Amy Tsuchida

Prescreening versus empirical immunization for hepatitis A in patients with chronic liver disease: a prospective cost analysis

OBJECTIVES:There are few prospective studies estimating the prevalence of hepatitis A in chronic liver disease patients. Furthermore, there are minimal cost-comparative data as to whether or not screening for hepatitis A exposure before immunization is an effective fiscal strategy. The objectives of this study were to determine the prevalence of prior hepatitis A infection and to perform a prospective cost analysis for hepatitis A immunization in patients with chronic liver disease.METHODS:This is a prospective cohort study of 100 patients with chronic liver diseases. Patients were screened for potential risk factors for hepatitis A including history of jaundice, socioeconomic status, birth origin, and ethnic background. Each patient underwent testing for evidence of prior infection using an ELISA. Seronegative patients then went on to receive an immunization series. Cost analysis of vaccination without prescreening (universal strategy) was compared to cost analysis of prescreening and selective immunization of those without prior infection (selective strategy).RESULTS:Fifty-three patients (53%) had serological evidence of prior hepatitis A infection (95% CI = 43–63%). Of the risk factors assessed, foreign birth was associated with prior hepatitis A exposure (p = 0.0002). Cost analysis revealed that prescreening for hepatitis A before vaccination was cost saving given the current prevalence.CONCLUSIONS:The seroprevalence of hepatitis A in those with chronic liver diseases was 53%. Cost analysis revealed that screening for hepatitis A before immunization is cost saving, and this strategy should be applied to follow current vaccination guidelines.

Ampullary Somatostatinoma in a Patient With Merkel Cell Carcinoma

A 59-yr-old white man with Merkel cell carcinoma of his right leg status post extensive skin resection and chemotherapy had dilated hepatic and common bile ducts on a routine follow-up abdominal CT scan. A 1.9-cm ampullary mass was appreciated on endoscopy. Histology showed psammoma bodies and positive immunoperoxidase staining consistent with a somatostatinoma. Merkel cell tumors and somatostatinomas are extremely rare neuroendocrine tumors derived from neural crest cells. Associations have been found between somatostatinomas and other islet cell tumors with multiple endocrine neoplasia syndromes, but no reported association has been published between islet cell tumors and Merkel cell tumors. This patient represents the first documented case of Merkel cell carcinoma and somatostatinoma in a single patient. Such an occurrence may represent a previously undescribed neuroendocrine tumor syndrome, and this possibility should be considered when either tumor is diagnosed.

Fluoroscopic decompression of the acutely dilated colon: Indications and technique

Decompression of the acutely dilated colon under fluoroscopy while using a nonendoscopic technique was first suggested by surgeons in 1975. Most radiologists are not familiar with this methodology, since the entities treated are uncommonly encountered by the general radiologist. Although endorsed by both radiologists and gastroenterologists as a preferred approach in patients with acute colonic pseudo-obstruction, it is also a successful alternative to colonoscopy in patients with volvulus and distal colonic obstruction. Fluoroscopic decompression with a long rectocolonic tube is a cheaper alternative to the placement of metallic stents as a short-term or palliative methodology in providing passage for stool and gas, or for colonic cleansing. Using computed tomography as a major branch point in the decision tree in order to appropriately refer to fluoroscopy and colonoscopy has proven to be helpful. Dramatic relief of a patients symptoms is found with this technique. We present a pictorial essay to illustrate the work-up, the indications, and the technique involved in this relatively simple procedure.

Hepatitis A: prescreening versus empiric immunization in reserve officer training cadets (ROTC), a prospective cost analysis

Hepatitis A: prescreening versus empiric immunization in reserve officer training cadets (ROTC), a prospective cost analysis

Hepatitis A: prescreening versus empiric immunization in chronic liver disease patients: a prospective cost analysis

Hepatitis A: prescreening versus empiric immunization in chronic liver disease patients: a prospective cost analysis