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Preston A. The Puerto Rico Journal of Public Health and Tropical Medicine (1925-1949): Coverage of Tropical Sprue. P R Health Sci J 2023; 42:91-101. [PMID: 37352530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Our current understanding of tropical sprue is that it is a malabsorption syndrome that responds to treatment with folic acid and a broad spectra antibiotic. This realization came only after countless years of research by legions of investigators. Twenty-seven individual studies on various aspects of tropical sprue were published in the Puerto Rico Journal of Public Health and Tropical Medicine from 1925 to 1949. This article summarizes significant findings, presented chronologically, and speculates on the direction of future investigations into tropical sprue.
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Affiliation(s)
- Alan Preston
- Professor Emeritus, Department of Biochemistry, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Salas-Álvarez JM, Campos-Martínez FJ, Moreno-Arciniegas A, Almorza-Gomar D, Pérez-Arana GM, Prada-Oliveira JA, Camacho-Ramírez A. A novel surgical technique focused on the study of the ileum: The preduodenal ileal transposition. CIR CIR 2020; 88:402-409. [PMID: 32567585 DOI: 10.24875/ciru.20001272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims Our main goal is to study the effects on the carbohydrate metabolism. Thus, we designed various experimental surgical models on healthy non-obese Wistar rats to reproduce several conditions. In this sense, we report a new experimental model. It is well known that bariatric surgery has important effects on the control of Type 2 Diabetes Mellitus. The underlying reasons are yet unknown, although the different theories focused in the release of different hormones after the pass of the nutrients through the tract. These released hormones have opposite effects that come together in a balanced glycemic metabolism. Materials and methods After bariatric surgical techniques, the modified anatomy resulted in an imbalance of the secreted hormones. Wistar rats were randomized in two groups Sham and surgical group. Our model consisted on the transposition of the terminal ileum right after the pylorus. Weight gain, food intake, and basal glycemia were measured weekly. Results We did not obtain significant differences between both groups for these functional variables. Conclusions This technique involved an early pass of the bolus through the ileum. The change on the luminal pH, along with the lack of enzymes to absorb the content, or the changes in the release of several hormones must be variables to the study. The mortality rate was assumable considering it was an experimental model on animals.
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Affiliation(s)
| | | | | | - David Almorza-Gomar
- Department of Operative Statistic Universidad de Cádiz. Cadiz, Spain.,Instituto de Investigación e innovación biomédica de Cádiz (INIBICA). Cadiz, Spain
| | | | - J Arturo Prada-Oliveira
- Department of Human Anatomy and Embryology, Faculty of Medicine, Universidad de Cádiz. Cadiz, Spain.,Instituto de Investigación e innovación biomédica de Cádiz (INIBICA). Cadiz, Spain
| | - Alonso Camacho-Ramírez
- Surgery Unit, Puerto Real University Hospital, Universidad de Cádiz. Cadiz, Spain.,Instituto de Investigación e innovación biomédica de Cádiz (INIBICA). Cadiz, Spain.,Surgery Unit, Puerta del Mar University Hospital of Cádiz. Cadiz, Spain
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Amateau SK, Lim CH, McDonald NM, Arain M, Ikramuddin S, Leslie DB. EUS-Guided Endoscopic Gastrointestinal Anastomosis with Lumen-Apposing Metal Stent: Feasibility, Safety, and Efficacy. Obes Surg 2019; 28:1445-1451. [PMID: 29500673 DOI: 10.1007/s11695-018-3171-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Traditionally, restoration of normal bowel continuity after resection and bypass of a diseased or obstructed gastrointestinal tract can only be achieved through surgery, which can be technically challenging and comes with a risk of adverse events. Here, we describe our institutions' experience with endoscopic-guided gastroenterostomy or enteroenterostomy with lumen-apposing metal stent (LAMS) from March 2015 to August 2016. Ten patients had gastrogastrostomy (gastric pouch to gastric remnant) and three patients had jejunogastrostomy (Roux limb to gastric remnant) for the reversal of Roux-en-Y bariatric surgery. One patient had gastroduodenostomy (stomach to duodenal bulb) post antrectomy and one patient had jejunojejunostomy for distal obstruction following Roux-en-Y reconstruction. Technical and clinical success were achieved in all patients, save for delayed anastomotic stenosis following stent removal in one patient, with a mean follow-up of 126 days (3-318 days) with minimal complications in two patients. Endoscopic gastrointestinal anastomosis therefore may be a safe and feasible technique to re-establish continuity of the digestive system following bypass in the short-term.
