Bifidobacterium and Lactobacillus can beneficially affect the host by producing acetic acid and lactic acid, which lower pH and thereby inhibit the growth of pathogens or allow the probiotic bacteria to compete with pathogens for epithelial adhesion sites and nutrients. The transmural migration of enteric organisms into the peritoneal cavity can cause peritonitis in peritoneal dialysis (PD) patients. We hypothesized that the composition of the intestinal microbiota with regard to Lactobacillus species and Bifidobacterium species differed between PD patients and healthy controls. The aim of the study was to investigate these differences by real-time PCR analysis of fecal samples. There is a large, complex, and diverse microbial community in the human intestine. The intestinal microbiota plays an important role in digesting food, metabolizing endogenous and exogenous compounds, and producing essential vitamins. It also stimulates the immune system and prevents the colonization of the gastrointestinal tract by pathogens, and hence it influences human health (7, 9). The gastrointestinal microbiota of an adult human consists of more than 500 species, with 10 11 to 10 12 CFU per gram of stool (12,25). The predominant microorganisms are non-spore-forming, obligate anaerobes, such as Bacteroides, Fusobacterium, Eubacterium, and Bifidobacterium species. Other anaerobic bacteria found in large numbers include Lactobacillus species, various anaerobic Gram-positive cocci, and Clostridium species (4). Hida et al. studied the fecal flora of hemodialysis (HD) patients and healthy controls using traditional plating methods and found quantitative and qualitative differences between the two groups (13). It is plausible to suggest that the chronic inflammatory state in dialysis patients is in part due to a microbial imbalance in the gut, resulting in alteration of proinflammatory cytokines and production of uremic toxins from proteins fermented in the large intestine (16). Moreover, impaired intestinal barrier function in peritoneal dialysis (PD) patients allows enteric organisms to enter the peritoneal cavity by transmural migration and to cause peritonitis (8,27). Peritonitis occasionally causes death and results in significant morbidity, including catheter loss, transfer to hemodialysis, transient loss of ultrafiltration, and possible permanent membrane damage (22). Bifidobacterium and Lactobacillus can beneficially affect the host by inhibiting the growth of pathogens through production of acetic acid and lactic acid, which lower pH, or by competing with pathogens for epithelial adhesion sites and nutrients (10).To the best of our knowledge, no study has investigated the intestinal microbiota in PD patients before. The aim of this study, therefore, was to evaluate the differences in the intestinal microbiota between PD patients and healthy controls by examining fecal samples. We focused on Bifidobacterium species, Lactobacillus species, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus species....

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We report two female patients with gonadal dysgenesis and sex chromosome mosaicism involving the Y chromosome. Conventional karyotyping was supplemented with fluorescent in situ hybridisation techniques in order to confirm the presence of Y chromosomes. One patient is a phenotypic female with karyotype 45,X/46,X,idic(Y)(q11.2). She underwent a laparoscopic gonadectomy at which streak ovaries without evidence of gonadoblastoma were removed. The second patient presented as a virilised female with karyotype 45,X/47,XYY. At laparoscopy, she was found to have mixed gonadal dysgenesis with a gonadoblastoma in situ. We recommend early gonadectomy in female children presenting with gonadal dysgenesis and the presence of a Y chromosome although once the gonadoblastoma locus on Y chromosome gene has been cloned it may be possible to identify those patients who have a low risk of developing gonadoblastoma.

Marfan syndrome is an autosomal dominant inherited disorder of connective tissue, with various complications manifested primarily in the cardiovascular system. It potentially leads to aortic dissection and rupture, these being the major causes of death. We report a patient who complained of acute abdominal pain, which presented as acute mesenteric ischemia combined with abdominal aortic dissection. Echocardiography showed enlargement of the aortic root and mitral valve prolapse. Abdominal computed tomography scan revealed acute mesenteric ischemia due to abdominal aortic dissection. Finally, the patient underwent surgery of aortic root replacement and had a successful outcome. Therefore, we suggest that for optimal risk assessment and monitoring of patients with Marfan syndrome, both aortic stiffness and the diameter of the superior mesenteric vein compared with that of the superior mesenteric artery are useful screening methods to detect acute mesenteric ischemia secondary to abdominal aortic dissection. Early diagnosis and early treatment can decrease the high mortality rate of patients with Marfan syndrome.

