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The E4 allele of apolipoprotein E (apoE4) has previously been associated with symptomatic gallstone disease. The aim of this study was to determine if apoE4 is associated with the development of gallbladder sludge and/or stones during pregnancy. We conducted a nested case-control study based on an ongoing cohort study of gallbladder disease in pregnancy. Women in this study receive gallbladder ultrasounds in each trimester of pregnancy. Cases (n ‫؍‬ 52) were defined as women with incident gallbladder sludge or stones diagnosed at the third trimester ultrasound. Controls (n ‫؍‬ 104) were defined as women without gallbladder sludge or stones on any of 3 study ultrasounds. ApoE genotyping was performed from stored white blood cell pellets. Data were analyzed by stratified analysis and multivariate logistic regression. Cases and controls were similar in baseline characteristics. Forty-two women had sludge, 6 had gallstones, and 4 had both sludge and stones. After adjusting for risk factors such as age, parity, and body mass index, the odds ratio (OR) for the association between heterozygosity or homozygosity for the apoE4 allele and incident gallbladder sludge or stones was 0. Gallstones are more common in women than in men at all ages. 1 This gender difference begins during puberty and continues during the childbearing years, but fades after menopause. Biliary sludge, a potential precursor to gallstones, forms in up to 30% of women during pregnancy, and gallstones form in 2% to 4%. 2-4 Biliary sludge, or microlithiasis, in pregnancy consists of clusters of cholesterol crystals in bile, which cast characteristic low amplitude echoes by ultrasonography. 5 Although not all cases of sludge will necessarily evolve to become gallstones, sludge is believed to be the initial step in gallstone formation 6 and is regarded as the earliest recognizable stage of lithogenesis. However, the risk factors for the development of sludge and gallstones during pregnancy are not clearly defined.Many studies have documented a familial and ethnic clustering of gallstones. 7-9 Because cholesterol hypersecretion in bile is a prerequisite for gallstone formation, one can postulate that alterations in cholesterol synthesis, metabolism, or transport may affect the risk of gallstone formation. Genetic variation in cholesterol metabolism may thus play a role. One protein proposed to be associated with gallstones is apolipoprotein E (apoE), 10,11 which is a component of very low-density lipoproteins and high-density lipoproteins (HDL). ApoE mediates binding of lipoprotein particles to low-density lipoproteins (LDL) and chylomicron remnant receptors and regulates the plasma cholesterol response to dietary cholesterol intake. 12 As such, it has a central role in cholesterol metabolism and transport.ApoE has 3 common genetic variants, E2, E3, and E4, which vary in their receptor-binding affinity 12 and catabolic rates. 13 These variations influence the serum levels and clearance of circulating lipoprotein particles. Compared with the E3 allele, the ...

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The seroprevalence of hepatitis A in those with chronic liver diseases was 53%. Cost analysis revealed that screening for hepatitis A before immunization is cost saving, and this strategy should be applied to follow current vaccination guidelines.

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A 59-yr-old white man with Merkel cell carcinoma of his right leg status post extensive skin resection and chemotherapy had dilated hepatic and common bile ducts on a routine follow-up abdominal CT scan. A 1.9-cm ampullary mass was appreciated on endoscopy. Histology showed psammoma bodies and positive immunoperoxidase staining consistent with a somatostatinoma. Merkel cell tumors and somatostatinomas are extremely rare neuroendocrine tumors derived from neural crest cells. Associations have been found between somatostatinomas and other islet cell tumors with multiple endocrine neoplasia syndromes, but no reported association has been published between islet cell tumors and Merkel cell tumors. This patient represents the first documented case of Merkel cell carcinoma and somatostatinoma in a single patient. Such an occurrence may represent a previously undescribed neuroendocrine tumor syndrome, and this possibility should be considered when either tumor is diagnosed.

Proximal jejunal mucosal biopsy was performed by a radiologist through the nasojejunal catheter at the time of enteroclysis. Seventeen patients (10 men and seven women, aged 23-73 years [mean, 46 years]) were studied with enteroclysis because of clinical signs of malabsorption with suspected small bowel disease. In seven (41%) patients, results at biopsy were positive, and results in another seven (41%) were positive at enteroclysis. In 10 (59%) patients, results were positive at one or both tests. Performance of both small bowel biopsy and enteroclysis at the same session is feasible and offers additional clinically pertinent information than can be obtained at enteroclysis alone.