Bariatric surgery represents one of the most efficient treatments addressing obesity and its associated complications with an increasing trend. Even if the medical benefits for patients are huge, due to weight loss and despite technical improvements in bariatric procedures, it is still associated with diverse types of complications. Most of the complications appear due to nutrient deficiency, as absorption is compromised after surgical anatomy modification. Neurological complications after bariatric surgery are very diverse with an occurrence within days to years after surgery, most frequently in patients with gastrointestinal or surgical complications. Any segment of the nervous system can be affected with distinct types of manifestations ranging from peripheral axonal neuropathy, nerve palsy secondary to compartment syndrome, encephalopathy, and myelopathy, to psychiatric and demyelinating central nervous system diseases. Identifying patients at risk and systematic screening for nutrient deficiency with proper supplementation is essential for preventing neurological complications and lifelong sequelae. In this paper, we present the spectrum of neurological complications reported after bariatric surgery.
Colorectal cancer is the third most common cancer worldwide and represents a significant major public health issue. Therefore, the interest in detecting the multiple factors implied in the development of cancer has increased recently. One of the factors could be the Helicobacter pylori infection, but a direct causal connection is missing. This gram-negative bacterium infects approximately 4 billion individuals globally and various conditions such as gastroduodenal ulcers or gastric adenocarcinomas can be induced by it. Some of the reported carcinogenic effects of Helicobacter pylori bacterium are hypergastrinemia, chronic inflammation, dysbiosis, and toxin production. Each of these elements involved in the pathogenesis has various mechanisms of action. Dysbiosis can occur due to various treatments for the eradication of the Helicobacter pylori infection. This bacterium also has a proinflammatory effect at the gastric level which can predispose to the development of dysplasia or even neoplasia. The toxins produced by this bacterium, such as the vacuolating cytotoxin A, promote inflammation. In this review, we discuss the possible connections between the Helicobacter pylori infection, through its diverse pathogenic mechanisms, and colorectal neoplasm. Prospective studies are necessary to determine whether there certainly is a direct link between the two conditions.
Gynecologic cancers are among the most common cancers in women and are a significant cause of mortality in women worldwide. FDG-PET images play a critical role in several areas of oncology and are an essential tool for the diagnosis and staging of gynecologic cancer, providing information about tumor metabolism. Aim: The aim of this study was to investigate the relationship between tumor differentiation, type of malignancy, and glucose metabolism in patients with confirmed gynecologic cancer. Materials and Methods We performed a retrospective review of 60 consecutive patients (ages 31-76) with histopathologically confirmed gynecologic cancer who underwent PET-CT in our department between January 2021 and March 2022. Quantitative data on glucose metabolism were collected using the maximum standardized uptake value normalized by lean body mass (SULmax). We reviewed a total of 60 patients with a mean age of 60±9 years, and a median of 62. Results: 14 patients were diagnosed with cervical cancer, 20 with endometrial cancer, and 26 with ovarian cancer; 13 patients had well- differentiated cancer, 11 had moderately differentiated cancer, and 36 had poorly differentiated cancer. A positive correlation was observed between the measured SULmax and the degree of tumor differentiation, indicating higher glucose uptake in poorly differentiated cancer. When examining the relationship between the type of cancer and SULmax, we found that endometrial cancer exhibited the highest mean SULmax (8.36±6.75), followed by ovarian cancer and cervical cancer. Additionally, we noted that glucose uptake was higher in patients aged over 62 years. Regardless of the tumor differentiation, the findings in endometrial cancer showed the highest mean SUVmax values in all grades of tumor differentiation. Conclusion: Our study showed that glucose consumption correlates not only with the degree of differentiation but also with age and type of tumor, with the highest values in patients older than 62 years with endometrial cancer. Given the correlation between glucose consumption and tumor aggressiveness, this finding may be important for prognostic evaluation of patients with gynecologic malignancies.
