Gastroenterology Commons^™

Complex And Simple Appendicitis: Restrictive Or Liberal Postoperative Antibiotic Exposure (Casa Relax) Using Desirability Of Outcome Ranking (Door) And Response Adjusted For Duration Of Antibiotic Risk (Radar): Study Protocol For A Randomized Controlled Trial, Daniel Dante Yeh, Gabrielle E Hatton, Claudia Pedroza, Gerd Pust, Alejandro Mantero, Nicholas Namias, Lillian S Kao

Faculty, Staff and Student Publications

OBJECTIVES: After appendectomy for simple or complicated appendicitis, the optimal duration of postoperative antibiotics (postop abx) is unclear and great practice variability exists. We propose to compare restrictive versus liberal postop abx using a hierarchical composite endpoint which includes patient-centered outcomes and accounts for duration of antibiotic exposure.

METHODS/DESIGN: Participants with simple or complicated appendicitis undergoing appendectomy are randomly assigned to either restricted or liberal strategy. Eligible subjects declining randomization will be recruited to enroll in an observation only cohort. The primary endpoint is an ordinal scale of mutually exclusive clinical outcomes with within-category rankings determined by duration of antibiotic …

Inflammatory Diseases And Resections Of The Digestive Tract Influence The Risk Of Circulating Food-Specific-Igg, Jacques Izard, Walker Carson, Joseph Baumert, Jennifer Clarke

Department of Food Science and Technology: Faculty Publications

Objectives: Individuals affected with inflammatory diseases of the digestive tract or have had surgical removal of sections of the digestive tract are often in need to adjust their diet. The symptomatology associated with food intake issues is often informally reported as food sensitivity. We investigated the circulating food-specific-IgG among ten conditions.

Conclusion: The risk of the having circulating food-specific IgG differed widely among the conditions investigated. The maintenance of a colonic environment might influence the risk of food sensitivity in ostomates.

Perforating Gastric/Duodenal Ulcer Development Following Roux-En-Y Gastric Bypass Surgery: A Case Series, Sugosh Anur, Michael A. Coscia Iii, Louis Balsama

Rowan-Virtua Research Day

Roux-en-Y gastric bypass is a well-studied procedure resulting in long term weight loss. Due to countless years of study, the morbidity and mortality associated with a Roux en Y gastric bypass has been greatly decreased. However, there are still several rare, yet serious, complications that may arise in the post-operative period. Anastomotic leaks and ulcers are just two of those complications. We describe a case of a 41 year old female developing postoperative perforated duodenal ulcer. A laparoscopic repair was performed using a Graham patch technique. This review aims to identify factors contributing to the ulcer development as well as …

The Surgical Management Of Pancreatic Pseudocysts – Outcomes On A Group Of Seven Patients, Mihai Faur, Andrei Moisin, Alexandru Dan Sabau, Dan Sabau

Journal of Mind and Medical Sciences

The pancreatic pseudocyst represents the main complication that occurred 3 to 6 weeks after an outbreak of acute or chronic pancreatitis represented by a collection containing pancreatic enzymes without their own epithelial wall. In the present paper, we present a study performed on 7 patients admitted to the Surgical Department of Sibiu County Emergency Clinical Hospital who were diagnosed with pancreatic pseudocyst between 2016 and 2020, and the drainage of the mini-invasive pancreatic pseudocyst by an incision in the right lumbar area, in the case of a 53-year-old patient known to have a history of multiple cardiac defects, the pancreatic …

Colonic Diverticulosis - Diagnostic And Therapeutic Difficulties, Cristian Meșină, Theodor Viorel Dumitrescu, Mihai Calin Ciorbagiu, Cosmin Vasile Obleaga, Ionica Daniel Vilcea, Mihaela Iustina Mesina-Botoran

Journal of Mind and Medical Sciences

Objectives. The objectives of this study are to highlight the diagnostic and therapeutic difficulties in patients with complicated acute colonic diverticulosis. Methods. The study group comprised 40 patients hospitalized to the Second Surgical Clinic of the Emergency County Hospital in Craiova, Romania, through the emergency service between 2015 and 2021. Regarding the sex distribution of the patients with colonic diverticular disease studied, there was a predominance of males. The distribution of patients was as follows: 22 patients with acute colonic diverticulitis, out of whom 21 patients suffered from left acute colonic diverticulitis and 1 patient suffered from right acute colonic …

