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Ray-Offor E, Egboh SM, Ijah RFOA, Hany Emile S, Wexner SD. Colonic Diverticulosis at Colonoscopy in Africa: A Systematic Review and Meta-Analysis of Pooled Estimates. Dig Surg 2024; 41:63-78. [PMID: 38377978 DOI: 10.1159/000536587] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION There is need to ascertain any epidemiologic shift of diverticulosis among Africans with traditionally high fiber diet consumption patterns and rare diverticulosis prevalence. METHODS We systematically searched PubMed, Scopus, Cochrane Library, African Journal Online (AJOL), and Google Scholar. Eligibility criteria included full-text observational and experimental human colonoscopy studies on asymptomatic and symptomatic African population from 1985 to 2022. Case reports, conference abstracts, dissertations, systematic reviews, and studies lacking colonoscopy findings were excluded. NIH quality assessment tool for observational cohort and cross-sectional studies was used to assess risk of bias. Meta-analysis was performed using the random-effect model. Heterogeneity was assessed using inconsistency (I2) statistics. RESULTS Thirty studies were included. Pooled prevalence rate of colonic diverticulosis in the last decade (2012-2022) has increased to 9.7% (95% CI 6.5-13.4; I2 = 97.3%) from 3.5% (95% CI 1.4-6.4; I2 = 62.7%). The highest regional prevalence rate was in West African studies at 11.3% (95% CI 7.6-14.9; I2 = 96.2%). Proportion of individuals with diverticulosis ≥50 years and male sex were 86.9% (95% CI 80.5-92.1) and 65.2% (95% CI 55.0-74.8), respectively. The left colon had the highest diverticulosis frequency (37% [148/400]). Bleeding/inflammation complications were sparingly detected (OR 0.2 [95% CI 0.03-0.75; p < 0.0001]). CONCLUSION An increasing utilization of colonoscopy revealed approximately a threefold increase in the prevalence rate of colonic diverticulosis in Africa. This pathology was most common in males aged >50. Left colon was predominantly affected. Further studies are needed to demonstrate the effect of westernization of diet.
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Affiliation(s)
- Emeka Ray-Offor
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery, University of Port Harcourt Choba, Choba, Nigeria
| | - Stella-Maris Egboh
- Department of Internal Medicine, Federal Medical Centre Yenagoa, Yenagoa, Nigeria
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rex F O A Ijah
- Department of Surgery, Rivers State University/University Teaching Hospital, Port Harcourt, Nigeria
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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Li Z, Wang D, Hu J, Zhang G, Sun J. Multi-slice spiral computed tomography diagnosis of juxta-papillary duodenal diverticulum and its relationship with biliopancreatic diseases. Technol Health Care 2024; 32:1-8. [PMID: 37270822 PMCID: PMC10789348 DOI: 10.3233/thc-220742] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/07/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Juxta-papillary duodenal diverticula (JPDD) are common but are usually asymptomatic, and they are often diagnosed by coincidence. OBJECTIVE To analyse the anatomy and classification of JPDD and its relationship with biliary and pancreatic disorders, and to explore the diagnostic value of multi-slice spiral computed tomography (MSCT) in patients with JPDD. METHODS The imaging data of patients with JPDD, which was obtained via abdominal computed tomography examination and confirmed via gastroscopy and/or upper gastrointestinal barium enema, in our hospital from 1 January 2019 to 31 December 2020 were retrospectively analysed. All patients were scanned using MSCT, and the imaging findings, classification and grading were analysed. RESULTS A total of 119 duodenal diverticula were detected in 96 patients, including 73 single diverticula and 23 multiple diverticula. The imaging findings were mainly cystic lesions of the inner wall of the duodenum protruding to the outside of the cavity. The thin layer showed a narrow neck connected with the duodenal cavity, and the shape and size of the diverticula were different: 67 central-type cases and 29 peripheral-type cases. There were 50 cases of type I, 33 cases of type II, 19 cases of type III and six cases of type IV. Furthermore, there were seven small, 87 medium and 14 large diverticula. The differences in the location and size of the JPDD in MSCT grading were statistically significant (P< 0.05). CONCLUSION The MSCT method has an important diagnostic value for the classification of JPDD, and MSCT images are helpful in the clinical evaluation of patients with JPDD and the selection of treatment options.
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Affiliation(s)
- Zhongwei Li
- Department of Radiology, Yantaishan Hospital, Yantai, Shandong, China
| | - Di Wang
- Department of Radiology, Yantaishan Hospital, Yantai, Shandong, China
- Department of Radiology, 970 Hospital of the PLA JLSF, Yantai, Shandong, China
| | - Jiashou Hu
- Department of Radiology, 970 Hospital of the PLA JLSF, Yantai, Shandong, China
| | - Guowei Zhang
- Department of Radiology, Yantaishan Hospital, Yantai, Shandong, China
| | - Jinfeng Sun
- Department of Radiology, 970 Hospital of the PLA JLSF, Yantai, Shandong, China
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Chiew SF, Toh YF, Looi LM, Cheah PL. Gastrointestinal stromal tumour in a jejunal diverticulum: The eighth reported case worldwide with a brief review of the literature. Malays J Pathol 2023; 45:473-478. [PMID: 38155388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Jejunal diverticulosis is uncommon and so are gastrointestinal stromal tumours (GIST) arising in the jejunum. GIST arising in a jejunal diverticulum is a rarity and to date there are only 7 cases in the English literature. Our case of GIST occurring in a jejunal diverticulum of a 48-year-old lady would be the first reported in Malaysia and the 8th in the world. As in most cases, the clinical presentation and radiological findings of this patient were non-specific. With a history of acute abdominal pain, vomiting and fever, the patient was provisionally diagnosed as a case of twisted ovarian cyst and subjected to laparotomy. An intact roundish jejunal diverticulum 5.0 cm x 5.0 cm, about 50 cm distal to the duodeno-jejunal junction was found and resected with a segment of small intestine. Microscopic examination showed a tumour of the cut open diverticular wall, with epithelioid to spindled cells, demonstrating a mitotic rate of 1-2 per 5 mm2, confined to, while infiltrating the wall of the diverticulum. The immunohistochemical profile of positive staining for CD117, DOG-1, smooth muscle actin and CD34, and negative expression of desmin and S100 protein, clinched the diagnosis of GIST. Based on the AFIP Criteria for risk stratification,1 the patient was categorised as having moderate risk for disease progression, and was not offered further targeted imatinib as an immediate measure. The patient has remained well at the time of writing i.e. 8 months following excision, and continues on active surveillance by the surgical and oncological teams, with the option of imatinib, should the necessity arise. This case is presented not merely for the sake of documenting its rarity, but as a reminder to stay alert for uncommon conditions in histopathology practice.
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Affiliation(s)
- S F Chiew
- University of Malaya Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia.
| | - Y F Toh
- University of Malaya, Department of Pathology, Kuala Lumpur, Malaysia
| | - L M Looi
- University of Malaya, Department of Pathology, Kuala Lumpur, Malaysia
| | - P L Cheah
- University of Malaya, Department of Pathology, Kuala Lumpur, Malaysia
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Toyonaga H, Hayashi T, Hama K, Iwano K, Ando R, Ishii T, Kin T, Motoya M, Takahashi K, Katanuma A. Tip-in endoscopic papillectomy for ampullary adenoma near diverticulum to minimize complications. J Hepatobiliary Pancreat Sci 2023; 30:e75-e77. [PMID: 37776049 DOI: 10.1002/jhbp.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 10/01/2023]
Abstract
Toyonaga and colleagues present a novel "tip-in endoscopic papillectomy" approach for resecting ampullary tumors, aiming to minimize complications like perforation and residual tumor by adapting the colonic polyp endoscopic mucosal resection tip-in method. The technique is described with accompanying video in a case of ampullary tumor near a diverticulum.
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Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kazuki Hama
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kosuke Iwano
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ryo Ando
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Masayo Motoya
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
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Alzerwi NA. Recurrent ascending cholangitis with acute pancreatitis and pancreatic atrophy caused by a juxtapapillary duodenal diverticulum: A case report and literature review. Medicine (Baltimore) 2020; 99:e21111. [PMID: 32629744 PMCID: PMC7337422 DOI: 10.1097/md.0000000000021111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum. PATIENT CONCERNS Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss. DIAGNOSES AND INTERVENTIONS Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion. OUTCOME Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery. LESSONS Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.
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Yue P, Zhu KX, Wang HP, Meng WB, Liu JK, Zhang L, Zhu XL, Zhang H, Miao L, Wang ZF, Zhou WC, Suzuki A, Tanaka K, Li X. Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation. World J Gastroenterol 2020; 26:2403-2415. [PMID: 32476801 PMCID: PMC7243649 DOI: 10.3748/wjg.v26.i19.2403] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Different types of periampullary diverticulum (PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation, but the clinical significance of the two current PAD classifications for cannulation is limited.
AIM To verify the clinical value of our newly proposed PAD classification.
METHODS A new PAD classification (Li-Tanaka classification) was proposed at our center. All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.
RESULTS A total of 3564 patients with native papillae were enrolled, including 967 (27.13%) PAD patients and 2597 (72.87%) non-PAD patients. In the Li-Tanaka classification, type I PAD patients exhibited the highest difficult cannulation rate (23.1%, P = 0.01), and type II and IV patients had the highest cannulation success rates (99.4% in type II and 99.3% in type IV, P < 0.001). In a multivariable-adjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio (OR) = 1.87, 95% confidence interval (CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group, the difficulty of cannulation in the type I PAD group according to the Li-Tanaka classification was greater (OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower (OR = 0.27, 95%CI: 0.11-0.66, P < 0.001), while it was higher in the type II PAD group (OR = 4.44, 95%CI: 1.61-12.29, P < 0.01).
CONCLUSION Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.
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Affiliation(s)
- Ping Yue
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical School of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ke-Xiang Zhu
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hai-Ping Wang
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wen-Bo Meng
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
| | - Jian-Kang Liu
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02451, United States
| | - Lei Zhang
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao-Liang Zhu
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hui Zhang
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Long Miao
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Zheng-Feng Wang
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wen-Ce Zhou
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Azumi Suzuki
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 602-8026, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 602-8026, Japan
| | - Xun Li
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical School of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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Zheng F, Kong L, Wang H, Fan H, Gong H, Zhang K, Du L. Transvaginal three-dimensional ultrasound combined with HD flow model for uterus scar diverticulum. J Infect Public Health 2019; 13:2014-2019. [PMID: 31526641 DOI: 10.1016/j.jiph.2019.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/18/2022] Open
Abstract
To study the influencing factors of scar diverticulum formation and its monitoring methods, 141 people with a history of cesarean section and kidney deficiency and blood stasis were selected as subjects. The transvaginal ultrasound technique was used to divide the case into the scar diverticulum case group and the complete group, and the clinical situation was analyzed. Transvaginal three-dimensional ultrasound combined with HD flow pattern was used to analyze the morphology of uterus scar diverticulum and the parameters of peripheral muscle blood flow. The relationship between the size of scar diverticulum and its influencing factors, the location of the uterus and the number of cesarean sections were studied. Studies have found that retroposition of the uterus or the number of cross-cutting will increase the possibility of uterus scar diverticulum formation. Therefore, transvaginal three-dimensional ultrasound combined with HD flow mode can identify and diagnose scar diverticulum.
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Affiliation(s)
- Fang Zheng
- Department of Ultrasonography, The First Affiliated Hospital of Xinxiang Medical University, Weihui City, Henan Province 453100, China
| | - Liru Kong
- Department of Ultrasonography, The First Affiliated Hospital of Xinxiang Medical University, Weihui City, Henan Province 453100, China
| | - Haiyan Wang
- Department of Ultrasonography, The First Affiliated Hospital of Xinxiang Medical University, Weihui City, Henan Province 453100, China
| | - Huijun Fan
- Department of Ultrasonography, The First Affiliated Hospital of Xinxiang Medical University, Weihui City, Henan Province 453100, China
| | - Hongyan Gong
- Department of Anesthesiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui City, Henan Province 453100, China
| | - Kai Zhang
- Department of Ultrasonography, The First Affiliated Hospital of Xinxiang Medical University, Weihui City, Henan Province 453100, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Hongkou District, Shanghai 200080, China.
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Beyens A, Van Meensel K, Pottie L, De Rycke R, De Bruyne M, Baeke F, Hoebeke P, Plasschaert F, Loeys B, De Schepper S, Symoens S, Callewaert B. Defining the Clinical, Molecular and Ultrastructural Characteristics in Occipital Horn Syndrome: Two New Cases and Review of the Literature. Genes (Basel) 2019; 10:genes10070528. [PMID: 31336972 PMCID: PMC6678539 DOI: 10.3390/genes10070528] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022] Open
Abstract
Occipital horn syndrome (OHS) is a rare connective tissue disorder caused by pathogenic variants in ATP7A, encoding a copper transporter. The main clinical features, including cutis laxa, bony exostoses, and bladder diverticula are attributed to a decreased activity of lysyl oxidase (LOX), a cupro-enzyme involved in collagen crosslinking. The absence of large case series and natural history studies precludes efficient diagnosis and management of OHS patients. This study describes the clinical and molecular characteristics of two new patients and 32 patients previously reported in the literature. We report on the need for long-term specialized care and follow-up, in which MR angiography, echocardiography and spirometry should be incorporated into standard follow-up guidelines for OHS patients, next to neurodevelopmental, orthopedic and urological follow-up. Furthermore, we report on ultrastructural abnormalities including increased collagen diameter, mild elastic fiber abnormalities and multiple autophagolysosomes reflecting the role of lysyl oxidase and defective ATP7A trafficking as pathomechanisms of OHS.
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Affiliation(s)
- Aude Beyens
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Kyaran Van Meensel
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium
| | - Lore Pottie
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium
| | - Riet De Rycke
- Department for Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research, 9000 Ghent, Belgium
- Ghent University Expertise Centre for Transmission Electron Microscopy and VIB BioImaging Core, 9000 Ghent, Belgium
| | - Michiel De Bruyne
- Department for Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research, 9000 Ghent, Belgium
- Ghent University Expertise Centre for Transmission Electron Microscopy and VIB BioImaging Core, 9000 Ghent, Belgium
| | - Femke Baeke
- Department for Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research, 9000 Ghent, Belgium
- Ghent University Expertise Centre for Transmission Electron Microscopy and VIB BioImaging Core, 9000 Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Frank Plasschaert
- Department of Orthopedic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Bart Loeys
- Center for Medical Genetics, University of Antwerp/Antwerp University Hospital, Antwerp, Belgium
| | - Sofie De Schepper
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sofie Symoens
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium
| | - Bert Callewaert
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium.
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Lee HJ, Park SJ, Cheon JH, Kim TI, Kim WH, Kim HJ. The relationship between diverticulosis and colorectal neoplasia: A meta-analysis. PLoS One 2019; 14:e0216380. [PMID: 31141507 PMCID: PMC6541260 DOI: 10.1371/journal.pone.0216380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/12/2019] [Indexed: 01/26/2023] Open
Abstract
Background/Aims Diverticulosis and colorectal neoplasia share epidemiological trends and risk factors which are common in Western countries and incidences increase with age. However, the data on an association between diverticulosis and colorectal neoplasia are conflicting. Thus, we performed a meta-analysis to evaluate whether diverticulosis is associated with colorectal neoplasia. Methods A systematic literature search of PubMed, EMBASE, Cochrane Library, Web of Science, and SCOPUS was conducted to identify studies that investigated the association between diverticulosis and advanced colorectal neoplasia (advanced adenoma, colorectal cancer), adenomas, or polyps. The demographic characteristics of patients, including age, gender, indication for colonoscopy, confounding factors, and outcomes of colorectal neoplasia were assessed. Results We identified 29 cross-sectional studies (N = 450,953) that investigated the association between diverticulosis and colorectal neoplasia. The meta-analysis found that diverticulosis was not associated with advanced colorectal neoplasia (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.63–1.50). Although there was a positive correlation between diverticulosis and adenomas (OR 1.47, 95% CI 1.18–1.84) and diverticulosis and polyps (OR 1.95, 95% CI 1.15–3.31), diverticulosis did not increase the risk of adenomas (OR 1.34, 95% CI 0.87–2.06) in patients who underwent screening colonoscopy. Moreover, all the increased risk of colorectal neoplasia in patients with diverticulosis was observed in published studies only, and not in unpublished ones. Conclusions This meta-analysis demonstrated that diverticulosis is not associated with an increased risk of advanced colorectal neoplasia. Although diverticulosis was associated with a higher risk of polyps and adenomas, the risk was not increased in screening populations. Moreover, the increased risk of colorectal neoplasia in patients with diverticulosis was observed only in published studies and not in unpublished ones.
