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Dysplasia is a precancerous lesion of colorectal cancer in patients with long-standing inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn's disease. Recent guidelines suggest endoscopic resection as a key modality for the treatment of endoscopically resectable dysplasia in patients with colitis. Endoscopic submucosal dissection (ESD) has been suggested as one of the therapeutic options for dysplasia that is potentially resectable but not suitable for the conventional endoscopic mucosal resection technique. Several recent studies supported the feasibility of ESD for the treatment of colitis-associated dysplasia in terms of the en bloc and complete resection rates and the risk of procedure-related complications. However, these studies were performed exclusively in expert centers. Moreover, the local and metachronous recurrence rates were relatively high, and long-term outcome data are still lacking. Endoscopists should be highly skilled in colorectal ESD and have an intensive understanding of not only the lesions but also the conditions of patients with IBDs. Therefore, the decision to perform ESD for colitis-associated dysplasia should be made scrupulously after careful discussion with patients, in collaboration with a multidisciplinary IBD team including physicians, surgeons, and pathologists specialized in IBDs. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the third most common cancer in males, the second in females and is the second leading cause of cancer related death worldwide. Despite recent advances in chemotherapy, and targeted therapy for CRC, the prognosis for patients with advanced cancer has remained poor, due to drug resistance, metastasis and recurrence. A small fraction of cells possess tumor propagation abilities. These are termed "cancer stem cells (CSCs). A subset of colorectal cancer stem cells, may hold a key to controlling cancer. The cancer stem cell (CSC) model suggests that tumors are hierarchically organized, only CSCs possess cancer-promoting potential. The killing of CSCs is thought to be a critical component of effective antitumor therapies. A number of signaling pathways, most notably the Wingless related (Wnt), transforming growth factor-beta (TGF-ß), Notch and Hedgehog signaling and other mechanisms have been found to be associated with CSCs in CRC. They play important roles in maintaining the growth and functional integrity of CSC. Many new molecules are now being studied to block theses pathways. Some of the molecules block the self-renewal and induction of apoptosis in CSCs. The design of CSC-targeted interventions is a rational target, and reduce local recurrence and metastasis. This review aims to summarize the issue on CSCs and signaling pathway relevant for CRC, which may lead to more effective therapeutic strategies for CRC. [ABSTRACT FROM AUTHOR]

Pancreatic cancer, known for its rapid progression and poor prognosis, usually presents with obstructive jaundice. Biliary drainage can be achieved by various techniques and approaches, with endoscopic drainage as the preferred method. However, open drainage of the biliary tree is indicated when unresectable tumor is found during resection surgery. This is a case of biliary drainage with a double bypass biliodigestive construction, which could be performed in patients with unresectable cancer in the head of the pancreas presenting with obstructive jaundice and gastric outlet obstruction. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) presents in one of three patterns: sporadic colorectal cancer in those without a family history (65-85%); those with a family history (familial CRC) 10-25% ofcases; inherited CRC accounting for less of 10% cases and presents as well-characterized cancer predisposition syndromes including Lynch syndrome (hereditary non-polyposis colorectal cancer/HNPCC) which comprises about 1-5% of all colorectal cancer, and multiple polyps CRC, which includes familial adenomatous polyposis (FAP, 1 %), rare CRC syndrome < 0.1 %). Many efforts have been made to discover the genetic and molecular features of CRC, and there is more evidence that these features determine the prognosis and response to treatment. Colorectal cancer (CRC) is a heterogeneous disease, with three known major molecular groups. The most common is the chromosomal instability group, characterized by an accumulation of mutations in specific oncogens and tumor suppressor genes. The second is the microsatellite instability group, caused by the dysfunction of DNA mismatch repair genes leading to genetic hypermutability. The CpG island methylation phenotype (CIMP) is the third group, distinguished by hypermethylation. In this review we would like to provide an up-to-date overview of molecular genetic aspects of CRC that are currently important and should guide clinical practice in colorectal cancer in the diagnosis and selection of therapy. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI) and hepatobiliary disorders are the most common complaints in patients with HIV/AIDS disease. These fundamental problems have not yet been addressed and remains a rewarding area for research. Data about the problems are scarce, especially in Indonesia. This study was aimed to identify gastrointestinal problems in HIV/AIDS patients who were hospitalized in Adam Malik Hospital, Medan. Method: A descriptive study was conducted based on medical records data from non-ambulatory HIV/AIDS patients who had GI problems and who were hospitalized in Internal Medicine wards of Adam Malik Hospital, Medan from 2010-2012. Spearman rank test was used to evaluate the correlation between CD4 level and GI problems among 68 patients with CD4 data. Results: We found 647 HIV/AIDS patients, i.e. 524 (80.9%) male and 123 (19.1%) female patients. Gastrointestinal problems were found in 315 (48.7%) patient among them. Oral candidiasis was the most common case found in 306 (97.1%), which was followed by chronic diarrhea 73 (23.2%), oral candidiasis with chronic diarrhea 64 (20.3%), dyspepsia 22 (6.9%), non-cirrhotic ascites 20 (6.3%), acute diarrhea 8 (2.5%), hepatomegaly 8 (2.5%), dysphagia 6 (1.9%), chronic hepatitis C virus 6 (1.9%), chronic hepatitis B virus 4 (1.3%), GI bleeding 3 (0.9%), and acute hepatitis A virus 1 (0.3%). Unfortunately, we found that there was only 68 data of CD4. Results of statistical tests showed a significant correlation between CD4 level and gastrointestinal problems (p = 0.04). Conclusion: Oral candidiasis is the most common gastrointestinal problems in HIV/AIDS patients hospitalized in Internal Medicine Wards of Adam Malik Hospital. [ABSTRACT FROM AUTHOR]