Cardiovascular-kidney-metabolic (CKM) syndrome describes the complex, bidirectional interplay among cardiovascular, renal, and metabolic dysfunctions, where impairment in one system accelerates decline in the others. This interconnected pathophysiology significantly elevates the risk and progression of heart disease, particularly heart failure, through mechanisms involving insulin resistance, systemic inflammation, neurohormonal activation, and endothelial dysfunction. In this context, therapeutic strategies targeting heart disease must address the multifaceted drivers of CKM. Recent advances highlight the need for an integrated, patient-centered approach that combines lifestyle interventions with pharmacological treatments tailored to individual cardiovascular risk. While foundational therapies such as RAAS inhibitors and statins remain essential, novel agents now offer additional prognostic and quality-of-life benefits. SGLT2 inhibitors have emerged as a cornerstone therapy, improving outcomes in heart failure with both preserved and reduced ejection fraction, independent of glycemic control. GLP-1 receptor agonists and dual GLP-1/GIP agonists like tirzepatide demonstrate cardiometabolic and renal protection, while finerenone shows promise in diabetic kidney disease and several heart failure phenotypes. These therapies not only target glycemic control but also reduce cardiovascular mortality, hospitalizations, and renal decline. Optimizing cardiovascular outcomes in CKM syndrome requires early, multifactorial therapeutic intervention, informed by evolving evidence and a deeper understanding of the heart–kidney–metabolism axis.
Laparoscopic sleeve gastrectomy (LSG) is becoming popular between the bariatric procedures. There are few studies available in the literature about LSG impact on esophageal motility, with debatable results. Technically, it modifies the anatomy of the esophago-gastric junction; it can damage the phreno-esophageal ligament and decrease the lower esophageal sphincter pressure that will predispose to reflux. Gastroesophageal reflux disease (GERD) is already common in obese patients due to frequent hiatal hernia, high intraabdominal pressure, increased transient lower esophageal sphincter relaxations (TLESR), altered esophageal motility and poor esophageal clearance. LSG can worsen gastroesophageal reflux disease, but also the weight loss achieved after it and the decrease of acid production in the small gastric pouch will probably reduce the GERD symptoms. Dysphagia and odynophagia were reported after sleeve gastrectomy, but usually associated with anatomical narrowing of the gastric sleeve, caused by esophageal dismotility or secondary to diabetes mellitus, low tiamine level, the use of opioids and non-steroidal anti-inflammatory drugs, even hypothyroidism. In addition to upper GI tract endoscopy, high-resolution esophageal manometry (HRM) should be required for all patients planning to undergo a LSG, and in the follow-up period according to the contractility pattern.
Background and aim: Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir in association with ribavirin was the only interferon-free regimen available in 2015 in Romania for compensated HCV cirrhosis. The aim of our study is to reveal our experience with interferon-free therapy in compensated HCV cirrhosis. Materials and methods: We conducted a multicenter prospective study including 90 patients with compensated (Child-Pugh A) HCV cirrhosis treated with Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir and Ribavirin regimen for twelve weeks. The HCV infection was diagnosed using clinical, biological, and FibroMax tests. Each patient had follow-up visits at four, eight, twelve and twenty-four weeks after the initiation of the treatment. Results: 44 (49% of) patients were female and 46 (51 % of) were male. The mean age of patients in the study was 61 years old. All the patients had HCV genotype 1b infection. 22 patients were naive and 68 had previous antiviral therapies based on pegylated IFN-α and ribavirin. At the initiation of treatment 64 (71%) of patients had cytolysis, 38 (42%) had thrombocytopenia, 19 (21%) patients had hyperbilirubinemia and 11 (12%) patients had anemia. It was noticed a decreasing of cytolysis, only 10% of 64 patients still having cytolysis after four weeks of treatment. One patient (1%) died after four weeks of treatment by complications of cirrhosis. 89 (99%) of patients had a virologic response (VR) at the end of treatment (EOT) and sustained virologic response (SVR) twelve weeks after the last dose administration. Conclusion: The most common side effect among the patients in the study group was anemia (47% cases). Cytolysis disappeared after four weeks of treatment in 61% of patients. The interferon-free combination treatment was safe and highly effective in compensated HCV cirrhosis.
Gastric antral vascular ectasia (GAVE) is an important cause of gastro-intestinal bleeding. The most common clinical presentation of GAVE is chronic occult bleeding that leads to symptomatic iron deficiency anemia, but some cases could present with acute massive bleeding. Frequently, patients are dependent by iron suplimentation, or in severe cases even blood transfusions. Endoscopic therapy is frequently necessary in acute or chronic blood loss. Over the past several years, treatment for GAVE has continued to evolve as the number of available effective therapeutic interventions has increased. These included: YAG laser, argon plasma coagulation (APC), endoscopic band ligation, cryotherapy and surgical anterectomy. Argon plasma coagulation is the most commonly used technique, but has been associated with several complications like sepsis, post-APC bleeding, gastric outlet obstruction and increased incidence of hyperplastic polyps. Endoscopic band ligation (EBL), a mechanical procedure, has been reported in the past years as an effective salvage therapy for GAVE that is refractory to other approaches, or even as the first line treatment. We present a case of nodular GAVE treated succesfully with endoscopic band ligation after unsuccesufull sessions with argon plasma coagulation.
Colorectal cancer prevalence is increasing worldwide. Modifiable risk factors are responsible for almost 50 % of cases and this could imply a huge potential of preventability. Among these factors the level of physical activity is of paramount importance. Physical activity has a positive impact on health status in general and it decreases the prevalence of various cancers including colorectal cancer. Physical activity decreases the prevalence of benign colorectal adenomas and it prolongs the disease free interval after surgery in colorectal cancer, thus increasing survival. The mechanisms involved are multiple: decreasing bowel transit time, regulating energy balance, decreasing peripheral insulin resistance, decreasing hyperinsulinism, antiinflamatory effects, increasing vitamin D production.
Gut microbiota is a superorganism involved in homeostasis and in pathogenesis. Microbiota composition is influenced by several factors such as: type of birth (cesarean or natural), role of age, role of diet. Pathological consequences of certain type of diet (especially western type of diet) may, in fact, be mediated by gut microbiota alteration. Also few studies have investigated the issue of gut microbiota composition in patients suffering of colorectal cancer, several reports notice relevant differences. Certain pathogenic bacteria in gut microbiota have been extensively studied in relation to their role in colorectal cancer. Thus, Fusobacterium nucleatum, which is abundant in colorectal cancer patient’s colon, may initiate the progression from adenoma to adenocarcinoma. A suggested pattern of oncogenesis in colorectal cancer may be represented by this: dysbiosis-inflammation-oncogenesis. A metanalysis that has been published in 2006 concluded a protective role of probiotics in colorectal cancer and in colonic adenoma.
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Introduction: Our objective is to review current international guidelines for Helicobacter Pylori treatment and our department`s experience in this field. Materials and methods: Helicobacter pylori is a Gram-negative, microaerophilic bacterium that can be found mainly in the gastric mucus or on the inner surface of the gastric epithelium, infecting up to 50% of the population. Colonization with this bacterium is not a disease in itself, but can cause chronic gastritis, peptic ulcer, gastric cancer and MALToma. Because of this, infection with H. pylori continues to be a major healthcare burden, especially in less-developed countries. A multitude of non-invasive tests are available for the diagnosis of Helicobacter pylori infection (blood antibody, stool antigen or urea breath test), but the most reliable method of diagnosis is histological examination from two sites after endoscopic biopsy, combined with either a microbial culture or rapid urease test. Treatment of Helicobacter pylori infection is becoming a challenge, as eradication following standard triple therapy is decreasing worldwide due to increased bacterial resistance against antibiotics, which has led to the development of newer therapies such as the sequential treatment in which a PPI and amoxicillin is given for 5 days followed by a PPI, clarithromycin and metronidazole for another 5 days, or the quadruple therapy based on a PPI, bismuth subcitrate, metronidazole and tetracycline for 10 days. Results and conclusion: H. pylori infection remains one of the most challenging infectious diseases, causing high morbidity and mortality, mainly because none of the actual antibiotic therapies can provide successful eradication.
