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ABSTRACT: Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of innumerable small discrete nodules involving a variable segment of the gastrointestinal tract. The association between nodular lymphoid hyperplasia and other benign and malignant diseases has been clearly described, with an increased risk of gastrointestinal tumours, namely gastrointestinal lymphoma. However, the association with extraintestinal lymphoma seems extremely rare. The authors present a clinical case of a patient with nodular lymphoid hyperplasia of the small and large intestine that subsequently developed an extraintestinal lymphoma (diffuse large B-cell lymphoma).
Acta gastro-enterologica Belgica 06/2012; 75(2):260-2. · 0.64 Impact Factor
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ABSTRACT: capsule endoscopy (CE) has revolutionized the study of small bowel. One major drawback of this technique is that we cannot interfere with image acquisition process. Therefore, the development of new software tools that could modify the images and increase both detection and diagnosis of small-bowel lesions would be very useful. The Flexible Spectral Imaging Color Enhancement (FICE) that allows for virtual chromoendoscopy is one of these software tools.
to evaluate the reproducibility and diagnostic accuracy of the FICE system in CE.
this prospective study involved 20 patients. First, four physicians interpreted 150 static FICE images and the overall agreement between them was determined using the Fleiss Kappa Test. Second, two experienced gastroenterologists, blinded to each other results, analyzed the complete 20 video streams. One interpreted conventional capsule videos and the other, the CE-FICE videos at setting 2. All findings were reported, regardless of their clinical value. Non-concordant findings between both interpretations were analyzed by a consensus panel of four gastroenterologists who reached a final result (positive or negative finding).
in the first arm of the study the overall concordance between the four gastroenterologists was substantial (0.650). In the second arm, the conventional mode identified 75 findings and the CE-FICE mode 95. The CE-FICE mode did not miss any lesions identified by the conventional mode and allowed the identification of a higher number of angiodysplasias (35 vs 32), and erosions (41 vs. 24).
there is reproducibility for the interpretation of CE-FICE images between different observers experienced in conventional CE. The use of virtual chromoendoscopy in CE seems to increase its diagnostic accuracy by highlighting small bowel erosions and angiodysplasias that weren´t identified by the conventional mode.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 05/2012; 104(5):231-6. · 1.55 Impact Factor
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ABSTRACT: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level.
evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding.
we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively.
with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleeding lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy´s lesion (n = 2), bleeding from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively.
intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 04/2012; 104(4):190-6. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 09/2010; 102(9):563-5. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 05/2010; 102(5):341-2. · 1.55 Impact Factor
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ABSTRACT: Capsule endoscopy (CE) can be prevented by difficulties in swallowing the device and/or its gastric retention. In such cases, endoscopic delivery of the capsule to duodenum is very useful. We describe the indications and outcomes of cases in which traditional endoscopic techniques allowed placement of the capsule in duodenum.
This is a retrospective, descriptive case series. All patients in the above conditions were identified and indications for CE, endoscopic-placement technique, complications and completeness of small bowel imaging were registered.
Endoscopic-assisted delivery of the capsule was necessary in 13 patients (2.1% of all CE; 7 males; mean age--47.9 +/- 24.9 years, range 13 to 79 years). Indications for endoscopic delivery included: inability to swallow the capsule (7), gastric retention in previous exams (3), abnormal upper gastrointestinal anatomy (3). In eight patients, the capsule was introduced in GI tract with: foreign body retrieval net alone (3), retrieval net and a translucent cap (2), prototype delivery device (2) or a polypectomy snare (1). Five patients ingested the capsule that was then placed in duodenum with a polypectomy snare (3) or a retrieval net (2). No major complications occurred. Complete small bowel examination was possible in 10 patients (77%).
Endoscopic placement of capsule endoscope in the duodenum is rarely needed. However it may be safely performed by different techniques avoiding some limitations of CE. The best methods for endoscopic delivery of the capsule in the duodenum seem to be retrieval net with a translucent cap when the patient is unable to swallow the device or a retrieval net only to capture the capsule in the stomach when the patients swallows it easily.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 01/2009; 100(12):758-63. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 12/2008; 100(11):731-3. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 05/2007; 99(4):233-4. · 1.55 Impact Factor
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ABSTRACT: Acute liver failure is rarely secondary to lymphoma or leukaemia and it is extremely uncommon as the initial presentation of malignancy. We report a case of a young adult patient with severe acute liver failure referred for liver transplant, in which a Burkitt acute lymphoblastic leukaemia was diagnosed by bone marrow examination. A complete recovery and long remission were obtained with chemotherapy.
European Journal of Gastroenterology & Hepatology 12/1997; 9(11):1113-5. · 1.76 Impact Factor
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Endoscopy 06/1995; 27(4):346. · 5.21 Impact Factor
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D de Freitas,
M Urbano,
M H Goulao,
M M Donato,
C Baldaia,
M I Martins,
P Souto,
C Gregorio, P Figueiredo,
H Gouveia,
J M Romaozinho
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ABSTRACT: Helicobacter pylori (Hp) may affect the normal balance between gastric epithelial cell proliferation and epithelial cell death, interfering thus with the maintenance of gastric mucosa integrity. The aim of this study was to investigate the effect of Hp infection on cell proliferation index (PI) and apoptotic index (AI) in gastric epithelium of the antrum and corpus.
Prospective study in forty-one patients with functional dyspepsia (14 males, 27 females, average age = 54+/-16.1 years). Day one: upper digestive endoscopy with biopsies of the antrum and corpus, and a cytological smear of the antral area for AgNOR (argyrophilic nucleolar organizer region) analysis. Biopsies for the programmed tests were sent in separate labeled containers: to study AI (antibody anti-M30), PI (antibody anti-Ki 67) and histology (Sydney criteria and the detection of Hp). Detection of the AgNORs through the Giménez-Mas et al. technique, using Visilog-Microptic Software. Day two: a blood sample was drawn from each patient for the serologic detection of the status CagA and VacA, and a breath test was carried out with 13C-Urea. Statistics: SPSS program with the application of Student's t, chi-square and Fisher tests.
24 patients were Hp(+) and 17 Hp(-). The PI (Ki 67 and AgNORs) in the antral area was significantly increased in the Hp(+) patients. AI showed no significant difference in the subgroups Hp(+) and Hp(-). Both subgroups showed increased PI in the antrum and increased AI in the gastric corpus. There was significantly higher PI in CagA(+), without an increase in the AI. The AI was significantly higher in CagA(-), when compared with CagA(+). The VacA protein had no influence on PI and AI. Acute and chronic gastritis was more frequent and more severe in Hp(+) patients. This group lacked any correlation between the histological findings and the PI, but the opposite was the case between AI and the degree of cellular infiltration.
In patients with functional dyspepsia, Hp infection induces an increase of PI, with significant presence in the antrum area, without the corresponding increase in AI. Cag A(+) promotes the increase of PI, and Cag A(-) promotes the increase of AI. The Vac A status has no influence on the PI or AI. The degree of cellular infiltration interferes with AI.
Hepato-gastroenterology 51(57):876-82. · 0.66 Impact Factor
