Isolated Gastric Varices in Lymphoma
Bibliographic record
Abstract
Purpose: A 48 year old man with bipolar disorder was recently treated with clozapine. He was admitted to the hospital with pancytopenia and an episode of coffee ground emesis. Upper endoscopy showed patchy erythematous folds in the gastric fundus without evidence of bleeding. He received blood transfusions and was treated with a proton pump inhibitor. Clozapine was discontinued and hematology evaluation was in progress. A month later, he developed massive hematemesis, melena, and hypotension. Emergency upper endoscopy revealed actively bleeding vascular lesion in the gastric fundus (Fig. 1). Bleeding was controlled with hemoclips application, intravenous proton pump inhibitor, and Sandostatin. Repeat upper endoscopy the next day clearly demonstrated isolated varices in the gastric fundus (Figure 2). Computerized tomography of the abdomen showed a large splenic mass invading the capsule medially and encasing hilar vasculature. The next day, the patient underwent splenectomy with distal pancreatectomy. Pathology showed Large B-cell lymphoma involving the spleen and the pancreas with extracapsular and peripancreatic extension. Patient is receiving chemotherapy consisting of rituximab, cyclophosphamide, vincristine, prednisone, and doxorubicin. Conclusion: This case illustrates the dramatic and rapid development of isolated gastric varices in conditions that induce splenic vein thrombosis. These conditions include chronic pancreatitis, acute pancreatitis, pancreatic carcinoma, hypercoagulable states, trauma, and lymphoma as seen in this patient. Splenectomy is necessary to control the ensuing life threatening upper gastrointestinal bleeding in addition to specific therapy to the underlying disease.[figure1][figure2]FigureFigure
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".