Radiofrequency ablation for the treatment of radiation proctitis: a case report and review of literature.

Radiation proctitis is a frequent complication of pelvic radiation for cancer. This condition can present acutely within several weeks of radiation, or chronically many months or years after radiation, leading to rectal bleeding and transfusion-dependent anemia. Various medical and endoscopic therapies have been described to treat this condition; however, some patients fail to respond to the current standard therapies. Here we present a case of refractory radiation proctitis, with suboptimal response to other therapies, treated successfully with a novel method, radiofrequency ablation.

Association of type 2 diabetes and colon adenomas.

INTRODUCTION: Type 2 diabetes mellitus (DM) is associated with hyperinsulinemia, which may lead to increased risk of carcinogenesis by increasing insulin-like growth factor-1 level. In this study, we sought to determine the association between type 2 DM and colon adenomas. METHODS: In this retrospective case-control study, all the colonoscopies performed in an urban medical center during a 3-year period were reviewed. Patients with adenomatous polyps were considered as cases (n = 261). Age- and sex-matched controls with a 2:1 ratio were selected (n = 522). Among diabetic subjects, the association of different anti-diabetic medications and HbA1C level with high-risk adenoma features was analyzed. RESULTS: Type 2 DM was significantly associated with colon adenomas (odds ratio (OR) = 1.45, 95% confidence interval (CI) = 1.05-2.01, p = 0.024). Exposure to insulin (OR = 1.734, 95% CI = 1.13-2.65, p = 0.013) and thiazolidinediones (OR = 2.83, 95% CI = 1.28-6.26, p = 0.01) was associated with developing adenomas. Neither the type of antidiabetic medication nor the level of HbA1C was a predictor for high-risk adenomas. Smoking (OR = 1.47, 95% CI = 1.07-2.02, p = 0.02), use of aspirin (OR = 1.59, 95% CI = 1.15-2.20, p = 0.005), and statins (OR = 1.54, 95% CI = 1.13-2.10, p = 0.007) appeared to increase the risk of adenomas. CONCLUSION: This study shows a significant association between type 2 DM and colon adenomas. Establishing this association may lead to inclusion of diabetic patients in the high-risk group for developing colorectal cancer.

Acute pancreatitis with normal serum lipase: a case series.

CONTEXT: Acute pancreatitis is diagnosed on the basis of clinical features, biochemical tests and imaging studies. Normal serum amylase level has been reported in the setting of acute pancreatitis but normal serum lipase level in acute pancreatitis is extremely rare. CASE REPORT: Herein, we present a case series of acute pancreatitis with normal serum lipase levels along with a review of the topic. CONCLUSION: In appropriate clinical setting, the diagnosis of acute pancreatitis should be entertained even with normal serum amylase and lipase levels.

Chronic kidney disease as a risk factor for Clostridium difficile infection.

INTRODUCTION: Clostridium difficile-associated diarrhoea (CDAD) is the most common cause of nosocomial diarrhoea in the USA. In this study, we sought to determine the association between chronic kidney disease (CKD) and CDAD. METHODS: A case-control study was designed to determine the association between CKD and CDAD in an urban hospital. Over a 2-year period, all patients diagnosed with CDAD (n = 188) were included as cases and the prevalence of CKD was calculated. Age- and sex-matched patients without CDAD were considered as controls with a ratio of 2:1 controls to cases. The prevalence of different stages of advanced CKD (stages 3-5) was determined and compared between groups. Also the calculated odds ratios (OR) were adjusted for multiple possible confounding variables using logistic regression analysis. RESULTS: There was no significant difference in prevalence of advanced CKD between cases and controls (OR = 1.38, 95% confidence intervals (CI) = 0.90-2.12, P = 0.1365). The association between CKD and CDAD remained insignificant in subjects with CKD stages 3-5 who were not on dialysis (OR = 1.07, 95% CI = 0.65-1.77), P = 0.7970). However, the group with end-stage renal disease on dialysis showed a significant association (OR = 2.60, 95% CI = 1.25-5.41, P = 0.0165). Controlling for antibiotics as a possible confounding variable, yielded an OR that was not statistically significant (OR = 2.05, 95% CI = 0.94-4.47, P = 0.07), but still showing a trend towards increased risk. CONCLUSION: End-stage renal disease may increase the risk of acquiring CDAD through unknown mechanisms. This suggests implementing better surveillance strategies for these patients and eliminating the known risk factors for CDAD.

Clostridium difficile infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors.

C. difficile-associated diarrhea (CDAD) has become a major cause of morbidity in hospitalized patients. In this study of five-year (2001-2005, inclusive) trends of incidence of CDAD among adults in an inner-city medical center, the overall annual incidence increased from 5.08 to 8.42 cases/10(3) admissions (p = 0.0005). Age distribution remained fairly constant for 2001-2004 but decreased significantly in 2005 (p = 0.005); no significant change was observed for gender. During the five-year period, we observed a decline in the use of histamine type 2 receptor antagonists (H2A) with a concomitant increase in the use of proton pump inhibitors (PPI) as a prophylactic measure to prevent stress ulcers. The usage of PPI correlated exactly (r(s) = 1.0; p = 0.017) with the increase in CDAD incidence. A case (n = 122)-control (n = 244) study for the final year was conducted, examining the association of PPI and H2A with CDAD. After controlling for the effect of antibiotic use, PPI either pre- or during admission was associated with CDAD (odds ratio, OR (adjusted) = 2.75, 95% CI = 1.68 to 4.52; p = 0.0001); the association with H2A was not significant (OR (adjusted) = 0.95, 95% CI = 0.39 to 2.34; p = 0.9153). If only first-time use during hospital stay is considered, PPI were also strongly associated with CDAD (OR (adjusted) = 1.88, 95% CI: 1.07 to 3.31; p = 0.0283) and H2A were not associated with CDAD (OR (adjusted) = 0.73, 95%CI: 0.26 to 2.06; p = 0.5520). These data suggest that the widespread prescription of PPI for stress ulcer prophylaxis in acute care facilities may contribute to the increased incidence of CDAD.