Risk factors for advanced adenomas amongst small and diminutive colorectal polyps: a prospective monocenter study.

BACKGROUND: The management of colorectal polyps <10mm in diameter is controversial. Our aim was to evaluate the rate and risk factors for advanced adenomas and high grade neoplasia amongst small (6-9 mm) and diminutive (1-5mm) colorectal polyps. METHODS: Endoscopic and pathological reports of colonoscopies performed in our centre were collected prospectively. Advanced adenoma was defined by presence of a villous component and/or high grade dysplasia; high grade neoplasia by presence of high grade dysplasia and/or intramucosal carcinoma. RESULTS: 1468 patients were included (53.1% male, mean age 59.5±14 years); 414 polyps <10mm were detected, 9.9% advanced adenomas and 1.7% high grade neoplasia. Amongst small polyps, 25 (35.2%) were advanced adenomas, mainly due to villous features, and 3 (4.2%) were high grade neoplasia. Polyp size was associated with advanced adenomas (odds ratio=8.47). CONCLUSION: The rate of advanced adenomas amongst small polyps was 35%, mainly due to the presence of villous features. Polyp size was identified as a risk factor of advanced adenoma amongst polyps <10mm. Given these results, we believe that polypectomy should be warranted for patients presenting with small polyps at computed tomography colonography.

[Non-traumatic spontaneous intramural hematoma of the small bowel: an infrequent complication of anticoagulation therapy]. / Hematoma intramural espontáneo no traumático del intestino delgado: una complicación poco habitual de los anticoagulantes.

Intramural hematoma of the small bowel is an infrequent complication of the use of oral anticoagulants. Diagnosis can only be performed when these symptoms are associated with a history of oral anticoagulant use and radiological tests. We report the case of a patient admitted for epigastric pain associated with oral anticoagulation therapy with warfarin and a 48-h history of retention vomiting. Ultrasound and abdominal computed tomography scans revealed a jejunal loop with diffuse parietal thickening, suggesting an intramural hematoma. Conservative therapy was provided with symptomatic regression on the second day and reabsorption of the jejunal intramural hematoma. Anticoagulation therapy was reintroduced with no recurrences.

[Acute liver failure]. / Insuficiência hepática aguda.

Acute liver failure refers to the rapid development of severe acute liver injury with impaired synthetic function in a patient who previously had a normal liver or a well compensated liver disease. Its aetiology is diversified and it provides one of the best indicators of prognosis thus being crucial its quick identification. Because it can progress to multiple organ failure syndrome these patients should be managed in an Intensive Care Unit. The first therapeutic approach consists of intensive care support until treatment for specific aetiologies can be started. Besides encephalopathy, many other complications can develop causing the high rates of morbidity and mortality of acute liver failure and so they need tight surveillance and treatment. Liver support systems are therapeutic options still in study and without proven success in a long term period which makes hepatic transplantation the final therapeutic. Given the wide limitations of hepatic transplantation the final decision is based on a correct diagnosis and prognostic scoring systems.