55-year-old woman, with no particular pathological history, hospitalized for the exploration of moderate ascites evolving for 4 months, associated with peripheral polyarthralgia of the elbows, wrists and knees. The patient had pallor of the skin with the signs of malnutrition and multiple non-necrotic ulcerations without inflammatory signs next to the lateral surfaces of the two lower limbs (Figure 1). There was no sign of right heart failure, no transit disorder and the lymph node areas were sain.

The Hemoglobin Level was 8.5g/dL and C-reactive protein (CRP) 52mg/L. The patient had a hyboalbuminemia at 19mg/L, hypocalcemia at 66mg/L with the prothrombin count at 55%, proteinuria of 24hours was negative. The results of ascites puncture reveals à protein level of 22.5 g/l with an albumin gradient of 7.7g/l, 150 leukocytes/mm 3 including 55% of lymphocytes. Abdominal ultrasound showed a steatotic homogeneous liver with no detectable nodular lesion with a very abundant peritoneal effusion visible in the peri-hepatic, peri-splenic, inter-handle and pelvic floor, with finely echogenic content.

Background: Relapse of adenocarcinoma of  ampulla of Vater (CAV) and its presentation after surgery continues to be a main issue and its patterns is unknown in our population.

Objectives: To describe the relapse patterns after radical surgery and to identify the associated risk factors in a mexican population at a Tertiary Care Center.

Methods: Retrospective Study. Patients with CAV who underwent surgery from January 2016 to December of 2020. Relapse: demonstrable disease by means of radiological studies after 3 months of surgery. Main outcomes: patterns of relapse and associated clinical and pathological factors.

Results: 72 patients CAV included. Relapse developed in 50% (36), 21 men (58.3%), mean age 60 years (range, 56.9 to 63), 18 in clinical stage III (50%), the procedure mostly performed: Traverso 29 (80.6%), the mean procedure duration: 353 minutes and surgical mortality 9.7%. Pancreatic fistula 33.3 % of relapse. CAV relapse: Regional lymph node 19.4%, liver metastasis 52.8%, lung metastasis 27.8%. Mean survival in each relapse pattern: pulmonary metastasis 27.5 months, liver metastasis 25.4 months and lymph nodes metastasis 23.6 months with P=0.002 (95% CI). Mean survival for local relapse 23.6 months and for distant relapse 25.9 months (95%, CI), P=0.29. Identified pancreatic fistula as independent risk factor associated with relapse (HR=2.4, 1.16-4.96, P=0.02).

Conclusions: Relapse patterns: liver (52.8%), pulmonar (27.8%) and regional lymph nodes (19.4%) of which regional lymph node relapse seems to have the worst survival prognosis. Pancreatic fistula was related to relapse and survival deterioration. Local or systemic recurrence have similar prognosis.

Vascular lesions of the gastrointestinal (GI) tract include arterio-venous deformations as angiodysplasia and Dieulafoy's lesion, venous ectasias (multiple phlebectasias and haemorroids), telangiectasia’s which can be associated with heritable hemorrhagic teleangiectasia (HHT), Turner's pattern and systemic sclerosis, hemangiomas’, angiosarcoma's and diseases of connective towel affecting blood vessels as pseudoxanthoma elasticum and Ehlers-Danlos's complaint. As a group, they're fairly rare lesions that still may be a major source of upper and lower gastrointestinal bleeding.

ABSTRACT:

One of the least studied motifs in the field of obstetrics is liver complaint during gestation, which creates a challenge for both gynecologists and hepatologists. Roughly 3 of pregnant women are affected by some form of liver complaint during gestation. Some of these conditions can be fatal for both the mama and child. In addition, 3 types of liver complaints need to be discerned during gestation. One type is liver complaint directly related to gestation, which can do at a specific time during gestation. Another type is a liver complaint not related to gestation, which can do at any time, similar to viral-or medicine- convinced hepatitis. Likewise, gestation can do in women with pre-existing liver complaints. It's essential that the clinicians are familiar with this complaint so they can respond instantly and appropriately in all of these situations, especially when emergency delivery is demanded and must not be held up.

ABSTRACT

Health care- associated infections (HCAIs) are infections that do while entering health care, developed in a sanitarium or other health care installation that first appear 48 hours or further after sanitarium admission, or within 30 days after having entered health care. Multiple studies indicate that the common types of adverse events affecting rehabilitated cases are adverse medicine events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million rehabilitated cases annually acquire HCAIs while being treated for other health issues and that further than cases (one in 17) die due to these. Several studies suggest that simple infection- control procedures similar as drawing hands with an alcohol- grounded hand irk can help help HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to help the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.