Entangled States Induced by Electron-Phonon Interaction in Two-Dimensional Materials.

We report on the effects of electron-phonon interaction in materials such as graphene, showing that it enables the formation of a gap bridged by unique edge states. These states exhibit a distinctive locking among propagation direction, valley, and phonon mode, allowing for the generation of electron-phonon entangled states whose parts can be easily split. We discuss the effect of the chiral atomic motion in the zone boundary phonons leading to this effect. Our findings shed light on how to harness these unconventional states in quantum research.

Inducing a topological transition in graphene nanoribbon superlattices by external strain.

Armchair graphene nanoribbons, when forming a superlattice, can be classified into different topological phases, with or without edge states. By means of tight-binding and classical molecular dynamics (MD) simulations, we studied the electronic and mechanical properties of some of these superlattices. MD shows that fracture in modulated superlattices is brittle, as for unmodulated ribbons, and occurs at the thinner regions, with staggered superlattices achieving a larger fracture strain than inline superlattices. We found a general mechanism to induce a topological transition with strain, related to the electronic properties of each segment of the superlattice, and by studying the sublattice polarization we were able to characterize the transition and the response of these states to the strain. For the cases studied in detail here, the topological transition occurred at ∼3-5% strain, well below the fracture strain. The topological states of the superlattice - if present - are robust to strain even close to fracture. The topological transition was characterized by means of the sublattice polarization of the states.

Efficacy and tolerability of a low-residue diet for bowel preparation: systematic review and meta-analysis.

BACKGROUND: Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy. METHODS: PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation. RESULTS: Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99-1.05; I2 = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12-1.23; I2 = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84-0.94; I2 = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with < 2000 kcal < 32 g of fibres/day had better tolerability. CONCLUSION: Based on these findings, our recommendation is strong in favour of a LRD for bowel preparation of patients undergoing a scheduled colonoscopy. This diet could also be useful as a preoperative colonic preparation, but this requires further research.

Experts' responses in script concordance tests: a response process validity investigation.

CONTEXT: The script concordance test (SCT), designed to measure clinical reasoning in complex cases, has recently been the subject of several critical research studies. Amongst other issues, response process validity evidence remains lacking. We explored the response processes of experts on an SCT scoring panel to better understand their seemingly divergent beliefs about how new clinical data alter the suitability of proposed actions within simulated patient cases. METHODS: A total of 10 Argentine gastroenterologists who served as the expert panel on an existing SCT re-answered 15 cases 9 months after their original panel participation. They then answered questions probing their reasoning and reactions to other experts' perspectives. RESULTS: The experts sometimes noted they would not ordinarily consider the actions proposed for the cases at all (30/150 instances [20%]) or would collect additional data first (54/150 instances [36%]). Even when groups of experts agreed about how new clinical data in a case affected the suitability of a proposed action, there was often disagreement (118/133 instances [89%]) about the suitability of the proposed action before the new clinical data had been introduced. Experts reported confidence in their responses, but showed limited consistency with the responses they had given 9 months earlier (linear weighted kappa = 0.33). Qualitative analyses showed nuanced and complex reasons behind experts' responses, revealing, for example, that experts often considered the unique affordances and constraints of their varying local practice environments when responding. Experts generally found other experts' alternative responses moderately compelling (mean ± standard deviation 2.93 ± 0.80 on a 5-point scale, where 3 = moderately compelling). Experts switched their own preferred responses after seeing others' reasoning in 30 of 150 (20%) instances. CONCLUSIONS: Expert response processes were not consistent with the classical interpretation and use of SCT scores. However, several fruitful and justifiable alternatives for the use of SCT-like methods are proposed, such as to guide assessments for learning.

Prevalence of incidental clinically relevant pancreatic cysts at diagnosis based on current guidelines.

