https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

Background and objective The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. Results The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. Conclusions This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.

/pdf/classification-of-acute-pancreatitis-2012-revision-of-the-608d2rjeud.pdf

Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus

Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN, FAHA, Biykem Bozkurt, MD, PhD, FACC, FAHA, Ralph G. Brindis, MD, MPH, MACC, Mark A. Creager, MD, FACC, FAHA[§§][1], Lesley H. Curtis, PhD, FAHA, David DeMets, PhD,

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

BACKGROUND In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. METHODS We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group). RESULTS Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). CONCLUSIONS These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)

/pdf/colonoscopic-polypectomy-and-long-term-prevention-of-26sw5itn6w.pdf

Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths

Non-lifting sign from cold biopsy of sessile serrated polyp

We read with great interest the recent article by Ross et al. [1] reporting one cancer center’s experience with the treatment of obstructive jaundice in patients with lymphoma. This article describes outcomes for 35 patients who underwent biliary decompression endoscopically or percutaneously; biliary stents were placed in 43 of the 50 ERCP’s completed, and all but four of these stents were plastic. As quoted by Ross et al. [1], the need for a permanent metal stent in cases of biliary obstruction secondary to lymphoma is less prevalent given the increased chemoresponsiveness of many lymphomas when compared to other more refractory types of malignant biliary obstruction. The authors conclude that metal stents should be reserved for patients with lymphomas refractory to treatment who are expected to live more than 6 months. Based on experiences at our institution, we fully agree with the placement of plastic biliary stents for obstructive lymphomas, but would also urge more caution when considering uncovered metal stent placement in these cases, given the potential complications which can ensue due to the difficult (if not impossible) removal of such stents. We have two cases that illustrate this point.

/pdf/metal-stents-and-biliary-obstruction-secondary-to-lymphoma-a-2q3leouu3e.pdf

Metal Stents and Biliary Obstruction Secondary to Lymphoma: A Tale of Caution

Slim endoscopes can be passed through gastrostomy tracts, but dilation is required for the passage of standard endoscopes, which may result in tract disruption. Large-diameter covered self-expandable metal stents (CSEMS) have been placed through percutaneous tracts to enable endotherapy. A 20-year-old man underwent complex thoraco-abdominal surgery following traumatic injury, resulting in a cervical esophagus that was disconnected from the remaining gut. Intermittent bleeding from a gastrojejunal anastomotic ulcer was diagnosed using slim (5.9-mm) endoscopes passed through a 20-Fr mature percutaneous endoscopic gastrostomy (PEG) tract, but the small working channel precluded passage of hemostatic accessories. Attempts at angiographic embolization were unsuccessful. An innovative endoscopic approach was undertaken to manage recurrent massive bleeding (●\" Figs.1–6, ●\" Videos1–3). With the patient under general anesthesia, the gastrostomy tube was removed and an ultrathin endoscope (Olympus GIF-XP160; Olympus, Tokyo, Japan) was advanced through the gastrostomy tract toward a 2-cm marginal ulcer with a visible vessel. After guide wire placement into the jejunum, and endoscope withdrawal, a 7-cm long, 18-mm diameter CSEMS (Alimaxx; Merit Endotek, Jordan, Utah, USA) was deployed across the PEG tract, with one end exiting the skin and the other intragastrically. Balloon dilation (18-mm ATLAS PTA Dilatation Catheter; BARD Peripheral Vascular Inc., Tempe, Fig.2 Dilation of transgastric self-expandable metal stent (SEMS) to 18mm using a peripheral vascular dilating balloon with high burst pressure. Fig.1 Esophageal self-expandablemetal stent (SEMS) deployed across percutaneous endoscopic gastrostomy (PEG) site.

/pdf/placement-of-an-esophageal-self-expandable-metal-stent-v572qbbk1y.pdf

Placement of an esophageal self-expandable metal stent through a percutaneous endoscopic gastrostomy tract, for endoscopic therapy of upper gastrointestinal bleeding

https://www.gastrojournal.org/article/S0016-5085(15)00242-5/pdf

Todd H. Baron

Papers

Non-lifting sign from cold biopsy of sessile serrated polyp

Metal Stents and Biliary Obstruction Secondary to Lymphoma: A Tale of Caution

Placement of an esophageal self-expandable metal stent through a percutaneous endoscopic gastrostomy tract, for endoscopic therapy of upper gastrointestinal bleeding

An Uncommon Cause of Peripancreatic Fluid.

Long-term outcome following successful endoscopic drainage of organized pancreatic necrosis (OPN): Skunk-poking revisited