Inflammatory Bowel Disease: Pathogenesis, Diagnosis And Current Therapeutic Approach, Adrian Silaghi, Vlad Denis Constantin, Bogdan Socea, Petrișor Banu, Vladimir Sandu, Liliana Florina Andronache, Anca Silvia Dumitriu, Stana Paunica

Journal of Mind and Medical Sciences

Inflammatory bowel disease is a group of conditions of unknown etiology, represented by Crohn’s disease and ulcerative colitis and characterized by the presence of intestinal wall inflammation. From the first cases described to date, several studies have been performed to elucidate the cause of inflammatory bowel disease. Generally, the genetic factors predispose to their occurrence while epigenetic and environmental factors trigger them. Genetic factors are mutations of the genes involved in the response and recognition of immune cells to different pathogens. The most studied epigenetic and environmental factors are smoking (which predisposes to Crohn’s disease and can be protective for …

Hur Plays A Role In Double-Strand Break Repair In Pancreatic Cancer Cells And Regulates Functional Brca1-Associated-Ring-Domain-1(Bard1) Isoforms, Aditi Jain, Matthew Mccoy, Carolyn Coats, Samantha Z Brown, Sankar Addya, Carl Pelz, Rosalie C Sears, Charles Yeo, Jonathan R Brody

Department of Surgery Faculty Papers

Human Antigen R (HuR/ELAVL1) is known to regulate stability of mRNAs involved in pancreatic ductal adenocarcinoma (PDAC) cell survival. Although several HuR targets are established, it is likely that many remain currently unknown. Here, we identified BARD1 mRNA as a novel target of HuR. Silencing HuR caused a >70% decrease in homologous recombination repair (HRR) efficiency as measured by the double-strand break repair (pDR-GFP reporter) assay. HuR-bound mRNAs extracted from RNP-immunoprecipitation and probed on a microarray, revealed a subset of HRR genes as putative HuR targets, including the BRCA1-Associated-Ring-Domain-1 (BARD1) (p < 0.005). BARD1 genetic alterations are infrequent in PDAC, and its context-dependent upregulation is poorly understood. Genetic silencing (siRNA and CRISPR knock-out) and pharmacological targeting of HuR inhibited both full length (FL) BARD1 and its functional isoforms (α, δ, Φ). Silencing BARD1 sensitized cells to olaparib and oxaliplatin; caused G2-M cell cycle arrest; and increased DNA-damage while decreasing HRR efficiency in cells. Exogenous overexpression of BARD1 in HuR-deficient cells partially rescued the HRR dysfunction, independent of an HuR pro-oncogenic function. Collectively, our findings demonstrate for the first time that BARD1 is a bona fide HuR target, which serves as an important regulatory point of the transient DNA-repair response in PDAC cells.

Clinical Symptoms Contributing To Zenker's Diverticulum Repair: A Retrospective Review, Jhon F. Martinez Paredes, Razan Al Fakir, Amy L. Rutt

School of Medicine Publications

Objective: Zenker's diverticulum (ZD) is usually associated with dysphagia and other symptoms due to the interrelated functions of several systems. Surgical management of ZD is effective for all sizes of diverticula, but not all patients decide to undergo surgery. The purpose of this study was to determine the relationship between clinical presentation and patients' decision to undergo surgical repair.

Subjects and methods: This is a retrospective study including 165 patients with ZD treated over the last 11 years. Data collection includes patients' chief complaints and symptoms, medical history, findings on radiologic swallow evaluations, and patients' decision to undergo surgery. Pearson …

Small Bowel Stomas Are Associated With Higher Risk Of Circulating Food-Specific-Igg Than Patients With Organic Gastrointestinal Conditions And Colostomies, Walker K. Carson, Joseph L. Baumert, Jennifer Clarke, Jacques Izard

Department of Food Science and Technology: Faculty Publications

Objective The effects of food sensitivity can easily be masked by other digestive symptoms in ostomates and are unknown. We investigated food-specific-IgG presence in ostomates relative to participants affected by other digestive diseases.