BACKGROUND: Most pancreatic cysts (PCs) found incidentally by CT and MRI scans might not be clinically important according to the Fukuoka guidelines, the American Gastroenterological Association (AGA) guidelines and European guidelines. AIMS: To determine and compare the prevalence of incidental clinically important PCs (CIPCs). METHODS: Abdominal contrast-enhanced CT or MRI scans performed during a one-year period were retrospectively reviewed to identify incidental PCs. CIPCs were defined as those cysts that would be capable of triggering further evaluation with endoscopic ultrasound, immediate surveillance (within 3-6 months) and/or surgery. Prevalence was calculated as the number of patients with CIPCs per 100 subjects imaged (%). RESULTS: Sixty patients (mean age 70±14 years) out of 565 were found to have incidental PCs, representing a prevalence of 8.7% (95% CI 6.3-11.5) in CT scans and 27.5% (95% CI 16-41) in MRI scans. Seven patients (11.6%, 95% CI 5-22) had CIPCs based on size ≥ 30mm (n=5), size ≥ 30mm and pancreatic duct (PD) dilation (n=1) and PD dilation and presence of solid component (n=1). Based on the Fukuoka guidelines, the prevalence of CIPCs was 1.2% (95% CI 0.4-2.5) in CT scans (6/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Based on the AGA and European guidelines, the prevalence of CIPCs was 0.2% (95% CI 0.1-1) in CT scans (1/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Patients with PCs initially classified as "AGA- or European-positive" had a higher surgical probability and this decision was taken earlier in the follow-up. CONCLUSIONS: In our cohort, the prevalence of important incidental pancreatic cysts was not negligible at around 1% according to current guidelines.

Risk of Metachronous Advanced Neoplastic Lesions in Patients with Sporadic Sessile Serrated Adenomas Undergoing Colonoscopic Surveillance.

OBJECTIVES: The risk of developing metachronous advanced neoplastic lesions (ANLs) during surveillance after resection of sessile serrated adenomas (SSAs) has not been quantified. METHODS: Patients with sporadic SSAs resected between 1 April 2007 and 31 December 2009 who underwent surveillance colonoscopy in our institution were prospectively evaluated. Patients with low-risk adenomas (LRAs), high-risk adenomas (HRAs), and negative index colonoscopy (NIC) during the same period were identified using the pathology database and electronic medical records, and were also included as a comparison cohort. The primary outcome was the comparison of the study groups with regard to incidence of metachronous ANLs during surveillance colonoscopy. RESULTS: A total of 185 patients had SSAs, of whom 75 with 101 resected polyps were finally included. The comparison cohort consisted of 564 patients: 140 LRAs (160 polyps), 87 HRAs (478 polyps), and 337 NICs. The overall mean colonoscopy follow-up was for 54.5 months (±s.d. 14). SSA patients with synchronous HRA on index colonoscopy presented a higher incidence rate of metachronous ANL (12.96 per 1,000 person-months) compared with patients with HRA (5.07 per 1,000 person-months), whereas those with synchronous LRA and without synchronous adenoma on index colonoscopy presented a low incidence rate of metachronous ANL (0 and 1.41 per 1,000 person-months, respectively) similar to LRA (1.47 per 1,000 person-months). Among patients with SSA the 3- and 5-year ANL free-cumulative probability was 64.3 and 32.1% in those with synchronous HRA, 100 and 100% in those with synchronous LRA, and 95.1 and 91.7% if no synchronous adenoma was found. CONCLUSIONS: Among patients with resected sporadic SSAs the risk of developing metachronous ANL is influenced by the presence of synchronous HRA on index colonoscopy. Patients with SSAs and synchronous HRA on index colonoscopy require closer surveillance, whereas those with synchronous LRA and those without synchronous adenomas may be followed up in the same way as those with LRAs.

The Use of Standard Gastrointestinal Endoscopic Ultrasound to Assess Cardiac Anatomy.

In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist. Eight of the 20 standard views of cardiovascular structures per the 1999 American Society of Echocardiography/Society of Cardiovascular Anesthesiologists guidelines for TEE could be obtained using the linear echoendoscope. The following cardiac valvular structures were visualized: aortic valve (100%), mitral valve (100%), tricuspid valve (33%), and pulmonic valve (11%). Left ventricular and right ventricular systolic function could be assessed in 89% and 67% of patients, respectively. Other structures such as the ascending and descending aorta, pericardium, left atrial appendage, and interatrial septum were identified in 100% of patients. Doppler-dependent functions could not be assessed. Given that the EUS images were not directly compared with TEE in these patients, we cannot comment definitively on the quality of these assessments and further studies would need to be performed to make a formal comparison. Based on this study, EUS technology can consistently assess the mitral valve, aortic valve, aorta, pericardium, and left ventricular function. Given its limitations, EUS technology, although not a substitute for formal echocardiography, could be a helpful early diagnostic tool in an emergency setting.

