臨床消化器病学ジャーナル

Background: Gallbladder cancer (GBC) is the fifth most common cancer of the gastrointestinal tract (GIT) and one of the most common cancers of the extra hepatic biliary tract with a high rate of mortality. There is no specific clinical presentation of early stage GBC and thus preoperative diagnosis is difficult in many. Chronic inflammation, infection and gallstones are the factors leading to malignant transformation of gallbladder epithelium (GB). The early diagnosis of GBC is not possible in all and in many the disease is diagnosed at an advanced stage.

Methods: The present study was an observational study done with the aim of studying the clinical and hepatic parameters in patients diagnosed with carcinoma gall bladder. Study was conducted on 72 patients who were diagnosed and staged according to AJCC staging criteria. The clinical profile and liver function tests were noted.

Results: The maximum number of cases (n=24; 33.3%) were in the age range of 41-50 years and in a ratio of M:F- 1:3. About 40.2% of patients presented had increased serum bilirubin levels, more than 50% of patients had deranged liver enzymes (SGOT, SGPT), levels of albumin were below normal in 62.5% cases and 66.6% of had elevated ALP levels. The presence of gall stones on ultrasonography was seen in 79.2% (n=57) of patients.

Conclusion: Liver function derangement is common in patients of carcinoma gall bladder in early as well as late stages and the dysfunction can be due to malignancy or the other diseases affecting liver.

Background and objective: Liposarcoma arising from colonic mesentery was rare and its biological behavior and clinical management is not well known. We aimed to explore the clinicopathological features and management of liposarcoma in colonic mesentery by presenting a case of pleomorphic liposarcoma of sigmoid mesentery with literature review.
Methods: A patient of sigmoid mesentery pleomorphic liposarcoma was successfully treated in Pengpai Commemorative Hospital. With this case included, there were total of 10 cases of colonic mesentery liposarcoma reported by reviewing literature from English database. Clinical and pathological features, treatment and prognosis were analyzed.
Results: The patient underwent complete tumor resection successfully, and had an uneventful recovery after surgery. Of total 10 patients, the median age was 49 years, with tumor size from 2 cm to 50 cm. In pathology, 4 (40%) were of well-differentiated, 3 (30%) of mucinous, 1 dedifferentiated, 1 pleomorphic, and 1 case of primary mucinous liposarcoma from the sigmoid mesocolon accompanied with well-differentiated liposarcoma in the pelvis. Eight of 10 patients had follow-up data. The median follow-up period was 21 months. Recurrence was recorded in 2 cases (25%), of which 2 cases were mucinous liposarcoma.
Conclusion: Sigmoid mesocolic pleomorphic liposarcoma is rare and of unfavorable prognosis. Complete resection is the mainstay of treatment. Tumor size and complete resection with clear margin are the main prognostic factors.

Abdominal actinomycosis has been described in the literature as a Crohn's disease mimic due to its indolent course and propensity to cause abscesses and fistulae. Actinomycosis rarely presents as an infectious complication in patients with IBD. We present a case of a 21-year-old male with Crohn's disease on immunosuppression, statuspost diverting loop ileostomy that developed a pelvic abscess complicated by Actinomyces bacteremia. Appropriate diagnosis of Actinomycosis can be delayed due to the fastidious growth in anaerobic blood cultures. Treatment involves a prolonged course (6-12 months) of antibiotics.

Background: Hospitalists frequently consult gastroenterologists (GEs) for inpatient care, but few studies have queried hospitalists for their opinions about how well GEs provide consultative and endoscopic services.
Objective: To determine how hospitalists 1) perceive the quality of consults and procedures provided by GEs, and 2) rate the procedural skills between GEs and surgeons.
Design: Web-based questionnaire.
Setting: Hospitals throughout the United States.
Results: Of 785 surveys analyzed, most respondents (75.3%) agreed/strongly agreed that they were satisfied with consultation services provided. Similar rates (>70% agreed/strongly agreed) of satisfaction were reported with regard to appropriateness of consultation and confidence in performing procedures. When asked if GEs were more interested in performing procedures than in treating disease, 38.4% agreed/strongly agreed, while 41.7% disagreed/ strongly disagreed (P=0.3). On this question, younger respondents (<30 years) were less likely to agree (25.4%) compared to older age groups (as high as 44.5%). When asked whether GE and surgeons were equally skilled at performing endoscopy, 47.4% disagreed, 37.8% were neutral, and 14.8% agreed. Of those who disagreed, 99.4% rated GEs as the more skilled proceduralist.
Conclusions: Overall, hospitalists expressed high satisfaction rates on various aspects of gastroenterology consultation quality and procedural skills. By a large majority, they ranked GEs as superior to surgeons in endoscopic proficiency. However, more than one-third of respondents agreed that GEs may overemphasize procedures, a perception that may unfavorably impact gastroenterology as a specialty.

In spite of its commonality, there is no universal standard in the management of appendicular mass. This study is a prospective one, aiming at comparing the different modalities of management in terms of efficacy and safety.

Over seven years, all patients presented with appendicular mass were involved in the study, where they were divided into four Groups; conservative management with routine interval appendectomy (Group A), conservative treatment without interval appendectomy as a routine (Group B), operative interference at the initial admission (Group C), and laparoscopic exploration (Group D). The study assessed the efficacy, complications, difficulties encountered in operative Groups, rate of recurrence, hospital stay, and durations of treatment.

169 cases were presented in this study. The conservative management was successful in about 88% patients Appendectomy was done in all patients of Groups A,C and D, and only 18% in Group B need appendectomy, Appendectomy was done in two settings (drainage then appendectomy) in ~5% of Group A, ~4% of Group B, 14% of Group C, and 27% of patients in Group D. The hospital stay and duration of treatment were >2 folds more in conservative (Groups A and B) than intervention (Groups C and D). Difficulties in operations were reported more in intervention (Groups C and D), where consultant was needed in all cases of Group D, 2/3 of Group B , and only 1/3 of Group B and 7% in Group A. There was no significant difference in operative difficulties between patient failed conservative measures and interventional Group from the start (Groups C and D).

Although there is a debate in the best modalities of treatment of appendicular mass, the conservative approach is still a quite effective and safe method of treatment, with no significant operative difficulties in failed group. The rate of recurrence after successful conservative management is low to justify interval appendectomy as a routine. CT and or colonoscopy is preferred to be done after relief of acute attacks to avoid missing another pathology. The laparoscopic approach seem to be promising, with early recovery as well as diagnostic superiority for a hidden pathology. It may become the best modality with the growing of the learning curve.