcutaneous r-HuEPO in a dose of 300 IU/kg body weight plus 100 mg iron intravenously (study group) and 32 patients received placebo medication and iron (control group). All patients received the medications daily for at least 7 days before and 7 days after the operation. Results Patients who received erythropoietin received significantly fewer transfusions intraoperatively and postoperatively. Postoperatively, the study group had significantly higher hematocrit, hemoglobin, and reticulocyte count values compared to the control group. The use of erythropoietin was also associated with a reduced number of postoperative complications and improved 1-year survival. Conclusions Patients with gastrointestinal tract cancer and mild anemia benefit from perioperative erythropoietin administration in terms of stimulated erythropoiesis, reduction in the number of blood transfusions, and a favorable outcome

Plasma adiponectin concentrations in patients with chronic renal failure: Relationship with metabolic risk factors and ischemic heart disease

Aims: To compare plasma adiponectin levels between healthy controls and patients with chronic renal failure and to examine for a relationship between plasma adiponectin levels and ischemic heart disease as well as aortic distensibility which is an early marker of atherosclerosis. Methods: We included 89 patients with CRF (45 on and 44 not on hemodialysis) and 70 controls in a cross-sectional study. Plasma adiponectin levels were measured by radioimmunoassay. Aortic distensibility was assessed by high-resolution ultrasonography. Results: Plasma adiponectin levels were significantly almost twice as high in patients with renal failure compared to controls (9.7 +/- 1.1 vs. 5.4 +/- 0.6 mug/ ml, p&lt;0.0001). No significant differences were found between renal patients on hemodialysis and not on hemodialysis (p = 0.71). Multivariate linear regression analysis in the renal patient group demonstrated a significant negative relationship between plasma adiponectin levels and ischemic heart disease (p = 0.02). The same analysis in the control subjects group showed a significant, negative relationship between plasma adiponectin levels and body mass index (p = 0.02) and a highly significant positive relationship with the high density lipoprotein cholesterol (p&lt;0.0001). In the total study population, glomerular filtration rate was the only independent predictor of plasma adiponectin concentrations. Aortic distensibility was lower in renal patients than in controls at a high level of significance (p&lt;0.0001). However, no significant relationship could be found between plasma adiponectin and aortic distensibility in either the controls or the renal patients. Conclusions: Plasma adiponectin levels are almost twice as high in patients with chronic renal failure in comparison with healthy controls, but not different between renal patients on and those not on hemodialysis. In addition, low plasma adiponectin levels are strongly associated with ischemic heart disease, but not with aortic distensibility in chronic renal failure

Improving Soil Erosion Prevention in Greece with New Tools

Unsustainable anthropogenic activities such as agriculture and urbanization have caused excessive erosion rates that exceed soil formation rates. The Mediterranean region has and continues to experience severe erosion because of the inappropriate agricultural management, overgrazing, deforestation, wildfires, land abandonment, intense road construction and other construction activities. The forecasted increase of intensive rainfall events and prolonged drought periods due to climate change, will enhance surface runoff and sediment transport capacity. The objective of this study was to develop new tools to help land managers mitigate erosion in the country of Greece. One of the tools was a new sensor (ASEMS) that is based on the physical properties of ultrasound to detect erosion locally with great accuracy (1 mm), while simultaneously measuring precipitation, soil moisture, and soil and air temperature. The other tool was the development of the Soil Erosion Integrated Information System (SE-I2S) that enables land managers through a series of questions to understand if they are facing erosion problems and what type of erosion. This tool can be applied to large areas. Overall, both new tools are user friendly and help land managers mitigate soil erosion cost-effectively.This proceeding was published as Zaimes, G.N., K. Ioannou, V. Iakovoglou, I. Kosmadakis, P. Koutalakis, G. Ranis, D. Emmanouloudis, & R.C. Schultz. 2016. Improving soil erosion prevention in Greece with new tools. Journal of Engineering Science and Technology Review 9 (2): 66-71. Posted with permission.</p

Improving Soil Erosion Prevention in Greece with New Tools

Unsustainable anthropogenic activities such as agriculture and urbanization have caused excessive erosion rates that exceed soil formation rates. The Mediterranean region has and continues to experience severe erosion because of the inappropriate agricultural management, overgrazing, deforestation, wildfires, land abandonment, intense road construction and other construction activities. The forecasted increase of intensive rainfall events and prolonged drought periods due to climate change, will enhance surface runoff and sediment transport capacity. The objective of this study was to develop new tools to help land managers mitigate erosion in the country of Greece. One of the tools was a new sensor (ASEMS) that is based on the physical properties of ultrasound to detect erosion locally with great accuracy (1 mm), while simultaneously measuring precipitation, soil moisture, and soil and air temperature. The other tool was the development of the Soil Erosion Integrated Information System (SE-I2S) that enables land managers through a series of questions to understand if they are facing erosion problems and what type of erosion. This tool can be applied to large areas. Overall, both new tools are user friendly and help land managers mitigate soil erosion cost-effectively

Proof explanation for the semantic web using defeasible logic

In this work we present the design and implementation of a system for proof explanation in the Semantic Web, based on defeasible reasoning. Trust is a vital feature for Semantic Web. If users (humans and agents) are to use and integrate system answers, they must trust them. Thus, systems should be able to explain their actions, sources, and beliefs. Our system produces automatically proof explanations using a popular logic programming system (XSB), by interpreting the output from the proof's trace and converting it into a meaningful representation. It also supports an XML representation (a RuleML language extension) for agent communication, which is a common scenario in the Semantic Web. The system in essence implements a proof layer for nonmonotonic rules on the Semantic Web