[Adrenal insufficiency in cirrhotic patients]. / Insuficiencia suprarrenal relativa en pacientes cirróticos.

Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 υg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh = 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with = 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.

Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography.

BACKGROUND AND STUDY AIM: Cannulation of the native papilla in surgically altered anatomy is difficult in endoscopic retrograde cholangiography (ERC). There are limited data regarding the success of single-balloon enteroscopy-assisted ERC (SBE-ERC) in patients with a native papilla and Roux-en-Y gastric bypass. Use of a plastic cap may assist cannulation in these cases. The aim of the current study was to investigate the use of SBE-ERC with a cap (Cap-SBE-ERC) in patients with surgically altered anatomy referred for ERC. PATIENTS AND METHODS: Patients with surgically altered anatomy (hepaticojejunostomy, gastric bypass surgery, and Whipple's surgery) who underwent Cap-SBE-ERC were identified from a prospectively maintained database. Outcomes were diagnostic and procedural success. Patients with a native papilla were compared with those with a biliary-enteric anastomosis. RESULTS: Among 56 patients with surgically altered anatomy, high rates of diagnostic and procedural success were observed (78.6 % and 71.4 %, respectively). High diagnostic and procedural success rates of 72.7 % and 65.9 %, respectively, were also observed for patients with Roux-en-Y gastric bypass anatomy with a native papilla (n = 44). CONCLUSION: High rates of diagnostic and procedural success were reported for SBE-ERC with the use of a cap, including a large subgroup of patients with Roux-en-Y gastric bypass and a native papilla.

Meal ingestion markedly increases liver stiffness suggesting the need for liver stiffness determination in fasting conditions.

INTRODUCTION: The introduction of noninvasive liver stiffness (LS) determination has heralded a new stage in the diagnosis and treatment of liver fibrosis. AIM: We evaluated the effect of food intake on LS in patients with different degrees of liver disease. PATIENTS AND METHODS: We evaluated 24 patients (F≤1, n=11 and F> 1, n=13). LS (Fibroscan®) and portal blood flow (PBF) (Doppler ultrasound) were studied before and 30min after ingestion of a standard liquid meal. RESULTS: Food intake increased PBF (51±10%, p<0.001). Splanchnic hyperemia was accompanied by a significant rise in LS (from 7.8±3.3 to 10.3±4.1kPa, p<0.001). These increases were similar in patients with minimal fibrosis(F≤1) and in those with more advanced fibrosis or cirrhosis (F>1). Hemodynamic and LS values returned to baseline pre-meal levels within 2hours. CONCLUSION: LS increases markedly after ingestion of a standard meal, irrespective of the degree of fibrosis. Our results strongly suggest that LS should be measured in fasting conditions.

[Endoscopic ultrasound-guided choledocho-duodenostomy in advanced pancreatic cancer with duodenal obstruction]. / Colédoco-duodenostomía guiada por ecoendoscopía en cáncer de páncreas avanzado con obstrucción duodenal.

Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first-approach for biliary drainage. In cases of ERCP failure, patients are usually referred for percutaneous transhepatic biliary drainage or surgical biliary bypass. In the last decade, the indications of endoscopic ultrasound (EUS) in the management of patients with pancreatic cancer have increased, and numerous cases of EUS-guided biliary drainage have been reported in patients with failures during the ERCP. Our goal is to report a patient with locally advanced pancreatic cancer who presented with painless jaundice and cholestasis with biliary and duodenal obstruction. A EUS-guided choledochoduodenostomy was performed by placement of a self-expanding metal stent.

