Pancreatic Tuberculosis With Duodenal Fistula Presenting as Life-Threatening Gastrointestinal Bleeding

Pancreatic tuberculosis (TB) warrants heightened suspicion in individuals with pancreatic lesions and risk factors such as HIV, organ transplantation, or pertinent immigration history. We present a 38-year-old man who presented with hemodynamically unstable gastrointestinal bleeding. He was found to have pancreatic TB complicated by a duodenal ulcer with fistula. Following 1 month of antitubercular therapy, he experienced complete resolution of symptoms, healing of the duodenal ulcer, closure of the fistulous tract, and a decrease in the size of the pancreatic lesion as observed on imaging. Our case highlights the importance of early diagnosis and treatment of pancreatic TB.

Use of Over-the-Scope Clips in the Management of Refractory Postbanding Ulcer Bleed in a Patient After Liver Transplant

Postbanding ulcer bleeds (PBUBs) are an uncommon complication of variceal band ligation. They are often treated with proton pump inhibitors in addition to endoscopic interventions such as epinephrine injections, hemostatic clips, electrothermal cautery, or further band ligation. Over-the-scope clips are being increasingly used for the management of acute nonvariceal upper gastrointestinal bleeds, but their use in the management of PBUBs has been reported only once before. We present a 24-year-old man with alcohol-associated decompensated cirrhosis with recurrent PBUB, despite multiple endoscopic interventions, transjugular intrahepatic portosystemic shunt, and liver transplant, treated successfully with an Ovesco clip.

Tip of the iceberg: A comprehensive review of liver disease in Inborn errors of immunity

Inborn errors of immunity (IEIs) consist of numerous rare, inherited defects of the immune system that affect about 500,000 people in the United States. As advancements in diagnosis through genetic testing and treatment with targeted immunotherapy and bone marrow transplant emerge, increasing numbers of patients survive into adulthood posing fresh clinical challenges. A large spectrum of hepatobiliary diseases now present in those with immunodeficiency diseases, leading to morbidity and mortality in this population. Awareness of these hepatobiliary diseases has lagged the improved management of the underlying disorders, leading to missed opportunities to improve clinical outcomes. This review article provides a detailed description of specific liver diseases occurring in various inborn errors of immunity. A generalized approach to diagnosis and management of hepatic complications is provided, and collaboration with hepatologists, immunologists, and pathologists is emphasized as a requirement for optimizing management and outcomes.

Longitudinal Assessment of Bile Duct Loss in Primary Biliary Cholangitis

INTRODUCTION

Bile duct involvement is a key finding of primary biliary cholangitis (PBC). The aim of this study was to evaluate baseline ductopenia and disease progression.

METHODS

Retrospective longitudinal histological follow-up of treatment-naive patients with PBC.

RESULTS

Eighty-three patients were included, with ductopenia correlated to fibrosis stage at baseline. The cumulative incidence of severe ductopenia remained stable after 5 years, whereas fibrosis continually increased over time. Baseline AST-to-Platelet Ratio Index and elevated alkaline phosphatase >2 times the normal with abnormal bilirubin were associated with ductopenia progression.

DISCUSSION

Bile duct injury does not seem to follow the same course as fibrosis in PBC.

Lateral patterning of multilayer InAs/GaAs(001) quantum dot structures by in vacuo focused ion beam

We report on the effects of patterning and layering on multilayer InAs/GaAs(001) quantum dot structures laterally ordered using an in vacuo focused ion beam. The patterned hole size and lateral pattern spacing affected the quantum dot size and the fidelity of the quantum dots with respect to the lateral patterns. 100% pattern fidelity was retained after six layers of dots for a 9.0 ms focused ion beam dwell time and 2.0 µm lateral pattern spacing. Analysis of the change in quantum dot size as a function of pattern spacing provided a means of estimating the maximum average adatom surface diffusion length to be approximately 500 nm, and demonstrated the ability to alter the wetting layer thickness via pattern spacing. Increasing the number of layers from six to 26 resulted in mound formation, which destroyed the pattern fidelity at close pattern spacings and led to a bimodal quantum dot size distribution as measured by atomic force microscopy. The bimodal size distribution also affected the optical properties of the dots, causing a split quantum dot photoluminescence peak where the separation between the split peaks increased with increasing pattern spacing.