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Gastric carcinoid in a patient infected with Helicobacter pylori:A new entity?

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World Journal of Gastroenterology 2011年第25期17卷 3066-3068页

作者： Pantelis Antonodimitrakis Apostolos Tsolakis Staffan Welin Gordana Kozlovacki Kjell berg Dan Granberg department of Medical Sciences Division of Endocrine OncologyUniversity Hospital of Uppsala

There are four types of gastric carcinoid tumors, classified according to their histology and malignant potential. Only a few cases of carcinoid tumors in patients infected with Helicobacter pylori （H. pylor/） have been reported so far. We report a patient infected with H. pylori presenting with a small solitary gastric carcinoid tumor with very low proliferative rate and normal gas- trin levels. The tumor was endoscopically removed and the patient received an eradication therapy against H. pylori. No signs of metastatic disease have been found so far during more than 3 year of follow-up. Infection with H. pylori may cause chronic gastritis with normal or elevated gastrin levels, leading to the develop- ment of gastric carcinoids by mechanisms unrelated to gastrin. Enterochromaffin-like cell tumors related to a chronic H. pylori infection may be considered as a distinct type of gastric carcinoid tumors.

关键词： Gastric carcinoids Gastrin Gastritis Heli-cobacter pylori

Disturbance of hepatic and intestinal microcirculation in experimental liver cirrhosis

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World Journal of Gastroenterology 2005年第6期11卷 846-849页

作者： Sasa-Marcel Maksan Eduard Ryschich Zilfi (U|¨)lger Martha Maria Gebhard Jan Schmidt department of surgery

AIM: To analyze hepatic, mesenteric and mucosal microcirculation and leukocyte-endothelium interaction (LEI) in a rat model with liver ***: Hepatic cirrhosis was induced in Wistar rats by gavage with carbon tetrachloride, and intravital videomicroscopy was performed in liver, mesentery and small intestine mucosa. Special emphasis is given on microcirculatory and morphometric changes during cirrhotic portal ***: LEI was influenced significantly in the cirrhotic liver but not in the gut. Blood flow measurement showed significant differences among liver, main mesenteric vessels and the mucosa. The results of our study indicate that liver cirrhosis leads to alterations in hepatic and mesenteric blood flow but not in mucosal blood ***: The enhanced inflammatory response in hepatic microvessels may be caused by a decrease of antithrombin Ⅲ levels and could be responsible for disturbances of organ pathology.

关键词： Liver cirrhosis Microcirculation Small intestine Liver

Utility of fusion CT-PET in the diagnosis of small pancreatic carcinoma

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World Journal of Gastroenterology 2005年第24期11卷 3800-3802页

作者： Brian Kim-Poh Goh Yu-Meng Tan Yaw-Fui Alexander Chung department of surgery

Pancreatic carcinoma has a poor prognosis and early detection is essential for potentially curative resection. Despite the wide array of diagnostic tools, preoperative detection of small pancreatic carcinomas remains difficult. We report a case of small pancreatic carcinoma of the head of pancreas with indeterminate findings on US, ERCP, MRI and EUS which was successfully diagnosed via fusion CT-PET. This case illustrates the utility of CT-PET in the diagnosis of patients with small pancreatic carcinoma with equivocal findings on conventional diagnostic modalities.

关键词： Pancreatic carcinoma Positron emission tomography Diagnosis

Gastrointestinal bezoars: A retrospective analysis of 34 cases

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World Journal of Gastroenterology 2005年第12期11卷 1813-1817页

作者： Kenan Erzurumlu Zafer Malazgirt Ahmet Bektas Adem Dervisoglu Cafer Polat Gokhan Senyurek Ibrahim Yetim Kayhan Ozkan department of surgery

AIM: Bezoars (BZ) are the most common foreign bodies of gastrointestinal tract. Clinical manifestations vary depending on the location of BZ from no symptoms to acute abdominal syndrome. When located in small bowel, they frequently cause small bowel obstruction (SBO). We aimed to present our experience by reviewing ***: Thirty-four patients with gastrointestinal BZ were presented. The data were collected from hospital records and analyzed retrospectively. Morbidity and mortality rates were statistically analyzed between the subgroups according to SBO and endoscopic or surgical treatment ***: The 34 patients had phytobezoars (PBZ). Two patients with mental retardation and trichotillomania had trichobezoars (TBZ). More than half of them (55.88%) had previous gastric surgery. Also most of them had small bowel bezoars resulting in obstruction. Surgical and endoscopic morbidity rates were 32.14% and 14.28% *** total morbidity rate of this study was 29.41%. Four patients in surgically treated group died. There was no death in endoscopically treated group. The total and surgical mortality rates were 11.76% and 14.28% respectively. The differences in morbidity and mortality rates between the subgroups were not statistically ***: BZ are commonly seen in stomach and small intestine. SBO is the most common *** uncomplicated, endoscopic or surgical removal can be applied easily.

