Association of IGF1 and IGFBP3 polymorphisms with colorectal polyps and colorectal cancer risk.

PURPOSE: Insulin-like growth factor 1 (IGF1) is a peptide growth factor that promotes cell proliferation and inhibits apoptosis. The bioavailability of IGF1 is regulated by the insulin-like growth factor binding protein 3 (IGFBP3). The purpose of this study was to examine the association of genetic variants in IGF1 (rs6214, rs6220, and rs35767) and IGFBP3 (rs2854744 and rs2854746) with risk of colorectal polyps and colorectal cancer. METHODS: In this ongoing colorectal cancer study of Austria (CORSA), a total of 3,360 Caucasian participants, consisting of 178 colorectal cancer patients, 328 patients with high risk polyps, 1,059 patients with low risk colorectal polyps, and 1,795 colonoscopy-negative controls, were recruited within a large colorectal screening project in the province Burgenland and from three hospitals in Vienna. Multiple logistic regression was applied to compare individuals of the control group against three different risk groups, namely, colorectal cancer group, high risk polyp group, and low risk polyp group. RESULTS: Carriers of the homozygous polymorphic genotype of the SNP rs6214 were associated with an increased colorectal risk (OR = 1.79, 95% CI 1.04-1.90) compared to the colonoscopy-negative controls; this was also found when combining colorectal cancer cases and high risk polyp group (OR = 1.39, 95% CI 1.01-1.90). CONCLUSION: Our results suggest that the SNP rs6214 of IGF1 could have an impact on developing colorectal cancer and colorectal polyps with villous elements.

Neurological consequences of atrioesophageal fistula after radiofrequency ablation in atrial fibrillation.

BACKGROUND: Radiofrequency ablation for atrial fibrillation (RAF) is an increasingly performed procedure. It is performed during cardiac surgery or percutaneously by catheter. A dangerous complication of RAF is atrioesophageal fistula (AEF), which predominantly manifests neurologically owing to food embolism. Because neurologists may not be familiar with AEF and the prognosis is dependent on a prompt diagnosis, awareness of AEF by the neurologist may play a crucial role. OBJECTIVE: To summarize for the neurologist the knowledge about fistula between the left atrium and esophagus occurring after RAF. DESIGN, SETTING, AND PATIENTS: Using a MEDLINE search, we collected reports about AEF after RAF in 28 patients. MAIN OUTCOME MEASURES: From the collected reports, the description of symptoms, diagnostic investigations, therapy, and outcome of the 28 patients were summarized. RESULTS: In 28 cases, AEF developed 3 to 38 days after RAF. Confusion, grand mal seizures, meningitis, focal cortical signs, and postprandial transient ischemic attacks associated with fever were the leading manifestations in 21 of 28 patients. Blood tests showed leukocytosis, elevated serum C-reactive protein levels, and thrombocytopenia. Blood cultures were frequently positive for bacteria. Lumbar puncture revealed pleocytosis, elevated protein levels, increased lactate levels, and bacteria. Diagnosis was established by thoracic contrast computed tomography. Endoscopy, insertion of nasogastric tubes, and transesophageal echocardiography were detrimental, leading to an increase in fistula size and food or air embolism. Therapy comprised surgery (n = 11) or temporary esophageal stenting (n = 1). The remaining patients died before attempted surgery or confirmation of the diagnosis. A neurological deficit persisted in 3 of the 9 surviving patients. CONCLUSIONS: In patients with meningitis, stroke, seizures, or impaired consciousness and fever, it should be determined whether they have had a previous RAF. In cases with a history of recent RAF, AEF should be strongly considered, especially if there are also symptoms such as dysphagia or chest pain. After RAF, the patient, his or her family, and his or her treating physicians should be informed about the signs of AEF, which may occur even weeks after RAF.

Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents.

Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.