Metastatic melanoma: endoscopy as aid to earlier in vivo diagnosis of gastrointestinal involvement. A case report.

Autopsy frequently reveals gastrointestinal involvement in patients that have died from melanoma, whereas little evidence of the latter emerges in ante-mortem diagnosis and, even then, largely in connection with emergency situations: obstructions, bleeding or perforation. Moreover, the frequently asymptomatic character of gastrointestinal melanoma explains why it largely eludes detection. The present report concerns a case of metastatic melanoma of the stomach, duodenum and liver, where symptoms were scarcely in evidence, and underlines the usefulness of digestive endoscopy both in the staging of the disease and even more so in follow-up.

Splenic abscess secondary to penetrating gastric ulcer.

Splenic abscess is a rare disease whose diagnosis is difficult, though the use of modern imaging methods has increased diagnosed cases in recent years. We report a case of splenic abscess whose aetiology is unusual, namely, a gastric ulcer penetrating into the splenic artery and causing arterial thrombosis and septic embolism. Ultrasonography and ultrasound-guided puncture resolved any diagnostic doubt, and subsequent surgery confirmed the diagnosis. Pathogenesis, clinical picture, diagnostic methods, and treatment are discussed with reference to the literature.

HLA class II favors clearance of HCV infection and progression of the chronic liver damage.

BACKGROUND/AIMS: This study was aimed to determine whether host-dependent genetic factors modulate the outcome of HCV infection. METHODS: HLA class II DRB and DQB typing was performed in 184 infected patients and 200 healthy volunteers. Among the patients, 149 subjects had persistent HCV viremia (Group 1) and 35 subjects underwent spontaneous viral clearance (Group 2). Group 1 included cirrhotic patients with transfusion-acquired infections (n = 79), asymptomatic HCV carriers (n = 42), and patients with chronic hepatitis C responsive to interferon therapy (n = 28). RESULTS: Spontaneous viral clearance was associated with HLA DRB1*1104 (pc = 0.054, OR = 4.51, 95% C.I. 2.02-10.1) and HLA DQB1*0301 (pc = 0.0039, OR = 4.52, 95% C.I. 2.15-9.51). In Group 1 the haplotype DRB1*1104/DQB1*0301 was less frequent (4.8%) than in Group 2 (18.3%) (pc = 0.009, OR = 7.38, 95% C.I. 2.58-21.59). At the HLA level, cirrhotic patients were not different from asymptomatic HCV carriers and patients with interferon-induced viral clearance. In cirrhotic patients infected with genotype 1b, the DQB1*0502 allele was more frequently found in those with rapidly progressive liver damage (OR = 8.15, 95% C.I. 1.49-44.44), but the corrected p-value was not significant (pc = 0.09). CONCLUSIONS: The HLA haplotype DRB1*1104/DQB1*0301 appears to contribute to the spontaneous clearance of HCV infection. The predominance of the DQB1*0502 allele in cirrhotic patients with a rapidly progressive disease possibly reflects an influence of this allele on the progression of the HCV-related liver disease.

Fatal ulcerative panenteritis following colectomy in a patient with ulcerative colitis.

A 37-year-old man, previously submitted to colectomy for ulcerative pancolitis unresponsive to medical therapy, presented with nausea, vomiting, epigastric pain, and bloody diarrhea. An upper gastrointestinal endoscopy revealed mucosal friability, petechiae, and erosions throughout the duodenum, whereas prestomal ileum showed large ulcers and pseudopolyps. Histologically, a dense inflammation chiefly composed of lymphocytes and plasma cells with few neutrophils was detected. No bacteria, protozoa, and fungi could be detected. Despite intensive care, intra-1194 venous antibiotics and steroids, the patient died of diffuse intravascular coagulation and multiorgan failure. At post-mortem examination severe ulcerative lesions were observed scattered throughout the duodenum up to the distal ileum. The dramatic clinical presentation with fatal outcome, the widespread ulcers throughout the intestine, and the histological picture are peculiar features in our patient which can not be ascribed to any type of the ulcerative jejunoenteritis so far reported. Patients with pancolitis and diffuse ileal involvement do not necessarily have Crohn's disease but rather may have ulcerative colitis.