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Affiliation(s)
- Stuart K Amateau
- Interventional and Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Department of Medicine, University of Minnesota Medical Center, MMC 36-420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Chin Hong Lim
- Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Nicholas M McDonald
- Interventional and Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Department of Medicine, University of Minnesota Medical Center, MMC 36-420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Mustafa Arain
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sayeed Ikramuddin
- Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel B Leslie
- Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
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Watanabe Y, Miyoshi N, Fujino S, Takahashi H, Haraguchi N, Hata T, Matsuda C, Yamamoto H, Doki Y, Mori M, Mizushima T. Cumulative Inflammation Could Be a Risk Factor for Intestinal Failure in Crohn's Disease. Dig Dis Sci 2019; 64:2280-5. [PMID: 30806860 DOI: 10.1007/s10620-019-05553-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intestinal failure is the most critical complication of Crohn's disease. Intestinal failure requires home parenteral nutrition, which worsens the quality of life of the patients and sometimes causes life-threatening complications. AIMS The purpose of this study was to investigate the incidence and risk factors for intestinal failure in Crohn's disease. METHODS We performed a retrospective analysis of Crohn's disease patients (162 cases) at Osaka University Hospital between January 2000 and December 2017. Kaplan-Meier analysis was used to investigate the cumulative incidence of intestinal failure. To identify the risk factors of intestinal failure, patient characteristics were analyzed by multivariate analysis, including disease classification, surgical history, medical treatment other than surgery, and cumulative inflammation was calculated using the average C-reactive protein value and disease duration. RESULTS The cumulative incidence of intestinal failure 5, 10, and 15 years after Crohn's disease diagnosis was 2.6%, 3.4%, and 8.6%, respectively. Multivariate analysis identified the following as independent risk factors for intestinal failure in Crohn's disease: residual small intestinal length < 200 cm (odds ratio 7.51, 95% confidence interval 2.14-29.96), non-use of anti-tumor necrosis factor-alpha therapy (3.34, 1.22-10.74), and cumulative inflammation (1.01, 1.001-1.038). We created a new predictive nomogram consisting of these risk factors. CONCLUSIONS Intestinal failure occasionally occurred during long-term treatment of Crohn's disease. Cumulative inflammation for the first time, in addition to short residual small intestinal length and non-use of anti-tumor necrosis factor-alpha therapy, was shown to be potential risk factors for intestinal failure in Crohn's disease.
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Hujoel IA, Johnson DH, Lebwohl B, Leffler D, Kupfer S, Wu TT, Murray JA, Rubio-Tapia A. Tropheryma whipplei Infection (Whipple Disease) in the USA. Dig Dis Sci 2019; 64:213-23. [PMID: 29572616 DOI: 10.1007/s10620-018-5033-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whipple disease (WD) is an infection caused by the bacterium Tropheryma whipplei (TW). Few cases have been reported in the USA. AIMS To report on the demographics, clinical manifestations, diagnostic findings, treatment, and outcomes of TW infection. METHODS Cases of TW infection diagnosed from 1995 to 2010 were identified in three US referral centers and from 1995 to 2015 in one. Definite classic WD was defined by positive periodic acid-Schiff (PAS) staining and probable WD by specific positive TW polymerase chain reaction (PCR) of intestinal specimens. Localized infections were defined by a positive TW PCR result from samples of other tissues/body fluids. RESULTS Among the 33 cases of TW infections, 27 (82%) were male. Median age at diagnosis was 53 years (range 11-75). Diagnosis was supported by a positive TW PCR in 29 (88%) and/or a positive PAS in 16 (48%) patients. Classic WD was the most frequent presentation (n = 18, 55%), with 14 definite and 4 probable cases. Localized infections (n = 15, 45%) affected the central nervous system (n = 7), joints (n = 4), heart (n = 2), eye (n = 1), and skeletal muscle (n = 1). Blood PCR was negative in 9 of 17 (53%) cases at diagnosis. Ceftriaxone intravenously followed by trimethoprim and sulfamethoxazole orally was the most common regimen (n = 23, 70%). Antibiotic therapy resulted in clinical response in 24 (73%). CONCLUSIONS TW infection can present as intestinal or localized disease. Negative small bowel PAS and PCR do not exclude the diagnosis of TW infection, and blood PCR is insensitive for active infection.