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Chronic liver disease is a late stage of progressive hepatic fibrosis. It consists of functional and structural disruptions in most chronic liver diseases. An accurate diagnosis allows us to establish the degree of fibrosis and the stage of the disease, the prognosis of the patient and to predict a treatment response. Despite the fact that liver biopsy is considered a gold standard, non- invasive methods for diagnosing liver fibrosis have gained more and more importance. Whether we talk about serum biomarkers or imagistic methods from transient elastography to 3-D magnetic resonance elastography, the question remains: are these useful or useless? Serum biomarkers represent blood components that can reflect liver histological changes, thus they can monitor the continuous process of fibrosis. These can be subcategorized in direct (that show extracellular matrix turnover) and indirect markers (that reflect disturbances in the hepatic function). However these markers alone are not as accurate in the staging of fibrosis, only help differentiate patients without or with low grade of fibrosis from those with significant fibrosis and cannot be considered alone in the diagnosis of liver fibrosis. Imagistic methods include: ultrasound-based transient elastography, magnetic resonance elastography (MRE), 2D-shear wave elastography, acoustic radiation impulse imaging (ARFI) and cross sectional imaging, the first being the most used. Using a combination of non-invasive tools allows us to diminish the number of patients in need of liver biopsy. However, the patient must always be informed of the advantages and disadvantages of each method and its limitations.
The burden of colorectal cancer (CRC) is increasing all over the world. The prevalence of diabetes mellitus is increasing. It is estimated that diabetes affects 387 million people worldwide. It is predicted that 552 million people worldwide will develop diabetes by 2030. A large pool of data indicate that DM increases by 2 fold the risk of CRC. This is the reason to firmly suggest the inclusion of DM in the criteria for CRC screening as an important measure to decrease the mortality of this ailment.
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Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types. Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases. Introduction: Insulinomas are localized preoperatively using conventional imaging studies as transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance imaging (MRI). Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas. Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and 15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012 at “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest. Results: US view was positive in 10% of patients (2 of 20), that presented proximal location. The sensitivity of CT was unsatisfactory, 21.05% (4 positive results of 19). CT failed to detect liver metastases, but identified nodal metastasis in one patient. MRI was performed in 18 patients and was diagnostic in 11 of them, recording a detection sensitivity of 61.11%, including infra- centimetric tumor size. EUS has a high resolution which allows detection of lesions with very small diameter is safe and minimally invasive. EUS was performed in all patients, being able to identify formations in 17, was inconclusive in 3, showing a diagnosis sensitivity of 81%. Liver metastases were demonstrated in 3 patients, one by US and all 3 by MRI. Conclusions: - CT with intravenous iodinated contrast agent had a poor sensitivity in detecting the primary tumors, was insensitive in detecting liver metastases, but showed metastases in lymph nodes. - MRI has higher sensitivity than CT in detecting primary tumors, including insulinomas with infracentimetric size, and is the imaging test of choice for possible liver metastases. - EUS is the preoperative imaging test of choice.
