The differentiation of amebic colitis from inflammatory bowel disease on endoscopic mucosal biopsies.

Background: Intestinal amebiasis is one of the important differential diagnoses of Inflammatory Bowel Disorders in areas where it is highly prevalent. Aim: Studies comparing the clinical, endoscopic and histological features of these disorders have never been done, so we undertook this study. Materials and Methods: A retrospective study comparing mucosal biopsies of 14 consecutive cases of intestinal amebiasis with 14 cases of Ulcerative colitis and 12 cases of Crohn’s disease. A total of 65 biopsies from patients with amebiasis, 56 biopsies from patients with Crohn’s disease and 65 biopsies of patients with Ulcerative colitis were reviewed. Results and Conclusions: Discrete small ulcers less than 2 cm in diameter in the cecum or rectosigmoid, with intervening normal mucosa, were the most common finding on endoscopy in patients with amebiasis. On histology, necrotic material admixed with mucin, proteinaceous exudate and blood clot lining ulcers, significant surface epithelial changes such as shortening and tufting adjacent to sites of ulceration, mild chronic inflammation extending into the deep mucosa and mild architectural alteration were features of amebiasis. Trophozoite forms of ameba were seen in the necrotic material lining sites of ulceration or lying separately, as well as over intact mucosa. Necrotic material lining ulcers was less common in IBD, but chronic inflammation, crypt abscess formation and architectural alteration were more severe.

Edwardsiella tarda sepsis with multiple liver abscesses in a patient with Cushing's syndrome.

Edwardsiella tarda is very seldom a cause for gastroenteritis in humans. This organism can also cause extraintestinal infections, such as soft tissue infections, meningitis, peritonitis, osteomyelitis, endocarditis and hepatobiliary tract disease, particularly in the setting of compromised immunity. We describe, for the first time a case of E. tarda sepsis with multiple liver abscesses associated with Cushing's syndrome as a result of recreational aquatic exposure.

Learning curve, diagnostic yield and safety of single balloon enteroscopy.

Background: Single balloon enteroscopy (SBE) is a recently developed diagnostic modality to assess small bowel mucosa. The data on learning curve of SBE is scanty. We aimed to assess the learning curve, diagnostic yield and safety of SBE Methods: All patients who underwent SBE at our centre from December 2007 to December 2010 were included retrospectively. The clinical details, enteroscopy findings and procedure related details were obtained for each patient from a prospectively maintained database. The extent of small bowel visualised with increasing number of procedures by a single endoscopist (Endoscopist A) who performed most of the procedures was used to estimate the learning curve using locally weighted regression curve. The diagnostic yield and complications rates of SBE were also estimated. The study was approved by the institute review board and ethics committee. Results: Ninety SBEs were performed in 84 patients (age: 42+15 years, 27.4% females). 57 procedures were performed (32 antegrade and 25 retrograde) by endoscopist A. There was gradual improvement in the extent of small bowel visualised during the first 15 procedures via antegrade route followed by flattening of curve. The retrograde route showed no definite trend towards improvement during the procedures performed. The overall diagnostic yield of SBE was 32.1%. There was no complication except for mild self-limiting abdominal pain in one patient. Conclusions: SBE via antegrade route has a higher success rate and better learning curve than the retrograde route. SBE is a safe procedure and helps in establishing a diagnosis in one-third of the patients examined.

Oat cell carcinoma of the oesophagus--a case report and review of literature.

A 45-year-old male presented with dysphagia, anorexia and progressive weight loss. He was a chronic smoker. Oesophagoscopy showed an ulceroproliferative growth of 25-30 cm size. Histopathology from the biopsy tissue showed small cell (oat cell) carcinoma. He received radiotherapy, but died 9 months later. Small cell carcinoma of the oesophagus constitutes 0.8-2.4% of all the oesophageal carcinoma. The tumour is an aggressive one with a poor prognosis irrespective of the treatment.