Notes

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We report a case of 33-year-old female with underlying genetic susceptibility for familial porphyria cutanea tarda due to novel UROD variant (c.636 + 2 dupT) unmasked by transient exposure to supraphysiological oestrogen concentrations following a single cycle of successful controlled ovarian stimulation for oocyte retrieval. Use of oral oestrogen in the form of oral contraceptive pills and hormone replacement therapy has been well known to trigger active porphyria cutanea tarda phenotype in susceptible women. However, to date, the emergence of clinically overt porphyria cutanea tarda has not been reported in association with fertility treatment in the literature before.Dear Editor, It was with great interest that we read the article of Luis Alcalá-Gonzáles et al (1). This work reinforces the scientific evidence regarding safety and effectiveness of self-expandable metal stent placement for the palliation of malignant gastric outlet obstruction (GOO). Our special interest about this topic makes us want to share the experience of our center and to strengthen some of the key points. Between January 2012 and December 2019, we placed 43 stents in patients with GOO. Interestingly, in contrast to the literature and this recently published paper, we had predominance of gastric stenosing neoplasms in relation to pancreatic neoplasms (60.4% vs 25.6%) (2), still achieving a technical (100%) and clinical (95.3%) success. The stent allows rapid clinical improvement, with shorter hospitalization compared to gastrojejunostomy, two important factors in the field of palliation. However, as we have also noted, there is a non-negligible need of reintervention (25.6% of our patients needed a second stent), either due to tumor growth, food impaction or stent migration. This fact becomes an important limitation in patients with reasonable performance status and expected survival, in which gastrojejunostomy should be considered primarily, with the use of gastroduodenal stents being more suited to individuals with shorter life expectancy (2,3). Thirty-day mortality of 46.5% and mean post-procedure survival of 81 ± 13 days are expected results for a technique with palliative purpose in a terminally ill patient. Thus, we consider that gastroduodenal stents constitute an effective and safe alternative to surgery, which is usually associated with greater morbility.Ischemic gastritis is an extremely rare entity due to the rich gastric vascularization. The case we are going to present could be the ideal setting to suspect it.Patient with normofunctional liver transplantation without portal hypertension needing hospitalization due to recurrent hepatic encephalopathy. Evidence of splenorenal shunt with varicose dilatation of splenic vein showed in the abdominal computed tomography. It is decided to perform percutaneous treatment in close collaboration between interventional radiology and interventional cardiology in order to implant an atrial septal closure device. Succesfull closure of the defect with no other episodes of encephalopathy during the following up.We read with interest the paper on the endoscopic treatment of a duodenal perforation related to a plastic biliary stent that was reported by Roa et al. (1). Now, we would like to add some comments about biliary stents as inserted during ERCP to palliate malignant jaundice in hilar strictures. It is our belief that the most convenient strategy in non-operable patients should be the insertion of at least one uncovered self-expanding metal stent (2). Metal stents are better suited to the angulations found in intrahepatic bile ducts. Only the anterior segment of the right hepatic duct has a relatively straight configuration. Usually, the insertion of a 10 cm long, 8 mm in diameter metal stent should be appropriate.Background and study's purpose It was aimed to compare carotid intima media (CIMT) and epicardial adipose tissue (EAT) measurements, which are considered as markers in detecting early atherosclerosis, in healthy control and inflammatory bowel diseases (IBD).
In a total of 60 IBD patients (25 crohn disease and 35 ulcerative colitis) and 60 healthy patients as control group, were included in the study. The measurement of CIMT and EAT were performed by using echocardiography and ultrasonography, respectively. Statistical analysis was employed for the relationship between the parameters.

The thickness of bilateral (right and left) CIMT and EAT were found to be significantly higher in IBD than those of the control group (P <0.05). There was a positive correlation between EAT and bilateral (right and left) CIMT in IBD patients (p<0,05).

IBD is associated with increased thickness of EAT and CIMT. Because chronic inflammation in IBD may increase the risk of atherosclerotic heart disease, only measuring the thickness of EAT and CIMT can be used as an objective, easy, simple, affordable, non-invasive and accessible assessment method in order to screen this risk.
IBD is associated with increased thickness of EAT and CIMT. Because chronic inflammation in IBD may increase the risk of atherosclerotic heart disease, only measuring the thickness of EAT and CIMT can be used as an objective, easy, simple, affordable, non-invasive and accessible assessment method in order to screen this risk.Dear Editor, We read with interest the article by Iñigo et al reporting the endoscopic management of a duodenal perforation. this website In fact we have dealt with a similar case using a different technique. A 71- year-old female patient underwent ERCP due to choledocholithiasis. After stone removal, a biliary plastic stent (9cm*10Fr) and a straight pancreatic plastic stent (6cm*5Fr) for post-ERCP pancreatitis prophylaxis were placed. The next morning the patient complained of epigastric pain and presented rebound tenderness and fever. A CT scan was ordered showing migration of the stent´s distal end through the duodenal wall to the colon. Endoscopy revealed the pancreatic stent penetrating the duodenal wall, which was removed with polypectomy snare. The perforation was closed by deploying 4 clips around the defect, which were then bundled together with an endoloop - a variation of "tulip bundle" technique. Eventually the patient was discharged. There are only few reports of pancreatic stent migration causing duodenal perforation.
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