Diagnosis and management of small bowel neuroendocrine tumors:A state-of-the-art

This review provides an update on the epidemiology,pathophysiology,symptoms,diagnosis and treatment of neuroendocrine neoplasms(NENs)of the small bowel(SB).These NENs are defined as a group of neoplasms deriving from neuroendocrine cells.NENs are currently the most common primary tumors of the SB,mainly involving the ileum,making the SB the most frequently affected part of the gastrointestinal tract.SB NENs by definition are located between the ligament of Treitz and the ileocecal valve.They are characterized by small size and induce an extensive fibrotic reaction in the small intestine including the mesentery,resulting in narrowing or twisting of the intestine.Clinical manifestations of bowel functionality are related to the precise location of the primary tumor.The majority of them are non-functional NENs and generally asymptomatic;in an advanced stage,NENs present symptoms of mass effect by non-specific abdominal pain or carcinoid syndrome which appears in patients with liver metastasis(around 10%).The main manifestations of the carcinoid syndrome are facial flushing(94%),diarrhea(78%),abdominal cramps(50%),heart valve disease(50%),telangiectasia(25%),wheezing(15%)and edema(19%).Diagnosis is made by imaging or biochemical tests,and the order of request will depend on the initial diagnostic hypothesis,while confirmation will always be histological.All patients with a localized SB NEN with or without near metastasis in the mesentery are recommended for curative resection.Locoregional and distant spread may be susceptible to several therapeutic strategies,such as chemotherapy,somatostatin analogs and palliative resection.

Chronic hepatitis C in hemodialysis patients:Prevalence and liver fibrosis impact in the National Center for Renal Health in Peru

Background:Hepatitis C(HCV)remains a serious public health problem in high-risk persons such as patients on chronic hemodialysis.We aimed to estimate the serological prevalence of HCV,the HCV viral load and genotype,and liver fibrosis stage among patients on chronic hemodialysis at the National Renal Health Center in Lima,Peru.Methods:From June 2019 to March 2021,all patients who received chronic hemodialysis were invited to participate.Subjects who provided written informed consent were enrolled.Patients with HCV-positive serology underwent determination of HCV viral load.Samples from subjects with detectable viral load,underwent determination of HCV genotype.Then,HCV infected subjects underwent determination of liver fibrosis using transitional elastography(Fibroscan 402):Metavir score:F0-F1:2.5-7.5 kPa,F2:7.6-9.5 Kpa,F3:9.6-12 Kpa,F4(Cirrhosis):12.1-75 Kpa.Results:Of the 303 subjects invited to participate,174(57.4%)subjects gave their written consent.Mean age was 52 years(range 22-91)and 116(66.6%)were male.HCV serology was positive in 35.1%of patients(61/174);however,the prevalence of positive serology with detectable viral load was 20.11%(35/174).Genotype 1a was the most prevalent(85%).The majority(83.6%)of subjects with detectable viral load had values lower than 800.000 IU/mL.Twenty-nine of those 35 subjects underwent elastography evaluation,and 13(44.8%)of them were found to have stage F2-F4 fibrosis.Conclusions:The prevalence of HCV at the largest reference center for hemodialysis in Lima remains high,with GT1a predominance,viral load usually below 800,000 IU/mL and significant liver fibrosis.