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Due to poor patient condition and the high risk associated with the procedure, colonoscopy is rarely performed in the intensive care unit (ICU). It is indicated for ICU patients with suspected ischemic colitis, decompression of colonic distension, or lower gastrointestinal hemorrhage. ICU patients usually have more co‐morbidities and higher mortality rates than other inpatient patients. Data in the literature regarding the outcomes of ICU patients after colonoscopy are limited. The aim of this study was to identify factors that are predictive of outcomes following colonoscopy in ICU patients. We retrospectively analyzed the medical records and imaging findings of patients who underwent colonoscopy in an ICU setting between January 2018 and June 2020. A total of 79 patients were identified and enrolled for analysis. The median age of the patients was 78 years. The colonoscopy findings included angiodysplasia (n = 3, 3.8%), colitis (n = 17, 21.5%), colonic ulcer (n = 2, 2.5%), diverticulosis (n = 3, 3.8%), hemorrhoid (n = 10, 12.7%), rectal ulcer (n = 16, 20.3%), tumor (n = 10, 12.7%), volvulus (n = 1, 1.3%), bleeding of unknown origin (n = 4, 5.1%), and no diagnosis (n = 13, 16.5%). A total of 46 patients (58%) survived to discharge. Patients who survived had statistically significantly higher Glasgow coma scale (GCS) scores (P= .009) and albumin levels (P= .002) than patients who did not survive. Patient survival is associated with GCS score and albumin level, but not with colonoscopy findings.

Proton pump inhibitor (PPI) is a commonly prescribed drug for peptic ulcer. Serious adverse events, such as Stevens‐Johnson syndrome (SJS), are very rare. A 58‐year‐old man had been experiencing tarry stools and endoscopic evaluation revealed active duodenal ulcer bleeding. After the failure of endoscopic therapy, arterial embolization resulted in successful hemostasis. The patient was administered PPI to prevent recurrent ulcer bleeding. High fever and generalized skin rash developed on hospital day 16 and subseqnent evaluation suggested esomeprazole associated SJS. Although rare, clinicians should be aware of this rare cutaneous complication of PPI. Early recognition and cessation of PPI can help prevent this lethal complication.

A 32‐year‐old man with a history of arthropathic psoriasis had regular follow‐up checkups and medications to control his arthropathic psoriasis at our rheumatology outpatient department. He had diarrhea for 20 days and visited our gastroenterology outpatient department. On the basis of the colonoscopy findings, a diagnosis of inflammatory bowel disease (Crohn's disease) was made. We reviewed his medical history and found that he had used secukinumab 2 months before. Pathological examination revealed chronic colitis with severe activity, compatible with inflammatory bowel disease. The biologic was shifted from secukinumab to adalimumab. His diarrhea gradually improved in the following 3 months. A follow‐up colonoscopy 6 months after revealed remission of the ileal and colonic ulcers.

AbstractThe two-sided nonlinear boundary crossing probabilities for one-dimensional Brownian motion and related processes have been studied in Fu and Wu (2010) based on the finite Markov chain imbedding technique. It provides an efficient numerical method to computing the boundary crossing probabilities. In this paper we extend the above results for high-dimensional Brownian motion. In particular, we obtain the rate of convergence for high-dimensional boundary crossing probabilities. Numerical results are also provided to illustrate our results.

The distributions of discrete, continuous and conditional multiple window scan statistics are studied. The finite Markov chain imbedding technique has been applied to obtain the distributions of fixed window scan statistics defined from a sequence of Bernoulli trials. In this manuscript the technique is extended to compute the distributions of multiple window scan statistics and the exact powers for multiple pulse and Markov dependent alternatives. An application in blood component quality monitoring is provided. Numerical results are also given to illustrate our theoretical results.

The distributions for continuous, discrete, and conditional discrete scan statistics are studied. The approach of finite Markov chain imbedding, which has been applied to random permutations as well as to runs and patterns, is extended to compute the distribution of the conditional discrete scan statistic, defined from a sequence of Bernoulli trials. It is shown that the distribution of the continuous scan statistic induced by a Poisson process defined on (0, 1] is a limiting distribution of weighted distributions of conditional discrete scan statistics. Comparisons of rates of convergence as well as numerical comparisons of various bounds and approximations are provided to illustrate the theoretical results.

We propose a new method to obtain the boundary crossing probabilities or the first passage time distribution for linear and nonlinear boundaries for Brownian motion. The method also covers certain classes of stochastic processes associated with Brownian motion. The basic idea of the method is based on being able to construct a finite Markov chain, and the boundary crossing probability of Brownian motion is cast as the limiting probability of the finite Markov chain entering a set of absorbing states induced by the boundaries. Error bounds are obtained. Numerical results for various types of boundary studied in the literature are provided in order to illustrate our method.

Pneumoperitoneum generally indicates the perforation of the hollow viscera and most cases require emergency surgical exploration and intervention. However, pneumoperitoneum may develop without viscera perforation and is then defined as “spontaneous pneumoperitoneum”. Herein, we describe an elderly patient who developed spontaneous pneumoperitoneum. This case should serve to remind physicians of the possibility that spontaneous pneumoperitoneum may occur.