Diagnosis and Treatment of Gastric Heterotopic Pancreas

Background Heterotopic pancreas (HP) in the stomach can be difficult to diagnose and there are many treatment options. The aim of this article is to review the contemporary diagnosis of and treatment options for HP in the stomach. Methods We undertook a retrospective review of patients with the diagnosis heterotopic pancreas registered at St. Olavs University Hospital in Trondheim from 1990 to 2002. We report on clinical findings, provide a histological review, and summarize the literature with particular emphasis on the diagnosis and treatment of HP in the stomach. Results We found 32 cases, most of them in the stomach and the small intestine. Sixteen patients were symptomatic. A histological examination showed that most of the tumors were submucosal and had the appearance of normal pancreas tissue. Conclusion Gastric HP is not an uncommon diagnosis compared with many other gastric tumors and should more often be considered as a differential diagnosis. Symptom correlation is not always easy to determine, but symptom relief after treatment is well established. An endoscopic ultrasound examination may help when screening patients for extended biopsy and in deciding on which type of operation is to be performed. When treated, minimally invasive techniques should be applied.     

Screening for PTSD in motor vehicle accident survivors using the PSS-SR and IES

The current study compares the total scores of two potential posttraumatic stress disorder (PTSD) screening tools, the Impact of Event Scale (IES) and the PTSD Symptom Scale, Self-Report (PSS-SR), to the Clinician-Administered PTSD Scale (CAPS) in a large sample of motor vehicle accident (MVA) survivors (N = 229, of whom 43% met criteria for PTSD). For the IES using a cutoff score of 27, sensitivity was .91, specificity was .72, and overall correct classification was .80. For the PSS-SR using a cutoff score of 14, sensitivity was .91, specificity was .62, and overall correct classification was .74. Compared to those in studies of other trauma populations, the identified IES cutoff score is somewhat lower for this population of MVA survivors and the identified PSS-SR cutoff score is consistent with previous findings. These data support the use of the IES and the PSS-SR as PTSD screening tools in MVA samples.     

Comparative Evaluation of the Therapeutic Efficacy and Safety of Injected Histaglobulin versus Autologous Serum Therapy in Chronic Urticaria

BACKGROUND: Urticaria affects 0.5 to 1 percent of the population at any given time. Treatments include nonsedative antihistamines, autologous serum therapy, and injected histaglobulin. OBJECTIVE: This study sought to compare the therapeutic efficacy and safety of injected histaglobulin with autologous serum therapy in chronic urticaria. METHODS: This was a hospital-based prospective study performed in the Department of Dermatology, Venereology, and Leprology at Guru Gobind Singh Medical College and Hospital in Faridkot, India. A total of 96 patients with chronic idiopathic urticaria were enrolled after applying inclusion and exclusion criteria and were divided into two groups of 48 patients each using an envelope method. Autologous serum skin tests were performed in each patient irrespective of their group assignment. Group A then received injected histaglobulin and Group B received autologous serum therapy (AST). Patient were evaluated using the Urticaria Activity Score (UAS) every week for six weeks, with follow-up conducted at three and six weeks after the completion of treatment. The Chronic Urticaria Quality of Life questionnaire was used to assess the quality of life of the study participants. RESULTS: Out of the 96 initially enrolled patients, 62 completed the six weeks of treatment and two follow-up visits. Twenty patients dropped out due to remission and 14 patients left the study for other reasons. Reductions in UAS values occurred in both the groups by the end of follow-up but were more significant in Group A. Improvement in quality of life scores was also greater in Group A. Recurrence occurred in both groups after treatment cessation but was less common in Group A. CONCLUSION: Both treatments were validated for treating chronic urticaria; however, injected histaglobulin showed statistically more consequential results than AST.     

Performance of pulse palpation compared to one‐lead ECG in atrial fibrillation screening

BackgroundThe 2020 European Society of Cardiology atrial fibrillation guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or ECG rhythm strip in those aged over 65 years.HypothesisWe aimed to compare the diagnostic accuracy of pulse palpation to ECG rhythm strip when screening for atrial fibrillation. A secondary aim was to investigate whether participants with palpitations were more likely to be diagnosed with new atrial fibrillation.MethodsThe study population were 75/76 year old individuals that participated in the STROKESTOP II study, a Swedish screening study for atrial fibrillation. Pulse palpation of the radial pulse for 30 sec was performed by healthcare professionals and recorded as regular or irregular. Thereafter a 30‐sec single‐lead ECG was registered. Patients were asked also if they had a history of palpitations.ResultsOf the 6159 participants included in the study, 461 (7.5%) had irregular pulse. Twenty‐two (4.8%) of those with irregular pulse were diagnosed with atrial fibrillation on single‐lead ECG rhythm strip. Among those with regular pulse, 6 (0.1%) cases of new atrial fibrillation were found. The sensitivity of the pulse palpation test was 78.6% and positive predictive value 4.8%. The proportion of newly diagnosed atrial fibrillation was not different between those with and without history of palpitations.ConclusionPulse palpation was inferior to single‐lead ECG when screening for atrial fibrillation. We therefore advocate the use of single‐lead ECG rather than pulse palpation when screening for atrial fibrillation. Palpitations did not predict atrial fibrillation.     

Anaphylaxis to Pegylated Liposomal Doxorubicin: A Case Report

Liposomal doxorubicin is used for the treatment of various cancers like epithelial ovarian cancers, multiple myeloma and sarcomas. We report the first case of anaphylaxis to pegylated liposomal doxorubicin.