Gastritis cystica profunda mimicking a GIST - A diagnostic challenge / Gastritis cystica profunda simulando GIST - un caso de desafío diagnóstico

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The Role of Routine Upper Gastrointestinal Endoscopy Before Bariatric Surgery.

BACKGROUND: Obesity remains a major health concern for which surgery has proven to be the most effective treatment in the long term. Routine upper gastrointestinal endoscopy (UGE) is recommended before surgery, but few studies have evaluated its impact on postoperative complications. METHODS: We studied a cohort of 613 patients submitted to UGE before being listed for bariatric surgery between May 2004 and May 2015. A logistic regression analysis was performed to evaluate potential predictors of postoperative complications. RESULTS: Three hundred forty-five patients (56.3 %) presented abnormal endoscopic findings. Helicobacter pylori (Hp) was the strongest predictor of an abnormal endoscopy (OR 10.343, 95 % CI [3.970-26.943], p < 0.001). Of the 342 patients who underwent surgery, 43 (12.6%) developed a postsurgical complication and 2 (0.6%) patients died. In regression analysis, endoscopic ulceration was the only predictor of postoperative complications (OR 11.10, 95 % CI [1.80-68.467], p = 0.01). All patients with gastroduodenal ulcers were infected with Hp. CONCLUSIONS: UGE before bariatric surgery can identify a wide range of abnormal findings. Gastric and duodenal ulcers appear to be the major findings associated with postoperative complications. Routine Hp eradication may potentially reduce the risk of postoperative complications and should be attempted in all patients before surgery.

Three decades of hepatitis B control with vaccination.

Hepatitis B virus (HBV) continues to represent a major health problem and can lead to acute liver failure, acute hepatitis, chronic carriership, chronic hepatitis of HBV, liver cirrhosis, liver cancer, liver transplantation and death. There is a marked difference in the geographic distribution of carriers. More than 240 million people worldwide are chronic HBV carriers. Mother-to-child transmission remains the most important mechanism of infection in countries with a high prevalence of HBV. Percutaneous/parenteral transmission and unsafe sexual practices are important mode of spread transmission of HBV in other countries. Vaccination against HBV is the gold measure for primary prevention and control of the disease. Currently, 179 countries have added HBV vaccination to their routine vaccination programs with great results. Neonatal immunization with HBV vaccine has been one of the most highly effective measures in public health and the first anti-cancer program to be launched. In this paper we review the achievements for the last three decades.

Role of endoscopy after an acute episode of diverticulitis: analysis of a cohort of Portuguese patients from a tertiary referral center.

INTRODUCTION: Acute diverticulitis represents an inflammatory process originating in a colonic diverticulum. Although acute diverticulitis usually follows a benign course - uncomplicated diverticulitis (UCD), up to 25% may develop complicated diverticulitis (CD) including abscesses, fistulas, strictures, and perforation. Current guidelines recommend performing colonoscopy after an episode of acute diverticulitis to rule out colorectal cancer (CRC). However, the literature supporting this recommendation is still scarce. AIM AND METHODS: Our aim was to assess the relevance of endoscopy following an acute diverticulitis. Using a large cohort from a tertiary center, we retrospectively evaluated endoscopic and histologic findings in patients with acute diverticulitis confirmed by abdominal ultrasound or computed tomography. Findings were characterized as (a) normal endoscopy (highlighting only the presence of diverticula), (b) abnormal endoscopy with low-grade lesions, and (c) abnormal endoscopy with high-grade lesions. RESULTS: A total of 427 patients were evaluated, including 347 cases with UCD and 80 cases with CD. The prevalence of normal findings at endoscopy was 67.3%. An advanced adenoma or neoplasm was found in 23.7%. The estimated number of endoscopies required for diagnosing a CRC was 29 in UCD and 10 in CD. Increasing age and male sex were associated significantly with the presence of polyps at endoscopy. Increasing age was associated with CD and cancer. CONCLUSION: In our series, the prevalence of high-grade lesions and CRC was higher than that in other studies. In our opinion, the findings justify endoscopic evaluation, especially in older patients with CD.

Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients.