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Affiliation(s)
- Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
- * E-mail:
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10
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Murray KA, Hoad CL, Garratt J, Kaviani M, Marciani L, Smith JK, Siegmund B, Gowland PA, Humes DJ, Spiller RC. A pilot study of visceral fat and its association with adipokines, stool calprotectin and symptoms in patients with diverticulosis. PLoS One 2019; 14:e0216528. [PMID: 31067253 PMCID: PMC6505945 DOI: 10.1371/journal.pone.0216528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/18/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Complications of diverticular disease are increasingly common, possibly linked to increasing obesity. Visceral fat could contribute to the development of symptomatic diverticular disease through its pro-inflammatory effects. OBJECTIVE The study had 2 aims. A) to develop a semi-automated algorithm to measure abdominal adipose tissue from 2-echo magnetic resonance imaging (MRI) data; B) to use this to determine if visceral fat was associated with bowel symptoms and inflammatory markers in patients with symptomatic and asymptomatic diverticular disease. DESIGN An observational study measuring visceral fat using MRI together with serum adiponectin, leptin, stool calprotectin and patient-reported somatisation and bowel habit. SETTING Medical and imaging research centres of a university hospital. PARTICIPANTS MRI scans were performed on 55 patients after an overnight fast measuring abdominal subcutaneous and visceral adipose tissue volumes together with small bowel water content (SBWC). Blood and stool samples were collected and patients kept a 2 week stool diary and completed a somatisation questionnaire. MAIN OUTCOME MEASURES Difference in the volume of visceral fat between symptomatic and asymptomatic patients. RESULTS There were no significant differences in visceral (p = 0.98) or subcutaneous adipose (p = 0.60) tissue between symptomatic and asymptomatic patients. However measured fat volumes were associated with serum adipokines. Adiponectin showed an inverse correlation with visceral adipose tissue (VAT) (Spearman ρ = -0.5, p = 0.0003), which correlated negatively with SBWC (ρ = -0.3, p = 0.05). Leptin correlated positively with subcutaneous adipose tissue (ρ = 0.8, p < 0.0001). Overweight patients (BMI > 25 kgm-2) showed a moderate correlation between calprotectin and VAT (ρ = 0.3, p = 0.05). Somatization scores were significantly higher in symptomatic patients (p < 0.0003). CONCLUSIONS Increasing visceral fat is associated with lower serum adiponectin and increased faecal calprotectin suggesting a pro-inflammatory effect which may predispose to the development of complications of diverticulosis.
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Affiliation(s)
- Kathryn A. Murray
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
- Trinity Medical Sciences University, Ratho Mill, Kingstown, St. Vincent, West Indies
| | - Caroline L. Hoad
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Jill Garratt
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Mehri Kaviani
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Luca Marciani
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Jan K. Smith
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Britta Siegmund
- Gastroenterology, Rheumatology, Infectious Diseases, Charité –Universitätsmedizin, Berlin, Germany
| | - Penny A. Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - David J. Humes
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Robin C. Spiller
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
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11
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Gachabayov M, Orujova L, Kubachev K. Traction Diverticulum of the Small Bowel with Enterolith as a Cause of Intestinal Obstruction. Clin Med Res 2018; 16:92-94. [PMID: 30587563 PMCID: PMC6306149 DOI: 10.3121/cmr.2018.1436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Mahir Gachabayov
- Department of Surgery named after N.D. Monastyrski, North-Western State Medical Academy named after I.I. Mechnikov, Saint Petersburg, Russia
| | - Lala Orujova
- Department of Surgery named after N.D. Monastyrski, North-Western State Medical Academy named after I.I. Mechnikov, Saint Petersburg, Russia
| | - Kubach Kubachev
- Department of Surgery named after N.D. Monastyrski, North-Western State Medical Academy named after I.I. Mechnikov, Saint Petersburg, Russia
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12
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Babcock Gilbert S, Reading JI, Post MD, Alvero R, Al-Safi ZA. Cornual uterine diverticulum following a failed pregnancy. Gynecol Endocrinol 2018; 34:928-929. [PMID: 29733747 DOI: 10.1080/09513590.2018.1469609] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The discovery of a uterine diverticulum is a rare event. Diverticula can lead to outcomes including pelvic pain, ectopic pregnancy, and diverticula rupture and should be considered in cases of uterine cystic masses. We report a case of a 32-year-old G3P0030 with a complicated pregnancy and surgical history who presented to us following an abnormal laparoscopy for severe pelvic pain four years after salpingectomy for a tubal pregnancy. This laparoscopy reported a cornual uterine cystic structure. Saline infusion sonohysterography was performed with fluid filling a uterine cornual cystic mass. On hysteroscopy, no outpouching was identified. With chromopertubation on laparoscopy, methylene blue filled the diverticulum. The diverticulum was laparoscopically removed. Pathology examination was consistent with a diverticulum containing a placental implantation site and necrotic chorionic villi.
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Affiliation(s)
- Sara Babcock Gilbert
- a Department of Obstetrics and Gynecology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Julia I Reading
- b David Geffen School of Medicine, University of California Los Angeles , Los Angeles , CA , USA
| | - Miriam D Post
- c Department of Pathology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Ruben Alvero
- a Department of Obstetrics and Gynecology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Zain A Al-Safi
- a Department of Obstetrics and Gynecology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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13
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Chen WG, Zhu HT, Yang M, Xu GQ, Chen LH, Chen HT. Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum: Clinical experience and endoscopic management. World J Gastroenterol 2018; 24:3462-3468. [PMID: 30122884 PMCID: PMC6092586 DOI: 10.3748/wjg.v24.i30.3462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Abstract
Heterotopic gastric mucosa (HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge. In the present study, a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia. Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum. Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum. Narrow band imaging further confirmed the histological results. Endoscopic ultrasound indicated that the lesion originated from the mucosal layer, and partially involved the submucosal layer. Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion. No bleeding, perforation or other adverse events were observed. The presence of HGM in the diverticular cavity greatly increased the surgical difficulty. A literature review was also carried out in our study.
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Affiliation(s)
- Wen-Guo Chen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hua-Tuo Zhu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ming Yang
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Qiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Li-Hua Chen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hong-Tan Chen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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14
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Naouar S, Boussaffa H, Amri M, Naouar R, Braiek S, El Kamel R. Giant urethral diverticulum calculus revealed by peri-urethral abscess. Tunis Med 2018; 96:391-392. [PMID: 30430479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Urethral diverticulum of the male is uncommon. We report a case of bulbar urethraldiverticulum with contained giant calculus presenting as left inguino-scrotal swellingsecondary to peri-urethral abscess in a 40 year-old male. In the light of this case Weemphasize the importance of investigation for the presence of urethral diverticulum in youngmale individuals presenting with voiding disturbances to preventrelated complications.
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Abstract
The normal aortic arch branching pattern is of a three-vessel arch with the vertebral arteries arising from the subclavian arteries. There are a variety of well-known symptomatic and asymptomatic aortic branching patterns widely reported in the literature. An anomalous right vertebral artery with a diverticulum of Kommerell is an extremely rare variant, with few other cases reported in the literature. Herein, we review the embryology of the aortic arch and vertebral artery, the various types of Kommerell's diverticula and the clinical significance of this anomaly.
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Affiliation(s)
- Alyssa Goldbach
- Department of Radiology, Temple University Health System, Philadelphia, PA, USA
| | - Chandra Dass
- Department of Radiology, Temple University Health System, Philadelphia, PA, USA
| | - Krishna Surapaneni
- Department of Radiology, Temple University Health System, Philadelphia, PA, USA
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16
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Abstract
RATIONALE Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small intestinal diverticulum with bleeding is difficult to detect by barium meal and angiographic methods and has been regarded as an important cause of obscure gastrointestinal tract bleeding in adolescents. Because of its complicated etiology and non-specific clinical manifestations, it is relatively difficult to detect small intestinal diverticulum with bleeding, especially in patients with a large amount of bleeding and hemodynamic instability. PATIENT CONCERNS This retrospective study collects clinical statistics of 19 patients admitted to our hospital from January 2010 to December 2016. Patients who had small intestinal diverticulum patients with bleeding were included in this study. Patients who were taking anticoagulants were excluded DIAGNOSES:: Small intestinal diverticulum patients with bleeding. INTERVENTIONS This retrospective study describes the clinical features of patients with small intestinal diverticulum whose main symptom was gastrointestinal bleeding and analyze the literature on this topic, with particular reference to the clinical characteristics, pathological features, and choice of examination methods. LESSONS Small intestinal diverticulum with bleeding is a common cause of obscure gastrointestinal bleeding, but it is difficult to detect using normal examination methods. For patients with repeated gastrointestinal bleeding and no positive results found on gastroscopy and colonoscopy, endoscopy of the small intestine and CTE with contrast can be considered as a diagnostic modality.
