Volume 77 - 2014 - Fasc.3 - Letters
Succesful treatment of type-1 gastric carsinoid by endoscopic polypectomy and argon plasma coagulation
Neuroendocrine tumors (NETs) are originating from neuroendocrine cells. Discrimination of the subtypes of gastric NETs is important for their management (1). Sug- gested management of these tumors have been controver- sial and been containing different therapeutic strate- gies (2). We herein report a rare case of type 1 gastric NET which was treated with endoscopic polypectomy and argon plasma coagulation (APC).
A-44-year-old woman was admitted to our hospital due to epigastric pain. On admission, laboratory tests showed low hemoglobin, mean corpuscular volume (MCV) and B12 levels. The patient underwent to esopha- gogastroduodenoscopy (EGD) because of iron and B12 deficiency. EGD examination revealed multiple intralu- minal polypoid lesions in gastric corpus (there were 7 small nodular lesions in diameter < 1 cm and one irregu- lar-shaped polyp in diameter with 18 mm) (Fig. 1A-B). Biopsy samples were taken from the lesions and also mu- cosal areas of antrum and corpus. Biopsy samples were examined after histochemical staining with Chromo- granin A, synaptophysin and proliferative activity (ki-67 index). They were positive by Chromogranin A (CgA) and synaptophysin. The surrounding mucosa indicated atrophic gastritis and hyperplasia of enterochromaffin- like (ECL) cells. Fasting serum gastrin value and serum antibody levels against gastric parietal cells were very high with 908pg/ml (normal levels: 13-115pg/ml), 94 U/ml (normal values < 10 U/ml), respectively. A di- agnosis of autoimmune atrophic gastritis, type 1 gastric carcinoid was made.
Rare complication of upper gastrointestinal endoscopy : bilateral swelling of parotid glands
Gastrointestinal endoscopic procedures are used quite frequently in clinical practice and have very rare compli- cations. Possible complications include ; infections, piercing or tearing of an organ, excessive bleeding, an allergic reaction to the anaesthetic. Swelling of the parotid glands has previously been reported as a rare complication of peroral endoscopy. Mechanism of this is unclear but retention of secretions may cause a blockage of salivary duct or duo to the dehydration secretions can get thicker that oclude salivary gland (1,3). In this article, development of bilateral parotid glands swelling after upper gastrointestinal endoscopy is presented.
An unusual polyp at the appendiceal orifice : appendix inversion
Polypoid lesions originating from the base of the appendix are usually embrassing for the endoscopists because of low levels of awareness due to their rarity and increased risk of complications following therapeutic interventions because of thin walled cecum. Herein we present a patient with a unusual polyp at the base of the appendix which was diagnosed by non-invasive meth- ods.
Protection of epithelial tight junction : a new therapeutic approach in the treat- ment of infectious diarrhea
Infectious diarrhea is a major gastrointestinal disease associated with morbidity and/or mortality in many countries. It is now well demonstrated that besides vari- ous modes of single bacterial penetration of epithelial cell or membrane receptor activation the bacterial inva- sion is linked to tight junction (intercellular) opening giving rise to a massive bacterial invasion of cells and submucosal layer (1). This invasion triggers mucosal defense mechanisms including water secretion (diarrhea), stimulation of the local resident immune system and at- traction of circulating immune cells (neutrophils, T-lym- phocytes, macrophages) and phenotypic changes of epi- thelial cells corresponding to an inflammatory reaction (2).