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Ham H, Lee BI, Oh HJ, Park SH, Kim JS, Park JM, Cho YS, Choi MG. A case of celiac disease with neurologic manifestations misdiagnosed as amyotrophic lateral sclerosis. Intest Res 2017; 15:540-542. [PMID: 29142524 PMCID: PMC5683987 DOI: 10.5217/ir.2017.15.4.540] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/05/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated enteropathy and is a rare disease in Asia, including in Korea. However, the ingestion of wheat products, which can act as a precipitating factor of CD, has increased rapidly. CD is a common cause of malabsorption, but many patients can present with various atypical manifestations as first presented symptoms, including anemia, osteopenia, infertility, and neurological symptoms. Thus, making a diagnosis is challenging. We report a case of CD that mimicked amyotrophic lateral sclerosis (ALS). The patient was a sexagenary man with a history of progressive motor weakness for 2 years. He was highly suspected as having ALS. During evaluation of his neurological symptoms, esophagogastroduodenoscopy (EGD) was performed because he had experienced loose stools and weight loss for the previous 7 months. On EGD, the duodenal mucosa appeared smooth. A biopsy revealed severe lymphoplasma cell infiltration with flattened villi. His serum endomysial antibody (immunoglobulin A) titer was 1:160 (reference, <1:40). Finally, he was diagnosed as having CD, and a gluten-free diet was immediately begun. At a 4-month follow-up, his weight and the quality of his stool had improved gradually, and the neurological manifestations had not progressed.
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Affiliation(s)
- Hyoju Ham
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jin Oh
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Park
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Su Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Seok Cho
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Nikfarjam M, Wilson JS, Smith RC. Diagnosis and management of pancreatic exocrine insufficiency. Med J Aust 2017; 207:161-165. [PMID: 28814218 DOI: 10.5694/mja16.00851] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In 2015, the Australasian Pancreatic Club (APC) published the Australasian guidelines for the management of pancreatic exocrine insufficiency (http://pancreas.org.au/2016/01/pancreatic-exocrine-insufficiency-guidelines). Pancreatic exocrine insufficiency (PEI) occurs when normal digestion cannot be sustained due to insufficient pancreatic digestive enzyme activity. This may be related to a breakdown, at any point, in the pancreatic digestive chain: pancreatic stimulation; synthesis, release or transportation of pancreatic enzymes; or synchronisation of secretions to mix with ingested food. Main recommendations: The guidelines provide advice on diagnosis and management of PEI, noting the following: A high prevalence of PEI is seen in certain diseases and conditions, such as cystic fibrosis, acute and chronic pancreatitis, pancreatic cancer and pancreatic surgery. The main symptoms of PEI are steatorrhoea or diarrhoea, abdominal pain, bloating and weight loss. These symptoms are non-specific and often go undetected and untreated. PEI diagnosis is predominantly based on clinical findings and the presence of underlying disease. The likelihood of PEI in suspected patients has been categorised into three groups: definite, possible and unlikely. If left untreated, PEI may lead to complications related to fat malabsorption and malnutrition, and have an impact on quality of life. Pancreatic enzyme replacement therapy (PERT) remains the mainstay of PEI treatment with the recommended adult initial enzyme dose being 25 000-40 000 units of lipase per meal, titrating up to a maximum of 75 000-80 000 units of lipase per meal. Adjunct acid-suppressing therapy may be useful when patients still experience symptoms of PEI on high dose PERT. Nutritional management by an experienced dietitian is essential. Changes in management as a result of these guidelines: These are the first guidelines to classify PEI as being definite, possible or unlikely, and provide a diagnostic algorithm to facilitate the early diagnosis of PEI and appropriate use of PERT.