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Affiliation(s)
- Lifang Zhao
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Wei Lu
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Yinping Sun
- The Outpatient Internal Medicine Department of Beijing Veteran Cadre Service Administration, Central Military Commission Logistics Support Department, Beijing, China
| | - Junrong Liang
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Shanshan Feng
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Yongquan Shi
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Qiong Wu
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Jianhong Wang
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Kaichun Wu
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
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17
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Marchesi M, Boracchi M, Gentile G, Maghin F, Zoja R. Sudden perinatal death due to rupture of congenital cardiac diverticulum. Pathological findings and medico-legal investigations in malpractice charge. Leg Med (Tokyo) 2017; 28:6-9. [PMID: 28728073 DOI: 10.1016/j.legalmed.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/06/2016] [Accepted: 07/11/2017] [Indexed: 11/17/2022]
Abstract
Congenital diverticula of the left ventricle, very rare malformations, are determined by an abnormal embryonic development of the ventricular wall and can be isolated or associated to other cardiac anomalies. In most of the cases, these pathologies are not symptomatic and in some patients can be associated to ventricular arrhythmia, cardiac rupture with tamponade and sudden death. Authors are presenting the case of a sudden death in an 8-weeks-old newborn due to rupture of a cardiac congenital diverticulum of the left ventricle, discovered only at the moment of the autopsic examination. The parents of the victim pressed charges against the medical staff that was appointed to the cares, blaming them with malpractice. The missed diagnosis of a cardiac congenital diverticulum of the left ventricle, a rare pathology, reflects the trickiness of the medical management that can lead to medico-legal controversies and, even though such rare conditions must be always taken into consideration when investigating possible dysfunction causing the death, diagnostic difficulties, in the case in exam, justify the missed diagnosis intra-vitam of cardiac ventricular diverticulum.
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Affiliation(s)
- Matteo Marchesi
- Responsabile USS Medicina Legale, Azienda SocioSanitaria Papa Giovanni XXIII, Ospedale di Bergamo, Italy
| | - Michele Boracchi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Guendalina Gentile
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Francesca Maghin
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
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18
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Barrenschee M, Wedel T, Lange C, Hohmeier I, Cossais F, Ebsen M, Vogel I, Böttner M. No neuronal loss, but alterations of the GDNF system in asymptomatic diverticulosis. PLoS One 2017; 12:e0171416. [PMID: 28152033 PMCID: PMC5289619 DOI: 10.1371/journal.pone.0171416] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/20/2017] [Indexed: 12/15/2022] Open
Abstract
Background Glial cell line-derived neurotrophic factor (GDNF) is a potent neurotrophic factor known to promote the survival and maintenance of neurons not only in the developing but also in the adult enteric nervous system. As diverticular disease (DD) is associated with reduced myenteric neurons, alterations of the GDNF system were studied in asymptomatic diverticulosis (diverticulosis) and DD. Methods Morphometric analysis for quantifying myenteric ganglia and neurons were assessed in colonic full-thickness sections of patients with diverticulosis and controls. Samples of tunica muscularis (TM) and laser-microdissected myenteric ganglia from patients with diverticulosis, DD and controls were analyzed for mRNA expression levels of GDNF, GFRA1, and RET by RT-qPCR. Myenteric protein expression of both receptors was quantified by fluorescence-immunohistochemistry of patients with diverticulosis, DD, and controls. Results Although no myenteric morphometric alterations were found in patients with diverticulosis, GDNF, GFRA1 and RET mRNA expression was down-regulated in the TM of patients with diverticulosis as well as DD. Furthermore GFRA1 and RET myenteric plexus mRNA expression of patients with diverticulosis and DD was down-regulated, whereas GDNF remained unaltered. Myenteric immunoreactivity of the receptors GFRα1 and RET was decreased in both asymptomatic diverticulosis and DD patients. Conclusion Our data provide evidence for an impaired GDNF system at gene and protein level not only in DD but also during early stages of diverticula formation. Thus, the results strengthen the idea of a disturbed GDNF-responsiveness as contributive factor for a primary enteric neuropathy involved in the pathogenesis and disturbed intestinal motility observed in DD.
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Affiliation(s)
| | - Thilo Wedel
- Institute of Anatomy, Kiel University, Kiel, Germany
| | | | - Ines Hohmeier
- Institute of Anatomy, Kiel University, Kiel, Germany
| | | | - Michael Ebsen
- Department of Pathology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Ilka Vogel
- Department of Surgery, Städtisches Krankenhaus Kiel, Kiel, Germany
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19
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Khan A, Khan F, Rafique K, Khan S, Majid A, Khan K, Ullah A. Small Gut Volvulus, A Rare Twist, In The Setting Of An Even Rarer Entity; Multiple Giant Jejuno Ileal Diverticula. J Ayub Med Coll Abbottabad 2017; 29:147-149. [PMID: 28712196] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Small gut volvulus with multiple Jejuno-ileal diverticulosis is an unusual pathology of the small intestine with a scarce number of cases reported so far. It usually goes unnoticed because it is often asymptomatic but complications like diverticulitis, perforation, bleeding or intestinal obstruction can occur in 10-30% of the cases. Mechanical obstruction, if it occurs, can be caused by adhesions or stenosis due to diverticulitis, intussusception at the site of the diverticulum and volvulus of the segment containing the diverticula. Acute volvulus of the small bowel is a serious abdominal emergency that poses a difficulty in diagnosis and delayed operative intervention can lead to dire consequences. We herein report the case of a 42-yearold man presented at the emergency department with acute abdominal pain, absolute constipation and vomiting. Preoperative investigations followed by laparotomy revealed small gut volvulus and multiple giant jejunal and ileal diverticula.
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Affiliation(s)
- Ayesha Khan
- Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Faheem Khan
- Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Kashif Rafique
- Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Sarwar Khan
- Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Anam Majid
- Internal Medicine, RWJ Hospital New Jersey, US
| | - Khalid Khan
- Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Asad Ullah
- Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
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20
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Celebi S, Kuzdan Ö, Özaydın S, Başdaş C, Özaydın İ, Yazıcı M, Sander S. The effect of bladder diverticula on bladder function: An experimental study in rabbits. J Pediatr Surg 2016; 51:1538-42. [PMID: 27041230 DOI: 10.1016/j.jpedsurg.2016.02.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/07/2016] [Accepted: 02/24/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aims to evaluate the effect of bladder diverticula (BD) on bladder function using a rabbit model, based on urodynamic findings. METHODS A total of 32 New Zealand white rabbits were randomly assigned to four groups: (1) sham surgery; (2) a single, 1-cm-diameter BD; (3) a single, large, 3-cm-diameter BD; and (4) four (multi) 1-cm-diameter BD. Urodynamic evaluations were performed preoperatively, and 1week and 1month postoperatively, to measure the postmicturition residual (PMR), maximum bladder capacity (MBC), filling and voiding detrusor pressure (Pdet), compliance, and unstable detrusor contractions. At the end of the study, the animals were sacrificed and assessed for pathologic evaluation and stone formation. RESULTS In groups 3 and 4, the rabbits all had PMR. At 30days postsurgery, the MBC was found to be 28% and 31% lower than the reference range in groups 3 and 4 and compliance was decreased (p<0.05). Further, the filling Pdet was significantly higher for large and multiple BD than in the 1-cm diverticula or sham groups (6.33±1.73, 4±1.26, p=0.0001). Groups 3 (62%) and 4 (50%) had unstable detrusor contractions. There was also a muscular/collagen ratio increase in the large and multiple BD groups. Four rabbits in the large group and one rabbit in the multiple BD group exhibited stone formation. CONCLUSIONS Large or multiple BD can alter bladder storage and emptying, and can decrease the capacity of the bladder and reduce its elasticity. Large or multiple bladder diverticula can lead to involuntary contractions, causing dysfunctional voiding.
