Regional variations in the concentrations of ketone bodies in cirrhosis and hepatic encephalopathy: a study in patients with TIPSS.

BACKGROUND: Little is known about the metabolism of acetoacetate and ß-hydroxybutyrate in patients with cirrhosis and encephalopathy. AIMS: We investigated the fate of ketone bodies in these conditions. MATERIALS AND METHODS: We studied 18 cirrhotic patients with encephalopathy and 17 cirrhotics without. At the time of insertion of a transjugular intrahepatic portosystemic stent shunt (TIPSS) or at the time of portographical assessment of the shunt's patency, we collected blood from the internal jugular, the right atrium, the inferior vena cava, the hepatic, the portal, the splenic veins and the radial artery. We used nuclear magnetic resonance spectroscopy to measure the concentrations of acetoacetate and ß-hydroxybutyrate. RESULTS: There was no difference in the total ketone body concentrations between the two groups. The mitochondrial redox potential was significantly higher in the encephalopathics (142/54=2.63 vs 52/83=0.62) (P<0.01). ß-hydroxybutyrate was significantly lower in the portal vein of encephalopathics (52 ± 4 vs 28 ± 3) (P<0.02) and in the splenic vein (48 ± 6 vs 32 ± 5) (P<0.04). Acetoacetate was significantly higher in encephalopathics in the internal jugular vein (134 ± 12 vs 92 ± 16) (P<0.03), the right atrium (112 ± 18 vs 68 ± 11) (P<0.03), the hepatic vein (162 ± 25 vs 115 ± 19) (P<0.05), the portal vein (133 ± 20 vs 81 ± 14) (P<0.02) and the splenic vein (167 ± 24 vs 122 ± 21) (P<0.04). All measurements are expressed in µmols/L. CONCLUSIONS: There are significant variations in the regional concentrations of the ketone bodies in encephalopathy.

Isolated enteric aspergillosis in a non severely immunocompromised patient. Case report and literature review.

UNLABELLED: Invasive aspergillosis is a life-threatening, opportunistic fungal infection that mainly affects immunocompromised patients, particularly those receiving immunosuppressive therapy or high-dose corticosteroids. The most common portal of entry in aspergillosis is the lung, so the isolated occurrence of intestinal aspergillosis in the absence of pulmonary disease is an unusual pattern. CASE REPORT: We report a case of a lung cancer patient who did not receive chemotherapy, presenting to the emergency department with fever and chills. The patient also developed abdominal pain and bloody diarrhoea during his hospitalisation. Colonoscopy revealed diffuse epithelial and subepithelial oedema of the terminal ileum, linear ulcers, denudation of the mucosa, and necrosis. Histopathological examination of terminal ileum diffuse biopsies showed haemorrhagic infiltrations, while microscopy revealed Y-shaped, branching septate hyphae, diagnostic for Aspergillus fungi. Additionally, the culture of biopsy samples showed the growth of Aspergillus fumigatus. The patient was negative for Aspergillus antibodies in his blood, and bronchoscopy and sputum samples were negative as well. CONCLUSION: This is a rare case of isolated aspergillosis of the small intestine, as there is no pulmonary or other systemic participation, as it also happens in a patient not being in a severely immunocompromised state.

Three Colon Adenocarcinomas Arising in a Patient with Serrated Polyposis Syndrome: Case Report and Review of the Literature.

BACKGROUND: Serrated polyposis syndrome (SPS) is a rare entity mainly concerning the 6th decade of life and which is characterized by the presence of multiple large hyperplastic polyps, sessile serrated adenomas, and adenomas within the colon. CASE REPORT: We describe the case of a SPS patient with 3 synchronous adenocarcinomas. The morphologic features of serrated colorectal lesions, their characteristic molecular alterations, and their role in colorectal cancer development are discussed herein. CONCLUSION: Our findings suggest that SPS is a rare condition with an increased risk for colon cancer. Patients suffering from SPS should have regular colonoscopic surveillance, and perhaps those with numerous dysplastic hyperplastic polyps should be treated with colectomy.

First diagnosis of inflammatory bowel disease in a 91-year-old man.

Inflammatory bowel diseases (IBDs) are diseases that occur primarily in adolescence and early adult life. A second peak of IBD incidence occurs at the age of 50-80 years, while reports of first diagnosis after the age of 80 years are extremely rare. It is difficult to establish the true incidence of IBD in older patients due to problems of case definition, population, and particularly because it may be confused with other clinical conditions. A 91-year-old man was admitted to the Emergency Department with progressively worsening abdominal pain and 2-4 episodes of bloody diarrhea daily for the last month. Similar symptoms were not reported by the patient or his family during the past. Complete blood count and biochemical tests were normal, while stool examination showed erythrocytes and white blood cells. Pelvic CT showed inflammatory changes and loss of homogeneity in the perirectal fat together with considerable bowel wall thickening of both the rectum and sigmoid. Colonoscopy revealed edema, hyperemia and spontaneous friability, as well as microulcerations of the rectosigmoid mucosa. Tissue biopsies revealed histopathological lesions compatible with IBD. Finally the patient was treated with metronidazole, ciprofloxacin and mesalazine, with clear clinical improvement during the 5th day of treatment, and was finally discharged with almost normal stools. In conclusion, we report the case of first diagnosis of IBD in a 91-year-old man. The prevalence of IBD in patients aged >80 years is difficult to determine. Diagnostic tools are the same as for other age groups, but diagnosis may be difficult because there are a number of clinical conditions that may mimic IBD at this age. The treatment options are those used in younger patients, but special precautions should be taken.

Endoscopic extraction of a metal key impacted within the appendix.

Ingested foreign bodies are rarely impacted in the appendix. They may be clinically latent or cause complications such as appendicitis or intestinal perforation, thus requiring prompt and appropriate therapy. A case is reported of a psychiatric, but in other respects asymptomatic, patient who presented with an ingested metal key deeply impacted within the appendix. The patient underwent urgent coloscopy for retrieval. Initially all conventional endoscopic instruments proved ineffective and the key was finally extracted using a simple manoeuvre, described herein.