Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first e...Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.展开更多
In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for incr...In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population.Building upon their final observation regarding the importance of understanding this association,we will delve into the topic of infections in patients with liver cirrhosis.These patients exhibit intrinsic characteristics that make them particularly susceptible to infections,both bacterial and fungal.This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations,including the development of acute-on-chronic liver failure,which markedly worsens prognosis and mortality.Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections,multidrug-resistant organisms,and atypical clinical presentations.Delayed or inadequate management can lead to unfavorable outcomes,further complicating the course of their underlying liver disease.The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections.Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality.By raising awareness among clinicians about the complexity of these cases,we hope to contribute to optimizing the care of this high-risk population.展开更多
Lynch syndrome(LS),also known as hereditary non-polyposis colorectal cancer(HNPCC),is an inherited condition associated with a higher risk of colorectal cancer(CRC)and other cancers.It is caused by germline mutations ...Lynch syndrome(LS),also known as hereditary non-polyposis colorectal cancer(HNPCC),is an inherited condition associated with a higher risk of colorectal cancer(CRC)and other cancers.It is caused by germline mutations in DNA mismatch repair(MMR)genes,including MLH1,MSH2,MSH6 and PMS2.These mutations lead to microsatellite instability(MSI)and defective DNA repair mechanisms,resulting in increased cancer risk.Early detection of LS is crucial for effective management and cancer prevention.Endoscopic surveillance,particularly regular colonoscopy,is recommended for individuals with LS to detect CRC at early stages.Additionally,universal screening of CRC for MMR deficiency can help identify at-risk individuals.Genetic counseling plays a valuable role in LS by guiding patients and their families in understanding the genetic basis,making informed decisions regarding surveillance and prevention,and offering reproductive options to reduce the transmission of pathogenic variants of the offspring.The aim of this review is to outline current strategies for the diagnosis,surveillance,and management of LS,with a focus on the role of genetic counseling,endoscopic screening,and emerging therapeutic approaches to mitigate cancer risk in affected individuals.展开更多
BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report present...BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report presents several complications resulting from a colorectal polypectomy.CASE SUMMARY We report the case of a 67-year-old man who presented with asthenia and abdo-minal discomfort after a scheduled polypectomy.The patient was initially diagnosed with PPS and managed conservatively.However,progressive clinical deterioration led to hospital admission.Imaging revealed a right-sided intra-abdominal abscess secondary to colonic perforation.The initial polyp was iden-tified as a subepithelial lipoma.The patient underwent successful percutaneous drainage,antibiotic therapy,and recovered without the need for surgical inter-vention.CONCLUSION This case highlights the importance of accurate endoscopic diagnosis and te-chnique selection.PPS should not preclude the consideration of concurrent comp-lications.Early identification and a tailored therapeutic approach can prevent Core Tip:Although therapeutic colonoscopy is generally safe,it may be associated with significant complications.This case illustrates how post-polypectomy syndrome can mask a colonic perforation with subsequent abscess formation.It em-phasizes the importance of an accurate initial endoscopic assessment,the use of advanced resection and closure techniques,and close clinical follow-up.Recognizing this spectrum of complications and intervening early can help prevent major surgical procedures and improve patient outcomes.展开更多
BACKGROUND Acute pancreatitis(AP)is commonly encountered in gastroenterology,with biliary and alcohol-related causes being predominant.Among less frequent etiologies,metabolic and drug-induced origin are the most prev...BACKGROUND Acute pancreatitis(AP)is commonly encountered in gastroenterology,with biliary and alcohol-related causes being predominant.Among less frequent etiologies,metabolic and drug-induced origin are the most prevalent.As an exception,non-pancreatobiliary malignancies may trigger AP,representing less than 1%of cases.We present a case of AP secondary to an uncommon oncologic etiology.CASE SUMMARY We describe the case of a 50-year-old male recently diagnosed with small-cell lung cancer(SCLC).The patient was admitted to the emergency department with acute abdominal pain and subsequently diagnosed with AP.He was hospitalized under the care of the gastroenterology service.During the etiological workup,metastatic pancreatic lesions were identified on imaging,which had not been observed on the initial cancer staging.Following resolution of the initial episode,oral intake was introduced,but the patient experienced recurrent abdominal pain and laboratory abnormalities consistent with new episodes of AP.This pattern repeated over the following days.After several episodes,and with suspicion of a metastatic origin,the case was discussed in multidisciplinary meeting.In agreement with the patient and given the need to initiate treatment for the primary tumor as well,chemotherapy was started.This treatment successfully alleviated symptoms,allowing dietary progression without complications and discharge from the hospital.CONCLUSION Oncologic treatment can be considered as part of the therapeutic approach in AP secondary to SCLC metastasis,especially chemotherapy.展开更多
The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This a...The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This article reviews the historical progression of LARC management,emphasizing the latest breakthroughs that are reshaping treatment paradigms.Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy,the emergence of total neoadjuvant therapy as a standard approach,and the adoption of minimally invasive surgical techniques,such as transanal endoscopic microsurgery.Watch and wait may reduce treatment-related morbidity and help preserve anorectal function,but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety.Additionally,the role of targeted therapies and immunotherapy is gaining prominence,offering new opportunities for personalized treatment.These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function,ultimately enhancing patients’quality of life.Despite these advancements,challenges remain in optimizing patient selection,refining treatment strategies,and ensuring long-term safety and efficacy.A multidisciplinary approach involving surgeons,oncologists,and radiation specialists is crucial to tailoring therapies to individual patient profiles.As research continues,integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.展开更多
文摘Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.