Design Food-specific-IgG was evaluated for 198 participants with a panel of 109 foods. Immunocompetency status was also tested. Jejunostomates, ileostomates, and colostomates were compared with individuals with digestive tract diseases with inflammatory components (periodontitis, eosinophilic esophagitis, duodenitis, ulcerative colitis, Crohn’s disease, and appendicitis), as well as food malabsorption due to intolerance. A logistic regression model with covariates was used to estimate the effect of the experimental data …

Effectiveness Of Stabilized Hypochlorous Acid In Acute Peritonitis Treatment: A Murine Surgical Study, Benjamin Michael Pomeroy

Graduate Theses/Dissertations

Peritonitis is an inflammatory condition affecting the mesothelial cells that line the peritoneal cavity and is commonly induced by bowel perforations. This medical emergency is treated through antibiotic therapy and surgical intervention followed by tissue irrigation (lavage). Acute treatments aim to remove the bacterial burden, however recurring peritoneal infections occur at high rates and contribute to patient morbidity. These recurring infections are likely due to the inability of lavage solutions to remove the entire massive intra-abdominal bacterial load due to intestinal perforation. Numerous antiseptic solutions and antibiotic additives have been evaluated in their ability to improve source control by abdominal …

Palliative Endoscopic Salvage Of A Functionally Obstructed Gastrojejunostomy - Report Of Technique, Elias A Chamely, Bryan Hoang, Nadim S Jafri, Melissa M Felinski, Kulvinder S Bajwa, Peter A Walker, Jaideep Barge, Erik B Wilson, Putao Cen, Shinil K Shah

Faculty, Staff and Student Publications

BACKGROUND: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.

CASE DESCRIPTION: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical …

Klebsiella Pneumoniae Cryptogenic Liver Abscess And Endophthalmitis – A Case Report And Review Of Literature, Mihai Leonard Grecescu, Monica Grecescu, Andreea Smarandache Maria, Cristian Mihai Branescu, Anca Anghelache, Anca Silvia Dumitriu, Stana Paunica, Andreea Cristina Costea

Journal of Mind and Medical Sciences

Klebsiella pneumoniae has emerged as the predominant pathogenic agent of liver abscess in Asia, and the incidence is increasing worldwide. Hypervirulent strains are associated with septic metastatic dissemination in the eyes, lungs, and central nervous system, causing severe morbidity. We present the case of a 54year old man, with no previous comorbidities, admitted in emergency for the blind red painful eye. Further investigation documented septic endophthalmitis with transscleral extension and orbital cellulitis. Thoraco-abdominal computed tomography evidenced a hepatic abscess as the locus of the primary infection. Intravenous antibiotherapy with cefuroxime, followed by meropenem and vancomycin were efficient for managing the …

A Rare Complication In A Covid-19 Positive Patient With Sigmoid Colon Cancer-Hemoperitoneum Due To Gallbladder Necrosis Following Micro-Thrombosis, Mihai Faur, Andrei Moisin, Calin Mohor, Dan Sabau

Journal of Mind and Medical Sciences

Covid-19, also known as acute respiratory syndrome 2019-nCoV, severe acute respiratory syndrome (SARS) 2, and Wuhan pneumonia, is a viral respiratory disease caused by a SARS-associated coronavirus (SARS-CoV-2). The most serious complications of Covid-19 are due to the development of micro-thrombosis in various organs and systems as a result of the high levels of pro-inflammatory cytokines (tumor necrosis factor alpha, interleukin 1 and 6) which initiate the activation of coagulation and the generation of thrombin. Several studies demonstrated the poor outcome of Covid-19-infected patients who underwent surgery, suggesting that surgery may accelerate and exacerbate Covid-19 progression. We report the case …

Esophageal Atresia Associating Gastrointestinal Malformations: A Study Of Clinical Approach, Dan Alexandru Iozsa, Andreea Cristina Costea, Nicolae Sebastian Ionescu

Journal of Mind and Medical Sciences

Digestive tract malformations requiring surgical repair in association with esophageal atresia are rare occurrences. Because of this uncommon presentation of esophageal atresia, its evaluation and management are often difficult, requiring extensive workup and multiple surgical procedures. We present our experience with esophageal atresia associating gastrointestinal congenital anomalies in the last 10 years. Clinical and surgical perspectives were pointed willing to make relevant observations in matters of diagnosis and treatment strategy in these patients. Therefore, 7 cases resembling this pattern were identified – duodenal atresia and anorectal malformation being the most common coexistent malformations. All the cases exhibited technical and procedural …