[De novo malignant tumors following liver transplantation. A single-center experience in Argentina]. / Tumores malignos de novo en el trasplante hepático. Experiencia de un centro en la Argentina.

The aim of the present study was to evaluate the incidence and clinical features of de novo tumors in patients undergoing liver transplantation in our center as well as to assess survival. We retrospectively analyzed 168 liver transplantations (159 patients) performed from May 2006 to May 2014. The incidence of de novo tumors was 7.5% (n = 12). The mean age at diagnosis was 63 ± 7 years. The most frequent neoplasms were non melanoma skin tumors and adenocarcinomas. Fifty percent of the tumors developed in the second and third year after transplantation. Type of immunosuppression did not influence tumoral type, although most patients receive tacrolimus in combination with mycofenolate and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 25 ± 29 months (range 0-76) and the mortality was 41%. The actuarial probability of survival at 1 and 5 years was 83 and 55%, respectively. De novo tumors are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow up of these patients is essential for early diagnosis.

Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?

BACKGROUND AND AIM: Proximal colorectal cancer may arise from sessile serrated adenomas (SSAs). Recognition of these lesions during colonoscopy can optimize the endoscopic approach. We aimed to identify specific endoscopic features of SSA with conventional colonoscopy. METHODS: Patients undergoing screening colonoscopies from January 2011 to September 2012, in whom colonic polyps were found, were prospectively included in our study. Polyp morphology, location, polyp pit pattern (Kudo classification), and other previously reported features of SSA were evaluated. Histological examination was conducted independently by two pathologists. Multivariate analysis was performed to identify independent predictors of SSA. RESULTS: A total of 272 patients were included, and 440 polyps were evaluated (1.6 polyps per patient). Thirty-four polyps (8%) were SSA, 135 (31%) hyperplastic, and 249 (56%) adenomas. The most prevalent endoscopic features of SSA were right-side location (94%), type II Kudo pit pattern (91%), mucus cap (41%), flat morphology (29%) and red-colored surface (26%). Multivariate analysis revealed that flat morphology (p = 0.002, OR = 3.81 CI 1.53-9.09), red-colored surface (p < 0.001, OR = 12.97 CI 4.43-37.69), right-side location (p < 0.001, OR = 22.21 CI 5.09-135.94) and mucus cap (p < 0.001, OR 8.77 CI 3.76-20.44) were independent predictors of SSA. CONCLUSION: We were able to identify specific features of SSA during conventional colonoscopy, which may help to identify, and therefore to optimize the endoscopic approach of these lesions.

[Cost analysis of liver transplantation in a community hospital: association with the Model for End-stage Liver Disease, a prognostic index to prioritize the most severe patients]. / Análisis del coste del trasplante hepático en un hospital de la comunidad: su relación con el Model for End-stage Liver Disease, un índice pronóstico que prioriza al paciente más grave.

INTRODUCTION: The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs. MATERIAL AND METHODS: We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40. RESULTS: The mean MELD score at transplantation was 19.2±7.0 (mean±SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493±8,825 in patients with a MELD score of 6-19 and was USD 36,506±15,833 in those with a score of 20-40; this difference was statistically significant (P=.04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r(2)=43%). DISCUSSION: Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD.

[Colorectal cancer screening with colonoscopy]. / La colonoscopia en la pesquisa de cáncer colorrectal.

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.

[Usefulness of transient elastography (Fibroscan®) in the assessment of fibrosis in patients with chronic liver disease]. / Utilidad de la elastografia de transición (Fibroscan®) en la evaluación de la fibrosis hepática en pacientes con hepatopatía crónica.

The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold standard for the staging and grading of fibrosis. Therefore, accurate noninvasive tests for liver injury are urgently needed. During the last years, transient elastography (Fibroscan®) has been proposed for the assessment of hepatic fibrosis in patients with chronic liver disease, by measuring liver stiffness. The aim of this study was to evaluate the effectiveness, objectivity and safety of this technique. We included 68 patients who underwent a liver biopsy in the last 18 months with a wide spectrum of chronic liver diseases. All procedures as well as the liver biopsies according to the METAVIR scoring system were analyzed by the same sonographer and the same specialist in pathology, respectively. Median value of stiffness with none or mild fibrosis (F0 and FI), and severe fibrosis or cirrhosis (F3 and F4) was 6.8 ± 3.0 kPa and 21.0 ± 15.1 kPa, respectively, with a significant difference between them (p < 0.01). The areas under the receiver operating characteristic curves showed the optimal liver stiffness cut-off values for each group. We found also a positive correlation between liver stiffness found by transient elastography and fibrosis stage on biopsy in all patients, independently of the liver disease etiology. Fibroscan® is an easy, quick to perform and safe non-invasive method, reliable for assessing liver fibrosis.

