Interval percutaneous cholecystostomy is effective for decompression of the common bile duct in high-risk elderly patients prior to endoscopic retrograde cholangiopancreatography.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for common bile duct decompression. Nevertheless, this procedure may be hazardous for high-risk elderly patients. OBJECTIVE: To assess retrospectively whether interval percutaneous cholecystostomy (PC) should be considered in high-risk patients until their condition has improved and allows ERCP to be performed. SETTING: Referral community teaching hospital. PATIENTS: 8 elderly high-risk patients with acute cholangitis. INTERVENTION: All underwent PC as a bridging procedure till performing ERCP. RESULTS: Age ranged from 72 to 91 years (median 87). All 8 patients underwent PC. PC insertion improved their general condition and allowed us to perform an ERCP later on. Median time between PC and ERCP was 5 days. In 3 patients there was no need to perform an ERCP. All were discharged in a generally good condition and after normalization of bilirubin and liver enzymes. Median length of stay in hospital was 18 days. CONCLUSIONS: PC, as a bridging procedure to ERCP, can be an appropriate approach for selective high-risk elderly patients in whom ERCP is considered to be difficult and hazardous at the time of presentation.

Fecal calprotectin as a predictor of abnormal colonic histology.

PURPOSE: Gastroenterologists have been seeking reliable noninvasive indices of inflammatory and malignant bowel disease. This prospective study was to assess the value of fecal calprotectin in predicting abnormal histologic findings in patients undergoing colonoscopy. METHODS: Stool specimens supplied before colonoscopy by 72 consecutive patients were measured for calprotectin levels, and the findings correlated with the colonoscopy results and other fecal and blood parameters. Receiver operating characteristics curve analysis was used to determine the predictive value of fecal calprotectin for abnormal colonic histology. RESULTS: Patients with abnormal histologic findings had significantly higher calprotectin levels (218 +/- 125 mg percent) than patients with normal colonoscopy (77 +/- 100 mg percent). There was a highly significant correlation between calprotectin levels and erythrocyte sedimentation rate (r = 0.45, P = 0.008), positive fecal occult blood test (r = 0.57, P = 0.0001), and abnormal colonic histology (r = 0.54, P = 0.0001). Patients with active inflammatory bowel disease had higher calprotectin levels than the rest of the study patients (r = 0.3; P = 0.01). On multivariate analysis, calprotectin was a significant predictor of abnormal colonic histology (P = 0.005; odds ratio, 1.007; 95 percent confidence interval, 1.002-1.012). The area under the receiver operating characteristics curve was 0.79. A fecal calprotectin concentration of 150 microg/ml had a sensitivity of 75 percent, specificity of 84 percent, positive predictive value of 80 percent, and negative predictive value of 75 percent in predicting abnormal colonic histology. CONCLUSIONS: Fecal calprotectin may serve as a simple, noninvasive surrogate marker of abnormal histologic findings in patients scheduled for colonoscopy.

Endobronchial metastases from colon cancer without liver metastases: report of eight cases.

PURPOSE: The liver is the most common site of hematogenous spread from colon tumors. Pulmonary metastases from colon cancer result, in most of the cases, from hepatic metastases. METHODS: We describe eight cases of colorectal cancers in which endobronchial metastases have been developed without any evidence of liver involvement. RESULTS: Median age was 62 years old. In most of the patients, the primary cancer developed in the left side. The median time from colorectal presentation to pulmonary onset was four years. Dyspnea was the major symptom in all cases. Pulmonary involvement included endobronchial metastasis in all cases. CT scan of the chest showed bilateral, diffuse, large, nodular infiltrates without lymph nodes enlargement and without pleural effusion. Endobronchial therapy brought symptomatic relief in all cases; however, two-year follow-up showed only 50 percent survival rate. CONCLUSIONS: Endobronchial metastasis should be suspected in patients with colon cancer with respiratory symptoms, even without known liver metastasis. To the best of our knowledge, such a case series has not been published yet.

Hepatic production of insulin-like growth factors in normal and diseased liver.

BACKGROUND/AIMS: IGF-I levels are reduced in cirrhotic patients. However, it is not known whether this decreased level is the result of reduced hepatic production or modified bioavailability secondary to decreased binding proteins. We determined the hepatic production of IGF-I and IGF-II and their receptors in normal and diseased liver. METHODOLOGY: Twenty-five patients included, 11 controls with normal liver and 14 with either chronic hepatitis or cirrhosis. mRNA for IGF-1, IGF-II and their receptors were measured. Immunohistochemical staining was performed to localize the IGF-producing cells. RESULTS: In 11 normal livers, the IGF-I mRNA levels were 4.95 +/- 1.8; in the 14 diseased livers, the levels were 1.22 +/- 0.69 (p < 0.001). IGF-II mRNA levels were 3.78 +/- 1.45 for the control and 5.11 +/- 2.15 in the diseased livers (NS). IGF-I receptor levels were 1.15 +/- 0.83 in the normal and 0.31 +/- 0.22 in the liver disease group (p < 0.05). There was no statistical difference between the two groups for IGF-II receptor. CONCLUSIONS: Patients with chronic liver disease have a significant reduction in their hepatic production of IGF-I, whereas IGF-II tends to be elevated. Treatment with recombinant IGF-I in patients with metabolic or endocrine complications of cirrhosis might prove useful.