The Impact Of Patient-Dependent Risk Factors On Morbidity And Mortality Following Gastric Surgery For Malignancies, Bogdan Dumitriu, Sebastian Valcea, Gabriel Andrei, Mircea Beuran

Journal of Mind and Medical Sciences

Gastric cancer remains a leading cause of mortality worldwide. The treatment for gastric cancer is multimodal, in which gastrectomy remains the only curative approach. However, gastric resection is often associated with increased morbidity and mortality rates, depending on several factors. These factors can be attributed to the patient as comorbidities or effects of the disease upon him and, on the other hand, there are risk factors independent of the patient, such as aspects of the tumor (type, staging, location), experience of the surgical and anesthetic team, logistics of the hospital, yield of adjuvant therapies etc. We recognize the fact that …

Intestinal Dysbiosis – A New Treatment Target In The Prevention Of Colorectal Cancer, Florinela-Andrada Dumitru, Sergiu Ioan Micu, Roxana Emanuela Popoiag, Marilena Musat, Andreea Daniela Caloian, Valentin Calu, Vlad Denis Constantin, Daniela Gabriela Balan, Cornelia Nitipir, Florin Enache

Journal of Mind and Medical Sciences

The gastrointestinal microbiome contains at least 100 trillion microorganisms (bacteria, viruses, fungi), whose distribution varies from the mouth to the rectum spatially and temporally throughout one's lifetime. The microbiome benefits from advancing research due to its major role in human health. Studies indicate that its functions are immunity, metabolic processes and mucosal barrier. The disturbances of these functions, dysbiosis, influence physiology, lead to diabetes, inflammatory bowel disease, obesity and colon tumorigenesis. The third most common form of cancer, colorectal cancer, is the result of many factors and genes, and although the link between dysbiosis and this type of cancer is …

How Opportune Is Multigene Testing In Metastatic Colorectal Cancer? A Review, Cristina Orlov-Slavu, Andreea Parosanu, Mihaela Olaru, Dragos Serban, Ioana Paunica, Cornelia Nitipir

Journal of Mind and Medical Sciences

Personalized treatment in oncology is the most innovative method of care. The best method to establish personalized treatment is by genetic characterization of the malignant cell.

Theoretically, the more detailed the characterization, the more effective the choice of treatment becomes. Currently, there are fast and relatively low-cost options that allow such genetic characterization. However, test results sometimes do not detect targetable alterations and, even if they do detect, the use of the treatment-alteration combination does not always generate a satisfactory oncological response.

The present paper aims to answer two questions. First, how targetable can the most common gene alterations in …

Hepatocellular Carcinoma With Extrahepatic Blood Supply From Right Renal Artery, Amir Humza Sohail, Ahmad Musa, Muhammad Salman Khan, Hassan Raza Hashmi, Basit Salam, Collin E M. Brathwaite

Department of Radiology

Extrahepatic blood supply is seen in around 17-27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70-83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any …

Output Consistency Scale To Standardize Ostomate Output Description In Clinical Practice And Studies, Lisa Whisenhunt, Linda Xu, Fan Yang, Jacques Izard

Food for Health: Publications

Stool descriptors have become popular due to the large diffusion of the Bristol Stool Form Scale (BSFS) via clinical studies, clinical trials, and social media. The applications have been numerous and centered around standardization of terminology that can be used by health care professionals and patients alike, as well as individuals interested in their wellness and the associated partners in the wellness industry. For a portion of the population, the digestive content is rerouted to an external manufactured pouch or bag, making the use of the BSFS visual descriptors of stool difficult. From day one post-resection surgery, ostomates are challenged …

Outcomes Of Primary Versus Revisional Robotically Assisted Laparoscopic Roux-En-Y Gastric Bypass: A Multicenter Analysis Of Ten-Year Experience, Pouya Iranmanesh, John Fam, Thomas Nguyen, David Talarico, Kavita D Chandwani, Kulvinder S Bajwa, Melissa M Felinski, Leon V Katz, Sheilendra S Mehta, Stephan R Myers, Brad E Snyder, Peter A Walker, Todd D Wilson, Angielyn R Rivera, Connie L Klein, Shinil K Shah, Erik B Wilson

Faculty, Staff and Student Publications

BACKGROUND: Postoperative morbidity after laparoscopic bariatric surgery is considered higher for patients undergoing revisional versus primary procedures. The objective of this retrospective cohort study was to compare outcomes between patients undergoing primary versus revisional robotically assisted laparoscopic (RAL) Roux-en-Y gastric bypass (RYGB).