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Affiliation(s)
| | - Jeremy S Wilson
- South Western Sydney Clinical School, Liverpool Hospital, UNSW, Sydney, NSW
| | - Ross C Smith
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW
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Kim PS, Jung EJ, Bang HY. Small bowel diverticulosis in patient with early gastric cancer. Ann Surg Treat Res 2014; 87:209-12. [PMID: 25317417 PMCID: PMC4196433 DOI: 10.4174/astr.2014.87.4.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 11/30/2022] Open
Abstract
Jejunal and ileal diverticula are rare in adults. Duodenal diverticula are five times more prevalent than jejunoileal diverticula. Most patients are asymptomatic. However, chronic symptoms including intermittent abdominal pain, flatulence, diarrhea and constipation are seen in 10%-30% of patients. Gastric cancer is the second most common cancer in South Korea and here we report a case of early gastric cancer with multiple duodenal and jejunal diverticula. A 67-year-old woman was admitted to Konkuk University Medical Center with chronic diarrhea and weight loss of 19 kg over 2 months. Following gastroduodenoscopy, we identified adenocarcinoma of the lower body of the stomach. On abdominopelvic computed tomography, diverticula of duodenum and jejunum were found. Patient underwent distal gastrectomy and gastroduodenostomy with lymphadenectomy. She was discharged on the tenth postoperative day without complications.
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Affiliation(s)
- Pyeong Su Kim
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Eun-Joo Jung
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ho Yoon Bang
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Choi SW, Seo KW, Oh JS, Lee JS, Cha HJ. Successful treatment of enteropathy associated with common variable immunodeficiency. Korean J Intern Med 2014; 29:256-8. [PMID: 24648813 PMCID: PMC3957000 DOI: 10.3904/kjim.2014.29.2.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/01/2013] [Accepted: 09/12/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Seung Won Choi
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang Won Seo
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ji-Seon Oh
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Soo Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Friesen N, Hansen RD, Abraham SF, Kellow JE. Fructose-sorbitol ingestion provokes gastrointestinal symptoms in patients with eating disorders. World J Gastroenterol 2009; 15:5295-9. [PMID: 19908337 PMCID: PMC2776856 DOI: 10.3748/wjg.15.5295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate gastrointestinal (GI) symptoms and breath hydrogen responses to oral fructose-sorbitol (F-S) and glucose challenges in eating disorder (ED) patients.
METHODS: GI symptoms and hydrogen breath concentration were monitored in 26 female ED inpatients for 3 h, following ingestion of 50 g glucose on one day, and 25 g fructose/5 g sorbitol on the next day, after an overnight fast on each occasion. Responses to F-S were compared to those of 20 asymptomatic healthy females.
RESULTS: F-S provoked GI symptoms in 15 ED patients and one healthy control (P < 0.05 ED vs control). Only one ED patient displayed symptom provocation to glucose (P < 0.01 vs F-S response). A greater symptom response was observed in ED patients with a body mass index (BMI) ≤ 17.5 kg/m2 compared to those with a BMI > 17.5 kg/m2 (P < 0.01). There were no differences in psychological scores, prevalence of functional GI disorders or breath hydrogen responses between patients with and without an F-S response.
CONCLUSION: F-S, but not glucose, provokes GI symptoms in ED patients, predominantly those with low BMI. These findings are important in the dietary management of ED patients.
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