Prospere Remy

Colon Cancer Screening Practices in New York City, 2003 Results of a Large Random-Digit Dialed Telephone Survey

New York City (NYC) has one of the highest concentrations of gastroenterologists in the country, yet only 33% of colorectal cancers in NYC are diagnosed early, and approximately 1500 New Yorkers die from colorectal cancer each year.

Correlation of viral RNA, alanine aminotransferase, and histopathology in hepatitis C virus-associated hepatitis.

BACKGROUND Hepatitis C virus (HCV) infection is usually monitored by the level of alanine aminotransferase (ALT) and histopathological changes in liver biopsy specimens. However, accumulating data indicate these parameters are not always correlated with disease progression or the response of HCV infection to therapy. MATERIALS AND METHODS Using the Amplicor PCR Monitor Test Kit (Roche Diagnostic Systems, Branchburg, NJ), HCV RNA level was measured in 38 patients with positive anti-HCV antibodies and in 21 of those patients after interferon treatment. The grade and stage of histological changes on hematoxylin and eosin-stained sections of liver biopsy specimens were evaluated on a scale of 1 to 4. In each case, the HCV RNA level was compared with the histological grade or stage and level of ALT and statistically analyzed by Students t-test. RESULTS ALT level did not correlate with pretreatment and posttreatment levels of HCV RNA or histopathological changes. However, there was a statistically significant correlation between HCV RNA and histological grade (P,.05). CONCLUSION HCV RNA measurement is a better means of determining and monitoring HCV infection than either ALT level or histopathological characteristics and may provide insight into hepatic injury caused by HCV infection even without an invasive liver biopsy.

Ascaris lumbricoides: To Expect the Unexpected during a Routine Colonoscopy

Ascaris lumbricoides is a common nematode infecting humans worldwide with increased prevalence in tropical and subtropical areas of less developed countries. Recently, it has been estimated that over one billion individuals are infected with ascariasis worldwide with 7% in USA. Although most of these cases are due to increasing immigration and travel outside America it is worth recognizing that prevalence of ascariasis is high in southeastern parts of USA due to their temperate climate. Infections of A. lumbricoides are largely asymptomatic, and hence a large population of people carrying this worm remains undetected for years until they develop some symptoms. Due to a large group of asymptomatic individuals with intestinal ascariasis, these worms are occasionally and unexpectedly identified during routine endoscopic procedures. Here, we present a case of an intestinal ascariasis found during routine colonoscopy in an African-American man from the Bronx with perianal itching. He denied any history of travel outside USA but reported frequent visits to South Carolina. This case illustrates the fact that ascariasis should be suspected even if immigration or travel outside USA is not involved. It should be suspected even in cases of travel within USA to the south east where endemic cases are reported.

Rare case of dysphagia, skin blistering, missing nails in a young boy.

Epidermolysis bullosa is a group of genetic disorders with an autosomal dominant or an autosomal recessive mode of inheritance and more than 300 mutations. The disorder is characterized by blistering mucocutaneous lesions and has several varying phenotypes due to anchoring defect between the epidermis and dermis. The variation in phenotypic expression depends on the involved structural protein that mediates cell adherence between different layers of the skin. Epidermolysis bullosa can also involve extra-cutaneous sites including eye, nose, ear, upper airway, genitourinary tract and gastrointestinal tract. The most prominent feature of the gastrointestinal tract involvement is development of esophageal stricture. The stricture results from recurrent esophageal mucosal blistering with consequent scarring and most commonly involves the upper esophagus. Here we present a case of a young boy with dominant subtype of dystrophic epidermolysis bullosa who presented with dysphagia, extensive skin blistering and missing nails. Management of an esophageal stricture eventually requires dilatation of the stricture or placement of a gastrostomy tube to keep up with the nutritional requirements. Gastrostomy tube also provides access for esophageal stricture dilatation in cases where antegrade approach through the mouth has failed.

Rare Presentation of Gastroesophageal Carcinoma with Rectal Metastasis: A Case Report

Patient: Female, 60 Final Diagnosis: Gastroesophageal carcinoma with rectal metastasis Symptoms: Bloating • constipation • weight loss Medication: — Clinical Procedure: Endoscopy • flexible sigmoidoscopy • lower endoscopic ultrasound Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: Gastroesophageal cancers, previously considered rare, are rapidly increasing worldwide. We present here a unique case of gastroesophageal carcinoma with metastasis to the rectum. Case Report: A 60-year-old female patient presented with constipation, bloating, and weight loss of 4-month duration. She had undergone sleeve gastrectomy 6 years before. Endoscopies performed revealed a friable-looking mucosa in the lower esophagus and a polypoid rectal mass. Histopathological examination from both the esophageal and rectal lesions revealed poorly differentiated adenocarcinoma cells. Immunohistochemistry stain from both specimens was positive for CK7 supporting the gastric site primary with metastasis to the rectum. Further evaluation also revealed metastasis to bone and malignant pleural effusion. Chemotherapy with palliative intent was initiated. Conclusions: Colorectal metastasis is commonly seen from cancers of the breast, stomach, melanoma, kidney, prostate, and ovaries. However, colorectal metastasis from gastroesophageal cancer has never been reported in the medical literature. Diagnosis relies on histopathologic examination and immunohistochemical staining of the tumor. Treatment depends on the tumor stage. Tumors with widespread metastatic disease are candidates for palliative chemotherapy.

Intermittent invagination of a terminal ileal carcinoid tumor

1 Kiesslich R, Goetz M, Vieth M, Galle PR, Neurath MF. Confocal laser endomicroscopy. Gastrointest. Endosc. Clin. N. Am. 2005; 15: 715–31. 2 Li C, Kim S, Lai JF et al. Advanced gastric carcinoma with signet ring cell histology. Oncology 2007; 72: 64–8. 3 Hoffman A, Goetz M, Vieth M, Galle PR, Neurath MF, Kiesslich R. Confocal laser endomicroscopy: Technical status and current indications. Endoscopy 2006; 38: 1275–83.

Increased Willingness to Undergo Colorectal Cancer Screening When Offered a Paid Day Off from Work Among Inner City Hospital Employees

Background: Though several modalities are available for colorectal cancer screening, only about half of adults are being screened. Barriers to compliance include fear of diagnosis, lack of motivation and logistical difficulties, includ- ing taking time off work. The aim of the study was to evaluate whether offering a paid day off from work would motivate more patients to undergo screening. Methods: A questionnaire was administered to employees at the the Bronx-Lebanon Hospital Center in 2007. Results: Of the 916 surveys returned, we focused on the 438 responders who needed a screening test due to age greater than 50, or less than 50 but with a family history of colon cancer. Of the 438, fifty responders were not sure or not willing to undergo screening. The remainder were willing or had been screened and were excluded from the analysis. Among the fifty, 17 (34%) were more willing to undergo screening when they were offered a paid day off from work. Six out of ten men (60%) changed their mind based on this incentive while only 11 out of 40 women (27%) did so (p= 0.05). Conclusions: A paid day off from work may increase screening compliance. This effect was more pronounced in men.