[Endoscopic ultrasonography versus helical CT in diagnosis and staging of pancreatic cancer]

Compare the performances of EUS to helical CT in the diagnosis and staging of pancreatic adenocarcinoma. Forty two consecutive patients [mean age 63 years; 25 men, 17 women] who had surgical exploration and histologically proved pancreatic cancer were retrospectively included. All our patients underwent with endoscopic ultrasonography [EUS] and helical computed tomography [helical CT]. Data analysis compared helical CT, EUS with the surgical data with or without histological study in diagnosis, staging and resectability of pancreatic cancer. Surgical findings were used as gold standard. For positive diagnosis EUS was more sensitive 100% [CI:93-100] than helical CT 88% [CI:77-95]. But helical CT was more specific 89% [CI:64-98] than EUS 83% [CI:58-96] for small tumors whose diameter is below 2,5 cm in which EUS was more sensitive in their detection [100% versus 83%]. In evaluating venous involvement EUS was more sensitive than helical CT [96% versus 50%; p<0.05], while CT was more specific [81% versus 75%; p<0.05]. Regarding lymph nodes invasion, the two imaging technique had the same sensibility [56%] with better specificity for helical CT [83% versus 75%; p<0.05]. The accuracy of EUS in identifying the T and N stages were 80% and 67% respectively, while helical CT have an accuracy of 50% and 71% respectively. EUS and helical CT correctly identified all resectable tumors while EUS was more accurate than helical CT in detecting non resectable tumors 94% versus 69%.EUS remains superior to helical CT in positive diagnosis of pancreatic adenocarcinoma especially for small tumors and also for the diagnosis of venous invasion and in identifying non resectable tumors. The two techniques have the same accuracy in the detection of lymph node involvement

[Prevalence of malnutrition in gastroenterology hospitalized patients: a 70 patients prospective study]

Malnutrition is a common problem in gastroenterology hospitalized patients. Its frequency varies considerably with the studied population and nutritional screening tools. The purpose of this study was to assess the prevalence of malnutrition in gastroenterology hospitalized patients. A prospective study was carried between January 2005 and March 2005 including 70 patients. The nutritional state of the patients was assessed according to the subjective global assessment scale [SGA]. anthropometric measurements and serum albumin level. Moderately and severely malnutrition was found for 54 patients [77 percent]. Statistical analysis found positive correlation between body mass index [BMI] and SGA C [p=0 .002] and between albumin level and SCA [p<0.005]. The median nutritional risk index [NRI] was 89.5 +/- 13 with significantly positive correlation with the other parameters [BMI, Albumin and SGA] respectively p=0.03, p=0.003 and p=0.004. Malnutrition is common in gastroenterology patients. The assessment of patient's nutritional state according to the subjective global assessment had a positive correlation with the others nutritional screening tools

[Nutritional and dietary management after extensive intestinal resection]

Short bowel syndrome arose after extended intestinal resection over two meters. It was observed in 15% of intestinal resection in adults. Crohn's disease [in UK] and mesenteric ischemia [in France] were the most frequent etiologies. In adults, the incidence was estimated at two adults/million inhabitants/year. This review aimed to provide answer for these questions: Who are patients interested by short bowel syndrome? 2. Which interventions are responsible? 3. What is evolution before and after nutritional assistance? An electronic search was performed between 1990 an 2006 in Medline database with the following keywords: "short bowel disease", "treatment" and "inflammatory bowel disease". Recent literature reviews and meta analysis were retained or analysis. After an extensive intestinal resection, nutritional management should start early during the post operative course. This strategy will prevent in time life threatening complications. NPDA is indicated temporarily for short bowel syndrome until intestinal readaptation or definitively in case of severe short bowel syndrome to improve survival and quality of life

[Histopathological study of gastric polyps. a report of 65 cases]

In a retrospective study of the specimens of gastric polypectomy, carried out between January 1992 and December 2002. we analysed the demographic and histological aspects of 65 polyps. This study revealed hyperplastic polyps in 66%, ade-nomatous lesions in 9.2%, Peutz-Jeghers polyps in 7.7%, inflammatory fibroid polyps in 6.15?, two cases of focal foveolar hyperplasia [3%]. two cases of Brunner's gland heterotopia [3%], 1 pancreatic heterotopia [1.5%], 1 fundic gland polyp [1.5%] and 1 carcinoid tumor [1.5%]. All adeno-mas and two Peutz-Jeghers polyps include intraepithelial neoplasia. Moreover, we identified a case of Brunner's gland heterotopia, which contain a focus of plane tubular adenoma with high-grade intraepithelial neoplasia. Other lesions were found within the polyps or into the surrounding gastric muco-sa, such as intestinal metaplasia and Helicobacter Pylori gastritis. This work allowed us to recommend complete removal of gastric polyps and the realization of biopsies of the non-polypoid gastric mucosa in the search of intraepithelial neo-plasia or other lesions with malignant potential

[Usefulness of endoscopic ultrasonography for diagnosis between multivesicular hydatid cyst and serous cystadenoma of the pancreas. Case report]

Hydatid cyst of the pancreas is very rare. However, it should be suspected in every case of pancreatic cyst, especially in hydatid countries where hydatic cyst disease is endemic. In the paper we report the first case of a multivesicular hydatid cyst of the pancreas explored by endoscopic ultrasonography. Endoscopic ultrasonography is very reliable in the investigation of pancreatic cystic tumors. However it did not allow us to define semiological criteria capable of permitting a differential diagnosis between a hydatid cyst and serous cystadenoma. Per-echoendoscopic transduodenal puncture might improve the efficiency of this procedure with of hydatid cysts of the head of the pancreas

Place de la ligature elastique dans la prevention secondaire de l'hemorragie digestive par rupture de varices oesophagiennes. Etude prospective de 102 cas

The aim of this study was to assess the efficacy and morbidity of endoscopic variceal ligation for the prophylaxis of rebleeding from oesophageal varices. This work is a prospective study including 102 patients having had at] least one episode of variceal bleeding. The mean age is 52,5 years. Oesophageal varices were eradicated in 83,3% of cases after an average of 3,5 sessions. Recurrence of oesophageal varices after eradication was observed in 22% after an average follow-up of 7 months. 10 patients died before eradication of oesophageal varices from causes unrelated to the technique. The endoscopic variceal ligation is effective for eradication of oesophageal varices, with a low morbidity. This technique appears to be a method of choice in the prophylaxis of rebleeding from oesophageal varices

densite minerale osseuse au cours de la maladie de Crohn: Apport de l'osteodensitometrie chez 53 patients

Fifty-three patients with Crohn disease were included in A prospective study. Bone mineral density was measured at the Femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Ten variables were analyzed in search of an association with bone demineralization; Age, sek, nutritional state, smoking, duration of the disease, hormonal status, inflammatory syndrome, site of disease ileal, colic or ileocolic, accumulated doses of corticoids and intestinal resection. A bone demineralization was observed in 58,5% of cases. The ileum location and the corticotherapie were predictives of bone demineralization. Crohn disease is a disease at high risk of bone demineralization. Predictors of the bone loss were smoking, long duration of the disease, ileal site and systematic corticotherapy