Sandra Faias

High Rate of Percutaneous Endoscopic Gastrostomy Site Infections Due to Oropharyngeal Colonization

We prospectively analyzed peristomal infection agents during the first week following percutaneous endoscopic gastrostomy (PEG) placement by the pull technique in patients with head and neck cancer. Nasal and pharyngeal swabs were obtained from a consecutive series of cancer patients prior to PEG placement. All patients underwent antibiotic prophylaxis with cefotaxime and oral disinfection. PEG site infection was prospectively evaluated at days 2, 3, and 7 after insertion. Twenty-eight patients (25 males; mean age, 58 years) were included. Oropharyngeal or nasal colonization were observed in 68% (19/28) and 19% (5/28) of patients, respectively. Early infections occurred in 36% (10/28) of the patients, all with oropharyngeal colonization and concordance between agents (P=0.01). Three patients required hospital admission and 1 required surgery. Head and neck cancer patients with oropharyngeal colonization have a high risk of early PEG site infection with substantial morbidity owing to oral–stomal spread.

Pemphigus vulgaris with exclusive involvement of the esophagus: case report and review

prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers. Gastrointest Endosc 2003;57:324-8. 21. Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD. A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol 2002;97:2250-4. 22. Lee YC, Wang HP, Yang CS, Yang TH, Chen JH, Lin CC, et al. Endoscopic hemostasis of a bleeding marginal ulcer: hemoclipping or dual therapy with epinephrine injection and heater probe thermocoagulation. J Gastroenterol Hepatol 2002;17:1220-5. 23. Gevers AM, De Goede E, Simoens M, Hiele M, Rutgeerts P. A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc 2002;55:466-9. 24. Lin LF, Siauw CP, Ho KS, Tung JC. Endoscopic hemoclip treatment of gastrointestinal bleeding. Chang Gung Med J 2001;24:307-12. 25. Lai YC, Yang SS, Wu CH, Chen TK. Endoscopic hemoclip treatment for bleeding peptic ulcer. World J Gastroenterol 2000;6:53-6. 26. Raju GS, Nath S, Zhao X, Jafri S, Gomez G, Luthra G. Duodenal diverticular hemostasis with hemoclip placement on the bleeding and feeder vessels: a case report. Gastrointest Endosc 2003;57:116-7. 27. Swain CP, Storey DW, Bown SG, Heath J, Mills TN, Salmon PR, et al. Nature of the bleeding vessel in recurrently bleeding gastric ulcers. Gastroenterology 1986;90: 595-8. 28. Kim JI, Kim SS, Park S, Han J, Kim JK, Han SW, et al. Endoscopic hemoclipping using a transparent cap in technically difficult cases. Endoscopy 2003;35:659-62.

Giant Pancreatic Cyst: An Unusual Entity

A 74-year-old woman was referred for further evaluation of a large pancreatic cystic lesion. She presented with abdominal discomfort, without weight loss, anorexia or history of pancreatitis or abdominal trauma. Physical examination revealed a large epigastric mass. A contrastenhanced computed tomography (CT) showed a huge, well-defined, multiloculated cyst of 12 cm in greatest dimension arising from the pancreatic body, with multiple wall calcifications, without typical imaging features of a particular pancreatic cystic neoplasm (Fig. 1). Endoscopic

Prognostic importance of pre-operative CEA and CA 19-9 levels in gastric carcinoma

was 68.8 months We made serial sections from formalm-fk,ved and paraffin embedded blocks, and perihuned H-E staming and itntnunohtstochemical staining for c-met. We classified the expression of c-met at the invasive front were evaluated as positive (+ ) or negative (--). The finding of budding at the invasive front was recorded according to Morodomi cnteria. Results The expression ot c-met was 37 lesions and was significantly correlated with budding, lymphatic invasion, lympMode metastasis, recurrence and progmosis. Budding was observed in 49 lesions and was also significantly correlated with lymphnode metastasis, recurrence and prognosis On the other hand the expression of c-met was closely associated with budding Muluvanate proportional hazard model revealed that the expression of c-met was the only significant co-factor of postoperative survival in pT3 colon cancer Conclusion To predict recurrence and prognosis, it is usefnl to investigated tile expression of c-met. Thus, this resnh suggests (hat stage II patients with c-met positive lesions should received postoperative adiuvant therapy even m the absence of lyrnphnode metastasis