Gabriel Constantinescu

Gabriel Constantinescu

The Labyrinth Behind an Acute Respiratory Failure

Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment.

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Upper GI Bleeding with Hemorrhagic Shock Caused by Infectious Esophagitis

CMV infection in healthy hosts is generally asymptomatic, producing a latent infection with antibodies persisting for months or even years after the recovery. In the population at risk, CMV infection is one of the most frequent opportunistic infection. The most frequent GI manifestation of CMV infection is colitis followed by esophagitis although it can affect all organs. CMV esophagitis has been reported in immunocompromised hosts by conditions like organ transplantation, bone marrow transplantation, in patients with HIV infection and AIDS or other debilitating diseases. [...]

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Crohn's Disease or Intestinal Tuberculosis. A Diagnostic Challenge

TB usually affects the lungs but many other organs may be involved. Intestinal tuberculosis primarily involves the distal ileum and cecum, followed by the jejuno-ileum, colon and rectum. The development of strictures and fistulas mimic Crohn’s disease, and generalized colonic involvement mimics ulcerative colitis. A 42 year old patient was admitted to the Gastroenterology Department of Emergency Clinical Hospital Bucharest with a 3 months history of unintentional weight loss (15 kg), diarrhea (7-8 unformed stools per day), right iliac fossa pain, night sweats. He had a history of recent fungal esophagitis and antral gastritis. He denied prior contact with patients with tuberculosis and has no pets. [...]

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Review on Non-Invasive Diagnosis of Pancreatic Cancer

The pancreatic cancer has the worst prognosis among gastrointestinal cancers with a mortality rate close to incidence. The analysis on the globe carried out by GLOBOCAN in 2012 places the pancreatic cancer on the 13th place in terms of incidence and on the 8th place in terms of mortality of all cancers and in relation with digestive cancers it occupies the 6th place for both epidemiological indices [1]. [...]

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Burden of Clostridium Difficile Infection in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and Ulcerative Colitis (UC), is characterized by chronic inflammation of the gastrointestinal tract. There is epidemiologic evidence that in patients with IBD, Clostridium difficile infection (CDI) occurs more frequently than in the general population and that these rates have been increasing over the past several decades. [...]

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Modern Management of Benign Bile Duct Strictures

Benign biliary strictures (BBS) are a heterogeneous group of disorders whose diagnosis and treatment may be challenging. Surgical injury of the bile duct is the most common cause in the Western world (1). Inflammatory lesions of the biliary ducts, such as chronic pancreatitis represent the second most common cause of BBS.
The appropriate evaluation and management frequently require collaboration between gastroenterologists, surgeons and radiologists. The confirmation of the stricture is preferably made by magnetic resonance cholangiopancreatography (MRCP). A mainstay of diagnosis is the differentiation of BBS from malignant obstructions which are more prevalent. Tissue sampling during ERCP or endoscopic ultrasound with fine needle aspiration can be useful.

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