关键词： Bezoars Phytobezoar Trichobezoar

Improvement of gastric emptying by enhanced recovery after pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2016年第2期15卷 198-208页

作者： Efstratios Zouros Theodoros Liakakos Anastasios Machairas Paulos Patapis Christos Agalianos Christos Dervenis department of surgery "Konstantopouleio" General Hospital First department of surgery Laiko University Hospital Third department of surgery Attikon University Hospital

BACKGROUND： Enhanced recovery after surgery（ERAS） has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on postoperative outcomes in patients undergoing pancreaticoduodenectomy. METHODS： Fifty patients who had received conventional peri operative management from 2005 to 2009（conventional group）were compared with 75 patients who had received perioperative care with an ERAS protocol（fast-track group） from 2010 to2014. Mortality, complications, readmissions and length of hospital stay were evaluated and compared in the ***： Compliance with each element of the ERAS pro tocol ranged from 74.7% to 100%. Uneventful patients had a significant higher adherence to the ERAS protocol（87.5% vs40.7%; P〈0.001）. There were no significant differences in de mographics and perioperative characteristics between the two groups. Patients in the fast-track group had a shorter time to remove the nasogastric tube, start liquid diet and solid food pass flatus and stools, and remove drains. No difference was found in mortality, relaparotomy, readmission rates and over all morbidity. However, delayed gastric emptying and length of hospital stay were significantly reduced in the fast-track group. The independent effect of the ERAS protocol in reduc ing delayed gastric emptying and length of hospital stay was confirmed by multivariate ***： ERAS pathway was feasible and safe in improving gastric emptying, yielding an earlier postoperative recovery, and reducing the length of hospital stay.

关键词： fast-track delayed gastric emptying compliance length of hospital stay morbidity

Patients with Helicobacter pylori positive and negative duodenal ulcers have distinct clinical characteristics

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World Journal of Gastroenterology 2005年第23期11卷 3518-3522页

作者： Kent-Man Chu Ka-Fai Kwok Simon Law Kam-Ho Wong department of surgery

AIM: To assess the clinical characteristics of Helicobacterpylori(H pylori) negative duodenal ***: Patients with an endoscopic diagnosis of duodenal ulcer between 1996 and 2002 were included in the present study. Patients were considered to be negative for Hpylori, if both histological examination and rapid urease test of biopsy specimens were negative. A comparison was made between patients with H pyloripositive and negative duodenal ***: A total of 1 343 patients were studied. Their mean age was 54.7±0.5 years. There was a male preponderance (M:F = 2.5:1). Three hundred and ninetyeight patients (29.6%) did not have H pylori infection. The annual proportion of patients with H pylori negative duodenal ulcers increased progressively from 1996 to2002. On multivariate analysis, patients with H pylorinegative duodenal ulcer were more likely to be older, have concomitant medical problem, pre-existing malignancy, recent surgery, underlying sepsis, or taken non-steroidal anti-inflammatory drugs. In terms of clinical presentations, patients with H pylori negative duodenal ulcer were more likely to present with bleeding, multiple ulcers and larger ***: The proportion of patients with H pylori negative duodenal ulcers is on the rise because of a continued drop in incidence of H pylori positive duodenalulcers in recent years. Such patients have distinct clinical characteristics and it is important to ascertain the H pylori status before starting eradication therapy.

关键词： Helicobacter pylori Duodenal ulcer

Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation

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World Journal of Gastroenterology 2005年第24期11卷 3742-3745页

作者： Hok-Kwok Choi Wai-Lun Law Judy Wai-Chu Ho Kin-Wah Chu department of surgery

AIM: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed. METHODS: Patients with adhesive small bowel obstruction were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 h had conservative treatment continued. Patients who showed no improvement in the initial 48 h were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 h were regarded as having partial obstruction and conservative treatment was continued. Patients in which the contrast failed to reach large bowel within 24 h were considered to have complete obstruction and laparotomy was performed. RESULTS: Two hundred and twelve patients with 245 episodes of adhesive obstruction were included. Fifteen patients were operated on soon after admission due to fear of strangulation. One hundred and eighty-six episodes of obstruction showed improvement in the initial 48 h and conservative treatment was continued. Two patients had subsequent operations because of persistent obstruction. Forty-four episodes of obstruction showed no improvement within 48 h and gastrografin was administered. Seven patients underwent complete obstruction surgery. Partial obstruction was demonstrated in 37 other cases, obstruction resolved subsequently in all of them except one patient who required laparotomy because of persistent obstruction. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin. CONCLUSION: The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative

