Justapapillar Duodenal Gastrointestinal Stromal Tumor (gist) Local Resection: A Case Report

Introduction: Gastrointestinal stromal tumors (GISTs) are the most frequent non-epithelial tumors of the gastrointestinal tract (GIT). The most common location is the stomach, followed by small intestine, being very rare the cases of duodenal origin, where it can cause digestive bleeding and anemia. The surgical resection of the tumor is the gold-standard treatment and the definitive diagnosis is based on immunohistochemical analysis of the surgical specimen.Case presentation: A case of exophytic and endophytic GIST located in the second portion of the duodenum, one centimeter below the duodenal papilla, was reported in a 33-year-old female patient.Conclusion: The gold-standard treatment is surgical resection of the tumor with negative margins (R0), with no need for lymphadenectomy. Local lesion resection or duodenopancreatectomy can be performed. Duodenopancreatectomy, unlike local resection of the lesion, is associated with increased length of hospital stay and longer intraoperative time. Therefore, it should be reserved for lesions that cannot be resected locally. Fortunately, a local resection was performed, which have a more favorable prognosis

Treatment of posterior gastric wall gastrointestinal stromal tumor with gastric sleeve: A case report

Gastrointestinal stromal tumors (GISTs) are the most common non-epithelial tumors of the gastrointestinal tract1. The most usual location is the stomach, followed by the small intestine, where it may cause digestive bleeding and anemia6. Surgical resection of the tumor is the gold standard treatment, and definitive diagnosis is based on immunohistochemical analysis of the surgical specimen8. We report the case of a 53-year-old man with gastric GIST presenting with endophytic and exophytic growth, located at the posterior wall of the stomach, in the antrum-body transitional zone, treated with gastric sleeve.Keywords: Gastrointestinal stromal tumors; gastrointestinal neoplasms; gastric sleeve; diagnosis; prognosis; treatmen

Development of multidrug resistant tuberculosis in Bangladesh: a case-control study on risk factors

Objective: To determine the risk factors for developing multidrug resistant tuberculosis in Bangladesh. Methods: This case-control study was set in central, district and sub-district level hospitals of rural and urban Bangladesh. Included were 250 multidrug resistant tuberculosis (MDR-TB) patients as cases and 750 drug susceptible tuberculosis patients as controls. We recruited cases from all three government hospitals treating MDR-TB in Bangladesh during the study period. Controls were selected randomly from those local treatment units that had referred the cases. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression were used to analyse the data. Results: Previous treatment history was shown to be the major contributing factor to MDR-TB in univariate analysis. After adjusting for other factors in multivariable analysis, age group ‘‘18–25’’ (OR 1.77, CI 1.07–2.93) and ‘‘26–45’’ (OR 1.72, CI 1.12–2.66), some level of education (OR 1.94, CI 1.32–2.85), service and business as occupation (OR 2.88, CI 1.29–6.44; OR 3.71, CI 1.59–8.66, respectively), smoking history (OR 1.58, CI 0.99–2.5), and type 2 diabetes (OR 2.56 CI 1.51–4.34) were associated with MDR-TB. Previous treatment was not included in the multivariable analysis as it was correlated with multiple predictors. Conclusion: Previous tuberculosis treatment was found to be the major risk factor for MDR-TB. This study also identified age 18 to 45 years, some education up to secondary level, service and business as occupation, past smoking status, and type 2 diabetes as comorbid illness as risk factors. National Tuberculosis programme should address these risk factors in MDR-TB control strategy. The integration of MDR-TB control activities with diabetes and tobacco control programmes is needed in Bangladesh

Univariate logistic regression analysis on factors related to Multidrug Resistant Tuberculosis (MDR-TB).

a<p>Confidence interval at 95% level.</p>b<p>p is the p value of Wald test statistic.</p>c<p>‘Others’ subgroup under ‘Occupation’ includes housewife and self-employed small works.</p><p>Only the significant variables are shown in the table (significance level at 0.05).</p

Multivariable analysis on factors related to Multidrug Resistance Tuberculosis (MDR-TB).

a<p>Confidence interval at 95% level.</p>b<p>p (Wald) is the p value of Wald test statistic.</p>c<p>p (lrt) is the p value corresponding to the Likelihood ratio test statistic.</p>d<p>“Others” subgroup under “Occupation” includes housewife and self-employed small works.</p><p>Only the significant variables in multivariable model are shown in the table (significance level 0.05).</p

Socio-demographic and clinical characteristics of the study participants.

a<p>P is the Probability of t-test or Chi-square (χ ²) tests. Fisher's exact Chi-square (χ ²) test was used for history of health care work, kidney disease, other disease, smoking status and hospitalization history.</p>b<p>‘Others’ subgroup under ‘Occupation’ includes housewife and self-employed small works.</p>c<p>BDT: Bangladeshi currency.</p>d<p>Cavitation related information was not available in 51% of the participants.</p>e<p>Other disease included hypertension, heart diseases, asthma, chronic obstructive pulmonary diseases and chronic dysentery.</p>f<p>Hospitalization history had one missing value.</p

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of &lt;30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy