Torresduffy9840

We report the case of a 96-year-old institutionalized male, with severe dementia, who was admitted to our hospital with sigmoid volvulus. After successful decompression, the patient developed recurrent sigmoid volvulus twice within 76 hours, which required endoscopic repositioning. However, after a new recurrence and rejecting surgery, we chose percutaneous endoscopic colostomy, using the standard gastrostomy technique, in order to fix the mobile intestine to the abdominal wall to prevent torsion. Although observational studies with more cases and longer follow-up are needed, percutaneous endoscopic colostomy could be a safe and effective alternative in patients in whom conventional surgery is considered unsafe or inappropriate.

endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anatomy is challenging. Single-balloon enteroscopy-assisted ERCP (SBE-ERCP) is an innovative alternative to reach the bile duct.

to report our experience in SBE-ERCP in patients who presented with Roux-en-Y anatomy and choledocholithiasis.

patients who presented choledocholithiasis and underwent SBE-ERCP between January 2018 and April 2020 were retrospectively identified via medical records and the digestive endoscopy database. Enteroscopy success was defined as reaching the biliary limb and papilla identification. ERCP diagnostic success was defined as a successful duct cannulation and cholangiography, and ERCP procedural success was defined as the ability to successfully carry out choledocholithiasis extraction. Complications of ERCP were defined according to standard criteria.

a total of eleven patients (two females) with a mean age of 81 years (range 60-91 years) with Roux-en-Y anastomosis underwent ERCP using a SBE on 13 occasions. The indication for all procedures was choledocholithiasis, which had been previously confirmed by magnetic resonance cholangiopancreatography (MRCP). selleck chemical Enteroscopy success occurred in 13/13 (100 %) of procedures. Overall ERCP diagnostic success was achieved in 11/13 (84.6 %) of procedures. The ERCP procedural success was obtained in 11/11 (100 %) of patients (84.6 % of procedures). A mild pancreatitis occurred in a patient with native papilla.

SBE-ERCP is feasible, efficacious and safe in patients with postsurgical Roux-en-Y anatomy and choledocholithiasis. Technical improvements may mean better outcomes.

SBE-ERCP is feasible, efficacious and safe in patients with postsurgical Roux-en-Y anatomy and choledocholithiasis. Technical improvements may mean better outcomes.

to assess the usefulness of medical treatment to achieve closure of internal fistulas detected on abdominal ultrasound in a series of patients with fistulizing Crohn's disease.

a retrospective analysis was performed of the medical records of patients with Crohn's disease with a fistula detected on abdominal ultrasound from 2010 to 2018. The study included patients who received medical treatment after the diagnosis of this complication and underwent ultrasonographic monitoring of the therapeutic response. The factors associated with the response to medical treatment or the need for surgery were investigated.

forty-six patients were included in the study. Enteromesenteric (69.6 %) was the most common type of fistula and associated abscesses were found in 14 (30.4 %) patients. Fistulas were classified as complex in 20 patients. Treatment with immunosuppressants was started in 14 (30.4 %) cases and a biologic drug was added in 18 (39.1 %) patients. Complete closure of the abdominal fistula was observed with ultrasonography in 24 (52.2 %) of the 46 patients. The only factor related to fistula closure was the type of fistula and was more likely to occur in patients with an enteromesenteric fistula. Thirteen (28 %) of the 46 patients needed a surgical resection. The only factor with a significant correlation with a lower need for surgery was fistula closure after treatment (8.3 % vs 50 %, p = 0.002).

medical treatment achieves internal fistula closure in more than half of cases and almost a third require surgical treatment. Abdominal ultrasound can detect abdominal fistulas at an earlier stage and allow prompt treatment changes.

medical treatment achieves internal fistula closure in more than half of cases and almost a third require surgical treatment. Abdominal ultrasound can detect abdominal fistulas at an earlier stage and allow prompt treatment changes.Vasculitis can also present with GI or solid organ involvement. IgA and ANCA associated vasculitis are more likely to have GI involvement. A 56-year-old female was admitted to the ER due to nausea, vomiting, epigastric pain and fever. The patient had a medical history of acromegaly and chronic kidney disease of an undetermined etiology, elevated C-reactive protein and renal dysfunction. Abdominal-CT revealed duodenal parietal thickening and pancreatic head edema. On esophagogastroduodenoscopy (EGD), duodenal mucosa had a diffusely nodular aspect with ulcerated areas. The following differential diagnosis were made, infectious enteritis, Whipple disease, infiltrative disorder and GI vasculitis. After discussion between a multidisciplinary team of Gastroenterology and Nephrology, they decided to initiate oral glucocorticoids due to worsening of the renal function, which lead to the resolution of digestive symptoms and renal function stabilization. Myeloperoxidase antineutrophilic-cytoplasmic antibodies (MPO-ANCA) were subsequently positive and histology confirmed duodenal involvement by vasculitis. The patient was asymptomatic after 4-weeks, with endoscopic healing and renal function stabilization. GI involvement limited to the duodenum in the setting of ANCA-MPO vasculitis is a rare condition. Moreover, histopathologic confirmation of vasculitis in endoscopic biopsy samples is exceptional.We present the case of a 55-year-old male that was admitted to our hospital for cholestatic hepatitis. Other causes of hepatitis were excluded with imaging, laboratory and serologic tests. A liver biopsy was performed, which was compatible with toxicity-induced hepatitis. Re-assessing the patient, he mentioned the start of treatment with candesartan cilexetil 3 weeks prior to the onset of the symptoms. Candesartan was withdrawn, with a progressive improvement in cholestasis and complete normalization of liver biochemistry at 6 months. The patient was diagnosed with candesartan-induced cholestatic hepatitis, probable according to CIOMS/RUCAM scale.Forty-eight year old man with epigastric pain. CT scan shows a common hepatic artery aneurysm (HAA) of 4,6 cm in size with permeable portal vein. Angiography demonstrates that it affects from the beginning of the celiac trunk until hepatic arteries bifurcation, producing a proximal splenic artery stenosis. Proximal and distal embolization is done achieving a complete aneurysm occlusion. A stent is placed in celiac trunk in order to maintain splenic flow. Permeability of distal hepatic artery through choledochal arteries is observed in a month follow-up CT scan. HAA are infrequent but potentially lethal. Endovascular techniques should be considered of choice currently. HAA embolization has an elevated risk of hepatic ischemia.Intestinal intussusception is a condition usually observed in pediatric patients and is rare in adults. It has been described as idiopathic or secondary to several etiologies. Intussusception occurring in the large bowel is more likely to have a malignant etiology. Abdominal computed tomography is the normal diagnostic modality. Colonoscopy may be helpful to distinguish benign from malignant lesions, prior to deciding an appropriate management. An endoscopy approach can be attempted in patients in whom a benign mass is suspected. However, surgery remains the mainstay in adult intussusception, especially when a malignant etiology cannot be ruled out. We present a rare case of colo-colonic intestinal intussusception in an adult diagnosed by outpatient colonoscopy, which is an uncommon way to discover this entity.The portal venous aneurysm(PVA) is a very rare entity, which can be congenital or acquired (if portal hypertension, cirrhosis, pancreatitis, surgical history). Although the discussion is still ongoing, treatment would be indicated in symptomatic PVA, over 30mm or progressive growth. In order to provide an update on the subject due to the low incidence of this finding, we present the case of a 51-year-old woman who comes to the ER for painful obstructive jaundice; the ultrasound shows the presence of cholelitiasis and choledicolitiasis and identifies a nodular image in continuity with the right portal branch of 25x22x21 mm. This dilation is confirmed by MRI. After committee evaluation, follow-up was decided and to reserve the possibility of embolization if growth or symptomatology appeared.Natural photosynthesis relies on a sophisticated charge transfer pathway among multiple components with precise spatial, energetic, and temporal organizations in the aqueous environment. It continues to inspire and challenge the design and fabrication of artificial multicomponent colloidal nanostructures for solar-to-fuel conversion. Herein, we introduce a plasmonic photocatalyst synthesized with colloidal methods with five integrated components including cocatalysts installed in orthogonal locations. The precise deposition of individual inorganic components on an Au/TiO2 nanodumbell nanostructure is enabled by photoreduction and photo-oxidation, which selectively occurs at the TiO2 tip sites and Au lateral sites, respectively. Under visible-light irradiation, the photocatalyst exhibited activity of oxygen evolution from water without scavengers. We demonstrate that each component is essential for improving the photocatalytic performance. In addition, mechanistic studies suggest that the photocatalytic reaction requires combining the hot charge carriers derived from exciting both the d-sp interband transition and the localized surface plasmon resonance of Au.Nanoparticle (NP)-mediated therapies are promising tools for the treatment of a wide range of diseases, including stroke and cancer, due to the outstanding performance they have shown for specifically targeting diseased sites. Importantly, the coupling of stiffness and shape of NPs has a significant influence on transportation via blood flow and internalization by targeted cells. Nevertheless, the underlying mechanism of this coupling effect on the endocytosis of NPs remains largely unexplored, resulting from a lack of clear measurement of stiffness for NPs in experiments, as well as the complexity of the endocytosis process. To overcome the above challenges, coarse-grained simulations, which can provide abundant nanoscale details and precise control of mechanical properties of NPs, were implemented to study the stiffness and shape dependence of the endocytosis of spherocylindrical NPs. To understand the coupling effect between shape and stiffness of NPs for membrane wrapping, coarse-grained molecular dynamicrespect to geometry and particle stiffness, providing a useful guideline for designs of nanoparticles that can be implemented in next-generation nanoparticle-assisted therapy.The first total synthesis of four naturally occurring dihydro-β-agarofuran esters has been accomplished via a highly stereocontrolled 14-step access to their common core triol, (-)-isocelorbicol. A semipinacol rearrangement of an epoxy alcohol to install a quaternary carbon, diastereoselective conjugate reduction of a spirocyclic butenolide for the establishment of a methyl-bearing chiral center, and ring-closing metathesis to construct the decalin ring system were exploited as the key steps for the high-yielding synthesis of (-)-isocelorbicol.