Food safety organizations indicate the likelihood of constant human and animal exposure to mycotoxin mixtures as a possible negative public health impact. Risk assessment demonstrates that certain mycotoxins of Aspergillus and Penicillium spp. are toxic and hold a significant genotoxic efficacy at nanomolar concentrations. The aim of the current study was to investigate the potential cytogenetic effects of sterigmatocystin (STER), ochratoxin A (OTA) and citrinin (CTN) alone or in combination, at pM to μΜ concentrations, on the human hepatocellular cancer cell line Hep3B. MTT reduction, mitotic divisions, cell cycle delays and sister chromatid exchange rates (SCE) were determined as endpoints of metabolic activity, cytotoxicity, cytostaticity, and genotoxicity, respectively. All mycotoxin treatments induce SCE rates from 10⁻¹² M, while their cytotoxic and cytostatic potential varies. In PRI and MI assays, but not at MTT, STER alone or in combination with OTA + CTN appeared cytostatic and cytotoxic, even at 10⁻¹² M, while CTN alone and all other combinations displayed substantial cellular survival inhibition in doses ≥ 10⁻⁸ M. Co-administration of STER + OTA or STER + CTN in concentrations ≤ 10⁻¹ M, increased the MI and MTT activity, while it did not affect the PRI. Mycotoxin co-treatments revealed in general similar-to-additive or antagonistic genotoxic and cytotoxic effects. Our results for the first time describe that STER alone or in combination with OTA and/or CTN share a cytotoxic and cytogenetic potential even at picoMolar concentrations on human hepatoma cells in vitro.

Introduction: Pneumoperitoneum is most commonly the result of a visceral perforation and usually presents with signs of acute peritonitis requiring an urgent surgical intervention. Non-surgical spontaneous pneumoperitoneum (not associated with a perforated viscus) is an uncommon entity related to intrathoracic, intra-abdominal, gynecologic, iatrogenic and other miscellaneous causes, and is usually managed conservatively. Idiopathic spontaneous pneumoperitoneum is an even more rare condition from which both perforation of an intra-abdominal viscus and other known causes of free intraperitoneal gas have been excluded. Case presentation: We present the case of an idiopathic spontaneous pneumoperitoneum. A 69-year-old Greek woman presented with acute abdominal pain, fever and vomiting. Diffuse abdominal tenderness on deep palpation without any other signs of peritonitis was found during physical examination, and laboratory investigations revealed leukocytosis and intraperitoneal air below the diaphragm bilaterally. Her medical history was unremarkable except for previous cholecystectomy and appendectomy. The patient did not take any medication, and she was not a smoker or an alcohol consumer. Emergency laparotomy was performed, but no identifiable cause was found. A remarkable improvement was noticed, and the patient was discharged on the seventh postoperative day, although the cause of pneumoperitoneum remained obscure. Conclusion: A thorough history and physical examination combined with the appropriate laboratory tests and radiologic techniques are useful tools in identifying patients with non-surgical pneumoperitoneum and avoiding unnecessary operations.

Toothpick ingestion is implicated in gut injuries which may cause severe complications, mimicking diseases causing acute abdomen. However, toothpick ingestion-related perforation may also cause mild, non-specific gastrointestinal symptoms without significant findings or major complications. We describe a young male with chronic postprandial lower abdominal pain caused by a toothpick impaction at the rectosigmoid junction after inadvertent ingestion. The foreign body was detected and successfully removed during flexible sigmoidoscopy. Perforation due to foreign body ingestion must be considered in the differential diagnosis in patients presenting with unexplained symptoms and findings, even when they do not recall any foreign body ingestion.

Phytobezoar may be a cause of bowel obstruction in patients with previous gastric surgery. Most bezoars are concretions of poorly digested food, which are usually formed initially in the stomach. Intestinal obstruction (esophageal and small bowel) caused by an occupational bezoar has not been reported. A 70-year old male is presented suffering from esophageal and small bowel obstruction, caused by an occupational bezoar. The patient has worked as a carpenter for 35 years. He had undergone a vagotomy and pyloroplasty 10 years earlier. The part of the bezoar, which caused the esophageal obstruction was removed during endoscopy, while the part of the small bowel was treated surgically. The patient recovered well and was discharged on the 8^th postoperative day. Since occupational bezoars may be a cause of intestinal obstruction (esophageal and/or small bowel), patients who have undergone a previous gastric surgery should avoid occupational exposures similar to the presented case.

Gastric cancer (GC) is one of the most common and deadly malignancies worldwide. Helicobacter pylori have been documented as a risk factor for GC. The development of sequencing technology has broadened the knowledge of the gastric microbiome, which is essential in maintaining homeostasis. Recent studies have demonstrated the involvement of the gastric microbiome in the development of GC. Therefore, the elucidation of the mechanism by which the gastric microbiome contributes to the development and progression of GC may improve GC’s prevention, diagnosis, and treatment. In this review, we discuss the current knowledge about changes in gastric microbial composition in GC patients, their role in carcinogenesis, the possible therapeutic role of the gastric microbiome, and its implications for current GC therapy.