An unusual cause of large bowel obstruction: are we aware of this?

Primary lymphomas of the colon account for 0.5% of all primary colon malignancies. Burkitt´s lymphoma is a B-cell lymphoma with aggressive clinical behavior. Herein, we describe a case of a male patient who presented with signs of large bowel obstruction, underwent surgery and found to suffer from Burkitt´s lymphoma of the ileocecal region. The histopathological examination was indicative for Burkitt´s lymphoma. To the best of our insight this is one of the few reported cases of such type of lymphoma in an adult patient presenting with bowel obstruction. Burkitt´s lymphoma is a rare malignancy in adults affecting gastrointestinal tract. It has a high proliferation potential and can rapidly progress to advanced disease. Early diagnosis is necessary to prevent complications and improve overall prognosis.

New global map of Crohn's disease: Genetic, environmental, and socioeconomic correlations.

Seventy-five years after the initial characterization of Crohn's disease (CD), much remains obscure about its etiology. The authors sought to evaluate the incidence trends of the last 25 years worldwide, and the existence of potential correlations with genetic, environmental, and socioeconomic factors that could be etiologically implicated in the pathogenesis of CD. Relevant medical literature for individual countries on the incidence of CD, on the incidence of associated genetic mutations, and on the incidence of suggested etiologic infectious agents such as Mycobacterium avium paratuberculosis were retrieved from published medical literature, reports from relevant international congresses, and through official reports from national health authorities. Increasing trends have been observed almost worldwide, with a broad north-south gradient still prevailing in Europe. Distinct regions of New Zealand, Canada, Scotland, France, the Netherlands, and Scandinavia represent the highest incidence areas. Industrialized status and affluence are the common denominators between endemic areas, but are too broad as terms to strongly indicate any particular etiological role. The increasing trends observed in Asia still account for a low prevalence of the disease and may represent increased detection and diagnostic ability of local health systems. Genetic associations are variably reproduced worldwide, in a manner inconsistent with a strong etiologic relationship. Data on paratuberculosis incidence are scarce, and the existing ones are ambivalent regarding an even indirect correlation between CD and an infectious trigger.

Baseline cholesterol is associated with the response to antiviral therapy in chronic hepatitis C.

BACKGROUND: Hepatitis C virus (HCV) partially interacts with low-density lipoprotein (LDL) receptors, suggesting a role for lipids in regulating HCV clearance. Our aim was to study if baseline lipids can discriminate responders from non-responders among patients with HCV infection. METHODS: A total of 109 HCV patients were studied. Laboratory measurements included serum lipids, aminotransferases and viral load, as well as HCV genotype determinations. RESULTS: Responders (n = 53) had significantly higher serum baseline levels of total cholesterol, LDL cholesterol and apolipoprotein B compared to non-responders (n = 56). Multivariate logistic regression analysis showed that a 10 mg/dL increase in total cholesterol was associated with 3.02 higher odds of responding to treatment (95% CI 1.74-5.32, P < 0.001), while a 10 mg/dL increase in apolipoprotein B levels was associated with 1.81 higher odds of responding to treatment (95% CI 1.37-2.54, P < 0.001), after adjustment for age, sex, body mass index (BMI), smoking habits, baseline viral load, liver histology and administration of pegylated interferon. An inverse association between BMI and response to treatment was also evident (adjusted odds ratio 0.73, 95% CI 0.55-0.96; P = 0.03). CONCLUSION: Baseline serum total cholesterol levels and BMI could be helpful in discriminating responders to antiviral therapy among patients with HCV infection.

Crohn's disease incidence evolution in North-western Greece is not associated with alteration of NOD2/CARD15 variants.

AIM: To assess the trends in the incidence of inflammatory bowel disease (IBD) over 23 years in the same area and to identify genetic factors related to incidence evolution. METHODS: Patients with IBD arising from North-western Greece were systematically recorded through the 1983-2005 period. Trends in disease incidence and genetic patterns related to CARD15 variants were documented and correlated. RESULTS: A total of 447 patients with IBD were recorded (23.5% Crohn's disease, 72.7% Ulcerative colitis and 3.8% indeterminate colitis). Mean annual incidence rates of CD and UC were 0.9/100,000 (95% CI 0.1-1.7) and 2.7/100,000 (95% CI 1.7-4.1) inhabitants, respectively. There was a statistically significant increase of CD incidence (P<0.01) during the study period, in contrast to the UC incidence. There were no statistical differences in CARD15 variants over the study period. CONCLUSION: The incidence of CD in North-western Greece has risen disproportionately to that of UC in the 21st century. This is not related to alterations of genetic background though.

Characteristics of ascitic fluid in cardiac ascites.

OBJECTIVE: Cardiac ascites remains a rare entity with unique clinical and pathogenetic features that are not adequately recognized by clinicians. The purpose of this study was to contribute towards elucidating the nature of cardiac ascites. MATERIAL AND METHODS: We describe a series of 26 ascitic fluid samples from eight patients with cardiac ascites that were referred and further evaluated for the etiology and nature of their ascites. RESULTS: In all samples ascitic fluid was an exudate with an increased serum-ascitic fluid albumin gradient, a pattern unique in ascites. Other causes of ascites were excluded, often through a protracted differential diagnostic procedure. CONCLUSIONS: The unique pattern of cardiac ascites should allow for rapid diagnosis and characterization: The clinical implications of furosemide use in its response and biochemical properties warrant further description.