[Celiac disease and risk of colorectal neoplasia]. / Riesgo de cáncer colorrectal en pacientes con enfermedad celíaca.

BACKGROUND: Although small bowel and esophagus neoplasia are recognized to occur more frequently in patients with celiac disease, the association with colorectal cancer is still controversial. OBJECTIVE: To determine the risk of colorectal neoplasia among patients with celiac disease. METHODS: A case-control study was conducted using the gastroenterology and endoscopy unit electronic data base. Patients with celiac disease and colonoscopy were regarded as cases and those without celiac disease and colonoscopy as controls. Patients were matched for age, sex, colonoscopy purpose and family history of colorectal cancer. The main outcome was the risk of colorectal polyps, adenomas, advanced lesions and cancer. The risk was expressed as odds ratio (OR) with the respective 95% confidence intervals (95% CI). RESULTS: Out of 178 celiac disease patients, 44 were included as cases. Eighty-eight non-celiac patients were included as controls. In cases, the presence of polyps, adenomas and advanced colonic lesions was 20%, 16% and 4.5%, respectively. In controls, it was 15%, 9% and3.4%, respectively. The risk of polyps, adenomas and advanced colonic lesions was similar in both groups: OR 1.48 (95% CI 0.59-3.73), OR 1.89 (95% CI 0.66-5.42) and OR 1.34 (95% CI 0.26-7.05). No colorectal cancer was identified. CONCLUSION: The risk of colorectal neoplasia within this cohort of patients with celiac disease was similar to the control population.

[Prevalence of serrated adenomas of the colon and association with synchronic and metachronic neoplastic lesions]. / Prevalencia de adenomas serratos de colon y asociación con lesiones neoplásicas sincrónicas y metacrónicas.

OBJECTIVE: To determine the prevalence of serrated adenomas (SA), the frequency of high grade dysplasia (HGD) and adenocarcinoma in these polyps, and the association with synchronic (SNL) and metachronic neoplastic lesions (MNL). METHODS: Reports from patients undergoing colonoscopy and polypectomy from January 2003 to April 2010, were obtained from our electronic database. SA were reanalyzed by two pathologists and classified on the basis of Snover's diagnostic criteria. The prevalence of these polyps and the clinical and endoscopic features were determined. SNL were defined by adenomas, cancer or advanced neoplastic lesions (ANL) (> 1 cm, HGD and/or >75% of villous component) in the same colonoscopy. MNL were identified in patients who underwent surveillance colonoscopies. An univariate and multivariate analysis was performed, looking for independent predictors of HGD/ cancer, SNL and MNL in patients with SA. RESULTS: The prevalence of SA was 0.87%. The mean age was 60 years old and 50.5% of patients were women. Most of the polyps were sessile (67%), small (63%) and located in ceco-ascending colon (47%). We found HGD in 4.4% ofSA and no adenocarcinoma. SNL was found in 31% ofpatients: 46% adenomas, 40.5% ANL and 13.5% adenocarcinoma. MNL was found in 29% of patients: 25% SA, 31% adenomas, 44% ANL and 0% adenocarcinoma. Age over 60 years old was significantly associated with MNL [Odds ratio 3.7 (95% confidence interval 1.16-11.8)] and polyp's size higher than 1 cm with sessile SA histology [Odds ratio 8 (95% confidence interval 1.28-49.4)]. CONCLUSION: The prevalence of SA was low. We found an association with neoplastic lesions. Therefore, it is important to establish specific guidelines for the management of these polyps.

