Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon.

Post-polypectomy bleeding (PPB) remains a significant procedure-related complication, with multiple risk factors determining the risk including patient demographics, polyp characteristics, endoscopist expertise, and techniques of polypectomy. Immediate PPB is usually treated promptly, but management of delayed PPB can be challenging. Cold snare polypectomy is the optimal technique for small sessile polyps with hot snare polypectomy for pedunculated and large sessile polyps.

Role of ERCP in Malignant Hilar Biliary Obstruction.

Malignant hilar biliary obstruction (MHO), an aggressive perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment method for biliary malignancies. However, most of the patients with MHO cannot undergo surgeries on presentation because of an advanced inoperable state or a poor performance state due to old age or comorbid diseases.

Endovascular treatment of a portosystemic shunt presenting with hypoglycemia; case presentation and review of literature.

Here we present a rare case of hyperinsulinemic-hypoglycemia due to congenital intrahepatic and extrahepatic portosystemic shunts. Performing percutaneous closure of such shunts has been reported to improve symptomatic hypoglycemia in this setting. This case is unique given the type of shunt (both with intrahepatic and extrahepatic components) and the clinical improvement following placement of a single vascular plug to occlude both intrahepatic and extrahepatic connections.

Safety and efficacy of remimazolam in high risk colonoscopy: A randomized trial.

Background: Procedural sedation of ASA III/IV patients has increased risk. Remimazolam (an ultra-short-acting benzodiazepine) has proven safe and efficient for outpatient colonoscopy sedation.

Methods: A double-blind, randomized, multi-center, parallel group trial was performed, comparing remimazolam to placebo with an additional open-label arm for midazolam in procedural sedation of 79 ASA III/IV patients undergoing colonoscopy.

Fecal Microbiota Transplantation for Ulcerative Colitis. Are We Ready for Primetime?

"Patients with inflammatory bowel disease, including ulcerative colitis (UC) and Crohn disease, have altered gut microbiomes. The success of fecal microbiota transplantation (FMT) in the treatment of Clostridioides difficile infection, a disease that is also marked by dysbiosis, has spurred research in applying FMT to UC. So far, 3 randomized controlled trials have demonstrated benefit in mild to moderate UC disease course after FMT.

Advanced MR Imaging of the Pancreas.

MR imaging can be optimized to evaluate a spectrum of pancreatic disorders with advanced sequences aimed to provide quantitative results and increase MR diagnostic capabilities. The pancreas remains a challenging organ to image because of its small size and location deep within the body. Besides its anatomic limitations, pancreatic pathology can be difficult to identify in the early stages.

Diffusion MR Imaging in the Head and Neck: Principles and Applications.

Diffusion imaging is a functional MR imaging tool that creates tissue contrast representative of the random, microscopic translational motion of water molecules within human body tissues. Long considered a cornerstone MR imaging sequence for brain imaging, diffusion-weighted imaging (DWI) increasingly is used for head and neck imaging. This review reports the current state of diffusion techniques for head and neck imaging, including conventional DWI, DWI trace with apparent diffusion coefficient map, diffusion tensor imaging, intravoxel incoherent motion, and diffusion kurtosis imaging.

The Case for High-Quality Colonoscopy Remaining a Premier Colorectal Cancer Screening Strategy in the United States.

Most colorectal cancer screening in the United States occurs in the opportunistic setting, where screening is initiated by a patient-provider interaction. Colonoscopy provides the longest-interval protection, and high-quality colonoscopy is ideally suited to the opportunistic setting. Both detection and colonoscopic resection have improved as a result of intense scientific investigation.

Toward Automation of the Supine Pressor Test for Preeclampsia.

Preeclampsia leads to increased risk of morbidity and mortality for both mother and fetus. Most previous studies have largely neglected mechanical compression of the left renal vein by the gravid uterus as a potential mechanism. In this study, we first used a murine model to investigate the pathophysiology of left renal vein constriction.

HPV and HPV Vaccination Knowledge and Attitudes Among Medical Students in Alabama.

In addition to being the most common sexually transmitted infection, the human papillomavirus (HPV) is associated with six types of cancer in men and women. The HPV vaccine provides long-lasting, effective protection from high-risk HPV infection, thus serving as a means of cancer prevention. An effective healthcare provider recommendation is well-established as the most significant influence on HPV vaccine uptake, and, as emerging providers, it is critical that medical students receive comprehensive training in this area.

Best Practices for Resection of Diminutive and Small Polyps in the Colorectum.