BACKGROUND: Biliary leaks have been treated with endoscopic management using different techniques with conflicting results. Furthermore the appropriate rescue therapy for refractory leaks has not been established. We evaluated the clinical effectiveness of initial endotherapy for postcholecystectomy biliary leaks using an homogenous approach (sphincterotomy + placement of a 10-French plastic stent) in a large series of patients as well as the optimal and efficacy of rescue endotherapy for refractory biliary leaks. METHODS: This was a multicenter, retrospective study of 178 patients who underwent endoscopic management of postcholecystectomy biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore (10-French) plastic stent. Data were collected to analyze the clinical outcomes and technical success, efficacy of the rescue endotherapy and the need for surgery, adverse events and prognostic factors for clinical success of endotherapy. RESULTS: Following endotherapy, closure of the leak was accomplished in 162/178 patients (91.0%). The multivariate logistic model showed that the type of leak, namely a high-grade biliary leak, was the only independent prognostic factor associated with treatment failure (OR = 26.78; 95% CI = 6.59-108.83; P < 0.01). The remaining 16 patients were treated with multiple plastic stents (MPSs) with a success rate of 62.5% (10 patients). The use of fewer than 3 plastic stents (P = 0.023) and a high-grade biliary leak (P = 0.034) were shown to be significant predictors of treatment failure with MPSs in refractory bile leaks. The 6 patients in whom the placement of MPSs failed were retreated with a fully cover self-expandable metallic stent (FCSEMS), resulting in closure of the leak in all cases. CONCLUSIONS: Endotherapy of biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore plastic stent is associated with a high rate of success (90%). However in our series there were several failures using MPSs as a strategy for rescue endotherapy suggesting that refractory biliary leaks should be treated with FCSEMS especially in patients with high-grade leaks.

Myeloid sarcoma of gastrointestinal tract: a rare cause of obstruction

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A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos).

BACKGROUND: Endoscopic management of postcholecystectomy biliary leaks is widely accepted as the treatment of choice. However, refractory biliary leaks after a combination of biliary sphincterotomy and the placement of a large-bore (10F) plastic stent can occur, and the optimal rescue endotherapy for this situation is unclear. OBJECTIVE: To compare the clinical effectiveness of the use of a fully covered self-expandable metal stent (FCSEMS) with the placement of multiple plastic stents (MPS) for the treatment of postcholecystectomy refractory biliary leaks. DESIGN: Prospective study. SETTING: Two tertiary-care referral academic centers and one general district hospital. PATIENTS: Forty consecutive patients with refractory biliary leaks who underwent endoscopic management. INTERVENTIONS: Temporary placement of MPS (n = 20) or FCSEMSs (n = 20). MAIN OUTCOME MEASUREMENTS: Clinical outcomes of endotherapy as well as the technical success, adverse events, need for reinterventions, and prognostic factors for clinical success. RESULTS: Endotherapy was possible in all patients. After endotherapy, closure of the leak was accomplished in 13 patients (65%) who received MPS and in 20 patients (100%) who received FCSEMSs (P = .004). The Kaplan-Meier (log-rank) leak-free survival analysis showed a statistically significant difference between the 2 patient populations (χ(2) [1] = 8.30; P < .01) in favor of the FCSEMS group. Use of <3 plastic stents (P = .024), a plastic stent diameter <20F (P = .006), and a high-grade biliary leak (P = .015) were shown to be significant predictors of treatment failure with MPS. The 7 patients in whom placement of MPS failed were retreated with FCSEMSs, resulting in closure of the leaks in all cases. LIMITATIONS: Non-randomized design. CONCLUSION: In our series, the results of the temporary placement of FCSEMSs for postcholecystectomy refractory biliary leaks were superior to those from the use of MPS. A randomized study is needed to confirm our results before further recommendations.

Comportamento agregativo, preferência por sítio de repouso e variações diurnas de atividade em Bulimulus tenuissimus (d'Orbigny, 1835) (Mollusca, Bulimulidae) no Laboratório / Basic ethogram, aggregative behavior and preference for site rest in Bulimulus tenuissimus (d'Orbigny, 1835) (Mollusca, Bulimulidae) in laboratory conditions

O comportamento de moluscos terrestres é pouco estudado, apesar de representar uma ferramenta importante para a conservação ou controle desses animais. Desse modo, objetivou-se descrever o etograma básico de Bulimulus tenuissimus, verificar a ocorrência de comportamento agregativo e preferência por sítio de repouso. Para descrição do etograma, observaram-se grupos de 15 moluscos durante 24 horas, através do método de varredura a intervalos de 10 minutos. Para verificação do comportamento agregativo, outros 50 animais foram divididos em grupos de 10 e acondicionados em terrários plásticos previamente divididos em quadrantes. A agregação foi estabelecida pelo número de moluscos/quadrante, e a preferência por sítio de repouso, pelo número de moluscos em posições pré-determinadas. Confirmou-se o hábito noturno da espécie, sendo os atos comportamentais explorar e alimentar-se os mais frequentes. Não se observou a existência de comportamento agregativo, e a parede do terrário foi o sítio de repouso mais utilizado pelos moluscos.