Introduction. The incidence of gastric remnant carcinoma does not decrease after partial gastrectomy. The aim of this study was to evaluate the clinical features and prognosis of gastric remnant carcinoma after treatment. Methods. Among 412 gastric carcinoma patients who were admitted to our hospital, 21 were found to have gastric remnant carcinoma. We analyzed their clinicopathological features and prognosis. Results. Prognosis did not differ significantly in terms of gender, age, tumor lymph node metastasis stage, tumor location, and time interval between first and subsequent operations. However, it was influenced by intensive curative gastrectomy with resection of local lymph nodes. Conclusion. Long-term follow-up after gastrectomy, appropriate curative resection, and prevention and management of comorbidities are important to detect gastric remnant carcinoma at an early stage.

Ectopic pancreatic rests are rare. We report two cases discovered in infants who underwent surgical exploration of the umbilicus for persistent umbilical discharge with peri-umbilical excoriation. A shallow sinus leading to a firm cyst was excised in both infants, and histopathological study confirmed the presence of exocrine and endocrine pancreatic tissue. There is only one other case of ectopic umbilical pancreatic tissue reported, and this was in a patient presenting with an umbilical mass.

Endoscopists frequently encounter severe tight strictures during therapeutic endoscopic retrograde cholangiopancreatography. Dilation using a Soehendra stent retriever (SSR) can be the approach of choice. However, reports of SSR use for the aforementioned strictures are scant. Patients presenting with strictures of the biliary or pancreatic ducts between July 2015 and March 2019 were prospectively screened. The aforementioned strictures allowed the passage of only a guidewire but denied 5.5‐French (Fr) catheter advancement and conventional balloon or catheter dilation. After guidewire passage and endoscopic sphincterotomy, an (7‐Fr) SSR was screwed clockwise over a guidewire and advanced progressively to traverse and dilate the stricture proximally. A plastic stent was then placed in the biliary or pancreatic duct for internal drainage. The stricture and procedural characteristics and immediate postprocedural status were analyzed. Eleven patients (nine men and two women; median age 58 [range 43‐75] years) with severe benign strictures of the biliary (n = 5) or pancreatic (n = 6) ducts were included. The median length of the strictures was 5 (range 2‐9) mm. All 11 severe strictures were successfully dilated using an SSR followed by stenting with a plastic stent (range 5‐7 Fr). Only one patient had brief minor hemobilia immediately after the procedure, and another briefly experienced acute cholangitis. Five (5/6, 83.3%) patients in the pancreatic group eventually achieved stent removal. None of the patients achieved stent removal in the biliary duct group until the end of follow‐up. Nonetheless, the patients did not require percutaneous or surgical interventions. Dilation using the SSR is safe, tolerable, and successful for the tight biliary and pancreatic duct strictures that defy conventional wire‐guided endoscopic access.

SummaryBackground and aimIntrahepatic cholangiocellular carcinoma (ICC) is an uncommon but lethal cancer. The aim of this study is to assess the factors affecting the survival of ICC patients and to evaluate the benefit of these factors when various therapeutic modalities are used.MethodsBetween October 2007 and June 2012, 66 ICC cases among 2255 liver cancer patients were identified by pathology and divided into two groups: Group I (surgery group; n = 17) and Group II (nonsurgery group; n = 49). Group II was further divided into Group IIa (those receiving palliative treatment; n = 19) and Group IIb (no treatment received; n = 30). Factors affecting patient survival over the study period were assessed (3‐ and 6‐month results were reported) and therapeutic benefits identified within each of the groups were evaluated.ResultsOf the 66 patients identified (male/female = 36/30), 10.6% (7/66) were in the early stages of illness. Overall, the mean patient survival duration was 3.50 ± 0.92 months (1.69–5.31 months). The mean survival duration of Group I patients was 10.50 ± 2.84 months (4.94–16.06 months). The mean survival duration of Group II patients was 3.50 ± 0.65 months (2.24–4.76 months) with Group IIa patients surviving on average 9.50 ± 3.27 months (3.10–15.90 months) and Group IIb patients surviving on average 1.50 ± 0.12 months (1.26–1.74 months). Better survival outcomes were observed in the groups receiving treatment, Group I and Group IIa, than in Group Iib, which did not receive treatment [9.50 ± 1.73 months (6.12–12.89 months) vs. 1.50 ± 0.12 months (1.26–1.74 months), p < 0.001]. Lower albumin, higher bilirubin, higher CA19‐9, advanced tumor stage, and no treatment were identified as important predictors of patient mortality at the 3‐ and 6‐month time‐points. These factors remained relevant throughout the entire study period (p = 0.002, 0.029, 0.027, 0.028, < 0.001, respectively).ConclusionThis study identified surgery as the treatment that provided the best survival prognosis for patients with ICC. Treatment involving either chemotherapy or radiotherapy could also prolong ICC patient survival. Better liver preservation, lower CA19‐9, and less aggressive tumor conditions were identified as factors which play crucial roles in enhancing patient survival.