Diminutive colorectal lesions are polyps and flat lesions 1 to 5 mm in size, and small are 6 to 9 mm in size. The best resection method is the cold snare. Cold forceps are acceptable for 1- to 3-mm lesions, but should not be used to piecemeal polyps.

Microbial shifts in Minas artisanal cheeses from the Serra do Salitre region of Minas Gerais, Brazil throughout ripening time.

The Minas artisanal cheese is a traditional product in its way of producing. Produced in the Minas Gerais state, Brazil, this cheese is made using raw cow's milk with the addition of an endogenous starter culture called "pingo", responsible for inoculating specific microorganisms that could enhance flavor and sensorial aspects. There are seven regions able to produce and commercialize this product - Araxá, Campo das Vertentes, Canastra Cerrado, Serra do Salitre, Serro and Triângulo Mineiro.

HPV vaccination, knowledge, and attitudes among young cervical cancer survivors in the Deep South.

Introduction: Although FDA approved for over 10 years, uptake of the human papillomavirus (HPV) vaccination has been slow, particularly among states in the Deep South with high cervical cancer incidence and mortality. The purpose of this study was to explore variables associated with cervical cancer among survivors who were age-eligible for the HPV vaccine and to assess HPV vaccination history, barriers, perceptions, and other associated behaviors within this cohort.

Methods: A mixed methods strategy was used for the study, first identifying eligible cervical cancer survivors from our institution and abstracting demographic and clinicopathologic medical record data.

Chronic Pancreatitis: What the Clinician Wants to Know from MR Imaging.

Diagnosis of chronic pancreatitis requires a complete medical history and clinical investigations, including imaging technologies and function tests. MR imaging/magnetic resonance cholangiopancreatography is the preferred diagnostic tool for detection of ductal and parenchymal changes in patients with chronic pancreatitis. Ductal changes may not be present in the initial phase of chronic pancreatitis.

Superior vena cava syndrome in a patient with locally advanced lung cancer with good response to definitive chemoradiation: a case report.

Background: The incidence of superior vena cava syndrome within the United States is roughly 15,000 cases per year. Superior vena cava syndrome is a potentially life-threatening medical condition; however, superior vena cava syndrome is not fatal in the majority of cases. Superior vena cava syndrome encompasses a collection of signs and symptoms resulting from obstruction of the superior vena cava, including swelling of the upper body of the head, neck, arms, and/or breast.

Imaging in Autoimmune Pancreatitis and Immunoglobulin G4-Related Disease of the Abdomen.

Autoimmune pancreatitis (AIP) is steroid-responsive fibroinflammatory disorder of the pancreas. There are 2 distinct subtypes of AIP, types 1 and 2. Type 1 is associated with systemic immunoglobulin (Ig)G4 disease and may affect multiple organs in the body.

Anesthetic Agents Commonly Used by Oral and Maxillofacial Surgeons.

Oral and maxillofacial surgeons have a variety of anesthetic agents that can be used to provide anesthesia safely and efficiently in the office-based environment. However, it is critical to have a thorough understanding of the particulars for each agent. Commonly used anesthetic agents, administered either individually or in combination, include diazepam, midazolam, propofol, ketamine, opioid agonists such as fentanyl or remifentanil, dexmedetomidine, and inhalational agents, including nitrous oxide and sevoflurane.

Imaging and Screening of Cancer of the Gallbladder and Bile Ducts.

Biliary cancers include gallbladder cancer (GBC) and cholangiocarcinoma (CCA). GBC may appear as a mass replacing the gallbladder, thickened gallbladder wall, or polypoid lesion in the gallbladder. Gallbladder polyps with low risk of GBC (eg, 6- to 10-mm polyps without other risk factors) are screened with sonography.

Endoscopic Ultrasound Imaging for Diagnosing and Treating Pancreatic Cysts.

Cystic pancreatic lesions are increasingly diagnosed owing to the abundant use of cross-sectional imaging. Given their malignant potential, true pancreatic cysts should be considered for resection or periodic follow-up. Cystic lesions of the pancreas (CLPs) require further evaluation and management.

Patient knowledge of hysterectomy and pap screening after minimally invasive hysterectomy.

Objective: To determine whether women know their own cervical cancer screening recommendations after hysterectomy, and to evaluate patients' understanding of hysterectomy terminology and cervical cancer screening.

Methods: A 19-item questionnaire was developed and administered to 413 women who had undergone minimally invasive hysterectomy with benign pathology between January 2008 and January 2012.

Results: A total of 190 women (46%) participated in the survey.