[THE COMBINED LAPAROSCOPIC AND ENDOSCOPIC TREATMENT FOR CONCOMITANT GALLSTONES AND COMMON BILE DUCT STONES: TWO STAGE OR SINGLE STAGE MANAGEMENT?].

Common bile duct stones occur in 3%-33% of patients suffering from gallbladder stones. Concurrent gallbladder and common bile duct stones should be treated due to the risk of life-threatening complications such as pancreatitis and cholangitis. There is no consensus regarding the optimal management of common bite duct stones associated with cho[elithiasis. Currently there are variable treatment protocols for concomitant gallstones and common bile duct stones which involve laparoscopic cholecystectomy and laparoscopic bile duct exploration alone, or in combination with preoperative, postoperative, or same session endoscopic retrograde cholangiopancreatography (ERCP). Treatment options depend on local expertise and resources. The aim of this review is to discuss the different treatment options and to assess their utility based on the most recent reports and reviews.

[ASYMPTOMATIC ADULT RETROGASTRIC BRONCHOGENIC CYST: DIAGNOSIS AND TREATMENT CONSIDERATION BY ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATION (EUS-FNA)].

BACKGROUND: Adult bronchogenic cysts are rare. Retrogastric bronchogenic cysts are even rarer with only over 30 cases being reported in the English literature. These foregut cysts can be confused with cystic tumors. CASE PRESENTATION: We describe the case of a large gastric bronchogenic cyst in an asymptomatic 61-year-old woman who underwent an abdominal computerized tomography as part of a routine follow-up after lumpectomy due to breast cancer. Final diagnosis was made by endoscopic ultrasound fine needle aspiration (EUS-FNA) which led to conservative management of the patient who has remained asymptomatic over the last 8 years. CONCLUSIONS: Preoperative diagnosis of adult gastric bronchogenic cyst has been difficult to achieve. Our case highlights the importance of EUS in establishing the definitive diagnosis, enabling just follow-up with repeated imaging studies. The relevant literature is discussed.

Retrospective study of the associations between hepatitis C virus infection and metabolic factors.

AIM: To evaluate the bidirectional association between metabolic syndrome (MS) components and antiviral treatment response for chronic hepatitis C virus (HCV) infection. METHODS: This retrospective cohort study included 119 HCV + patients treated with pegylated-interferon-α and ribavirin. Metabolic characteristics and laboratory data were collected from medical records. Differences in baseline clinical and demographic risk factors between responders and non-responders were assessed using independent samples t-tests or χ2 tests. The effects of sustained viral response (SVR) to antiviral treatment on de novo impairments in MS components, including impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM), were assessed using univariable and multivariable logistic regression analysis, while the effect of MS components on SVR was assessed using univariable logistic regression analysis. RESULTS: Of the 119 patients, 80 (67%) developed SVR over the average 54 ± 13 mo follow-up. The cumulative risks for de novo T2DM and IFG were 5.07- (95%CI: 1.261-20.4, P = 0.022) and 3.87-fold higher (95%CI: 1.484-10.15, P = 0.006), respectively for non-responders than responders, when adjusted for the baseline risk factors age, sex, HCV genotype, high viral load, and steatosis. Post-treatment triglyceride levels were significantly lower in non-responders than in responders (OR = 0.27; 95%CI: 0.069-0.962, P = 0.044). Age and HCV genotype 3 were significantly different between responders and non-responders, and MS components were not significantly associated with SVR. Steatosis tended to attenuate SVR (OR = 0.596; 95%CI: 0.331-1.073, P = 0.08). CONCLUSION: SVR was associated with lower de novo T2DM and IFG incidence and higher triglyceride levels. Patients infected with HCV should undergo T2DM screening and antidiabetic treatment.

Primary effusion lymphoma-like lymphoma in a patient with inflammatory bowel disease.

A 77-year-old man with inflammatory bowel disease (IBD) and who was treated with anti-tumor necrosis factor (TNF), 6-mercaptopurine and corticosteroids, presented with primary effusion lymphoma-like lymphoma (PEL-like lymphoma) with massive ascites. The patient's clinical course was complicated by acute renal insufficiency and hypotension, which led to death within 2 wk. In general, patients with IBD may have an increased risk for development of lymphoma, which is frequently associated with immunosuppressive and/or anti-TNF antibody therapies. PEL is a rare subset of lymphoma localized to serous body cavities, lacks tumor mass or nodal involvement, and is associated with infection by human herpes virus 8 (HHV-8). Primary neoplastic effusion may also be present in patients with large B-cell lymphoma without evidence of human immunodeficiency virus or HHV-8 infections. This type of lymphoma is classified as PEL-like lymphoma. Both PEL and PEL-like lymphoma types have been reported in patients undergoing immunosuppressive therapy, but to the best of our knowledge, the case described herein represents the first PEL-like lymphoma occurring in a patient with IBD.

Diagnostic challenges of Wilson's disease presenting as acute pancreatitis, cholangitis, and jaundice.

Wilson's disease is a rare disorder of copper transport in hepatic cells, and may present as cholestatic liver disease; pancreatitis and cholangitis are rarely associated with Wilsons's disease. Moreover, cases of Wilson's disease presenting as pigmented gallstone pancreatitis have not been reported in the literature. In the present report, we describe a case of a 37-year-old man who was admitted with jaundice and abdominal pain. The patient was diagnosed with acute pancreatitis, cholangitis, and obstructive jaundice caused by pigmented gallstones that were detected during retrograde cholangiopancreatography. However, because of his long-term jaundice and the presence of pigmented gallstones, the patient underwent further evaluation for Wilson's disease, which was subsequently confirmed. This patient's unique presentation exemplifies the overlap in the clinical and laboratory parameters of Wilson's disease and cholestasis, and the difficulties associated with their differentiation. It suggests that Wilson's disease should be considered in patients with pancreatitis, cholangitis, and severe protracted jaundice caused by pigmented gallstones.

The relation between NOD2/CARD15 mutations and the prevalence and phenotypic heterogeneity of Crohn's disease: lessons from the Israeli Arab Crohn's disease cohort.

The prevalence of Crohn's disease depends on geographic location and racial background. Arg702Trp, Gly908Arg, and Leu1007fsinsC mutations in the NOD2/CARD15 gene are associated with Crohn's disease in Caucasians. The mutation rate among Israeli Jewish patients is 27%-41%. The prevalence of Crohn's disease is much lower in the Israeli Arab compared to the Israeli Jewish population. We studied the NOD2/CARD15 mutation rate and disease phenotype (according to the Vienna classification) among the Israeli Arabs and compared them with those in an Israeli Jewish cohort. We recruited 66 Israeli Arab patients and 122 ethnically matched controls. Five patients (8.2%) and three controls (2.3%) carried one NOD2/CARD15 mutation. The phenotypic characteristics of the Arab and Jewish patients were very similar. We conclude that NOD2/CARD15 mutations do not contribute to Crohn's susceptibility in the Israeli Arab population and suggest that NOD2/CARD15 mutations have an important effect on Crohn's prevalence within a specific population but not on the phenotype.