Diffuse nodular duodenitis in a woman presenting with dyspepsia and weight loss.

Duodenal nodularity is an uncommon endoscopic finding charac-trized by numerous visible mucosal nodules in the duodenum. It is important to consider giardiasis in patients with symptoms include abdominal pain, nausea, anorexia, diarrhea, vomiting, weight loss and abdominal distension. It is also important to remind giardiasis in patients with duodenal nodularity.

Prevalence of advanced histologic features in diminutive colon polyps.

BACKGROUND/AIMS: Accurate in vivo differentiation of colon polyp histology may serve to prevent the resection of diminutive hyperplastic polyps in the distal colon or the need for histologic assesment of diminutive polyps after resection. The clinical implementation of these strategies depends on the prevalence of advanced histologic findings among diminutive polyps. We aimed to determine the prevalence of advanced histologic features (villous features, high-grade dysplasia, and adenocarcinoma) in diminutive colon polyps and compare it to small and larger polyps. PATIENTS/METHODS: The data of patients who had undergone elective colonoscopy at a tertiary-care referral center were retrospectively reviewed. The size, morphology, and location of all polyps were recorded. Polyps were divided into 3 groups according to their size: diminutive (≤ 5 mm), small (6-9 mm), and large (≥ 10 mm). RESULTS: A total of 7160 polyps in 3226 eligible patients were evaluated. The mean diameter of the polyps were 6.7 ± 4.9 mm. Histopathologic diagnosis were adenomatous in 4548 (63.5%) and non-adenomatous in 2612 (36.5%). Out of 7160 polyps, 4902 (68.5%) were diminutive (1-5 mm), 1360 (19%) were small (6-9 mm), and 898 (12.5%) large (≥ 10 mm) polyps. Among the diminutive polyps 2739 (55.9%) had adenomatous histology. There were 66 polyps (1.3%) with advanced histology in the diminutive group, 72 (5.2%) in the small group, 263 (29.2%) in the large polyp group. Diminutive polyps had a lower frequency of advanced histology compared to small and large polyps (p = 0.001). When the histology of the polyps were evaluated based on the size of the largest polyp the patient has, 2202 patients had polyp(s) ≤ 5 mm. The frequency of advanced histology was 2.2% in these patients. CONCLUSIONS: The prevalence of advanced histology in diminutive polyps is quite low (1.3%) which supports the clinical implementation of discard, resect and discard strategies in diminutive polyps.

Predictive Value of Unenhanced Computerized Tomography for Detecting Hepatosteatosis in Living Liver Donors.

OBJECTIVE: Macrovesicular hepatosteatosis is related to post-transplantation complications, so preoperative hepatosteatosis determination plays a critical role in donor selection. The aim of this study was to evaluate the efficacy of unenhanced computerized tomography (CT) in determining hepatosteatosis in liver donor candidates. METHODS: Information about donor candidates was retrospectively reviewed. In this screening, 27 donor candidates who underwent liver biopsy because of suspected hepatosteatosis in routine abdominal CT examination before transplantation, were reviewed. Liver biopsies and CT images were reevaluated by an experienced pathologist and radiologist. Macrovesicular hepatosteatosis was graded according to percentage and divided into 3 groups. Three radiologic liver attenuation indices were used: 1) hepatic attenuation value (CT(L)); 2) the difference between hepatic attenuation and spleen attenuation (CT(L-S)); and 3) the ratio of hepatic attenuation to splenic attenuation (CT(L/S)). RESULTS: CT(L), CT(L-S), and CT(L/S) values of donors with hepatosteatosis were significantly higher than the donors without hepatosteatosis. In receiver operating characteristic analysis, the optimal cutoff value of these indices for determining hepatosteatosis were; 42.5, -5, and 0.98, respectively. At these cutoff values, the sensitivity and specificity of these indices were calculated to be 80% and 75%, 93.3% and 83.3%, and 93.3% and 83.3%, respectively. There were no statistical differences between their diagnostic performances. When these 3 indices were used for detect significant hepatosteatosis (>20%) it was observed that hepatosteatosis of only one donor could not be determined whereas it was seen that specificity was decreased markedly. CONCLUSIONS: Despite the high diagnostic yield of unenhanced CT, it is not suitable to use alone for assessment of hepatosteatosis in clinical practice.

Splenic abscess in ulcerative colitis under anti tumor necrosis factor treatment.

Splenic abscess are rare conditions. Since morbidity and mortality rates are high, immediate diagnosis should be required. Here we presented an ulcerative colitis patients who develops splenic abscess under anti tumor necrosis factor treatment.