5 research outputs found
Endoscopic faces of Helicobacter Pylori infection
Introduction: The infection caused by H. pylori appears secondary after a bacterial
colonization of the stomach and the initial portion of the small bowel. H. pylori –infected patients
can develop gastritis, peptic ulcer, stomach cancer or MALT lymphoma. H. pylori infection is
defined by WHO like a type I carcinogen, its role in gastric carcinogenesis being supported by the
greatest researchers.
Objectives: In this study our purpose was to determine the endoscopic appearances in H. pylori
infection quoted in medical literature until now and the frequency of their appearance in our
group of interest.
Materials and methods: In this study it was made an analytic study in which it was realized a
retrospective cohort investigation at the Emergency Central Military and University Hospital “Dr.
Carol Davila” Bucharest, gastroenterology branch –endoscopic department between 18.12.2012-
21.08.2013 on 1694 patients between 18 and 92 years old, with the medium age of 55 years old.
As a diagnostic method for H. pylori infection we used superior digestive endoscopy during which
were taken biopsies and it was made a fast urease test.
Results: Regarding the variation of the endoscopic aspects at the population of study, we have
found gastritis with all its aspects (which was Sidney classified) in the biggest percentage meaning
59.3% of the cases, followed with a percentage of 18.8% by those without any endoscopic
abnormality, and then in 10,33% of the cases we have found peptic ulcer. With a smaller
percentage, under 10%, we have found duodenitis at 8.67% of this patients, and finally the most
severe lesions represented by gastric cancer and lymphoma were found at 2,7% of the H.pylori
infected patients
Diagnostic and treatment difficulties in insulinomas
Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and
relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types.
Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases.
Introduction: Insulinomas are localized preoperatively using conventional imaging studies as
transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance
imaging (MRI).
Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas.
Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and
15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012
at “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest.
Results: US view was positive in 10% of patients (2 of 20), that presented proximal location. The
sensitivity of CT was unsatisfactory, 21.05% (4 positive results of 19). CT failed to detect liver
metastases, but identified nodal metastasis in one patient. MRI was performed in 18 patients and
was diagnostic in 11 of them, recording a detection sensitivity of 61.11%, including infracentimetric
tumor size. EUS has a high resolution which allows detection of lesions with very small
diameter is safe and minimally invasive. EUS was performed in all patients, being able to identify
formations in 17, was inconclusive in 3, showing a diagnosis sensitivity of 81%. Liver metastases
were demonstrated in 3 patients, one by US and all 3 by MRI.
Conclusions:
- CT with intravenous iodinated contrast agent had a poor sensitivity in detecting the primary
tumors, was insensitive in detecting liver metastases, but showed metastases in lymph nodes.
- MRI has higher sensitivity than CT in detecting primary tumors, including insulinomas with
infracentimetric size, and is the imaging test of choice for possible liver metastases.
- EUS is the preoperative imaging test of choice