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Affiliation(s)
- Süleyman Celebi
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey.
| | - Özgür Kuzdan
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - Seyithan Özaydın
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - Cemile Başdaş
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - İpek Özaydın
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pathology, Turkey
| | - Mehmet Yazıcı
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - Serdar Sander
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Urology, Turkey
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21
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Medlicott SAC, Brown HA, Roland B, Beck PL, Auer I, Mansoor A. Multiple Lymphomatous Diverticulosis and Comorbid Chronic Lymphocytic Leukemia: Novel Manifestations of Ileocolic Mantle Cell Lymphoma. Int J Surg Pathol 2016; 15:408-13. [PMID: 17913952 DOI: 10.1177/1066896907302372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mantle cell lymphoma (MCL) has tropism for the gastrointestinal tract (GIT) identifiable as multiple polyps and mass lesions throughout the GIT. We describe 2 novel manifestations of MCL. A 60-year-old woman with known chronic lymphocytic leukemia (CLL) had an exophytic mass of the appendiceal orifice. Multiple polypoid masses of the distal ileum were identified in the right hemicolectomy specimen (multiple lymphomatous polyposis). Ancillary studies confirmed the coexistence of the 2 independent lymphoproliferative disorders. A 69-year-old man had recurrent urinary tract infections and pneumatouria caused by a colovesicular fistula complicating diverticulosis coli. Segmental resections of the sigmoid and ileocecum confirmed diverticulosis of the left and right colon. Histology identified infiltrates of MCL confined to the penetrating aspects of colonic diverticula. MCL has not been documented to coexist with CLL. An invaginating morphology of lymphoma, multiple lymphomatous diverticulosis is also a novel presentation. These 2 scenarios expand MCL's known manifestations within the GIT.
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MESH Headings
- Aged
- Biomarkers, Tumor/metabolism
- Bone Marrow Cells/pathology
- Colonic Neoplasms/metabolism
- Colonic Neoplasms/pathology
- Colonic Neoplasms/surgery
- Combined Modality Therapy
- Diverticulum/complications
- Diverticulum/metabolism
- Diverticulum/pathology
- Female
- Humans
- Ileal Neoplasms/metabolism
- Ileal Neoplasms/pathology
- Ileal Neoplasms/surgery
- In Situ Hybridization, Fluorescence
- Intestinal Fistula/complications
- Intestinal Fistula/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Mantle-Cell/metabolism
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Mantle-Cell/therapy
- Male
- Middle Aged
- Neoplasms, Multiple Primary/metabolism
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Treatment Outcome
- Urinary Bladder Fistula/complications
- Urinary Bladder Fistula/pathology
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Affiliation(s)
- Shaun A C Medlicott
- Department of Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
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23
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Cameron AP. Urethral diverticulum in the female: a meta-analysis of modern series. Minerva Ginecol 2016; 68:186-210. [PMID: 26545036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Urethral diverticula are a complex problem for the female pelvic surgeon. Given the rarity of the condition most published series are small and single institutional. This is a review article and a meta-analysis including all case series of female urethral diverticulum from the year 2000 to 2015 including only those case series with a minimum of ten subjects. EVIDENCE ACQUISITION Twenty-five articles were included and data was sufficient to perform a meta-analysis on patient age, symptoms at presentation, physical exam findings, location of diverticulum, diverticular size, radiological findings, pathology, complications, and recurrence rates. EVIDENCE SYNTHESIS Urethral diverticulum have variable symptom presentation and can mimic many other common conditions, but often present with a palpable urethral mass. Surgical diverticulectomy is the most commonly performed procedure, but does put the patient at risk for de novo stress incontinence and recurrent diverticula are not rare. Patients with pre-existing stress incontinence can be safely offered concomitant autologous pubovaginal sling at the time of diverticulectomy. CONCLUSIONS Pathology is benign 97% of the time but one must have a high degree of suspicion in the case of a firm mass or if MRI indicates a mass within the diverticula. Physicians need to have a high degree of suspicion particularly in those patients whose symptoms do not resolve with standard treatment and pelvic MRI is the investigation of choice.
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Elhjouji A, Jaiteh L, Bounaim A, Aitali A, Sair K. [Duodenal diverticulitis: unusual complication not always easy to manage]. Pan Afr Med J 2015; 22:259. [PMID: 26958122 PMCID: PMC4764320 DOI: 10.11604/pamj.2015.22.259.7784] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
Les diverticules duodénaux sont assez fréquents, la majorité reste asymptomatique. Les complications les plus fréquemment rapportées sont les hémorragies et les pancréatites. Contrairement aux diverticules coliques, la survenue de diverticulite est rare. Nous rapportons le cas d'une infection d'un gros diverticule duodénal en mettant le point sur la difficulté de la prise en charge de cette entité pathologique.
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Affiliation(s)
- Abderrahman Elhjouji
- Service de Chirurgie Viscérale I, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Lamine Jaiteh
- Service de Chirurgie Viscérale I, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Ahmed Bounaim
- Service de Chirurgie Viscérale I, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Abdelmounaim Aitali
- Service de Chirurgie Viscérale I, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Khalid Sair
- Service de Chirurgie Viscérale I, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
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Štimac G, Knežević M, Grubišić I, Soipi S, Tomas D, Krušlin B. A RARE CASE OF SQUAMOUS CELL CARCINOMA IN URINARY BLADDER DIVERTICULUM SUCCESSFULLY TREATED BY BLADDER-SPARING SURGERY. Acta Clin Croat 2015; 54:363-366. [PMID: 26666109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
The aim is to report a rare case of squamous cell carcinoma arising in a urinary bladder diverticulum and present recent literature overview of treatment options. A 56-year-old man presented with intermittent hematuria. Ultrasound examination indicated primary carcinoma in the urinary bladder diverticulum. Diagnosis was confirmed with cystoscopy and computed tomography. Transvesical diverticulectomy with regional lymphadenectomy was undertaken. Two years after initial treatment, the patient was well without evidence of tumor relapse. This report implicates that although aggressive surgical approach is recommended in the majority of bladder diverticulum tumors, simple diverticulectomy may be indicated in selected, confined cases.
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Liu Z, Dong C, Wang X, Han X, Zhao P, Lv H, Li Q, Wang Z. Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study. Neuroradiology 2015; 57:747-53. [PMID: 25845808 DOI: 10.1007/s00234-015-1517-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/17/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The mechanism of occurrence of sigmoid sinus dehiscence/diverticulum (SSDD) in pulsatile tinnitus (PT) patients remains under debate. Its association with idiopathic intracranial hypertension (IIH) lacks evidence, which is important for therapeutic planning and improving the clinical outcome. This study aimed to evaluate the association between SSDD and IIH by comparing the prevalence of several established imaging features of IIH between PT patients with SSDD and healthy volunteers. METHODS Thirty-three unilateral PT patients with SSDD identified on CT images and 33 age- and sex-matched healthy volunteers underwent T1-weighted volumetric magnetic resonance imaging (MRI). The optic nerve, pituitary gland, transverse sinus, and ventricles were assessed. The prevalence of established IIH imaging features was compared between the two groups. Furthermore, the PT patients were divided into two subgroups: PT patients with dehiscence only and PT patients with diverticulum. The same statistical analysis was performed on each pathophysiologic entity respectively. RESULTS The PT patients with SSDD showed a significantly higher prevalence of empty sella (P < 0.001), flattened posterior sclera (P = 0.001), vertical tortuosity of the optic nerve (P = 0.001), protrusion of the optic nerve (P = 0.006), transverse sinus stenosis (P = 0.011), and distension of the optic nerve sheath (P = 0.000). There were no significant differences between the PT and control groups in the maximum widths of the third and fourth ventricles and the lateral ventricle size. In contrast to controls, the imaging findings persisted in both of pathophysiologic entities, except for transverse sinus stenosis. CONCLUSIONS Several IIH imaging features occur more frequently in PT patients with SSDD than in healthy individuals, which suggests a potential correlation between SSDD with PT and IIH.
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Affiliation(s)
- Zhaohui Liu
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, NO.1, Dongjiaominxiang Road, Beijing, 100730, China,
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Abstract
Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms.
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Affiliation(s)
- ZhiLong Dong
- From the Second Hospital of Lanzhou University, Lanzhou City, Gansu Province, China (ZLD, LJZ); Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA (HZW); The Second People's Hospital of Gansu Province, Lanzhou City, Gansu Province, China (MLH)
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28
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Loran OB, Sokolov AE, Guspanov RI, Polegen'kiĭ VV. [Simultaneous radical retropubic prostatectomy, diverticulectomy]. Urologiia 2014:96-98. [PMID: 25799736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Presented clinical case demonstrates a combination of rare congenital abnormality - giant true diverticula of the bladder - and high-risk prostate cancer, as well as a successful result of simultaneous operation - a radical prostatectomy with diverticulectomy.