文摘In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population.Building upon their final observation regarding the importance of understanding this association,we will delve into the topic of infections in patients with liver cirrhosis.These patients exhibit intrinsic characteristics that make them particularly susceptible to infections,both bacterial and fungal.This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations,including the development of acute-on-chronic liver failure,which markedly worsens prognosis and mortality.Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections,multidrug-resistant organisms,and atypical clinical presentations.Delayed or inadequate management can lead to unfavorable outcomes,further complicating the course of their underlying liver disease.The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections.Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality.By raising awareness among clinicians about the complexity of these cases,we hope to contribute to optimizing the care of this high-risk population.
文摘Lynch syndrome(LS),also known as hereditary non-polyposis colorectal cancer(HNPCC),is an inherited condition associated with a higher risk of colorectal cancer(CRC)and other cancers.It is caused by germline mutations in DNA mismatch repair(MMR)genes,including MLH1,MSH2,MSH6 and PMS2.These mutations lead to microsatellite instability(MSI)and defective DNA repair mechanisms,resulting in increased cancer risk.Early detection of LS is crucial for effective management and cancer prevention.Endoscopic surveillance,particularly regular colonoscopy,is recommended for individuals with LS to detect CRC at early stages.Additionally,universal screening of CRC for MMR deficiency can help identify at-risk individuals.Genetic counseling plays a valuable role in LS by guiding patients and their families in understanding the genetic basis,making informed decisions regarding surveillance and prevention,and offering reproductive options to reduce the transmission of pathogenic variants of the offspring.The aim of this review is to outline current strategies for the diagnosis,surveillance,and management of LS,with a focus on the role of genetic counseling,endoscopic screening,and emerging therapeutic approaches to mitigate cancer risk in affected individuals.
文摘BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report presents several complications resulting from a colorectal polypectomy.CASE SUMMARY We report the case of a 67-year-old man who presented with asthenia and abdo-minal discomfort after a scheduled polypectomy.The patient was initially diagnosed with PPS and managed conservatively.However,progressive clinical deterioration led to hospital admission.Imaging revealed a right-sided intra-abdominal abscess secondary to colonic perforation.The initial polyp was iden-tified as a subepithelial lipoma.The patient underwent successful percutaneous drainage,antibiotic therapy,and recovered without the need for surgical inter-vention.CONCLUSION This case highlights the importance of accurate endoscopic diagnosis and te-chnique selection.PPS should not preclude the consideration of concurrent comp-lications.Early identification and a tailored therapeutic approach can prevent Core Tip:Although therapeutic colonoscopy is generally safe,it may be associated with significant complications.This case illustrates how post-polypectomy syndrome can mask a colonic perforation with subsequent abscess formation.It em-phasizes the importance of an accurate initial endoscopic assessment,the use of advanced resection and closure techniques,and close clinical follow-up.Recognizing this spectrum of complications and intervening early can help prevent major surgical procedures and improve patient outcomes.
文摘BACKGROUND Acute pancreatitis(AP)is commonly encountered in gastroenterology,with biliary and alcohol-related causes being predominant.Among less frequent etiologies,metabolic and drug-induced origin are the most prevalent.As an exception,non-pancreatobiliary malignancies may trigger AP,representing less than 1%of cases.We present a case of AP secondary to an uncommon oncologic etiology.CASE SUMMARY We describe the case of a 50-year-old male recently diagnosed with small-cell lung cancer(SCLC).The patient was admitted to the emergency department with acute abdominal pain and subsequently diagnosed with AP.He was hospitalized under the care of the gastroenterology service.During the etiological workup,metastatic pancreatic lesions were identified on imaging,which had not been observed on the initial cancer staging.Following resolution of the initial episode,oral intake was introduced,but the patient experienced recurrent abdominal pain and laboratory abnormalities consistent with new episodes of AP.This pattern repeated over the following days.After several episodes,and with suspicion of a metastatic origin,the case was discussed in multidisciplinary meeting.In agreement with the patient and given the need to initiate treatment for the primary tumor as well,chemotherapy was started.This treatment successfully alleviated symptoms,allowing dietary progression without complications and discharge from the hospital.CONCLUSION Oncologic treatment can be considered as part of the therapeutic approach in AP secondary to SCLC metastasis,especially chemotherapy.
文摘The treatment of locally advanced rectal cancer(LARC)has evolved significantly over the past century,driven by a deeper understanding of tumor biology,technological advancements,and multidisciplinary approaches.This article reviews the historical progression of LARC management,emphasizing the latest breakthroughs that are reshaping treatment paradigms.Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy,the emergence of total neoadjuvant therapy as a standard approach,and the adoption of minimally invasive surgical techniques,such as transanal endoscopic microsurgery.Watch and wait may reduce treatment-related morbidity and help preserve anorectal function,but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety.Additionally,the role of targeted therapies and immunotherapy is gaining prominence,offering new opportunities for personalized treatment.These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function,ultimately enhancing patients’quality of life.Despite these advancements,challenges remain in optimizing patient selection,refining treatment strategies,and ensuring long-term safety and efficacy.A multidisciplinary approach involving surgeons,oncologists,and radiation specialists is crucial to tailoring therapies to individual patient profiles.As research continues,integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.
