Paeds Gastrointestinal Disorders

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Second primary malignancy in patients with esophageal adenocarcinoma and squamous cell carcinoma.

Medicine (Baltimore). 2019 Sep;98(36):e17083

Authors: Zhang G, Wu B, Wang X, Li J

There have been no studies on implementing effective screening models for esophageal adenocarcinoma and squamous cell carcinoma survivors. We used a proportional subdistribution hazards model to estimate second primary malignancy risks among patients with esophageal adenocarcinoma and squamous cell carcinoma. We validated models using a bootstrap cross-validation method and performed decision curve analysis to evaluate their clinical utility. Age group and SEER historic stage were significantly associated with second primary malignancy risk after diagnosis of esophageal adenocarcinoma and squamous cell carcinoma. Saving positive lymph nodes and distant metastasis were significant factors in the adenocarcinoma group, and marital status, tumor location, and chemotherapy were significant factors in the squamous cell carcinoma group. Calibration plots show good concordance between predicted and actual outcomes except in high-probability areas for the risk of a second primary malignancy in patients with esophageal squamous cell carcinoma. Discrimination performances of the Fine-Gray models were evaluated using c-indices, which were 0.691 and 0.662 for second primary malignancies in patients with esophageal adenocarcinoma and squamous cell carcinoma, respectively. Decision curve analysis yielded a range of threshold probabilities (0.020-0.177 and 0.021-0.133 for patients with esophageal adenocarcinoma and squamous cell carcinoma, respectively) at which the clinical net benefit of the risk model was larger than those of hypothetical all-screening and no-screening scenarios. Our nomograms enable selection of patient populations at high risk for a second primary malignancy and thus will facilitate the design of prevention trials for affected populations.

PMID: 31490413 [PubMed - indexed for MEDLINE]

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Henoch-Schönlein purpura with intussusception and hematochezia in an adult: A case report.

Medicine (Baltimore). 2019 Sep;98(36):e16981

Authors: Cui XH, Liu H, Fu L, Zhang C, Wang XD

RATIONALE: Henoch-Schönlein purpura (HSP) is a common disease in children. However, HSP with intussusception and intestinal obstruction has a low morbidity in children and is occasionally seen in adults. Herein, a rare adult case of HSP complicated with intussusception and hemafecia that was successfully treated with surgery is described.
PATIENT CONCERNS: A 19-year-old Chinese man suffered from HSP combined with intussusception and intestinal obstruction and presented with vomiting, diarrhea, abdominal pain, and rash.
DIAGNOSIS: Henoch-Schönlein purpura with intussusception and intestinal obstruction.
INTERVENTIONS: The patient underwent an emergency laparotomy and manual reset.
OUTCOME: The patient was discharged 7 days after surgery in stable condition. We followed the patient to the sixth month after surgery. This patient has no long-term complications after surgery.
LESSONS: HSP with intussusception and intestinal obstruction is rarely seen in adults. Patients with HSP often present with abdominal pain as the first symptom, which is easily confused with other diseases. Once the HSP is diagnosed, surgery should be performed as soon as possible, provided there is no absolute contraindication.

PMID: 31490379 [PubMed - indexed for MEDLINE]

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Ileostomy for steroid-resistant acute graft-versus-host disease of the gastrointestinal tract.

Ann Hematol. 2019 Oct;98(10):2407-2419

Authors: Turki AT, Bayraktar E, Basu O, Benkö T, Yi JH, Kehrmann J, Tzalavras A, Liebregts T, Beelen DW, Steckel NK

Steroid-resistant acute graft-versus-host disease (GVHD) of the gastrointestinal tract associates with important morbidity and mortality. While high-dose steroids are the established first-line therapy in GVHD, no second-line therapy is generally accepted. In this analysis of 65 consecutive patients with severe, steroid-resistant, intestinal GVHD (92% stage 4), additional ileostomy surgery significantly reduced overall mortality (hazard ratio 0.54; 95% confidence interval, 0.36-0.81; p = 0.003) compared to conventional GVHD therapy. Median overall survival was 16 months in the ileostomy cohort compared to 4 months in the conventional therapy cohort. In the ileostomy cohort, both infectious- and GVHD-associated mortality were reduced (40% versus 77%). Significantly declined fecal volumes (p = 0.001) after surgery provide evidence of intestinal adaptation following ileostomy. Correlative studies indicated ileostomy-induced immune-modulation with a > 50% decrease of activated T cells (p = 0.04) and an increase in regulatory T cells. The observed alterations of the patients' gut microbiota may also contribute to ileostomy's therapeutic effect. These data show that ileostomy induced significant clinical responses in patients with steroid-resistant GVHD along with a reduction of pro-inflammatory immune cells and changes of the intestinal microbiota. Ileostomy is a treatment option for steroid-resistant acute GVHD of the gastrointestinal tract that needs further validation in a prospective clinical trial.

PMID: 31338570 [PubMed - indexed for MEDLINE]

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Prevalence of noroviruses in children hospitalized for acute gastroenteritis in Hohhot, China, 2012-2017.

BMC Infect Dis. 2019 Jul 09;19(1):595

Authors: Li HY, Zhang YG, Lei X, Song J, Duan ZJ

BACKGROUND: Noroviruses (NVs) are an important cause of acute gastroenteritis (AGE) worldwide. There are limited data on the prevalence and molecular characterization of NVs in children in Hohhot, China.
METHODS: Between January 2012 and December 2017, 1863 stool samples were collected at Maternal and Child Health Hospital in Hohhot. All samples were screened for NVs by real-time reverse transcription polymerase chain reaction (real-time RT-PCR).
RESULTS: NVs were detected in 24.15% of these inpatient cases, ranging from 12.78 to 32.92% in different years. NV was detected throughout the year, with a peak in winter. Based on sequence analysis of the partial VP1 gene, the 306 identified NV strains were divided into six genotypes: GII.3 (71.24%), GII.4 (23.53%), and GII.2, GII.5, GII.6, and GII.13 (total 5.23%). Based on further sequence analysis of the RNA-dependent RNA polymerase (RdRp), GII.P12/GII.3, GII.Pe/GII.4, and GII.P4/GII.4 were identified as predominant genotypes, accounting for 92.6% of genotyped strains. The median age of the children with NV infection was 8.0 (range 0-59) months. However, children infected with GII.3 were younger (median 7.0 months) than GII.4-positive patients (median 10.0 months).
CONCLUSION: NV contributed greatly to AGE among hospitalized children in Hohhot in China. Continuous surveillance is important for understanding the local prevalence and characterization of NV.

PMID: 31288749 [PubMed - indexed for MEDLINE]

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Ultrasonography for diagnosis of appendicitis in children.

Pediatr Surg Int. 2019 08;35(8):921-922

Authors: Karabulut R, Turkyilmaz Z, Sonmez K

PMID: 31190128 [PubMed - indexed for MEDLINE]

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Letter to the Editor concerning: "the non-visualized appendix and secondary signs on ultrasound for pediatric appendicitis in the community hospital setting".

Pediatr Surg Int. 2019 08;35(8):919

Authors: Rogerson T, Do-Wyeld M, Cundy TP, Gent R, Goh DW

PMID: 30712084 [PubMed - indexed for MEDLINE]

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