METHODS: Data of all patients who underwent RAL primary and revisional RYGB between 2009 and 2019 at two accredited, high-volume bariatric surgery centers-the Memorial Hermann - Texas Medical Center, Houston, TX, and the Tower Health, Reading Hospital, Reading, PA, were analyzed. Primary outcomes were early (< 30 days) and overall postoperative complications. Secondary outcomes included intraoperative complications, operative times, conversions to laparotomy, length of hospital stay, early (< 30 days) postoperative readmissions and deaths.

RESULTS: Data of 1072 patients were analyzed, including 806 primary and 266 …

Extracorporeal Membrane Oxygenation Rescue For Severe Aspiration Pneumonitis In Two Patients After Roux-En-Y Gastric Bypass Procedure, Melissa M Felinski, Daniyal Abbas, Peter A Walker, John A Primomo, Tanyaradzwa M Kajese, Biswajit Kar, Igor D Gregoric, Igor Banjac, Lisa Janowiak, Sriram Nathan, Rahat Hussain, Sheilendra S Mehta, Kulvinder S Bajwa, Shinil K Shah, Bindu Akkanti

Faculty, Staff and Student Publications

Roux-en-y gastric bypass (RYGB) is one of the most common weight loss surgical procedures performed in the United States. Early post-operative small bowel obstruction is a rare but potentially morbid, complication of RYGB. We report two patients who underwent RYGB and required subsequent treatment for a post-operative small bowel obstruction. Their post-operative course was complicated by severe aspiration pneumonitis leading to hypoxemic respiratory failure requiring rescue with femoral veno-venous extracorporeal membrane oxygenation (V-V ECMO). Both patients were successfully extubated, weaned off V-V ECMO support, and discharged to home. These cases highlight the potential role of V-V ECMO for patients who …

Gum Chewing, Added To Conventional Feeding, Reduces Risk Of Post-Operative Ileus After Elective Hip And Knee Arthroplasty Procedures In Elderly Population: A Protocol For A Parallel Design, Open-Label, Randomized Controlled Trial, Obada Hussein Hasan, Laraib Mazhar, Ahsun Jiwani, Dilshad Begum, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Medicine

Introduction: Postoperative ileus (poi) is defined as a temporary cessation of bowel movement after a surgical procedure. Cessation of bowel movement not only leads to disturbing constipation but also may lead to nausea, loss of appetite, and food intolerance. Literature reports "sham feeding" (gum-chewing) effect as an increase in chewing and saliva which enhances the gastric emptying and overall motility of gut as a cephalic phase of digestion. Therefore, we aim to assess the effect of adding gum-chewing to the conventional postoperative feeding regimen on restoring postoperative bowel function and length of stay in hospital of patients undergoing elective hip …

Preoperative Ca 19-9 Level As Additional Predictor Of Pancreatic Head Adenocarcinoma Resectability, Pasihulizan Pasihulizan, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. Determining eligibility criteria for resection is the basis of pancreatic head adenocarcinoma treatment planning, yet the currently used CT scan only has 80% accuracy as its primary modality. This study aimed to investigate preoperative CA 19-9 level use to help predict resectability of pancreatic head adenocarcinoma.

Method. Determining eligibility criteria for resection is the basis of pancreatic head adenocarcinoma treatment planning, yet the currently used CT scan only has 80% accuracy as its primary modality. This study aimed to investigate preoperative CA 19-9 level use to help predict resectability of pancreatic head adenocarcinoma.

Results. There were …

Quality Of Life Of Post-Gastrectomy Patients: A Study In Indonesia's National Central Hospital, Herlan Napitupulu, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. Several studies suggest gastrectomy is associated with deterioration in a patient's quality of life (QOL). This study is conducted to assess the impact of distal (DG), proximal (PG), or total (TG) gastrectomy and the cause of disease on a patient's QOL.

