Gastrostomy placement : when fluoroscopy helps the endoscopist.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy is the most common therapeutic procedure performed by the digestive endoscopists in the upper gastrointestinal tract. It aims to feed patients presenting denutrition and/or insufficient oral intake. Percutaneous endoscopic gastrostomy feasibility is about 95-100 % although in some cases it is impossible to achieve it, leading to ask for a surgical placement. Even though the feasibility of the surgical approach is excellent its complications are quite higher than percutaneous endoscopic placement, it requires general anesthesia and sometimes these patients could be non elligible for it due to their comorbidities (malnutrition, cardio-vascular diseases etc.). Another alternative technique is the percutaneous radiological gastrostomy but this procedure is rarely available in our country. PATIENTS AND METHODS: We described four cases in patients with previous failure of PEG, in which we used an hybrid approach between radiological and endoscopic techniques, allowing the placement of gastrostomy tube, without general anesthesia. RESULTS: This was successful in all patients and there was no complication related to the procedure. CONCLUSIONS: This technique offers an additionnal opportunity to avoid general anesthesia and surgical complications in patients with unfavorable conditions.

Tuberculosis diagnosed after major hepatectomy for suspected malignancy.

A patient with a history of surgery and adjuvant chemotherapy 2 1/2 years previously for Dukes C colonic adenocarcinoma was diagnosed with a focal liver lesion on follow-up examinations. Ultrasound and computed tomography scan revealed a 3.8 cm soft tissue mass. Positron emission tomography scan showed intense uptake, corroborating the diagnosis of a colonic liver metastasis. Major hepatectomy was performed but pathology revealed that the lesion was in fact a benign tuberculosis pseudo-tumour. In developed countries liver tuberculosis remains extremely rare, particularly the macronodular form. The diagnosis is often made only after hepatectomy for suspected malignancy. The increasing use of potent anticancer chemotherapy may favour the reactivation of quiescent tuberculosis, posing a difficult differential diagnosis with liver metastases.

Role of organic matter in framboidal pyrite oxidation.

An experimental system has been set up to investigate the reaction kinetics of framboidal pyrite oxidation in real, reactive acid sulfate soil assemblages. This study was undertaken to determine the degree to which pyrite oxidation rates are reduced by bacteriological reactions and organic matter, which both modify the net reaction mechanisms and compete for available oxygen. The results from these experimental runs not only confirm the role of organic matter in mitigating pyrite oxidation but indicate that at least initially, the acidity produced is consumed or otherwise ameliorated by parallel reactions. Tracking pH or [H+] in both a reactor and in soil does not accurately reflect reaction progress and may not correctly indicate the true level of risk. In comparison, the tracking of pyrite oxidation with the concentration of sulfate in solution is not affected by side reactions or precipitation and is therefore a better indicator for the rate of pyrite destruction.