Treatment and retreatment in patients with chronic hepatitis C: 10 years clinical practice in a single centre.

AIM: Therapy for chronic hepatitis C (HCV) has mainly been evaluated in large clinical, select population, trials. We sought to evaluate whether prognostic factors of therapeutic response are similar in clinical practice, where treated population is more diverse. METHODS: Retrospective study of HCV-infected patients who completed >6 months of treatment/retreatment with various therapeutic regimens, in a single reference centre over a 10-year period. Adjuvant treatment with hemopoetic growth factors was used when warranted by treatment side effects. RESULTS: Overall, 77/125 patients (61.6%) achieved sustained virological response (SVR). Fifty-four naïve patients (43.2%) achieved SVR; 19 (26%) with interferon-alpha (IFN-alpha), 13 (59.1%) with IFN-alpha and ribavirin, and 22 (73.3%) with pegylated IFN-alpha and ribavirin. Seventeen patients responded after two courses of therapy and six after more than three courses, achieving a total SVR of 32%. Patients with genotype-1 were less probable to achieve SVR [odds ratio (OR)=6.23], while younger patients were more possible to achieve SVR, OR=0.97. Most non-responders after >2 regimens were genotype-1 patients (90%). CONCLUSIONS: In clinical practice, where strict selection criteria cannot be applied, genotype-1 remains the most significant prognostic factor of response failure. Addition of adjuvant hemopoetic growth factors, when warranted, may increase compliance and thus overall SVR.

Rectal Epstein-Barr virus-positive Hodgkin's lymphoma in a patient with Crohn's disease: case report and review of the literature.

We present the case of a 35-year-old man with Crohn's disease diagnosed at the age of 27, several months after an operation for small-bowel adenocarcinoma. Seven years after the adenocarcinoma diagnosis, the patient presented with severe continuous anal pain and diarrhea. In parallel with antibiotic administration, the patient was given treatment with Infliximab, but without clinical symptom amelioration. Sigmoidoscopy and subsequent biopsies from an ulcerated rectal area supported the diagnosis of Epstein-Barr virus-positive (EBV+) primary Hodgkin's lymphoma. Infliximab administration was immediately discontinued and the patient underwent oncological follow-up and began a course of chemotherapy. Only a few cases with primary gastrointestinal Hodgkin's lymphoma in Crohn's disease patients have so far been reported, including a variety of scenarios on the causal relationship including disease duration, presence of EBV, long-term immunosuppressive treatment and, recently, anti-TNFalpha administration.

Octreotide in the treatment of refractory ascites of cirrhosis.

Dietary sodium restriction and diuretic treatment have been shown to be effective in the treatment of ascites in the majority of cirrhotic patients. However, approximately 5 to 10% of patients develop refractory ascites, which is defined as ascites that does not respond to intensive diuretic therapy (diuretic-resistant) or ascites that cannot be controlled because the patient develops diuretic-induced complications that prevent the use of an effective diuretic dose (diuretic-intractable). Current therapeutic approaches for refractory ascites include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunting. In the present report, subcutaneous octreotide treatment improved renal function and hemodynamics and diuretic response in two patients with refractory ascites in line with a marked decrease in renin and aldosterone secretion. We consider that octreotide could be of value in the management of refractory ascites in cirrhotic patients.

Differential effects of NOD2 variants on Crohn's disease risk and phenotype in diverse populations: a metaanalysis.

OBJECTIVES: Three variants of the CARD15/NOD2 gene (SNP8, SNP12, and SNP13) have been associated with Crohn's disease (CD). We assessed the impact of NOD2 variants on the CD risk across diverse populations and examined possible associations with disease phenotype. METHODS: We performed a metaanalysis searching MEDLINE and EMBASE (last search 05/2004) and contacting field experts. RESULTS: Forty-two eligible studies contributed data on 206 comparisons. No variants were detected in Asians. In non-Jewish descent Caucasians carriage of SNP8, SNP12, or SNP13 had an odds ratio (OR) for CD of 2.20 (95% CI: 1.84-2.62), 2.99 (95% CI: 2.38-3.74), and 4.09 (95% CI: 3.23-5.18), respectively. For Jewish descent patients the corresponding ORs were 1.74, 1.93, and 2.45, respectively. The OR in carriers of at least two alleles was 17.1 (95% CI: 10.7-27.2). Large studies tended to yield more conservative estimates than smaller studies, so publication or other bias cannot be excluded. Among CD patients, carrying at least one high-risk variant increased slightly the risk for familial disease (OR = 1.49, (95% CI: 1.18-1.87)), modestly the risk of stenosing CD (OR = 1.94, (95% CI: 1.61-2.34)), and more prominently the risk of small bowel involvement (OR = 2.53, (95% CI: 2.01-3.16)). CONCLUSIONS: SNP8, SNP12, and SNP13 have differential effects on CD risk, with SNP13 having the strongest genetic effect. These NOD2 variants are also significant risk factors for CD phenotype, in particular ileal location.