Introduction : Hepatocellular carcinoma (HCC) is a leading global cause of cancer-related deaths. Thermal ablation techniques, especially radiofrequency ablation (RFA) and microwave ablation (MWA), have become pivotal treatments for HCC. This systematic review and meta-analysis aim to compare these modalities, highlighting their efficacy, strengths, and limitations in treating HCC. Methods : A comprehensive literature search was conducted across major databases (PubMed, MEDLINE, Springer, ProQuest, EBSCOhost, Cochrane, and EMBASE) targeting studies on hepatocellular carcinoma with RFA and MWA. Heterogeneity analyses and pooled outcomes using random-effect models with were evaluated to compare both thermal ablation methods. Results : Nine studies, which consists of 368 patients underwent RFA and 387 patients underwent MWA, were included in review. The findings showed no significant differences in pooled analysis of volume of ablation, complete ablation rate, local tumor progression, survival rates, major complications, and adverse events. Subgroup analysis showed significantly higher risk of local tumor progression in RFA in African populations. Conclusion : No statistically significant difference was seen between outcomes across studies. MWA may offer a potential for longer therapeutic response with comparable risk of complications and adverse outcomes., (© 2024 Imelda Rey et al., published by Sciendo.)

Backgroud: Immune impairment, marked by increased expression of cytotoxic T lymphocyte antigen (CTLA)-4, promotes the disease progression of chronic hepatitis B., Objective: This study aimed to determine the association between serum CTLA-4 level and disease progression in patients with chronic hepatitis B., Methods: A cross-sectional study was conducted at Haji Adam Malik General Hospital Medan, Indonesia between October 2021 to September 2022. A total of 150 participants were enrolled. Patients aged 18 years or older with evidence of chronic hepatitis B, HBV-related liver cirrhosis, and HBV-related hepatocellular carcinoma (HCC) were enrolled. Exclusion criteria were history of chronic hepatotoxic drug consumption, underlying liver abnormalities other than HBV infection, and liver injury due to metastasized malignancy from other sites. Serum CTLA-4 level was determined from serum using human CTLA-4 enzyme linked immunosorbent assay kit., Results: Most participants were males and aged between 40 and 60 years. Serum CTLA-4 level was positively associated with chronic hepatitis B progression (P<0.001). Serum CTLA-4 level was negatively correlated with serum platelet (P<0.001) and albumin levels (P<0.001) but positively correlated with serum ALT (P=0.045) and total bilirubin levels (P<0.001)., Conclusions: Serum CTLA-4 level is associated with disease progression in patients with chronic hepatitis B., Competing Interests: authors declare that there are no conflicts of interest., (© 2023 Darmadi Darmadi, Dharma Lindarto, Jelita Siregar, Tri Widyawati, Muhammad Rusda, Mustafa Mahmud Amin, Fauzi Yusuf, Putri Chairani Eyanoer, Masrul Lubis, Imelda Rey.)

Aim To investigate CD133 expression and its relationship to clinicopathological profile in colorectal cancer (CRC) patients. Methods This cross-sectional study was performed at the Internal Medicine Department, School of Medicine, Adam Malik General Hospital. The colorectal cancer tissue was taken from surgical resection and colonoscopy biopsy from CRC patients. Clinical profile was obtained by a questionnaire. Histopathology examination was done using hematoxylin and eosin staining. Immunohistochemistry (distribution score and intensity score) combined with ROC analysis were conducted to determine CD133 expression. An association between CD133 expression and clinicopathological profile was then analyzed. Results Out of 118 patients, 690 (58.5%) were male. The high and low level of CD133 expression were found in 44 (37.3%) and 74 (62.7%) patients, respectively. No difference between gender, age, body mass index, hemoglobin, leucocytes, platelets, and histopathology with CD133 expression was found. There was a significant difference between CD133 and different CRC locations (p=0.002). CD133 expression was higher in the proximal colon than the rectum (p=0.002), and it was higher in the distal colon than the rectum (p=0.008), especially in terms of percentages of stained cancer cells (distribution score). Conclusion CD133 expression was associated with the tumour location, but not with other clinicopathological factors., (Copyright© by the Medical Assotiation of Zenica-Doboj Canton.)