George K Anagnostopoulos

Bax and Bcl-2 protein expression in gastric precancerous lesions: immunohistochemical study.

Background and Aims:u2002 Bcl‐2 protein prolongs cell survival in the face of classical apoptotic stimuli, and is considered to be a suppressor of apoptosis. Bax plays a key role in apoptosis by accelerating cell death after an apoptotic stimulus. The aim of our study was to determine the roles of the Bax proapoptotic gene and the Bcl‐2 antiapoptotic gene in the carcinogenesis of gastric cancer.

Inflammatory fibroid polyp of the small intestine causing intussusception: a report of two cases.

Inflammatory fibroid polyp (IFP) is a rare, localized, nonneoplastic lesion originating in the submucosa of the gastrointestinal tract. When localized in the small bowel, the presenting symptoms are colicky abdominal pain and obstruction (1). Intussusception due to IFPs is uncommon; moreover, jejunojejunal intussusception has only rarely been reported (2‐9). We describe two cases of IFPs of the small intestine causing jejunojejunal and ileoileal intussusception, respectively. The literature and radiologic findings are briefly reviewed. CASE 1 A 54-year-old woman presented to our hospital with an 8-month historyof intermittent episodes of abdominal pain, vomiting, and diarrhea. The patient denied any previous surgical operation or systemic disease. Physical examination was normal. Laboratory tests showed only mild hypochromic anemia. Upper and lower gastrointestinal endoscopies were performed and showed no abnormalities. An enteroclysis study revealed a quite typical configuration of ileo-ileal intussusception, causing small bowel obstruction, with pronounced proximal dilatation. The presence of a well-rounded, intraluminal filling defect was suspected at the distal part of the formation (Figure 1). An ultrasound scan that followed showed a hypoechoic, round, 35-mmdiameter soft tissue mass at the end of a dilated, thick-walled ileal loop at the right flank. Abdominal CT scan demonstrated an intussusception formation in the midabdomen, due to a smooth soft tissue mass, with concomitant high-degree dilatation of the proximal small bowel loops. A diagnosis of intraluminal ileal stromaltumor was suggested. Partial enterectomy was performed. The

Budd-Chiari syndrome and portal vein thrombosis due to right atrial myxoma

Budd-Chiari syndrome is a rare disorder characterized by hepatic venous outflow obstruction. Atrial myxomas account for 35% to 50% of primary cardiac tumors and are usually located in the left atrium. We describe a patient who presented with hepatic inferior vena cava and portal vein thrombosis due to a large myxoma of the right atrium. After the successful removal of the tumor, ascites resolved completely. We conclude that right atrial myxoma is a rare but potentially curable cause of Budd-Chiari syndrome.

Potential Interaction Between Telithromycin and Warfarin

OBJECTIVE: To report a case of warfarin—telithromycin interaction resulting in an elevated international normalized ratio (INR) and hemoptysis. CASE SUMMARY: A 73-year-old white man developed an elevated INR and mild hemoptysis as a result of an interaction between warfarin and telithromycin 800 mg/day. The INR increased from 3.1 before telithromycin was started to 11 after 5 days of telithromycin therapy. The INR returned to the therapeutic range 4 days after telithromycin was discontinued. DISCUSSION: Telithromycin is the first member of the macrolide subclass of ketolides and offers potential advantages over traditional macrolides/azalides for community-acquired respiratory tract infections caused by macrolide-resistant pathogens. As of July 16, 2004, bleeding complications and an increased INR as a result of an interaction between warfarin and telithromycin have not been described. Although the mechanism for this interaction remains unknown, it is suspected that it is a result of the inhibition of the metabolism of the R-isomer of warfarin, which is metabolized predominantly by CYP1A2 and less by CYP3A4. Further research is required to elucidate this issue. An objective causality assessment revealed that this adverse drug event as a result of the warfarin and telithromycin interaction was probable. CONCLUSIONS: We recommend close monitoring of INR levels in patients on warfarin who receive telithromycin therapy in an effort to control and prevent bleeding complications.

Combined carcinoid‐adenocarcinoma tumour of the anal canal

The concurrence of carcinoid admixed with adenocarcinoma in the gastrointestinal tract is an unusual phenomenon that has been reported in the oesophagus, stomach, small intestine, appendix, colon and rectum. These mixed or ‘composite’ tumours seem to be derived from a multipotential stem cell capable of bidirectional differentiation and have a worse prognosis than ordinary adenocarcinoma. Chromogranin‐A staining has increased the diagnostic yield for detecting these tumours and provides information for perioperative management and long‐term prognosis. We describe a patient who presented to our department due to painful defecation. Sigmoidoscopy demonstrated a mass in the anal canal. Histology revealed that the tumour was a mixed carcinoid‐adenocarcinoma neoplasm. To our knowledge, this is the first report in the English literature of a composite tumour of the anal canal.

Early (mucosal) gastric cancer with synchronous osteosclerotic bone metastases: a case report.

Early gastric cancer (EGC) is defined as an adenocarcinoma confined to the gastric mucosa or submucosa, regardless of the presence of lymph node metastases. Early gastric cancer carries an excellent prognosis, with a 5-year survival rate at least 85% in most series. However, there are rare cases where distant metastases exist. Bone metastases are rare in gastric cancer; osteoblastic bone metastases are even rarer. We report a patient with EGC (mucosal) and synchronous osteosclerotic bone metastasis. To our knowledge, this is the first reported case of submucosal EGC with synchronous bone metastases. The patient was operated and he received adjuvant chemotherapy and radiotherapy. He died 18 months after gastric surgery from generalized disease.

Cholecystocolic fistula demonstrated by endoscopic retrograde cholangiopancreatography

Cholecystocolic fistulas comprise between 10% and 20% of all biliary intestinal fistulas. In the majority of cases they are a sequel of cholecystitis but are reported to complicate only 0.13% of cases.1nnA 72 year old man was admitted in our hospital for evaluation of unexplained pneumobilia demonstrated on a routine ultrasound examination of the abdomen. The patient admitted that in previous years he had recurrent episodes of biliary-type …

Tuberous sclerosis associated with giant bilateral bleeding angiomyolipomas

Tuberous sclerosis is a systemic disorder characterised by benign hamartomatous tumours that involve multiple organ systems. Angiomyolipomas are found in about two thirds of the kidneys of patients with tuberous sclerosis at necropsy.1nnA 29 year old woman with tuberous sclerosis presented with diffuse abdominal pain, gross haematuria, and hypotension. At the age of 22 the patient had been admitted to our hospital with acute upper abdominal pain and gross haematuria. Physical examination had revealed bilateral massive abdominal masses with no tenderness. Computed tomography had …