Basic Endoscopic Findings — Normal and Pathological Findings

Since its inception, colonoscopy has evolved to become the cornerstone for colorectal imaging. The increasing indications for endoscopic evaluation and potential therapeutic intervention parallels technological advances and the expanding diagnostic and therapeutic capabilities of colonoscopy. The diagnostic and therapeutic yield of colonoscopy is highly user dependent. Thus, it is essential for the clinical endoscopist to perform a thorough endoscopic evaluation and be cognizant of normal and pathologic findings. This review details normal and pathologic endoscopic findings in a variety of disease states that are often encountered by the clinical endoscopist including colon polyps, inflammatory bowel disease, and infectious and non-infectious colitides. In addition, we review the diagnostic and therapeutic role of colonoscopy in the evaluation of an acute lower gastrointestinal bleed

The “Scope” of Post-ERCP Pancreatitis

AbstractPancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography, with the potential for clinically significant morbidity and mortality. Several patient and procedural risk factors have been identified that increase the risk of post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Considerable research efforts have identified several pharmacologic and procedural interventions that can drastically affect the incidence of PEP. This review article addresses the underlying mechanisms at play for the development of PEP, identifying patient and procedural risk factors and meaningful use of risk-stratification information, and details current interventions aimed at reducing the risk of this complication

Not Your Everyday Case of Acute Pancreatitis: A Rare Complication of a Common Diagnosis

Pancreaticopericardial fistula is an extremely rare complication of chronic pancreatitis and is virtually unheard of in the setting of acute pancreatitis. A 67-year-old male presented with acute pancreatitis complicated by pancreaticopericardial fistulization. The patient's initial presentation was consistent with tamponade physiology. Computed tomography demonstrated a gas-containing pericardial fluid llection extending into the anterior upper abdomen and ill-defined fluid collections within the pancreas representing necrosis with probable infection. Surgical exploration of the window revealed a pancreatic pericardial fistula and an infected window. The patient ultimately passed away from septic shock. We present this rare complication of pancreatitis and review the relevant literature

A wolf in another wolf’s clothing

This case of infective endocarditis masquerading as mixed cryoglobulinemia in a man with a history of intravenous drug use (IVDU) and hepatitis C virus (HCV) highlights the importance of maintaining a broad differential and continually re-evaluating the working diagnosis as new information presents itself. The patient presented to an outside hospital and was treated for presumptive mixed cryoglobulinemia with corticosteroid therapy. When the patient did not improve, he was transferred to a tertiary care center for possible Rituximab and/or plasmapheresis. Further investigation revealed Enterococcus bacteremia with subsequent workup consistent with infective endocarditis (IE). This case highlights a diagnostic dilemma and demonstrates the importance of a thorough evaluation as it pertains to overlapping features of IE and mixed cryoglobulinemia

Clustering approach for Moving object detection from video sequence

ABSTRAC

New insight into the role of electronic apex locators in detecting simulated horizontal root fractures: An In vitro study

Aim and Objectives: The aim of this study is to check the accuracy of two different electronic apex locators (EALs): Canal Pro and Root ZX – in locating simulated horizontal root fractures (HRFs). Materials and Methods: Forty-five recently extracted, single-rooted, human permanent teeth were selected for the study. Endodontic access cavity was prepared, and canal patency was checked using no. 10-K file. Horizontal fractures were simulated using 0.2-mm thick diamond disk in coronal, middle and/or apical third of root by operator one, until half of the canal was exposed circumferentially. Using both the apex locators, all the fractures were detected by the second operator to confirm the accuracy of EALs. The actual length of the fractures was then measured under ×2.5 magnification, and results were subjected to statistical analysis. Results: Results were analysed using the one-way analysis of variance and Tukey's post hoc test, and the differences between all the test samples were analysed. All the measurements were compared to the actual values separately. A statistically significant difference was determined at 95% confidence level (P ≤ 0.05). Conclusion: Investigated both the EAL are capable of detecting simulated HRF and that the Canal Pro showed a higher accuracy rate

Microbiome and Gastroesophageal Disease: Pathogenesis and Implications for Therapy

There is growing evidence that gastroesophageal disease is influenced by the esophageal microbiome, and that commensal bacteria of the oropharynx, stomach, and colon are thought to have a role in modulatiing pathogenesis. These emerging hypotheses are based on observed changes in the composition of the esophageal flora, notably, repeated observations: 1. There is an abundance of gram-positive bBacteria in the healthy esophagus. are more gram positive prevalent 2. The esophageal bacterial population becomes increasingly gram negative with disease progression. Associated with this shift to a more gram negative prevalence is an increase in the potential for the presence of antigenic lipopolysaccharide (LPS). The immunoreactivity of LPS endotoxin thought to promote susceptibility to inflammation and disease. The pathogenesis of the more common diseases of the esophagus e.g. gastroesophageal reflux disease (GERD), esophageal dysmotility (achalasia), eosinophilic esophagitis (EoE), Barrett’s esophagus (BE), and esophageal cancer, are well-established. Emerging data suggest however, that these are all characterized by an immune-mediated inflammatory cascade, propogated by a dysbiotic state. Thereby, the ability of the healthy “normative state” to protect against foreign bacteria is compromised. This dysbiosis thereby can create adverse inflammatory or immunoregulatory responses with progression of disease. In the normal healthy state, the esophageal microbiome is constituted in-part, by a multitude of gram positive bacteria, many of which produce antibacterial peptides called bacteriocins. Bacteriocins are selective and used to maintain population integrity by killing off foreign bacteria. When the “normative biome” is interrupted (e.g. antibiotics, medications, diet, environmental factors), the constitutional changes may allow a more hospitable imbalance favoring the proliferation of opportunistic pathogens. Therefore it seems rational that defining, perhaps that defining, perhaps cultivating, a protective bacterial community that could help prevent or mitigate inflammatory diseases of the esophagus. Furthermore, in conjunction with evidence demonstrating that some bacteriocins are cytotoxic or antiproliferative toward cancer cell lines, further exploration might provide a rich source of effective peptide-based drug targets. Therapeutic options targeting the microbiome, including prebiotics, probiotics, antibiotics and bacteriocins, have been studied, albeit the attributable effects on the esophagus for the most part, have been unrecognized by clinicians. This review focuses on the current knowledge of the involvement of the microbiome in esophageal diseases (most notably GERD/Barrett’s esophagus/esophageal cancer) and identifies emerging new concepts for treatment