Introduction: The infection caused by H. pylori appears secondary after a bacterial colonization of the stomach and the initial portion of the small bowel. H. pylori –infected patients can develop gastritis, peptic ulcer, stomach cancer or MALT lymphoma. H. pylori infection is defined by WHO like a type I carcinogen, its role in gastric carcinogenesis being supported by the greatest researchers. Objectives: In this study our purpose was to determine the endoscopic appearances in H. pylori infection quoted in medical literature until now and the frequency of their appearance in our group of interest. Materials and methods: In this study it was made an analytic study in which it was realized a retrospective cohort investigation at the Emergency Central Military and University Hospital “Dr. Carol Davila” Bucharest, gastroenterology branch –endoscopic department between 18.12.2012- 21.08.2013 on 1694 patients between 18 and 92 years old, with the medium age of 55 years old. As a diagnostic method for H. pylori infection we used superior digestive endoscopy during which were taken biopsies and it was made a fast urease test. Results: Regarding the variation of the endoscopic aspects at the population of study, we have found gastritis with all its aspects (which was Sidney classified) in the biggest percentage meaning 59.3% of the cases, followed with a percentage of 18.8% by those without any endoscopic abnormality, and then in 10,33% of the cases we have found peptic ulcer. With a smaller percentage, under 10%, we have found duodenitis at 8.67% of this patients, and finally the most severe lesions represented by gastric cancer and lymphoma were found at 2,7% of the H.pylori infected patients.
Acute mesenteric ischemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. AMI may be classified as arterial or venous, non-occlusive or occlusive. The overall prevalence of AMI is 0.1% of all hospital admissions [1]. The exact prevalence of mesenteric venous ischemia (MVT) is not known, because many cases are presumed to be limited in symptomatology and to resolve spontaneously.
Autoimmune cholangitis defines a spectrum of cholestatic liver diseases that are characterized by inflammation of bile ducts and a reasonable response to immunosuppressive therapy. The two most common diseases associated with this term in the literature are: an overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis and a form of hyper IgG4 syndrome (currently associated with autoimmune pancreatitis). Liver biopsy is mandatory for the diagnosis. There are, whatsoever, in clinical practice, many cases that do not meet current diagnostic criteria but that have a good response to corticosteroid treatment.
Bio-terrorism involves using biological agents/toxins with the intent to intimidate or coerce a government or civilian population to further political or social objectives, usually leading to deaths or illnesses of humans but also of plants/animals. Their use would probably initially be considered as a natural or unintentional event, especially in case of live biological agents. Moreover, a natural occurring disease outbreak could have the same destructive outcome as an efficient biological weapon. There is a need for proper differentiation between natural and intentional events although in the first stages the medical response should be similar; however, the course of incident management would take different paths later on. Biological agents’ investigation of dangerous pathogens, from natural unusual outbreaks or bio- terrorist attacks/other intentional use, imply the collaboration of different institutions with responsibilities in public health but also in national security and defense. The National Security and the Defense System institutions think mainly in security terms while national health care system institutions think principally` in medical care/prevention terms. These two ways of acting have to be combined in order to deal properly with hazardous biological agents.
Chronic pancreatitis is characterised by progressive and irreversible damage of the pancreatic parenchyma and ductal system, which leads to chronic pain, loss of endocrine and exocrine functions. Clinically, pancreatic exocrine insufficiency becomes apparent only after 90% of the parenchima has been lost. Despite the simple definition, diagnosing chronic pancreatitis remains a challenge, especially for early stage disease. Because pancreatic function tests can be normal until late stages and have significant limitations, there is an incresing interest in the role of imaging techniques for the diagnosis of chronic pancreatitis. In this article we review the utility and accuracy of different imaging methods in the diagnosis of chronic pancreatitis, focusing on the role of advanced imaging (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography and endoscopic ultrasound).
Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of fat in the liver (hepatic steatosis) either on imaging or on liver histology only after the exclusion of secondary causes of fat accumulation in the liver (e.g. high alcohol drinking, drugs and other medical ailments). Considering the fact that there are many causes of hepatic steatosis, the term NAFLD is reserved for the liver disease that is predominantly associated with obesity and metabolic syndrome. The presence of inflammation and cell injury defines steatohepatitis (NASH) which has the potential to evolve into cirrhosis and hepatocarcinoma, being, therefore, the stage of NAFLD most amenable to treatment. Among the treatments available, the most important are: weight loss, vitamin E and, last but not least, probiotics.