Method. This retrospective study was conducted in dr. Cipto Mangunkusumo Hospital with collected data from the medical records throughout July-September 2020. Inclusion criteria were patients after proximal, distal, or total gastrectomy for a tumor or any non-tumor indications. They were assessed using the World Health Organization Quality of Life Questionnaire Abbreviated Version (WHOQOL-BREF). Collected data were …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Infliximab As Rescue Therapy In Pediatric Severe Colitis, Kayla B. Briggs

Research Days

Background: Infliximab has been shown to be effective in achieving clinical remission in patients with ulcerative colitis (UC) refractory to conventional therapy. However, there is conflicting data in the literature regarding its effectiveness as rescue therapy in acute severe colitis. Furthermore, most studies were conducted in adults, and pediatric onset of inflammatory bowel disease (IBD) is associated with more severe disease that may be less amenable to rescue therapy.

Objectives/Goal: We reviewed our experience with pediatric severe colitis and report outcomes following attempted rescue therapy with infliximab.

Methods/Design: A retrospective review was conducted of patients with UC or indeterminate colitis …

Incidental Malrotation In Adolescent Diagnosed With Appendicitis, David Ho, Jinsy Jacob, Russell Mordecai, Adam Richards

Rowan-Virtua Research Day

17-year-old male patient with a history of autism presenting with right lower quadrant pain that started in the morning. The appendix was not able to be visualized by ultrasonography. An abdominal and pelvic CT with contrast showed a dilated appendix with surrounding inflammation. Malrotation was not identified on CT Scan. Patient was transferred to a nearby Children’s Hospital for laparoscopic appendectomy. During the procedure, the pediatric surgeon noted that initially, neither the appendix nor cecum was present in the right lower quadrant. This case represents an uncommon finding for a patient in the adolescent age group.

Case Report: Splenic Infarct S/P Sleeve Gastrectomy, Dhara Patel, James Espinosa, Kishan Patel

Rowan-Virtua Research Day

A case of splenic infarct s/p sleeve gastrectomy is presented. A 28-year-old female presented with LUQ pain s/p sleeve gastrectomy POD7. CT scan with IV contrast revealed an area of nonenhancement at the superomedial aspect of the spleen consistent with a small splenic infarct. She was transferred out to the hospital under the service of the surgeon who had performed her sleeve gastrectomy. Splenic infarction is a rare post-op complication s/p sleeve gastrectomy. The spleen has dual blood supply via the splenic artery and short gastric arteries making complete infarction rare. It is usually diagnosed via CT with IV contrast. …

Efficacy Of Weight Reduction On Pediatric Nonalcoholic Fatty Liver Disease: Opportunities To Improve Treatment Outcomes Through Pharmacotherapy., Chance S. Friesen, Chelsea Hosey-Cojocari, Sherwin S. Chan, Iván L. Csanaky, Jonathan B. Wagner, Brooke Sweeney, Alec Friesen, Jason D. Fraser, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

Obesity is the single greatest risk factor for nonalcoholic fatty liver disease (NAFLD). Without intervention, most pediatric patients with NAFLD continue to gain excessive weight, making early, effective weight loss intervention key for disease treatment and prevention of NAFLD progression. Unfortunately, outside of a closely monitored research setting, which is not representative of the real world, lifestyle modification success for weight loss in children is low. Bariatric surgery, though effective, is invasive and can worsen NAFLD postoperatively. Thus, there is an evolving and underutilized role for pharmacotherapy in children, both for weight reduction and NAFLD management. In this perspective article, …

A Pedunculated Esophageal Chondromatous Hamartoma In A Child, Dan-Alexandru Iozsa, Maria Puscasu, Catalin Gabriel Cirstoveanu, Vlad Denis Constantin, Anca Silvia Dumitriu, Stana Paunica, Nicolae Sebastian Ionescu

Journal of Mind and Medical Sciences

Esophageal tumors are uncommon in pediatric population and most of them are benign. Esophageal hamartomas have been reported extremely rare in children. These can present as intramural tumors of the esophageal wall or as polyps. Dysphagia is the main symptom described in their case, but other specific symptoms are also reported. Such symptoms encountered in clinical practice are represented by obstructive apnea episodes and bradycardia, poor weight gain, epigastric or retrosternal pain, hematemesis or melena, dysphonia or tracheal sounds. Diagnosis can be delayed due to the insidious onset and non-specific symptoms, therefore patient’s compliance to follow-up and broad, careful evaluation …