[Diffuse gastric cancer associated with Ménétrier's disease]. / Adenocarcinoma gástrico difuso asociado a enfermedad de Ménétrier.

BACKGROUND: Ménétrier's disease is a rare disease of the stomach generally described as hypertrophic gastropathy. Its etiology is unknown and its malignant potential is controversial. Only a few reports supporting its association with gastric cancer have been found. We present a case of gastric cancer associated with Ménétrier's disease. CASE REPORT: We present a 72 year-old-male with epigastric pain and early satiety during the last 5 months. He had been treated with proton pump inhibitors with unfavorable response and began with loss of weight and asthenia. An upper digestive endoscopy showed an erythematous nodular gastric mucosa, with enlarged folds. An abdominal CT scan demonstrated a circumferential parietal thickening of the gastric wall and adenopathies. A gastric macrobiopsy done by endoscopic mucosal resection evidenced a mucin infiltrating adenocarcinoma with invasion of the lamina propria. Subtotal gastrectomy was done. The histology showed a stomach with changes compatible with Ménétrier's disease and diffuse infiltration by a highly undifferentiated adenocarcinoma (plastic linitis). CONCLUSION: A patient with diffuse gastric adenocarcinoma and Ménétrier's disease is reported.

[Role of antibodies in celiac disease after one year of treatment to predict the adherence to gluten-free diet]. / Rol de los anticuerpos en la enfermedad celíaca luego de un año de tratamiento para predecir la adherencia a la dieta libre de gluten.

INTRODUCTION: The celiac disease (CD) is characterized by a permanent sensitivity to gluten. The treatment for this disease is the life-long strict compliance with a gluten-free diet (GFD). The average of compliance with GFD ranges between 15% and 80%. Antibodies' role in the follow up of these patients regarding the adherence to the GFD is not well established. Objective. To determine the relationship between the antibodies for CD and the adherence to the GFD in patients with over a year of treatment. MATERIAL AND METHODS: Patients with CD with a minimum of one year of GFD were prospectively included They were asked to complete a self-survey regarding to the compliance to GFD and the level of adherence was determined: low (no compliance or more than 2 gluten intakes per week), medium (1 or 2 gluten intakes per week or 2 or 3 gluten intakes per month), or high (1 gluten intake per month or less than 3 intakes per year). The follow up was performed by their general practitioners. From one year of GFD onwards, the results of the available antibodies at the time of the last follow up were assessed: antigliadine IgA (AGA) and IgG (AGG), anti-endomysium IgA (EMA) and IgG (EMG), anti-transglutaminase (ATG), and deaminated peptides of gliadine IgA and IgG, considering them as positive or negative. Through an univariate analysis, the above-mentioned antibodies were correlated (independent variables) in order to identify predicting factors of high and low adherence to the GFD (dependent variables). RESULTS: Ninety patients were analyzed, age 43.6 +/- 15.3 years old, 89% women, 58% classic celiacs. The average time of GFD was 7.9 years and 63% had been on a GFD for over 3 years. A 71% of patients (95% CI 69%-80%) showed high adherence to the GFD, and a 67% (95% CI 2%-13%) showed low adherence. GFD of less than 3 years was a determining factor for low adherence [relative risk (RR) 2.41 (95% CI 1.2-2.89)]. The predictive antibodies for GFD high adherence were: (1) negative EMA [RR 1.27 (95% CI 1.03-1.54)], (2) negative ATG [RR 1.62 (95% CI 1.12-2.47)], and (3) all negative requested ones [RR 1.60 (95% CI 1.17-2.18)]. The predictive antibodies for GFD low adherence were: (1) positive AGA [RR 15.5 (95% CI 2.29-105)], (2) positive EMA [RR 10.2 (95% CI 2.19-47.7)], (3) positive ATG [RR 9.63 (95% CI 1.53-63.4)], and 4) all negative requested ones [RR 0.11 (95% CI 0.018-0.71)]. CONCLUSION: After one year of treatment, the negativity of EMA or ATG antibodies had a significant correlation with the high adherence to GFD and the positivity of AGA, EMA or ATG antibodies had a significant correlation with a low adherence.