Why do I have a bitter taste in my mouth?

A bitter taste can have many causes, including pregnancy, acid reflux, and dry mouth. Learn more about symptoms, causes, and how to get rid of the taste.

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Comparison of Propofol Monotherapy and Propofol Combination Therapy for Sedation During Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis

Abstract

Background

Previous randomized controlled trials have reported conflicting findings comparing propofol combination therapy(PCT) with propofol monotherapy(PMT) for sedation of patients undergoing gastrointestinal endoscopy. Therefore, a systematic review was performed to compare the efficacy and safety of PCT and PMT in such patients.

Methods

We searched MEDLINE, EMBASE and CENTRAL databases to identify all randomized controlled trials that compared the efficacy and safety of PCT and PMT for sedation of patients undergoing gastrointestinal endoscopy. The primary endpoints were the incidence of respiratory complications, hypotension, and arrhythmia, the dose of propofol used, and the recovery time. The procedure duration and the satisfaction of patients and doctors were also evaluated.

Results

A total of 2250 patients from 22 studies were included in the final analysis. The combined analysis did not reveal any difference between PCT and PMT in the incidence of respiratory complications(risk ratio[RR],0.80; 95% CI, 0.52 to 1.23;I²=58.34%), hypotension(RR,1.06; 95% CI, 0.63 to 1.78; I²=72.13%), arrhythmia(RR,1.40; 95% CI, 0.74 to 2.64;I²=43.71%), recovery time(standardized mean difference[SMD],0.16; 95% CI, -0.49 to 0.81;I²=95.9%) and procedure duration(SMD,0.04; 95% CI, -0.05 to 0.14;I²=0.0%), patient satisfaction(SMD,0.13; 95% CI, -0.26 to 0.52; I²=89.63%) or doctor satisfaction(SMD,0.01; 95% CI, -0.15 to 0.17;I²=0.00%).

However, the dose of propofol used was significantly lower in PCT than in PMT(SMD,-1.38; 95% CI, -1.99 to -0.77;I²=97.70%).

Conclusion

PCT showed comparable efficacy and safety to PMT with respect to respiratory complications, hypotension and arrhythmia, recovery time, procedure duration, patient satisfaction, and doctor satisfaction. However, the average dose of propofol used was higher in PMT.

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Esophago-Jejunal Anastomotic Dehiscence Successfully Repaired by Endoluminal Suture and Stent Positioning: Report of a Mini-Invasive Approach

Abstract

A 32-year-old gentleman underwent a laparoscopic wedge resection of the stomach for gastrointestinal stromal tumor, with subsequent anastomotic dehiscence treated with urgent surgical revision. Following acute abdominal pain and severe sepsis, the patient was directly referred for a total gastrectomy with esophago-jejunal anastomosis.

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An insider's view on how Ki-67, the bright beacon of cell proliferation, became very popular.A tribute to Johannes Gerdes (1950 - 2016)

Abstract

In July 2016 Johannes Gerdes passed away, 25 years after the Journal of Pathology published a groundbreaking paper on Ki-67. The manuscript has been quoted nearly 1400 times since then.Thomas Scholzen, Christiane Gerlach and Giorgio Cattoretti, former coworkers, collaborators and friends of Hannes present a reconstruction of the scientific ambience of the field in the world and in their labs, anecdoctes of the discovery and a very brief summary of published and unpublished research on Ki-67 as a tribute to Hannes Gerdes.

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Transbronchial lung biopsy for the diagnosis of IgG4-related lung disease

Abstract

Aims

The diagnosis of IgG4-related disease (IgG4-RD) requires a multidisciplinary approach, in which histology plays an important role. Although a diagnosis was previously established using surgically resected specimens, there is increasing clinical demand to diagnose this systemic condition by biopsies. The present study aimed to elucidate how useful transbronchial lung biopsies (TBLBs) are for this diagnostic purpose.

Methods and Results

The study cohort consisted of 20 consecutive patients diagnosed with IgG4-RD in other organs who underwent TBLBs for potential pulmonary involvement. One case showing multiple granulomas suggestive of other conditions was excluded. Seven of the remaining 19 cases (37%) showed apparently normal lung tissue, indicating a sampling error, while 12 (63%) had microscopic abnormalities. Nine cases (47%) with a dense lymphoplasmacytic infiltrate met the number and ratio criteria of IgG4-positive plasma cell infiltration (>20 cells/high power field [HPF] and >40% IgG4/IgG-positive cell ratio). Obliterative phlebitis and storiform fibrosis were observed in one case each. In 43 control cases of various inflammatory conditions, tissue IgG4 elevations appeared to be uncommon with only 2 cases (5%) each meeting the number or ratio criterion and one case (2%) fulfilling both. All control cases with tissue IgG4 elevations were of eosinophilic pneumonia.

Conclusions

TBLBs provided histological findings that were supportive for the diagnosis of IgG4-RD in 47% of cases with 98% diagnostic specificity. Therefore, they have potential as a useful and acceptable diagnostic approach for IgG4-related lung disease.

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Primary fallopian tube sex cord tumour: Tubal counterpart of uterine tumour resembling ovarian sex cord tumour

Abstract

Uterine tumour resembling ovarian sex cord tumour (UTROSCT) is an uncommon mesenchymal neoplasm which morphologically resembles and expresses markers of ovarian sex cord-stromal tumours (1,2). It has an uncertain histogenesis and this is reflected in the 2014 World Health Organization (WHO) Classification of tumours of the female reproductive organs where it is included in the category of miscellaneous uterine neoplasms (3).

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A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach

A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.

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