Bilateral adrenal histoplasmosis presenting as adrenal mass mimicking malignancy in an immunocompetent patient.

We report a case of a 78-year-old immunocompetent man who presented with worsening fatigue and lethargy for one month. He had also been complaining of cough and SOB for two months which had been attributed to his underlying COPD and possible pneumonia. CT showed bilateral pleural effusions, ground-glass opacities, cirrhosis, splenomegaly and bilateral adrenal masses which was highly suspicious for malignancy.

Utilization of screening for hepatocellular carcinoma in the United States.

Background: Screening for hepatocellular carcinoma (HCC) has been recommended for patients at high-risk of developing HCC. Yet, the utilization and determinants of screening remain unclear.

Methods: All patients diagnosed with HCC at 3 medical centers during 1998 to 2003 were identified.

Detection of Barrett's esophagus after endoscopic healing of erosive esophagitis.

Background: The presence of erosive esophagitis (EE) in patients presenting for upper endoscopy may prevent the detection of underlying Barrett's esophagus (BE) in the distal esophagus.

Aim: To prospectively determine the proportion of patients detected with BE upon repeat endoscopy after healing of EE.

Methods: Patients with endoscopically confirmed EE without BE were treated with standard doses of acid suppression therapy and a repeat endoscopy was performed to assess the presence of BE.

The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus.

Background: A narrow band imaging (NBI) endoscopy system has been developed that allows superficial surface imaging of esophageal tissue in vivo.

Objective: The objective was to assess the potential of NBI for prediction of histology during screening and surveillance endoscopy in patients with Barrett's esophagus (BE).

Design: A prospective cohort study.

Angiogenic switch in Barrett's adenocarcinoma: the role of vascular endothelial growth factor.

The development of cancerous cells from the normal cells is the consequence of multiple genetic and epigenetic abuses. Activation of "Angiogenic switch" or formation of new blood vessels is one of the upshots of these abuses. Multiple factors are associated with the activation of angiogenic switch.

Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus.

Background & Aims: The exact incidence of adenocarcinoma in patients with Barrett's esophagus (BE) is not known and is reported to vary from 0.2%-2% per year. Published series of patients with BE have included relatively small numbers of patients with limited duration of follow-up.

Visible endoscopic and histologic changes in the cardia, before and after complete Barrett's esophagus ablation.

Background: Adverse events associated with the thermal ablation of Barrett's esophagus (BE) include the generation of gastric mucosa buried beneath the neosquamous regrowth, and unrecognized development and growth of adenocarcinomas. No reports exist regarding the endoscopic appearance and histology of the cardia before and after BE ablation. The aim of our study was to assess the relative frequency of the occurrence of visible endoscopic and histologic changes in the cardia, before and after complete BE ablation.

The frequency of Barrett's esophagus in high-risk patients with chronic GERD.

Background: The reported frequency of Barrett's esophagus (BE) in patients with reflux symptoms varies from 5% to 15%. The exact frequency of long-segment BE (LSBE) (>3 cm) and short-segment BE (SSBE) (<3 cm) in patients with chronic symptoms of GERD is uncertain. The aim of this study was to determine the frequency of LSBE and SSBE in consecutive patients presenting for a first endoscopic evaluation with GERD as the indication.

Detection of cardia intestinal metaplasia: do the biopsy number and location matter?

Background And Aim: Presence of intestinal metaplasia in the gastric cardia (cardia intestinal metaplasia, CIM) has been reported in 5-34% of patients undergoing upper endoscopy and is a topic of interest given the rising incidence of cancer in this location. The aim of this article is to determine the prevalence of CIM in biopsies obtained from two separate locations within the gastric cardia.

Methods: Patients presenting to the endoscopy unit for upper endoscopy for any symptoms were invited to participate in the study.

Development of Barrett's esophagus six months after total gastrectomy.

Barrett's esophagus (BE) is an acquired disease of the esophagus, in which esophageal squamous epithelium is changed by injury from reflux to metaplastic intestinal type columnar epithelium. BE is the premalignant lesion of adenocarcinoma of the esophagus. It is widely accepted that the long-standing reflux of gastric acid is a catalyst for the development of BE.

Risk stratification of Barrett's esophagus: updated prospective multivariate analysis.

Objectives: Prospective evaluation of Barrett's esophagus (BE) in order to determine what demographic, endoscopic, and histologic features are predictive of the prevalence and incidence of Barrett's high-grade dysplasia (HGD) and adenocarcinoma (Ca).

Methods: Newly diagnosed BE patients were entered into and followed in a standardized surveillance protocol. The following features were examined using either forward, stepwise multiple regression analysis, or Cox proportional hazards to determine their ability to predict the presence of HGD or Ca at index BE diagnosis as well as their ability to predict progression of BE during follow-up: age, race, gender, length of BE in cm, size of a hiatal hernia, severity of dysplasia at index diagnosis as well as during surveillance, gastric Helicobacter pylori infection status, and type of medical acid-reflux treatment.

The prevalence of Barrett's esophagus and erosive esophagitis in patients undergoing upper endoscopy for dyspepsia in a VA population.

The purpose of this study was to establish the prevalence of Barrett's esophagus and erosive esophagitis in a group of patients undergoing upper endoscopy for dyspepsia. Computerized endoscopy records were retrospectively evaluated to identify patients who underwent upper endoscopy for dyspepsia. Objective findings were recorded, including the presence of Barrett's esophagus, erosive esophagitis, and peptic ulcer disease.

Use of lasers in Barrett's esophagus.

Lasers are used in the management of Barrett's esophagus for specific tasks. First is for the ablation of non-dysplastic and dysplastic Barrett's as part of an aggressive, minimally invasive, yet unproven preventive interventional strategy for both low-risk and high-risk of progression subgroups. Secondly is for potentially curative treatment of early mucosal cancers (Tis and T1mN0M0).

Metastatic renal cell carcinoma of spleen diagnosed by fine-needle aspiration.

Splenic metastases are infrequent, and determination of the primary site by fine-needle aspiration (FNA) can be complex. We report the case of a 65-year-old man who was found to have a large heterogeneously enhancing 8 x 7-inch splenic mass by abdominal computed tomography (CT). FNA by transesophageal endoscopic ultrasonography demonstrated atypical cells conclusive for malignancy and consistent with metastatic renal cell carcinoma based on cytomorphology, histochemical lipid positivity, and immunohistochemical positivity for cytokeratin, vimentin, and renal cell carcinoma marker.

Neodymium:yttrium-aluminum garnet contact laser ablation of Barrett's high grade dysplasia and early adenocarcinoma.

Objectives: We describe the efficacy and safety of neodymium:yttrium-aluminum garnet (Nd:YAG) contact laser ablation of Barrett's high grade dysplasia (HGD) and/or early adenocarcinoma.

Methods: Consecutive Barrett's patients in whom HGD or adenocarcinoma was detected were eligible. Radial array echoendosonography and high frequency catheter probe ultrasonography were performed.

Yield of intestinal metaplasia in patients with suspected short-segment Barrett's esophagus (SSBE) on repeat endoscopy.

Biopsies from short segments of columnar appearing mucosa in the distal esophagus often fail to reveal intestinal metaplasia (IM). The yield of IM on repeat upper endoscopy (EGD) and biopsy in these patients is not known. Our aim was to prospectively evaluate the yield of IM on repeat EGD in patients with suspected SSBE (negative for IM on first EGD).