The behavior of land snails is few studied, although it represents an important tool for conservation or control of such animals. Thus, it was aimed to describe the basic ethogram of Bulimulus tenuissimus, verify occurrence of aggregative behavior and preference for site rest. To describe the ethogram, groups of 15 snails was observed for 24 hours by the scanning method at intervals of 10 minutes. To verify the aggregative behavior, other 50 animals were divided into groups of 10 animals and kept in plastic terrariums previously divided into quarters. Aggregation was established by the number of snails/quadrant and the preference for site rest, by the number of snails in pre-determined positions. It was confirmed the nocturnal habits of this species, and the most frequents acts behavioral were explore and food. It wasn't observed aggregative behavior and the terrarium's wall was the site rest most often used by snails.

Comportamento agregativo, preferência por sítio de repouso e variações diurnas de atividade em Bulimulus tenuissimus (d'Orbigny, 1835) (Mollusca, Bulimulidae) no Laboratório / Basic ethogram, aggregative behavior and preference for site rest in Bulimulus tenuissimus (d'Orbigny, 1835) (Mollusca, Bulimulidae) in laboratory conditions

O comportamento de moluscos terrestres é pouco estudado, apesar de representar uma ferramenta importante para a conservação ou controle desses animais. Desse modo, objetivou-se descrever o etograma básico de Bulimulus tenuissimus, verificar a ocorrência de comportamento agregativo e preferência por sítio de repouso. Para descrição do etograma, observaram-se grupos de 15 moluscos durante 24 horas, através do método de varredura a intervalos de 10 minutos. Para verificação do comportamento agregativo, outros 50 animais foram divididos em grupos de 10 e acondicionados em terrários plásticos previamente divididos em quadrantes. A agregação foi estabelecida pelo número de moluscos/quadrante, e a preferência por sítio de repouso, pelo número de moluscos em posições pré-determinadas. Confirmou-se o hábito noturno da espécie, sendo os atos comportamentais explorar e alimentar-se os mais frequentes. Não se observou a existência de comportamento agregativo, e a parede do terrário foi o sítio de repouso mais utilizado pelos moluscos.(AU)

The behavior of land snails is few studied, although it represents an important tool for conservation or control of such animals. Thus, it was aimed to describe the basic ethogram of Bulimulus tenuissimus, verify occurrence of aggregative behavior and preference for site rest. To describe the ethogram, groups of 15 snails was observed for 24 hours by the scanning method at intervals of 10 minutes. To verify the aggregative behavior, other 50 animals were divided into groups of 10 animals and kept in plastic terrariums previously divided into quarters. Aggregation was established by the number of snails/quadrant and the preference for site rest, by the number of snails in pre-determined positions. It was confirmed the nocturnal habits of this species, and the most frequents acts behavioral were explore and food. It wasn't observed aggregative behavior and the terrarium's wall was the site rest most often used by snails.(AU)

Life history of the land snail Habroconus semenlini (Stylommatophora: Euconulidae) under laboratory conditions

Habroconus semenlini is a micro-terrestrial gastropod native to South America. There are no previous studies on its biology. We studied its pattern of growth, fertility and lifespan under laboratory conditions. For this purpose, 80 snails were either grouped or kept isolated (40 animals in each condition) during their lifetime. Growth is indeterminate and the species is capable of self-fertilization with high reproductive success. Grouped snails had lower fecundity than the animals that were kept in isolation. This species has a short lifespan and only one reproductive period, which characterizes the occurrence of semelparity. Rev. Biol. Trop. 57 (4): 1217-1222. Epub 2009 December 01.

Habroconus semenlini es un gastrópodo micro-terrestre nativo de América del Sur. Actualmente se carece de estudios sobre su biología. Este estudio tuvo como objetivo verificar el patrón de crecimiento, la fecundidad y la esperanza de vida de esta especie en condiciones de laboratorio. Con este fin, 80 caracoles fueron mantenidos aislados o agrupados (40 animales en cada condición) durante su ciclo de vida. La especie tiene crecimiento indeterminado y es capaz de auto-fertilización con alto grado de éxito reproductivo. Los caracoles agrupados tuvieron menor fecundidad que los que se mantuvieron en aislamiento. Esta especie tiene una vida útil corta, y sólo un período reproductivo, lo que caracteriza la semelparidad.

Life history of the land snail Habroconus semenlini (Stylommatophora: Euconulidae) under laboratory conditions.

Habroconus semenlini is a micro-terrestrial gastropod native to South America. There are no previous studies on its biology. We studied its pattern of growth, fertility and lifespan under laboratory conditions. For this purpose, 80 snails were either grouped or kept isolated (40 animals in each condition) during their lifetime. Growth is indeterminate and the species is capable of self-fertilization with high reproductive success. Grouped snails had lower fecundity than the animals that were kept in isolation. This species has a short lifespan and only one reproductive period, which characterizes the occurrence of semelparity.