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29
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Lee YJ, Son SJ, Paick JS, Kim SW. Preoperative CT voiding cystourethrography using 16-multidetector CT in female urethral diverticulum. PLoS One 2014; 9:e107448. [PMID: 25216189 PMCID: PMC4162593 DOI: 10.1371/journal.pone.0107448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/11/2014] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the clinical usefulness of preoperative CT voiding cystourethrography (CT-VCUG) using 16-multidetector computed tomography for female urethral diverticula. Materials and Methods Preoperative CT-VCUG was performed in 15 consecutive patients who underwent urethral diverticulectomy from May 2004 to December 2012. The result of preoperative cystourethroscopy and surgical findings were recorded by a single surgeon and CT-VCUG findings including the location of osita were retrospectively reviewed by another urologist who was blinded to the surgical finding. The location of the ostium detected on CT-VCUG was compared descriptively with the intraoperative surgical and preoperative cystourethroscopic findings. Results A total of 14 consecutive patients who underwent preoperative CT-VCUG and urethral diverticulectomy were included in the analysis. Ostia were detected on CT-VCUG in all cases, whereas ostia were identified in 10 patients (71.4%) by cystourethroscopy. Ostia were located between the 4 and 8 o’clock direction. Mean distance from the bladder neck to the ostium was 24.2 mm. Circumferential and horseshoe shaped diverticula were observed in 6 and 4 patients, respectively. The surgical findings correlated well with the CT findings. Conclusions Preoperative CT-VCUG can be useful in identifying the ostia of urethral diverticula in patients scheduled for urethral diverticulectomy and can provide structural information, useful to establish surgical strategy.
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Affiliation(s)
- Young Ju Lee
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung Jun Son
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- * E-mail:
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30
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Muramatsu H, Kanao K, Morinaga S, Kajikawa K, Kobayashi I, Nishikawa G, Yoshizawa T, Kato Y, Watanabe M, Zennami K, Nakamura K, Sumitomo M. [A case of neuroendocrine carcinoma in a diverticulum of the bladder]. Hinyokika Kiyo 2014; 60:439-442. [PMID: 25293798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a case of neuroendocrine carcinoma in a diverticulum of the bladder. A 65-year-old Japanese woman visited our hospital with the chief complaint of gross hematuria. Cystoscopy revealed a non-papillary broad-based tumor in a diverticulum of the posterior wall. She underwent transurethral resection of bladder tumor (TURBT) and subsequently total cystectomy with ileal conduit on the diagnosis of an invasive urothelial carcinoma. There was no residual tumor in the surgical specimen. Immunohistochemistry of TUR specimens showed positive synaptophysin, chromogranin A, CD56 and high ratio of positive Ki-67. Finally, it was diagnosed as a neuroendocrine carcinoma of the bladder. To our knowledge, this is the second case report of the neuroendocrine tumor or small cell carcinoma in a diverticulum of the urinary bladder in the Japanese literature.
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Affiliation(s)
| | - Kent Kanao
- The Department of Urology, Aichi Medical University
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Affiliation(s)
- Andrei Mihai Voiosu
- Colentina Clinical Hospital, Gastroenterology Department, Bucharest, Romania.
| | - Traian Patrascu
- "Dr. I Cantacuzino" Clinical Hospital, Surgery Department, Bucharest, Romania.
| | - Florin Bobirca
- "Dr. I Cantacuzino" Clinical Hospital, Surgery Department, Bucharest, Romania.
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Coe P, Iqbal J, Rudralingam V, Duff S. Snapshot quiz 14/6. Caecal diverticular disease with an associated stricture of the ileocaecal valve. Br J Surg 2014; 101:501-549. [PMID: 24765653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Nagai J, Kondoh N, Kajio K, Tsujimura T. [Small cell carcinoma in a vesical diverticulum: a case report]. Hinyokika Kiyo 2014; 60:151-153. [PMID: 24759504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a case of small cell carcinoma located within the vesical diverticulum. A 73-year-old woman referred to our hospital with a chief complaint of gross hematuria. Cystoscopy confirmed a non-papillary tumor within the vesical diverticulum. Histopathologic diagnosis with transurethral resection of the tumor (TURBT) specimen was small cell carcinoma. Later, tumor recurrence occurred within the same diverticulum. TURBT and biopsy of the vesical mucosa were performed. After confirming that no tumor was detected outside of the diverticulum, partial cystectomy was done including an adequate margin around the diverticulum in September, 2010. Since the histopathologic finding of the specimen revealed urothelial carcinoma (UC) this time and microinvasion and venous invasion were detected, we performed an adjuvant chemotherapy according to the protocol of gemcitabine and cisplatin therapy. To our knowledge, this is the 4th case report of small cell carcinoma located in a vesical diverticulum in Japan.
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Affiliation(s)
- Jun Nagai
- The Department of Urology, Kawanishi City Hospital・The Department of Urology, Kyowakai Kyoritsu Hospital
| | - Nobuyuki Kondoh
- The Department of Urology, Kawanishi City Hospital・The Department of Urology, Kyowakai Kyoritsu Hospital
| | - Keisuke Kajio
- The Department of Urology, Kyowakai Kyoritsu Hospital
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Reeves FA, Inman RD, Chapple CR. Management of symptomatic urethral diverticula in women: a single-centre experience. Eur Urol 2014; 66:164-72. [PMID: 24636677 DOI: 10.1016/j.eururo.2014.02.041] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/17/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Urethral diverticula (UDs) affect between 1% and 6% of adult women. A total of 1.4% of women with stress urinary incontinence (SUI) have a UD. Clinically significant diverticula are rare and can be challenging to manage. OBJECTIVE To review results of surgery on UDs in a single surgical centre. DESIGN, SETTING, AND PARTICIPANTS We retrospectively evaluated a group of 89 patients with symptomatic UDs referred for surgical intervention to one teaching hospital. Data were from two surgeons over an 8-yr period between October 2004 and November 2012. Follow-up period ranged from 3 mo to 20 mo, and all patients were physically reviewed postoperatively in an outpatient setting. INTERVENTION The surgical technique involved placing the patient prone, ureteric catheterisation, dissection and removal of the diverticulum, and layered closure. Where a large defect was present following excision, a Martius flap was interposed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome data collected included symptomatic cure, continence, de novo SUI, early versus late complications, and recurrence. RESULTS AND LIMITATIONS Early complications included one urinary tract infection and one Martius graft infection, both requiring intravenous antibiotics. Overall, 72% of patients were dry and cured postoperatively; 13 patients had de novo SUI following surgery. Those with bothersome SUI went on to have an autologous sling at 6 mo. All were dry; three (23%) required clean intermittent self-catheterisation. Three patients had a recurrent residual diverticulum (3.4%) following surgery. One chose conservative management. The other two had a redo diverticulectomy performed via a dorsal approach. They have recovered well and are dry. Two (2.2%) diverticula revealed unexpected abnormal pathology. The first was a leiomyoma; the second was a squamous cell carcinoma requiring further surgery. CONCLUSIONS The recommended preoperative imaging is postvoid sagittal magnetic resonance imaging and appropriate use of urodynamic assessment at baseline. The 72% dry rate (including a number with preoperative incontinence) is comparable with the literature as is the development of de novo SUI in 15% of patients. There is a small risk of unexpected tumours (2%). PATIENT SUMMARY A urethral diverticulum should be excluded as a diagnosis in anyone troubled by symptoms of a swelling of the urethra often associated with discomfort, pain on intercourse, urinary dribbling after passing urine, and/or recurrent urinary infections. In these circumstances patients should seek advice from their doctors and consider referral for a specialist assessment. If the diagnosis is made and the problem is symptomatic, surgery is likely to resolve the problem but should be carried out in a specialist centre with expertise in the management of this condition.
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Affiliation(s)
- Felicity A Reeves
- The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Richard D Inman
- The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
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Dzheng S, Dobrovol'skiĭ SP. [Connective tissue dysplasia as a reason of recurrent inguinal hernia]. Khirurgiia (Mosk) 2014:61-63. [PMID: 25327748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The examination results of 78 patients with recurrent inguinal hernia revealed presence of systemic connective tissue abnormalities in addition to dysplasia of posterior wall of inguinal canal in 48 (61.6%) patients. Hernial disease was observed in 37 (47.4%) patients including umbilical hernia in 12 cases, femoral hernia in 8 patients, hiatal hernia in 3 patients and bilateral inguinal hernia in 14 cases. Group of other diseases included varicose veins of lower limbs in 15 (19.2%) patients, mitral valve prolapse in 3 (3.8%) patients, violation of skin elasticity (striae) in 6 (7.7%) cases, diverticulum of bladder in 2 (2.6%) patients, diverticulum of esophagus in 1 (1.3%) patient, diverticulosis of small intestine in 2 (2.6%) cases. Our data prove that inguinal hernia is local manifestation of systemic disease.
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MESH Headings
- Age Factors
- Comorbidity
- Connective Tissue/pathology
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/epidemiology
- Connective Tissue Diseases/pathology
- Diverticulum/epidemiology
- Diverticulum/etiology
- Diverticulum/pathology
- Female
- Hernia, Femoral/epidemiology
- Hernia, Femoral/etiology
- Hernia, Femoral/pathology
- Hernia, Hiatal/epidemiology
- Hernia, Hiatal/etiology
- Hernia, Hiatal/pathology
- Hernia, Inguinal/epidemiology
- Hernia, Inguinal/etiology
- Hernia, Inguinal/pathology
- Hernia, Umbilical/epidemiology
- Hernia, Umbilical/etiology
- Hernia, Umbilical/pathology
- Humans
- Inguinal Canal/pathology
- Male
- Middle Aged
- Mitral Valve Prolapse/epidemiology
- Mitral Valve Prolapse/etiology
- Mitral Valve Prolapse/pathology
- Risk Factors
- Statistics as Topic
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Craiu D, Kaler S, Craiu M. Role of optic microscopy for early diagnosis of Menkes disease. Rom J Morphol Embryol 2014; 55:953-956. [PMID: 25329126 PMCID: PMC6456807] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the case of a male patient with a normal development in the first three months of life, presenting for global regression, central axial hypotonic syndrome, pyramidal syndrome, focal epileptic seizures, and a particular aspect of the hair - almost absent, short, sparse, lightly colored, at age of five months, becoming coarse, twisted (kinky hair) by the age of 21 months. Different diseases associate similar neurological and macroscopic aspect of the hair (biotinidase deficiency, argininosuccinic aciduria, aminoaciduria, giant axonal neuropathy, trichothiodistrophy and Menkes syndrome). The microscopic aspect of the patient's hair showing normal hair, silver colored hair, hair shafts twisting 1800, trichoclasis, and trichoptilosis, was highly characteristic for Menkes disease. Diagnosis was further supported by the low concentration of serum copper and ceruloplasmin and exclusion of other metabolic disorders with similar macroscopic aspect of the hair. Molecular genetic testing by multiplex PCR indicated deletion of exon 22 in the ATP7A gene situated in Xq21.1 region, consistent with the clinical and biochemical phenotype. Physicians should use microscopic evaluation of the hair more often when suspicion of Menkes disease is raised, aiming a narrow further diagnostic workup and early positive diagnosis and genetic advice for the affected families.
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Affiliation(s)
- Dana Craiu
- Discipline Pediatric Neurology, Department of Neurology, Pediatric Neurology, Psychiatry, Neurosurgery, Psychiatry for Children and Adolescents, "Carol Davila" University of Medicine and Pharmacy, Clinic of Pediatric Neurology, "Alexandru Obregia" Clinical Psychiatric Hospital, Bucharest, Romania;
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Velayos B, Pons-Renedo F, Fernández-Salazar L, Muñoz MF, Olmo L, Almaraz A, Beltrán-Heredia J, Hernández-González JM. Atmospheric pressure does not influence acute diverticular disease. Int J Colorectal Dis 2013; 28:1725-6. [PMID: 23411679 DOI: 10.1007/s00384-013-1666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Benito Velayos
- Department of Gastroenterology, University Hospital of Valladolid, Av Ramón y Cajal 3, 47005, Valladolid, Spain,
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Alizai PH, Schulze-Hagen M, Klink CD, Ulmer F, Roeth AA, Neumann UP, Jansen M, Rosch R. Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis--a comparison of stoma reversal rates. Int J Colorectal Dis 2013; 28:1681-8. [PMID: 23913315 DOI: 10.1007/s00384-013-1753-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The ideal treatment of patients with perforated diverticulitis is still controversial. Hartmann's procedure has been the treatment of choice for decades, but primary anastomosis with a defunctioning stoma has become an accepted alternative. The aim of this study was to evaluate the stoma reversal rates after these two surgical strategies. METHODS A retrospective review of the data from patients with perforated sigmoid diverticulitis between 2002 and 2011 undergoing a Hartmann's procedure (HP) versus a primary anastomosis with a defunctioning stoma (PA) was performed. Additionally, patients were contacted by mail or telephone in March 2012 using a standardized questionnaire. RESULTS A total of 98 patients were identified: 72 undergoing HP and 26 patients receiving PA. The median follow-up time was 63 months (range 4-118). Whilst 85 % of patients with PA have had their stoma reversed, only 58 % of patients with an HP had a stoma reversal (p = 0.046). The median period until stoma reversal was significantly longer for HP (19 weeks) than for PA (12 weeks; p = 0.03). The 30-day mortality for PA was 12 % as opposed to 25 % for HP (p = 0.167). According to the Clavien-Dindo classification, surgical complications occurred significantly less frequently in patients with PA (p = 0.014). CONCLUSION The stoma reversal rates for PA are significantly higher than for HP. Thus, depending on the overall clinical situation, primary resection and anastomosis with a proximal defunctioning stoma might be the optimal procedure for selected patients with perforated diverticular disease.
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Affiliation(s)
- P H Alizai
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany,
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Xue L, Qiu T, Song Y, Shan L, Liu X, Guo L, Ying J, Zou S, Shi S, Polydorides AD, Zhao X, Lu N, Lin D. Long segmental hyperplasia of interstitial cells of Cajal with giant diverticulum formation. Int J Clin Exp Pathol 2013; 6:2989-2996. [PMID: 24294389 PMCID: PMC3843283] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/05/2013] [Indexed: 06/02/2023]
Abstract
Sporadic gastrointestinal stromal tumors (GISTs) usually form a well-circumscribed mass. In contrast, diffuse interstitial cell of Cajal (ICC) hyperplasia along the Auerbach plexus without a discrete mass may occur in patients with germline mutations in the NF1, c-KIT or PDGFRA genes. However, sporadic, diffuse ICC hyperplasia without c-KIT or PDGFRA mutations has not been reported. We describe herein one such case, forming a giant diverticulum. A 63-year-old woman with no features of Neurofibromatosis 1 (NF1) presented with increasing abdominal pain for more than 30 years. A large, diverticulum-like mass in the ileum was resected. Microscopically, a diffuse proliferation of bland spindle cells was seen extending for 12 cm, replacing the muscularis propria and lined by intact mucosa. The spindle cells were CD117+/CD34+/DOG1+/SMA+/Desmin-/S100-. Mutation analyses did not reveal any mutations in c-KIT or PDGFRA. The lesion had two silent mutations in the NF1 gene. It is rare of the diffuse form of sporadic ICC hyperplasia showing diffuse longitudinal microscopic growth completely replacing the muscularis propria, mimicking diffuse ICC hyperplasia in hereditary GIST syndromes, but without solid components and no c-KIT or PDGFRA gene mutations. This peculiar form of sporadic ICC hyperplasia may be related to intestinal dysmotility in this ileal segment and giant diverticulum formation.
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Affiliation(s)
- Liyan Xue
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Tian Qiu
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Ying Song
- Department of Imaging Diagnosis, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Ling Shan
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Xiuyun Liu
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Lei Guo
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Jianming Ying
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Shuangmei Zou
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Susheng Shi
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | | | - Xinming Zhao
- Department of Imaging Diagnosis, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Ning Lu
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
| | - Dongmei Lin
- Department of Pathology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh 160 012, India.
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Böttner M, Barrenschee M, Hellwig I, Harde J, Egberts JH, Becker T, Zorenkov D, Schäfer KH, Wedel T. The GDNF System Is Altered in Diverticular Disease - Implications for Pathogenesis. PLoS One 2013; 8:e66290. [PMID: 23805210 PMCID: PMC3689736 DOI: 10.1371/journal.pone.0066290] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/07/2013] [Indexed: 01/19/2023] Open
Abstract
Background & Aims Absence of glial cell line-derived neurotrophic factor (GDNF) leads to intestinal aganglionosis. We recently demonstrated that patients with diverticular disease (DD) exhibit hypoganglionosis suggesting neurotrophic factor deprivation. Thus, we screened mRNA expression pattern of the GDNF system in DD and examined the effects of GDNF on cultured enteric neurons. Methods Colonic specimens obtained from patients with DD (n = 21) and controls (n = 20) were assessed for mRNA expression levels of the GDNF system (GDNF, GDNF receptors GFRα1 and RET). To identify the tissue source of GDNF and its receptors, laser-microdissected (LMD) samples of human myenteric ganglia and intestinal muscle layers were analyzed separately by qPCR. Furthermore, the effects of GDNF treatment on cultured enteric neurons (receptor expression, neuronal differentiation and plasticity) were monitored. Results mRNA expression of GDNF and its receptors was significantly down-regulated in the muscularis propria of patients with DD. LMD samples revealed high expression of GDNF in circular and longitudinal muscle layers, whereas GDNF receptors were also expressed in myenteric ganglia. GDNF treatment of cultured enteric neurons increased mRNA expression of its receptors and promoted neuronal differentiation and plasticity revealed by synaptophysin mRNA and protein expression. Conclusions Our results suggest that the GDNF system is compromised in DD. In vitro studies demonstrate that GDNF enhances expression of its receptors and promotes enteric neuronal differentiation and plasticity. Since patients with DD exhibit hypoganglionosis, we propose that the observed enteric neuronal loss in DD may be due to lacking neurotrophic support mediated by the GDNF system.
