Esophageal and small bowel obstruction by occupational bezoar: report of a case

BACKGROUND: Phytobezoar may be a cause of bowel obstruction in patients with previous gastric surgery. Most bezoars are concretions of poorly digested food, which are usually formed initially in the stomach. Intestinal obstruction (esophageal and small bowel) caused by an occupational bezoar has not been reported. CASE PRESENTATION: A 70-year old male is presented suffering from esophageal and small bowel obstruction, caused by an occupational bezoar. The patient has worked as a carpenter for 35 years. He had undergone a vagotomy and pyloroplasty 10 years earlier. The part of the bezoar, which caused the esophageal obstruction was removed during endoscopy, while the part of the small bowel was treated surgically. The patient recovered well and was discharged on the 8(th )postoperative day. CONCLUSIONS: Since occupational bezoars may be a cause of intestinal obstruction (esophageal and/or small bowel), patients who have undergone a previous gastric surgery should avoid occupational exposures similar to the presented case

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Paired comparison between water and nutrient drink tests in healthy volunteers

CONTEXT: Drink tests constitute an inexpensive and non-invasive tool, which has been proposed to discriminate individuals with altered fluid intake, as dyspeptics. However, their use in everyday clinical practice is still limited as standardization still lacks. OBJECTIVE: To perform a direct, paired comparison between the water and the nutrient drink test in normal volunteers. METHODS: Thirty eight normal volunteers (19 males, 19 females, mean age 24.4 ± 0.4 years) underwent drink test with water and nutrient (Nutridrink) within 7-10 days. Both tests included a loading (consumption of 100 mL/min for water and 15 mL/min for Nutridrink for the longest possible period of time) and a recuperation phase (observation after cessation of fluid intake), being separated by the maximal saturation point. During phases, satiety, fullness, discomfort, bloating, belching, nausea, pain and burning sensation (epigastric and thoracic) were recorded using a 0-100 visual analogue scale score (VAS). For the purpose of configuration, four variables were considered: time (t), VAS score (V), VAS slope (S) for a given time period, and probability of participation (Q) at a given timepoint. RESULTS: The loading phase lasted for 11.6 ± 1.7 min in water (total VAS: 879 ± 123, total VAS slope 72.6 ± 10.9 min-1) and 93.3 ± 18.4 min in Nutridrink test (total VAS: 1462 ± 411, total VAS slope 15.9 ± 3.2 min-1); P<0.001. The mean ingested volume recorded was 1155 ± 164 mL for water and 1399 ± 276 mL for nutrient; P = 0.076. Cessation of fluid intake was mainly attributed to fullness (76.3%) in water and satiety (69.2%) in Nutridrink test. Nausea was recorded only in Nutridrink test (15.4%). No volunteer reported substantial, persistent pain or burning sensation. The recuperation phase lasted 63.6 ± 7.8 min in water (total VAS: 278 ± 75, total VAS slope 3.97 ± 0.95 min-1) and 123.2 ± 17.5 min in Nutridrink test (total VAS: 841 ± 126, total VAS slope 6.81 ± 1.63 min-1); P<0.001. Concerning total VAS scores for both phases of the two tests, fullness and satiety represented a mere four fifths of the total (43% and 36%, respectively). Belching (8%), bloating (6%), nausea (4%), and discomfort (3%) followed, while pain and burning sensation represented <1% of the whole. However, intra- and intertest correlations concerning total and symptom-specific VAS scores revealed statistically significant variations underlying differences in physiology of liquid intake. A multiple regression model considering body mass index, gender and age as dependent variables, and total and symptom-specific VAS scores and slopes for both phases of the two tests as independent variables, did not reveal any primary correlation. The function linking the expected probability of participation Q and symptom-specific VAS score V with time t is approached by the formulas Q(t)=1/[1+(t/c)&#094;k] and V(t)=V0*e&#094;(-t/c), respectively; V0 is the mean symptom-specific VAS score, c, and k are phase- and test- related constants, and e = 2.718 is the base of natural logarithms. CONCLUSION: The comparative standardization of both drink tests in normal individuals might provide a tool for clinical application, targeting the diagnosis and treatment of relevant functional disorders

Case Report - Primary biliary cirrhosis complicated by transverse myelitis in a patient without Sj\uf6gren's syndrome

Transverse myelitis is an acute inflammatory process, affecting one or more segments of the spinal cord. Its association with primary biliary cirrhosis has been documented in only four cases - all along with Sj\uf6gren's syndrome. Herein, we report for the first time, a patient who developed recurrent acute transverse myelitis in association with primary biliary cirrhosis without any clinical or histological indication of Sj\uf6gren's syndrome. A 42-year-old woman with primary biliary cirrhosis developed acute onset quadriparesis and urinary retention. Diagnostic evaluation excluded the presence of Sj\uf6gren's syndrome, other autoimmune syndromes, infections and multiple sclerosis. Magnetic resonance imaging of the spinal cord disclosed signal intensity abnormalities from C1 to T2 after gadolinium enhancement. As diagnosis of acute transverse myelitis was prominent, the patient was treated with intravenous methylprednisolone. The patient had a fair outcome despite an early recurrence of the symptoms after treatment withdrawal

Case Report - Primary biliary cirrhosis complicated by transverse myelitis in a patient without Sjögren's syndrome

Transverse myelitis is an acute inflammatory process, affecting one or more segments of the spinal cord. Its association with primary biliary cirrhosis has been documented in only four cases - all along with Sjögren's syndrome. Herein, we report for the first time, a patient who developed recurrent acute transverse myelitis in association with primary biliary cirrhosis without any clinical or histological indication of Sjögren's syndrome. A 42-year-old woman with primary biliary cirrhosis developed acute onset quadriparesis and urinary retention. Diagnostic evaluation excluded the presence of Sjögren's syndrome, other autoimmune syndromes, infections and multiple sclerosis. Magnetic resonance imaging of the spinal cord disclosed signal intensity abnormalities from C1 to T2 after gadolinium enhancement. As diagnosis of acute transverse myelitis was prominent, the patient was treated with intravenous methylprednisolone. The patient had a fair outcome despite an early recurrence of the symptoms after treatment withdrawal

Primary biliary cirrhosis complicated by transverse myelitis in a patient without Sj&#x00F6;gren&#x0027;s syndrome

Transverse myelitis is an acute inflammatory process, affecting one or more segments of the spinal cord. Its association with primary biliary cirrhosis has been documented in only four cases - all along with Sj&#x00F6;gren&#x0027;s syndrome. Herein, we report for the first time, a patient who developed recurrent acute transverse myelitis in association with primary biliary cirrhosis without any clinical or histological indication of Sj&#x00F6;gren&#x0027;s syndrome. A 42-year-old woman with primary biliary cirrhosis developed acute onset quadriparesis and urinary retention. Diagnostic evaluation excluded the presence of Sj&#x00F6;gren&#x0027;s syndrome, other autoimmune syndromes, infections and multiple sclerosis. Magnetic resonance imaging of the spinal cord disclosed signal intensity abnormalities from C1 to T2 after gadolinium enhancement. As diagnosis of acute transverse myelitis was prominent, the patient was treated with intravenous methylprednisolone. The patient had a fair outcome despite an early recurrence of the symptoms after treatment withdrawal