Carlos Sofia

Aberrant crypt foci: endoscopic assessment and cell kinetics characterization.

Background and aimsAberrant crypt foci (ACF) are preneoplastic lesions in animal models of colorectal cancer. The aim of the study is to investigate if ACF are involved in human colorectal carcinogenic process and if they can be helpful in predicting the presence of a colorectal neoplasia.MethodsThe study included, between 2003 and 2005, 182 patients, 62 with adenoma, 55 with colorectal carcinoma, 53 without colorectal lesions, and 12 with nonneoplastic mucosal polyps. The number of rectal ACF was determined by colonoscopy. Proliferation and apoptosis indexes were evaluated by immunohistochemistry in rectal ACF, in normal rectal mucosa, and in carcinomatous tissue.ResultsThe mean number of rectal ACF in patients with rectal neoplasia was 12.64, significantly higher than in patients with neoplastic lesions elsewhere in the colon (pu2009=u20090.01). The apoptosis index in ACF of patients with colorectal carcinoma or adenoma aged 50xa0years or older was significantly lower than in younger patients (1.3% vs 2.7%, pu2009=u20090.01) and, in patients with carcinoma, lower than in normal mucosa (1.1% vs 2.1%, pu2009=u20090.002). The proliferation index was significantly higher in ACF of patients with colorectal neoplasia aged less than 50xa0years than in normal mucosa (10.9% vs 7.7%, pu2009=u20090.02). The apoptosis index in ACF foci of patients with carcinoma (1.1%) was significantly lower than in patients without lesions (2.2%) and than in normal mucosa (2%). The mean number of ACF is significantly higher in patients with polyps larger than 1xa0cm (11.28 vs 6.27, pu2009=u20090.02).ConclusionAberrant crypt foci probably precede the appearance of neoplasia and may be helpful in predicting the presence of a colorectal neoplastic lesion.

Oesophageal lichen planus

Lichen planus is a common skin and mucosal disease, with very rare symptomatic oesophageal involvement. We report a case of painful dysphagia due to oesophageal lichen planus in a 60-year-old woman who also had oral, cutaneous and genital lichen planus lesions. Steroid treatment produced considerable improvement of all lesions and a rapid symptomatic remission.

Evaluation of MELD score and Maddrey discriminant function for mortality prediction in patients with alcoholic hepatitis.

BACKGROUND/AIMSnMaddrey discriminant function (DF) is the traditional model for evaluating the severity and prognosis in alcoholic hepatitis (AH). However, MELD has also been used for this purpose. We aimed to determine the predictive parameters and compare the ability of Maddrey DF and MELD to predict short-term mortality in patients with AH.nnnMETHODOLOGYnRetrospective study of 45 patients admitted in our department with AH between 2000 and 2010. Demographic, clinical and laboratory parameters were collected. MELD and Maddrey DF were calculated on admission. Short-term mortality was assessed at 30 and 90 days. Student t-test, χ2 test, univariate analysis, logistic regression and receiver operating characteristic curves were performed.nnnRESULTSnThirty-day and 90-day mortality was 27% and 42%, respectively. In multivariate analysis, Maddrey DF was the only independent predictor of mortality for these two periods. Receiver operating characteristic curves for Maddrey DF revealed an excellent discriminatory ability to predict 30-day and 90-day mortality for a Maddrey DF greater than 65 and 60, respectively. Discriminatory ability to predict 30-day and 90-day mortality for MELD was low.nnnCONCLUSIONSnAH remains associated with a high short-term mortality. Maddrey DF is a more valuable model than MELD to predict short-term mortality in patients with AH.

Gastric splenosis: a rare cause of digestive bleeding.

with coffee grounds vomit and melena during the previous 48 hours. He had been subject to a major abdominal surgery with splenectomy at age of 38, after a traumatic injury. Regular medication was low-dose acetylsalicylic acid. On physical examination: blood pressure was 100/73 mmHg; heart rate 74 bpm; cardiac-pulmonary auscultation was normal and abdomen was tender and painless; rectal examination confirmed melena. Laboratory data: hemoglobin 11.7 g/dL; platelets 221 x 10^/μL; INR 1.2; aPTT 24.5; BUN 44 mg/dL; creatinine 0.7 mg/dL. Esophagogastroduodenoscopy visualized an ulcer located on the greater curvature of the proximal gastric body with well delimited borders over an elevated formation (Fig. 1). On computed tomography there was a solid nodular lesion on the greater curvature of the stomach with enhancement on arterial phase highly suggestive of gastric splenosis (Fig. 2A). This hypothesis was confirmed with scintigraphy (Fig. 2B). The patient was medicated with pantoprazole. Three weeks after discharge, endoscopy was repeated revealing frank ulcer healing. Gastric splenosis: a rare cause of digestive bleeding