关键词： Gastrografin Adhesions Intestinal obstruction

Metastatic liver cancer: A rare case

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World Journal of Gastroenterology 2005年第27期11卷 4281-4284页

作者： Bong-Wan Kim Hee-Jung Wang In-Ho Jeong Sang-Ick Ahn Myoung-Wook Kim department of surgery

Hemangioperioltoma is a rare tumor especially when it rises in the peritoneal cavity. We present a case of a 60-year-old woman with an isolated recurrent hemangiopericytoma of the liver. The patient presented with a palpable right upper quadrant abdominal mass, which occurred 7 years after undergoing resection of a malignant hemangiopericytoma arising from the greater omentum. She had not followed up 6 mo after surgery. Various imaging studies showed a single large, well-capsulated liver tumor with central necrosis, accompanied by hypervascularity typical of a vascular tumor. Preoperative laboratory HBsAg and anti-HCV workup were both negative. Under the impression of recurrent malignant hemangiopericytoma, right trisegmentectomy was performed to completely resect the tumor. Pathological examination confirmed the diagnosis of recurrent hemangiopericytoma. Even though the incidence of the hemangiopericytoma is relatively low, malignant hemangiopericytoma has a tendency to recur frequently after a long-term disease-free interval. Also, the recurrent hemangiopericytoma is not easily detected early during follow-up until it becomes symptomatic because there are no specific tumor markers, and because of the diversity with regard to site of recurrence. The authors suggest that Positron Emission Tomogram （PET） may be a useful tool for the detection of recurrent hemangioperioltoma. We describe herein some characteristics and behaviors of malignant hemangiopericytoma, particularly after surgical resection.

关键词： Hemangiopericytoma Greater omentum Hepatic metastasis Follow-up Positron emission tomography

Value of two-phase dynamic multidetector computed tomography in differential diagnosis of post-inflammatory strictures from esophageal cancer

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World Journal of Gastroenterology 2015年第29期21卷 8878-8887页

作者： Grigory G Karmazanovsky Svetlana A Buryakina Evgeny V Kondratiev Qin Yang Dmitry V Ruchkin Dmitry V Kalinin department of Radiology Vishnevsky Institute of Surgery department of Thoracic surgery (Esophageal surgery group) Vishnevsky Institute of Surgery department of Pathomorphology Vishnevsky Institute of Surgery

AIM: To characterize the computed tomography(CT) findings in patients with post-inflammatory esophageal strictures(corrosive and peptic) and reveal the optimal scanning phase protocols for distinguishing postinflammatory esophageal stricture and esophageal ***: Sixty-five patients with esophageal strictures of different etiology were included in this study: 24 patients with 27 histopathologically confirmed corrosive strictures, 10 patients with 12 peptic strictures and 31 patients with esophageal cancer were evaluated with a two-phase dynamic contrast-enhanced MDCT. Arterial and venous phases at 10 and 35 s after the attenuation of 200 HU were obtained at the descending aorta, with a delayed phase at 6-8 min after the start of injection of contrast media. For qualitative analysis, CT scans of benign strictures were reviewed for the presence/absence of the following features: "target sign", luminal mass, homogeneity of contrast medium uptake, concentric wall thickening, conically shapedsuprastenotic dilatation, smooth boundaries of stenosis and smooth mucous membrane at the transition to stenosis, which were compared with a control group of 31 patients who had esophageal cancer. The quantitative analysis included densitometric parameter acquisition using regions-of-interest measurement of the zone of stenosis and normal esophageal wall and the difference between those measurements(ΔCT) at all phases of bolus contrast enhancement. Esophageal wall thickening, length of esophageal wall thickening and size of the regional lymph nodes were also evaluated. RESULTS: The presence of a concentric esophageal wall, conically shaped suprastenotic dilatation, smooth upper and lower boundaries, "target sign" and smooth mucous membrane at the transition to stenosis were suggestive of a benign cause, with sensitivities of 92.31%, 87.17%, 94.87%, 76.92% and 82.05%, respectively, and specificities of 70.96%, 89.66%, 80.65%, 96.77% and 93.55%, respectively. The features that

关键词： Multidetector computed tomography Esophageal cancer Corrosive stricture Peptic stricture