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Syphilis
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
The anti-mercurialists, who recognized mercury for the poison that it was, put forth an alternative: guaiacum. The powdered wood of the guaiacum tree was first championed by the German scholar Ulrich von Hutten (1488–1523) in his De morbo gallico (1519), which was an account of his own experience with the French Sickness and his treatment with the imported wood. Guaiacum (or guaiac) came from Hispaniola, where the local population found the material effective, according to eyewitnesses such as the aforementioned Oviedo. Like mercury, guaiac had laxative and sweat-inducing properties but did not cause severe salivation. Still, the treatment protocol was even more brutal, involving severe diarrhea, residence in a hot room for a biblical 40 days, and strict fasting for that same time.53
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
Tell me briefly about the NHS Colorectal Screening Programme.Bowel cancer screening started in England in 2006 for 60–69-year olds on a biennial basis, using guaiac faecal occult testsThis has now been expanded to 60–74 years old in England, although screening starts at the age of 50 in Scotland.The guaiac test has largely been superseded by faecal immunochemical tests (FIT) which are at least as sensitive as guaiac-based tests and identify precursors of colorectal cancer earlier, have higher uptake and detect human haemoglobin. (FIT replaced guaiac testing in England in 2018.)Bowel scope is a new screening test in addition to faecal occults tests and invites all 55-year-old men and women for a one-off flexible sigmoidoscopy.If positive patients are reviewed in a screening clinic and consented regarding the risks and benefits of a colonoscopy to reach a definitive diagnosis.
The Large Bowel and the Anal Canal
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The stools guaiac test is relatively simple and inexpensive. It has an overall positivity of about 2%. Of these, 15 to 30% will have colorectal polyps or cancers, usually in an early stage.26 This technique tests a large number of the population, at low cost, for occult blood, then evaluates them for potential colorectal cancers. The disadvantages include a high false negative rate — which can be as high as 30% for invasive carcinoma and 60% for benign polyps — and a high false positive rate. However, controlled clinical trials are now on the way to find out if such an approach can reduce the mortality rate from colorectal cancer in the screened population. Digital rectal examination is good in detecting tumors at mid-rectum or below. Colonoscopy is ideal but is it expensive, has low yield in screening, and has poor compliance from the population.
Advances in tests for colorectal cancer screening and diagnosis
Published in Expert Review of Molecular Diagnostics, 2022
Sarah Cheuk Hei Chan, Jessie Qiaoyi Liang
One of the well-established methods of CRC screening is to detect the presence of hemoglobin in stool using fecal occult blood tests, namely guaiac fecal occult blood test (gFOBT) and FIT [40]. gFOBT makes use of the reaction between heme and hydrogen peroxide, which produces a color change to indicate the results, while FIT utilizes the binding of globin in hemoglobin with antibodies [41]. Substances in fruits and vegetables can mimic heme and cause the chemical reaction to be falsely positive in gFOBT. Because of the difference in testing mechanism, no dietary or medication restrictions are required when performing FIT. Together with fewer samples to be collected, these features result in higher patient compliance for FIT [42]. In addition, FIT has a higher sensitivity and cost-effectiveness compared to gFOBT [43–45]. With regard to its superiority to gFOBT, FIT is recommended by the US multi-society Task Force on Colorectal Cancer for CRC screening [42].
Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis
Published in Baylor University Medical Center Proceedings, 2022
Colten Watson, Mazen Hassan, Grant Breeland
Upon admission, the patient’s skin was highly jaundiced with a measured bilirubin of 43.8 mg/dL and a blood pressure of 104/50 mm Hg. Acute diffuse abdominal pain was present on palpation. Some shortness of breath was noted with rhonchi and abdominal distention. A rectal exam was guaiac positive and showed occult blood. His hemoglobin was 6.3 g/dL, resulting in the immediate transfusion of 4 units of packed red blood cells on his first day of admission. His total bilirubin of 43.8 mg/dL was fractionated, and direct bilirubin measured 32.7 mg/dL. The blood bank laboratory tests also had several findings; an antibody screen was positive and was confirmed with a direct Coombs test. The lab then discovered a warm agglutinin IgG antibody through a direct antiglobulin test. Other notable laboratory data included a lipase level of 390 U/L, elevated lactate dehydrogenase, decreased haptoglobin, and 1+ schistocytes (Supplemental Table).
Rosai-Dorfman disease in a symptomatic elderly man
Published in Baylor University Medical Center Proceedings, 2022
Gaurav Synghal, Risha Bhavan, Sharad K. Jain, Umesh D. Oza
An 81-year-old man presented to a hematologist with fatigue, a 10-pound weight loss, and laboratory findings suggesting anemia of chronic disease with elevated ferritin, decreased total iron binding capacity, decreased iron, and a low-normal iron percent saturation. The patient had multiple negative stool guaiac tests to rule out underlying colon carcinoma. He was started on iron and B12 supplementation, and a bone marrow biopsy showed a normocellular marrow with trilineage hematopoiesis. At the same time, the patient visited his urologist due to persistent urinary tract infections; computed tomography (CT) showed large retroperitoneal lymphadenopathy and soft tissue density infiltrating the kidneys (Figure 1a, 1b). Additional workup revealed an enlarged 3.8 cm supraclavicular lymph node amenable to surgical excision. Upon histopathologic and immunohistochemical evaluation, the lymph node demonstrated marked sinus histiocytosis with co-expression of S100 and CD68, suggesting RDD. Next-generation sequencing demonstrated no targetable mutations, 5% positive PD-L1 expression, and lack of PDGFRA expression. Positron emission tomography (PET)/CT helped evaluate the full extent of the patient’s disease burden (Figure 1c). The patient was started on corticosteroids with subsequent symptomatic improvement, stable hemoglobin, and improving adenopathy over the course of 12 months of follow-up.