Short Term Outcomes of Using Fecal Immunochemical Test for a Pilot Colorectal Cancer Screening Program. A Single Center Study on 3024 Consecutive Patients.

Background: In Romania, colorectal cancer does not benefit yet from a national screening program. In order to decrease the harm and burden of colorectal cancer (CRC), opportunistic programs relying on endoscopy has been adopted by each centre according to its capacity. A colorectal cancer (CRC) screening programme based on faecal immunochemical test (FIT) was launched at Ponderas Academic Hospital (PAH) in 2019. Aim: The present study analyses the outcomes after the first 1500 tests in the PAH-FIT-CRC Screening Program. We have also aimed to compare the efficiency of the FIT testing program with the screening colonoscopies performed in our Center, withing the same time interval (2019). Methods: The test was recommended in asymptomatic patients over 45 years, and it was followed by a colonoscopy when the test results were positive. Furthermore, we performed a retrospective observational study gathering data from all the consecutive patients prospectively included in the respective databases of our hospital, comparing the efficacy of the two colorectal cancer screening methods (FIT versus colonoscopy). Results: Between 01.01.2019 and 01.01.2020, 1524 screening colonoscopies were performed, and the resulting data were compared with those obtained in the FIT group (1500 FIT tests freely distributed). In the screening colonoscopy group, the polyp detection rate was 38.98% and 22 (1.44%) adenocarcinomas were identified. In the FIT group, the FIT uptake rate was 71% with a positivity rate of 21.7%. The colonoscopy compliance rate for positive FIT patients was 29.4%, with only 2 adenocarcinomas detected. Conclusions: Following data analysis, the need for improvement of uptake rate and colonoscopy compliance rate was suggested, due to the lower acceptance of FIT tests and colonoscopies, especially among men. Moreover, special efforts should be made in order to improve quality indicators for screening colonoscopies (especially adenoma detection rate) with the purpose of decreasing interval CRC.

Symptomatic Stenosis after Laparoscopic Sleeve Gastrectomy - Incidence and Management in a High-Volume Bariatric Surgery Center.

Background: Owing to the increased use of laparoscopic sleeve gastrectomy (LSG) as a metabolic procedure, a rarely associated complication, the Symptomatic Stenosis (SS) will be more often encounter. The objective of this study is to establish a safe and effective management of SS after LSG. Methods: We have analyzed all the patients with SS after LSG treated in Ponderas Academic Hospital from 2011 to 2018. The information was retrospectively extracted from a prospectively maintained database. Laparoscopy and/or endoscopy were used to treat the organic or functional SS. The procedure's outcomes (effectiveness and complications) were analyzed. Results: Out of the 4304 patients with LSG 47 (1.1%) patients were identified with SS after LSG. The incidence is depending on the LSG technique. Other 4 patients referred to our center have been added. Surgery was the first choice in 9 cases with only 33.3% success rate. For the 46 patients referred to endoscopy there have been 79 pneumatic dilation with an average of 1.7+- 1.1 per patient. We have encountered 1 perforation but any hemorrhage or death. Follow-up rate was 93.5%. Over all, the success rate of endoscopic dilatations was 90.7%. Conclusion: The incidence of SS is low. Endoscopic pneumatic dilation is a safe and effective procedure and should be the front line choice in the management of SS after LSG.

The riddle of the right ventricle.

Right ventricular (RV) myxoma is a very rare finding. Its differential diagnosis includes cardiac thrombus, and its risk of life-threatening complications mandates early diagnosis followed by surgical resection. We report the case of a patient with an incidental RV mass and a difficult differential diagnosis. A 66-year-old woman, first assessed in neurosurgery due to a lumbar herniated disc, was referred to cardiology for examination before proceeding to surgery. She complained of dyspnea on exertion present for the last few months and reported no fainting or syncope. Clinical examination showed intermittent pulmonary systolic murmur. Transthoracic echocardiography revealed an oval-shaped sessile mobile mass (42∕18 mm) attached to the anterior RV wall. Computed tomography confirmed the presence of a RV mass with lower attenuation than the myocardium and extension towards the pulmonary trunk, without other abdominal or pulmonary masses that would suggest a thrombus. Cardiac magnetic resonance imaging described an ovoid mass (47∕16 mm) in the right ventricle, "clinging" to the apical trabeculae, swinging during the cardiac cycle, causing partial obstruction of the pulmonary valve during systole. The patient underwent surgical resection of the tumor. Macroscopic specimen showed a translucent polypoid mass with hemorrhagic areas. Microscopy confirmed the diagnosis of RV myxoma. The case illustrates the difficulty of establishing the correct etiological diagnosis of a cardiac mass, especially when located in the right ventricle. Multimodality imaging remains the cornerstone of noninvasive tissue characterization of cardiac masses, still requiring histopathological confirmation, particularly in the setting of conflicting imaging results.

A rare cause of Dysphagia - Dysphagia aortica - complicated with intravascular disseminated coagulopathy.

ABSTRACT: Dysphagia aortica is an uncommon condition defined by the difficulty in swallowing caused by extrinsic compression of the esophagus due to an ectatic, tortuous, or aneurysmatic atherosclerotic thoracic aorta. We report the case of a 93 year old woman with dysphagia secondary to extrinsic compression by a giant sacciform aneurysm of the descending thoracic aorta. As a consequence of small liniar dissection tracts of the aneurysm, the patient developed disseminated intravascular coagulopathy with spontaneous forearm hematoma and multiple bruising, a clinical setting with a difficult therapeutic approach. Taking into account that aneurysm of the thoracic aorta is a very rare cause of dysphagia, the case report on this rare cause should contribute to better diagnosis of dysphagia aortica and swallowing difficulties in general. Dissecting aneurysm of the thoracic aorta is a very rare cause of DIC so the combination of easy bruising or spontaneous hematoma and an aortic aneurysm demands special caution.