Bariatric surgery is associated with increased risk of new-onset inflammatory bowel disease: case series and national database study.

BACKGROUND: Case series suggest a possible association between bariatric surgery and incident IBD. AIM: The aim of this study was to evaluate the association between bariatric surgery and new-onset IBD. METHODS: We first conducted a multi-institutional case series of patients with a history of IBD and bariatric surgery. We next conducted a matched case-control study using medical and pharmacy claims from 2008 to 2012 in a US national database from Source Healthcare Analytics LLC. Bariatric surgery was defined by ICD-9 or CPT code. Bariatric surgery was evaluated as recent (code in database timeframe), past (past history V code) or no history. Conditional logistic regression was used to estimate odds ratios (OR) and 95% CI for new-onset IBD, CD and UC. RESULTS: A total of 15 cases of IBD (10 CD, 4 UC, 1 IBD, type unclassified) with a prior history of bariatric surgery were identified. Most cases were women, had Roux-en-Y surgery years prior to diagnosis and few IBD-related complications. A total of 8980 cases and 43 059 controls were included in our database analysis. Adjusting for confounders, a past history of bariatric surgery was associated with an increased risk of new-onset IBD (OR 1.93, 95% CI 1.34-2.79). However, patients who had recent bariatric surgery did not appear to be at shorter term risk of IBD (OR 0.94, 95% CI 0.58-1.52). CONCLUSION: New-onset IBD was significantly associated with a past history of bariatric surgery. This potential association needs to be confirmed in future prospective studies.

RET is a potential tumor suppressor gene in colorectal cancer.

Cancer arises as the consequence of mutations and epigenetic alterations that activate oncogenes and inactivate tumor suppressor genes. Through a genome-wide screen for methylated genes in colon neoplasms, we identified aberrantly methylated RET in colorectal cancer. RET, a transmembrane receptor tyrosine kinase and a receptor for the glial cell-derived neurotrophic factor family ligands, was one of the first oncogenes to be identified, and has been shown to be an oncogene in thyroid cancer and pheochromocytoma. However, unexpectedly, we found RET is methylated in 27% of colon adenomas and in 63% of colorectal cancers, and now provide evidence that RET has tumor suppressor activity in colon cancer. The aberrant methylation of RET correlates with decreased RET expression, whereas the restoration of RET in colorectal cancer cell lines results in apoptosis. Furthermore, in support of a tumor suppressor function of RET, mutant RET has also been found in primary colorectal cancer. We now show that these mutations inactivate RET, which is consistent with RET being a tumor suppressor gene in the colon. These findings suggest that the aberrant methylation of RET and the mutational inactivation of RET promote colorectal cancer formation, and that RET can serve as a tumor suppressor gene in the colon. Moreover, the increased frequency of methylated RET in colon cancers compared with adenomas suggests RET inactivation is involved in the progression of colon adenomas to cancer.

Claudication in an adolescent with a hypoplastic femur.

The most common cause of claudication is atherosclerosis obliterans. However, when it presents in adolescence, other causes should be considered. We describe the case of a 15-year-old girl who had severe intermittent claudication 8 years after a limb-lengthening procedure for a hypoplastic femur. The lesion responsible was an isolated fibromuscular dysplastic segment of the distal superficial femoral artery and proximal popliteal artery. The etiology, treatment, and histopathology are discussed.

Splenic rupture in a human immunodeficiency virus-infected patient with primary splenic lymphoma.

Splenic rupture presenting as primary malignant lymphoma of the spleen is a rare event. We report such an occurrence in a young man who had a primary B-cell immunoblastic lymphoma of the spleen and was found to be HIV-positive. We suggest that serologic tests for HIV should be performed in unusual cases of malignant lymphoma.

DNA quantification in colorectal carcinoma using flow and image analysis cytometry.

Numerous studies using flow cytometry (FCM) have shown that DNA quantification and ploidy classification can provide information of prognostic significance for patients with colorectal carcinoma; recent advances in image analysis cytometry (image cytometry, ICM) provide a new, alternative technique for DNA quantification. This study investigated whether (1) patients with colorectal carcinomas that exhibit a diploid pattern of DNA distribution have improved five-year survival statistics as compared to their non-diploid counterparts and (2) ICM provides quantitative data comparable to that obtained by FCM. DNA quantification and ploidy classification of 27 cases of primary colorectal carcinoma was performed on archival paraffin-embedded tissue by both FCM and ICM; 70% (19) of the tumors were classified as nondiploid by ICM while 56% (15) were similarly classified by FCM. Diploid tumors were associated with Dukes' stage A while nondiploid tumors were associated with Dukes' stage D. The overall five-year survival rate was 75% for patients with ICM diploid tumors and 67% for patients with FCM diploid tumors. The five-year survival was only 53% for patients with nondiploid tumors identified by both techniques. This study confirmed that DNA quantification is an important prognostic indicator for patients with colorectal carcinoma. It also showed that ICM provides data comparable to that of FCM and may be more sensitive.

Light chain cardiomyopathy associated with small-vessel disease.

Intramyocardial small-vessel disease associated with systemic light chain deposition is a rare condition that may occur in patients with monoclonal plasma cell proliferation. This article describes a 39-year-old woman who had experienced several episodes of subendocardial myocardial infarction and was found to have plasma cell dyscrasia. Endomyocardial biopsy revealed kappa light chain deposits along the sarcolemmal and vascular basement membranes, the latter of which resulted in vascular occlusion and myocardial infarction. Postmortem examination showed polyvisceral deposition of kappa light chains. This rare complication of plasma cell proliferative process has a poor prognosis.