[Carcinoid syndrome in neuroendocrine tumors--not easy to recognize].

Neuroendocrine tumors (NET) are solid potentially malignant tumors originated from the diffuse neuroendocrine system. They could origin in many organs, with highest prevalence in lungs, small intestine and rectum. Characteristics of NET are slow growth, non-specific clinical presentation causing diagnostic problems. Thus, in majority of patients diagnosis is established in the metastatic phase of the disease. Hopefully, there are new and very potent treatment options capable to successfully control the disease. Clinical presentation cause local tumor growth or para-neoplastic syndrome. Secretory active tumors produce peptides or hormones causing different clinical syndromes. In most cases NET cause carcinoid syndrome. It is often misinterpreted, because similar symptoms are present in more prevalent disorders. Symptoms are not specific and include flashing, diarrhea, abdominal pain, right heart disease, bronchoconstriction ... and to establish the right diagnosis medical doctor have to think about NET as a possibility. Thus, it is very important to recognize symptoms and signs of the carcinoid syndrome, and distinguish them from other gastrointestinal disorders. Early diagnosis and treatment have significant impact in control of the disease, and overall treatment results.

Decompressive tube jejunogastrostomy after esophagectomy for carcinoma.

BACKGROUND/AIMS: Gastric distension after esophagectomy and reconstruction with gastric conduit can promote both pulmonary complications and conduit ischaemia. The aim of this paper is to present a method of retrograde transjejunal decompression, with special emphasis on surgical technique and specific technique-related complications. METHODOLOGY: In the period from January 2005 to December 2008 we prospectively evaluated 95 patients who underwent esophagectomy for carcinoma. In all of these patients decompressive jejunogastrostomy was employed. RESULTS: There was no peritonitis or re-operation due to the decompressive tube placement, the most common complication that occurred was cellulitis and it was present in 7 patients. Decompressive tube was usefull in preventing postoperative gastric conduit distension. No patient complained of discomfort due to the jejunogastric tube placement. Postoperative pneumonia developed in 8 patients (8.4%). CONCLUSIONS: We believe that the usage of jejunogastric tube decompression during the open esophagectomy is a safe, simple and useful technique, which improves postoperative recovery, and possibly reduces respiratory complications.