Aurelio Costa

T-tube removal after liver transplantation: A new technique that reduces biliary complications

This article discusses a new simple, fast, and easily performed technique that allows reduction of morbidity and hospital stay after T-tube removal. A retrospective analysis was conducted of 145 recipients who underwent T-tube removal 3 months after orthotopic liver transplantation. Patients were divided in two groups: group 1 (n=93) underwent T-tube removal and contemporary placement under fluoroscopic guidance of a counter-drain. Group 2 (n=52) T-tubes were removed from the bile duct under fluoroscopy but were left in place as a counter-drain. Overall, there were 33 (22.7%) complications related to T-tube removal. Treatment was always conservative and no deaths were related to T-tube. In group 1, 29 (31.2%) complications occurred; and the mean hospital stay was 9.4±9.3 days. In group 2, four complications (7.7%) occurred (P =0.002); and the mean hospital stay was 5.8±5.5 days (P =0.012). The adoption of this new technique—under fluoroscopic guidance, using the T-tube itself as a counter-drain—for T-tube removal allowed us to significantly reduce biliary complications and hospital stay.

Apoptosis is reduced in the colonic mucosa of patients with acromegaly.

Background  Patients with acromegaly have an increased risk of developing colonic tumours; reduced apoptosis is considered a leading mechanism in tumorigenesis. GH and IGF‐1 decrease apoptosis in several cell lines including human colonic adenocarcinoma, but it is unknown whether epithelial cells of colonic mucosa of patients with acromegaly have reduced apoptosis.

Changes in the expression of suppressor of cytokine signalling (SOCS) 2 in the colonic mucosa of acromegalic patients are associated with hyperplastic polyps

Background  Acromegalic patients have increased prevalence of colonic polyps. Development of hyperplastic polyps was related to suppressor of cytokine signalling (SOCS) 2 haploinsufficiency in animal models of acromegaly.

Colonic polyps of acromegalic patients are not associated with mutations of the peroxisome proliferator activated receptor γ gene

Peroxisome proliferator activated receptor (PPAR)γ plays a pivotal role in regulating adipocyte differentiation and metabolism, but also has an antiproliferative effect in several tissues, including colonic mucosa, where it is highly expressed. Loss-of-function mutations have been reported in about 10% of sporadic primary colon cancer. Acromegalic patients have an increased prevalence of colonic neoplasms and lower PPARγ levels in the colonic mucosa. Thus, PPARγ may act as a tumor suppressor gene, and its reduced expression or loss-of-function mutations may contribute to tumorigenesis. In this study the expression and mutations of the PPARγ gene in the colonic polyps and mucosa outside polyps were investigated in 10 acromegalic and 17 non-acromegalic patients. PPARγ expression was evaluated by RT-PCR. PPARγ was expressed in each sample, but expression appeared to be lower in polyps than in mucosa outside polyps from either acromegalic or non-acromegalic patients. All exons of the PPARγ gene were directly sequenced after PCR amplification: no mutations were found either in acromegalic or in non-acromegalic patients. In conclusion, the results of this preliminary study suggest that the lower expression of PPARγ rather than somatic mutations of this gene is involved in colonic tumorigenesis.

Comparison of colonoscopy and fecal occult blood testing as a first-line screening of colonic lesions in patients with newly diagnosed acromegaly.

Content: Patients with acromegaly have frequently colonic neoplasms; however, how acromegalic patients should be screened for colonic lesions is still unsettled. Aims: To compare fecal occult blood testing (FOBT) and colonoscopy in the screening program of patients with acromegaly. Design: Colonoscopy and FOBT were performed at the first diagnosis of acromegaly. Setting: Tertiary University center. Patients: Eighty-five consecutive patients with untreated active acromegaly submitted to colonoscopy and FOBT. Results: FOBT, which was positive in 16 (18.8%) out of 85 patients, identified 2 patients with colonic adenocarcinoma and 2 with adenoma; the remaining 12 patients had no detectable colonic lesions. Colonoscopy revealed colonic lesions in 29 patients: 3 (3.5%) cancers, 11 (12.9%) adenomas, and 15 (17.6%) hyperplastic polyps. The remaining 56 acromegalic patients had no detectable lesions. A patient with cancer and 9 patients with adenoma were missed if screened only by FOBT. Conclusions: Colonoscopy is superior to FOBT in detecting colonic lesions at the first diagnosis of acromegaly.

Abnormal expression of PPAR gamma isoforms in the subcutaneous adipose tissue of patients with Cushing's disease

Background  Obesity is a clinical feature of patients with Cushings disease. Peroxisome proliferators‐activated receptor (PPAR)γ is the master regulator of adipogenesis; however, the expression of PPARγ isoforms in the subcutaneous adipose tissue (SAT) of patients with Cushings disease is unknown.