G. Tappero

Cold snare excision of small colorectal polyps

This study describes a new technique for excision of small colorectal polyps in a series of 210 consecutive patients, who had total colonoscopy, and in whom any clotting problems had been excluded. A total of 288 small polyps of 5 mm or less in diameter were transected by mechanical strangulation with a polypectomy snare, but without applying any electrical energy. All polyps were recovered whole and sent for histologic examination. No case of perforation, serious bleeding, or mortality was recorded, nor was there any need for blood transfusion because of sudden or delayed bleeding. Of the small polyps, 56% were adenomas, 43% hyperplastic, and 1% were other types. No invasive cancer was found, but in seven small adenomas severe dysplasia was observed. No correlation between the macroscopic appearance of small polyps at endoscopy and their nature at histology was found. Our data confirm that all visible polypoid lesions of the colon should be removed, and that cold snare excision of small polyps is a safe and effective alternative method of treatment in patients without clotting problems.

Familiar clustering and spreading of hepatitis delta virus infection

The prevalence of hepatitis delta virus (HDV) infection was significantly higher among the relatives of 79 carriers of HBsAg with antibody to HDV (index cases) than among relatives of 111 carriers without serological evidence of HDV infection (controls). Antibody to HDV was found in 45 of the 80 (56%) carriers of HBsAg in families of index cases but only in 2 of 59 (3%) carriers in families of controls (P less than 0.0001). During follow-up new HDV infection developed in 31% of 13 susceptible carriers in families of index cases, but only in 1.2% of 162 susceptible carriers in families of controls (P less than 0.001). None of the family members previously unexposed to the hepatitis B virus had HDV markers in serum or developed this infection during the follow-up. Familial clustering shows that HDV is transmitted by personal contacts, presumably through the inapparent permucosal or percutaneous passage of virus during close or intimate contact. The family model indicates that endemic HDV is maintained and spread through the network of carriers in the community, and that HBsAg carriers in contact with HBsAg/HDV carriers are at high risk of contracting HDV.

Re-treatment with interferon-beta of patients with chronic hepatitis C virus infection

Objective To evaluate the efficacy of interferon-beta (IFN-β) in the re-treatment of patients with chronic hepatitis C who did not respond to IFN-α monotherapy. Patients and methods Thirty patients (24 men and six women; mean age, 41 ± 13 (SD) years; range, 23–62 years), with chronic hepatitis C that was non-responsive to a standard course of IFN-α therapy, were re-treated with recombinant human IFN-β-1a. All patients received IFN-β, 12 MIU subcutaneously, three times weekly for 3 months, after which time patients’ responses were evaluated. Responders (normal alanine aminotransferase, and negative for serum hepatitis C virus RNA) continued to receive IFN-β, 12 MIU, for a further 3 months. Non-responders had their dose increased to 18 MIU for the remaining 3 months of treatment. After 6 months of treatment, therapy was stopped and patients were followed-up for a further 6 months. Results Overall, six (20%) of the 30 patients exhibited a response at the end of treatment. One patient (3.3%) maintained a sustained virological response at the end of post-treatment follow-up. Conclusions Treatment with recombinant IFN-β, at doses of up to 18 MIU for 6 months, is safe and well tolerated. However, the results of the trial do not support the use of IFN-β monotherapy in patients with chronic hepatitis C that is resistant to IFN-α.

LCT-13910C > T polymorphism-associated lactose malabsorption and risk for colorectal cancer in Italy

BACKGROUND The activity of epithelial lactase (LCT) associates with a polymorphism 13910 bp upstream the LCT-encoding gene (LCT-13910C>T). The relationship between LCT-13910C>T polymorphism and risk for colorectal cancer is unclear. AIMS We examined the relationship between the LCT-13910C>T polymorphism causing lactose intolerance and risk for colorectal cancer/polyps onset in the Italian population. PATIENTS AND METHODS 793 subjects (306 with colorectal cancer, 176 with polyps and 311 controls) were genotyped for the LCT-13910C>T variant by TaqMan real time-PCR. RESULTS Lactose malabsorption linked to the CC genotype did not associate with an increased risk for either colorectal cancer (OR=1.041; 95% CI=0.751-1.442; p=0.868) or polyps (OR=0.927; 95% CI=0.630-1.363; p=0.769). There was no association with colorectal cancer/polyps site. 60% of the subjects overall bore the CC genotype. CONCLUSION In the Italian population the LCT-13910C>T polymorphism is not associated to the risk for colorectal cancer or polyps.

Antitissue Antibodies in Chronic Pancreatitis

Organ- and nonorgan-specific autoantibodies (AA) have been investigated in 49 patients affected by alcoholic or idiopathic chronic pancreatitis (CP) to evaluate their prevalence and correlation with the clinical features of the disease. AA have been found in about 50% of CP and their recurrence rate was similar to that of alcoholic or cryptogenic liver cirrhosis (LC); age- and sex-matched healthy subjects (C) showed only about 8% positive sera (C vs. CP, p less than 0.001). Quite different IFL patterns between CP and LC have been detected. Antibrush border, antireticulin and antigastric parietal cell antibodies alone or combined prevailed in CP, while antinuclear and antismooth muscle AA prevailed in LC. No correlation with sex, age, etiology, presence of pancreatic stones, diabetes, symptoms and years of CP was found for one or more AA. In conclusion, the detection of AA in CP is a quite common finding of still unclear clinical significance.