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Affiliation(s)
- Martina Böttner
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
- * E-mail:
| | | | - Ines Hellwig
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jonas Harde
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Thomas Becker
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Dimitri Zorenkov
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Karl-Herbert Schäfer
- Department of Informatics and Microsystems Technics, University of Applied Sciences, Kaiserslautern, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
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Terada T. Diverticulitis of multiple diverticulosis of the terminal ileum. Int J Clin Exp Pathol 2013; 6:521-523. [PMID: 23411586 PMCID: PMC3563182] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 12/01/2012] [Indexed: 06/01/2023]
Abstract
Diverticulosis of the terminal ileum is very rare. We report a case of diverticulitis of multiple diverticula of the terminal ileum. A 67-year-old Japanese woman consulted to our hospital because of abdominal pain and melena. A blood laboratory revealed severe anemia increased CRP (11.21 mg/dl). The upper and lower gastrointestinal endoscopic examination revealed no significant changes. The colon was free from diverticulum. CT demonstrated two tumors in the small intestine. PET identified a few shadows identical to the tumors detected by CT. The clinical diagnosis was small intestinal tumors, particularly malignant lymphoma. Operation was performed, and it revealed multiple tumor-like masses in the terminal ileum. The ulcers are deep and appeared diverticula. Microscopically, the diverticula were located in the proper muscle and subserosa. The walls of the diverticula were composed of granulation tissue with heavy lymphocytic and neutrophilic infiltration. Diverticular mucosal walls were recognized in some areas. The lymphocytes were free from atypia, and no features of malignant lymphoma were recognized. The pathological diagnosis was severe diverticulitis of multiple diverticula in the terminal ileum.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital Shizuoka, Japan.
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Arabadzhieva E. The role of surgery in treatment of diverticular disease of lower gastrointestinal tract. Khirurgiia (Mosk) 2013:36-46. [PMID: 23847809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Diverticulosis of lower gastrointestinal tract is a common disease with potentially lethal complications. Recent studies demonstrated that the number of attacks of uncomplicated diverticulitis is not necessarily an overriding factor in defining the appropriateness of surgery so the approach has to be more individualized. On the other hand, the complicated diverticular disease requires surgical treatment, often matter of urgency, and depends on localization and severity of the process. There is not sufficient evidence supporting the aggressive approach to treatment in younger patients. The available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised individuals.
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Affiliation(s)
- E Arabadzhieva
- Department of General and Hepatopancreatic Surgery, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria
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Mascarenhas V, Marques H, Valentim H, Guerra A, Afonso PD, Ventura C, Gaspar A. [Aortic vascular anomalies and Kommerell's diverticulum, an imagiologic diagnosis]. Rev Port Cir Cardiotorac Vasc 2012; 19:217-220. [PMID: 24490199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Indexed: 06/03/2023]
Abstract
Aortic vascular anomalies are complex anatomic entities requiring often complex and problematic surgical approaches. The authors report the clinical case of a Kommerell's diverticulum and right-sided aortic arch. Right-sided aortic arch is an uncommon congenital defect of the aorta and it is rare in the setting of an otherwise normal heart. A right-sided aortic arch was described more than two centuries ago. Several classifications of these anomalies have been proposed on the basis of the arrangement of the arch vessels, relationships with the esophagus, or the presence of congenital heart anomalies. In the adult population, a right-sided aortic arch is often asymptomatic, unless aneurismal disease develops. This usually occurs at the level of the take-off of an aberrant left subclavian artery and is known as a Kommerell's diverticulum. In spite of its rarity, this condition is clinically relevant due to the mortality associated with rupture, morbidity caused by compression of mediastinal structures, and complexity of surgery.
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Affiliation(s)
- Vasco Mascarenhas
- Centro de Imagiologia, Departamento de Medicina Geral e Familiar do Hospital da Luz, Lisboa, Portugal
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Chan KW, Chu WH, Law IC. Giant urethral diverticulum calculus presenting as scrotal abscess. Hong Kong Med J 2012; 18:66-67. [PMID: 22302916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
We report herein a patient with a urethral calculus associated with urethral diverticulum. A 39-year-old man presented with scrotal swelling and acute retention of urine. Computed tomography of the pelvis and cystoscopy demonstrated a giant calculus in the proximal penile urethra. Emergency in-situ lithotripsy was performed. Complete stone clearance was achieved and a large urethral diverticulum was encountered. The rare occurrence of urethral diverticulum and associated stone disease were discussed.
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Affiliation(s)
- K W Chan
- Department of Surgery, Kwong Wah Hospital, Yaumatei, Hong Kong.
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Endo Y, Matsumoto T, Oki E, Kusumoto T, Yoshikawa K, Kitano S. [A case of true diverticulosis of the appendix with intussusception]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:1566-1570. [PMID: 21891997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 50-year-old woman who was given a diagnosis of acute appendicitis was referred to our hospital. Because an abdominal enhanced CT revealed a dilated and cystic lesion in the appendix, operation was performed under the diagnosis of the suspicion of acute appendicitis or appendiceal mucocele. We performed laparoscopic cecal resection because of the intraoperative diagnosis of intussusception of the appendix. On the resected specimen, an elevated lesion was identified near the base of appendix. Histopathologically it was shown to be a true diverticulum in which the proper muscle layer are intact. To the best of our knowledge, this is the first report of true diverticulosis of the appendix with intussusception in the Japanese literature.
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Affiliation(s)
- Yuichi Endo
- Department of Surgery and Clinical Research Institute, National Hospital Organization Beppu Medical Center.
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Ou YC, Huang KH, Lin H, Eng HL, Lu HM, Changchien CC. Sepsis secondary to cesarean scar diverticulum resembling an infected leiomyoma. Taiwan J Obstet Gynecol 2011; 50:100-2. [PMID: 21482384 DOI: 10.1016/j.tjog.2011.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2009] [Indexed: 11/18/2022] Open
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Hong KD, Lee SI, Moon HY. Rectal diverticular perforation complicating diagnostic colonoscopy: a case report and review of the literature. J Laparoendosc Adv Surg Tech A 2011; 21:745-8. [PMID: 21819215 DOI: 10.1089/lap.2011.0210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Abstract The presence of retroperitoneal, mediastinal, and subcutaneous emphysema due to rectal diverticular perforation during diagnostic colonoscopy has not been reported. Further, the management of colonoscopic perforation remains a controversial issue. In this case report, the authors discuss the importance of recognizing this rare complication after colonoscopy and its response to conservative treatment.
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Affiliation(s)
- Kwang Dae Hong
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
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Gunasekaran K, Davila GW, Ghoniem GM. Giant urethral diverticulum -- repair augmented with bovine pericardium collagen matrix graft and tension-free vaginal tape. J Indian Med Assoc 2011; 109:513-515. [PMID: 22315853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 44-year-old nulliparous woman was diagnosed with a giant urethral diverticulum. Surgical excision of the diverticulum was done. The urethral defect was closed with 2-0 vicryl sutures. A piece of bovine pericardium collagen matrix graft was placed over the fascial repair. A tension-free vaginal tape (TVT) sling was then placed over the graft. Concomitant anti-incontinence procedure can be combined with diverticulum repair.
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Vicente-Bártulos A, García-Cabero JM, Martin-Ruiz O, Molina-Villar J. [Giant sigmoid diverticulum]. Cir Esp 2011; 89:e10. [PMID: 21333975 DOI: 10.1016/j.ciresp.2010.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 05/02/2010] [Accepted: 05/03/2010] [Indexed: 11/19/2022]
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