Noninvasive diagnosis of left ventricular outflow tract obstruction caused by a porcine mitral prosthesis

A patient developed shortness of breath 8 years after mitral valve replacement with a porcine prosthesis. Doppler echocardiography revealed left ventricular outflow tract obstruction created by a protruding prosthesis

Diagnosis and surveillance of Barrett’s esophagus (BE)

Sp. Cl “Sf. Maria”, Clinica de Chirurgie Generală și Esofagiană, București, România, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: EB este o afecțiune ce apare în urma refluxului gastro-esofagian cronic și care este factor de risc în apariția adenocarcinomului esofagian. Scop: evaluarea metodelor de diagnostic și de urmărire a pacienților cu EB. Metoda: În perioada 2006-2010, 36 de pacienți au fost diagnosticați cu EB prin Endoscopie Digestivă Superioară (EDS) cu biopsie. S-a folosit manometria esofagiană și pH-metria pe 24 ore pentru evaluarea răspunsului la tratament. Pacienții au primit 3-6 luni tratament medical. În urma lipsei de răspuns sau a complianței la tratamentul medical s-a efectuat tratament chirurgical. Pacienții au fost supravegheați conform protocoalelor. Rezultate: EDS a diagnosticat 15 pacienți fără leziuni asociate, 8 cu esofagită grd.A-C, 8 cu hernie hiatală asociată, 2 cu ulcer esofagian și 3 cu reflux biliar. Sfinterul esofagian inferior (SEI) incompetent și pH-metrie modificată au fost decelate la 3, respectiv 4 din pacienții fără leziuni asociate, la 5 din cei cu esofagită și la 8, respectiv 7 din cei cu hernie hiatală. Examenul histologic a decelat 2 pacienți cu displazie low-grade. După tratamentul medical sau chirurgical s-a obținut ameliorarea simptomatologiei și vindecarea leziunilor de esofagită. După fundoplicatura, parametrii pH-metrici și manometrici au revenit la normal, iar după Diversie Duodenala Totală s-a observat absența refluxului biliar esofagian. Concluzii: Diagnosticul și supravegherea pacienților cu esofag Barrett sunt foarte importante datorită riscului de evoluție către adenocarcinom.Introduction: BE is a disease induced by chronic gastro-esophageal reflux and is a risk factor for the development of esophageal adenocarcinoma. Aim: to evaluate the methods of diagnosis and follow-up of the patients with BEMethods: Between 2006 and 2010, 36 patients were diagnosed with BE using Upper Endoscopy (UE) with multiple biopsies. We used esophageal manometry and 24 hours pH-metry for assessing the outcome. The patients received initially for 3-6 month medical treatment. When lacking response or compliance at drug therapy, the surgical treatment was applied. The patient’s follow-up was made according to protocols.Results: The UE diagnosed 15 patients with no associated findings, 8 had grd.A-C esophagitis, 8 had hiatal hernia, 2 had esophageal ulcer and 3 presented biliar reflux. The lower esophageal sphincter (LES) was incompetent and the pH-metry was abnormal in 3, respective 4 of patients with no associated findings, in 5 of those with esophagitis and in 8, respective 7 of those with hiatal hernia. The histological exam finds 2 patients with low-grade dysplasia. The improvement of symptomatology and the healing of esophagitis were noticed after medical treatment and in all patients surgically treated. After fundoplication, the pH-metric and manometric values restored to normal and after total duodenal diversion no more biliary reflux was noticed. Conclusions: The diagnosis and surveillance of Barrett’s esophagus are very important due to the risk of development of adenocarcinoma

Extension of adrenocortical carcinoma into the right atrium – echocardiographic diagnosis: A case report

BACKGROUND: Adrenocortical carcinoma is a rare, highly malignant tumor. Cardiac involvement of the tumor is very rare. Echocardiography facilitates the evaluation of the cardiac involvement of the tumor. CASE PRESENTATION: We describe a patient with an adrenal tumor. Transthoracic echo showed its extension into the right atrium. Accordingly, a combined abdominal and cardiac operation was performed, monitored by transesophageal echocardiography. CONCLUSION: This case highlights the importance of echocardiography in revealing the cardiac involvement by this tumor and in planning the operative procedure

Towards screening Barrett’s Oesophagus: current guidelines, imaging modalities and future developments

Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials