Dupinder Singh

Resolution of Isolated, Aspergillus Colonization in a Deep Esophageal Ulcer in an Immunocompetent Patient with Ulcer Healing Without Specific Antifungal Therapy

Isolated gastrointestinal (GI) aspergillosis is relatively rare with only 18 previously reported cases, and in all these cases, the Aspergillus infection was invasive and occurred in immunosuppressed patients (Table 1; [1–11]). A case is reported of isolated, superficial, Aspergillus GI infection with novel features including: (1) Aspergillus colonizing a deep esophageal ulcer without tissue invasion, (2) this colonization occurring in an immunocompetent patient, and (3) resolution of the colonization with antiulcer therapy without antifungal therapy. Methods

PIB: A Score to Select Sorafenib Treatment Candidates for Hepatocellular Carcinoma in Resource-Limited Settings

James S Leathers1,*, Domingo Balderramo2, Jhon Prieto3, Fernando Diehl2, Esteban Gonzalez-Ballerga4, Melina R. Ferreiro4, Enrique Carrera5, Fernando Barreyro6, Javier DiazFerrer7, Dupinder Singh8, Angelo Z. Mattos9, Flair Carrilho10, and Jose D. Debes8,** 1School of Medicine, Vanderbilt University, Nashville, USA 2Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina

Percutaneous transhepatic cholangioscopy with intraductal electrohydraulic lithotripsy for management of choledocholithiasis in an inaccessible papilla

An 81-year-old woman with a history of hypertension, hyperlipidemia, and dementia presented with nausea and vomiting; CT of the abdomen suggested gastric outlet obstruction from a soft-tissue mass at the level of the duodenum (Fig. 1). Upper endoscopy confirmed a malignant-appearing stricture in the second portion of the duodenum, which did not permit the passage of a pediatric gastroscope. The patient underwent exploratory laparotomy, which confirmed a well-differentiated duodenal adenocarcinoma, and she received a palliative surgical gastrojejunostomy. Her course was complicated by obstructive jaundice secondary to multiple bile duct stones. Owing to the inaccessibility of her papilla, she underwent percutaneous

Biliary Ascariasis Diagnosed and Extracted by ERCP in the United States

A 53-year-old female Bangladeshi immigrant to the United States, status post uncomplicated laparoscopic cholecystectomy without sphincterotomy 6 months earlier for cholelithiasis, presented with colicky abdominal pain for 6 weeks. Physical examination revealed a soft, non-tender abdomen, and esophagogastroduodenoscopy revealed no endoscopic abnormalities. Laboratory testing revealed leukocytes 16,100/mm with no eosinophilia, serum alkaline phosphatase 321 U/L, aspartate aminotransferase 428 U/L, alanine aminotransferase 232 U/L, total bilirubin 1.5 mg/dL, and lipase 30 U/L. Abdominal ultrasound revealed a 9-mm choledochus containing long, parallel segments of non-shadowing echogenic material, initially thought to represent choledochal sludge (Figure 1). Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed only mild extrahepatic biliary dilatation, attributed to prior cholecystectomy.