The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.

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Background: it is necessary to find serological markers accessible in clinical practice to prevent the need to perform repeated endoscopies.Objective: to assess the efficacy of eosinophil activity markers in monitoring eosinophilic esophagitis (EoE).Material and methods: thirty patients were included prospectively, all under dietary treatment -diets excluding 6 foods, and allergy test based diet (skin prick test and specific IgE). The variables assessed were demographic parameters, eosinophil cationic protein (ECP) levels (μg/mL), total IgE (KU/L), peripheral blood eosinophils (PBE) (U/mm 3 ), and the maximum peak of eosinophils/hpf in esophageal biopsies. The variation found between these figures was assessed in line with response to dietary treatment.Results: thirty patients (66.7 % males; mean age 33.43 years) were included in the study, 22 responders and 8 non-responders. Ninety percent presented a personal history of atopy. No significant decrease was detected in serum total IgE and ECP after diet in responder and nonresponders. However, the PBE decreased significantly in responders but not in nonresponders, PBE in responders (pre-diet. 397.27 vs. post-diet 276.81, p = 0.024) and non-responders PBE (pre-diet. 460 vs. post-diet 317.5, p = 0.23).Conclusion: serum total IgE and ECP do not act as markers for EoE activity. However PBE may play a role in this regard, bearing in mind that this parameter may be influenced by concomitant atopic conditions.

Familial amyloidotic polyneuropathy is an inherited form of amyloidosis associated with a mutant form of a protein called transthyretin. The Methionine-30 variant is the most frequent mutation observed. This disorder is caused by deposition of this protein as amyloid in several organs, such as the heart, kidneys, and peripheral nervous system. The disease is always progressive and fatal, and patients die 7 to 10 years after the onset of symptoms. Liver transplantation is at present the only choice for these patients because it provides improvement of symptoms and/or stops progression of the disease in most patients. We report the case of a patient who showed clear progression of cardiomyopathy and neuropathy after liver transplantation. Copyright 1999 by the American Association for the Study of Liver DiseasesF amilial amyloidotic polyneuropathy (FAP) is an autosomal dominant inherited form of amyloidosis associated with a mutant form of a protein called transthyretin or prealbumin. This disorder is caused by the systemic deposition of variant transthyretin molecules as amyloid fibrils in the extracellular matrix of several organs, such as the heart, kidneys, peripheral nervous system, and eyes. 1-3 More than 30 amyloidogenic mutations in the transthyretin gene have been reported, but the Methionine-30 (Met-30) transthyretin variant is the most frequent. 4 Symptoms begin in the middle life with peripheral polyneuropathy, autonomic dysfunction, cardiomyopathy, vitreous opacities, and, occasionally, nephrotic syndrome and renal failure. The disease is always progressive and fatal, and patients usually die 7 to 10 years after the onset of symptoms. 1 The presence of cardiomyopathy is the most important factor that affects patient survival. 5 In 1990, Holmgren et al 6 proposed orthotopic liver transplantation (OLT) as a treatment to remove the major source of variant transthyretin production, thereby arresting the progression of amyloid deposition. Since then, many patients with FAP have received liver transplants in several countries, with a high success rate. Several investigators have reported improvement in autonomic and peripheral neuropathies and nutritional status. 6-9 Although OLT is, at present, the only lifesaving treatment for FAP, recent reports have suggested that cardiomyopathy can progress after OLT for FAP. 10,11 We report the case of a patient who underwent OLT for FAP caused by Tyrosine-77 (Tyr-77) transthyretin variant in whom clinical worsening with progression of cardiomyopathy and neuropathy has been observed after OLT. Case ReportA 61-year-old man had a 2-year history of progressive muscle weakness, sensory impairment (paresthesis and loss of pain and temperature sensations), and deep arreflexia of the limbs, particularly in the legs. In addition, he showed symptoms of autonomic dysfunction with hypotensive episodes, dysuria, impotence, and severe diarrhea accompanied by a weight loss of 12 kg during the last year. The presence of an axonal polyneuropathy was verified by electromyography and n...

BackgroundEosinophilic oesophagitis (EoE) is characterized by the presence of eosinophils in oesophageal mucosa. Other inflammatory cells, mainly lymphocytes, dendritic cells, and mast cells may also play an important role in this disease. The aim of this study is to compare the inflammatory pattern of the mucosa between EoE and gastro-oesophageal reflux disease (GERD), using automatic image analysis in digital slides, and to assess treatment response after elimination diet and food challenge test.MethodsFrom 2010 to 2013, 35 oesophageal biopsies from EoE and GERD patients were randomly selected. In six EoE biopsies, patients had been treated with selective food exclusion diet. Immunohistochemical study with CD3, CD20, CD4, and CD8 for lymphocyte populations, CD1a for dendritic cells, and CD117/c-kit for mast cells was performed. Slides were scanned using Leica Aperio Scanscope XT with 40× magnification. Immunohistochemical expression was quantified in 245 immunohistochemistry digital slides with Leica Aperio positive pixel count algorithm using two different approaches: whole slide analysis versus selection of a 2 mm2 hot spot area.ResultsAverage eosinophil cell count was significantly higher (p < 0.001) in the first biopsy of EoE patients before treatment (30.75 eosinophils per high power field - HPF) than in GERD patients (0.85 eosinophils/HPF) or in EoE patients after treatment with elimination diet (1.60 eosinophils/HPF). In the immunohistochemical study, manual count and automatic image analysis showed a significant increase in the number of CD3 and CD8 cells in EoE patients, compared with GERD patients. However, the increase of CD117/c-kit was only statistically significant when manual counting procedures were used. CD20 positive cell count also showed a non-statistically significant tendency to reduce after elimination diet treatment.Manual eosinophil count correlated much better with CD3 and CD8 count using hot spot approach than with a whole slide approach.ConclusionsPositive pixel count algorithm can be a useful tool to quantify the immunohistochemical expression of inflammatory cells in the diagnosis and follow up of eosinophilic oesophagitis.

Among the many complications of celiac disease, mesenteric lymph node syndrome cavitated is considered one of the rarest, there is few case series published in the literature. The etiology and pathophysiology are unknown but because of its high mortality rate, estimated to be around 50%, it should recognize at an early stage in order to institute appropriate therapy as soon as possible.

Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion.