Massive Intrabile Duct Invasion Caused by a Fatal Progression of Colonic Adenocarcinoma: Abdominal Computed Tomography Findings and Cholangiography Correlation.

In this report, we present an unusual case of jaundice in a patient with advanced colorectal cancer due to intraductal tumour invasion of the intra- and extrahepatic biliary tree. This complication proved to be fatal despite aggressive therapeutic management. A correct diagnosis of this type of involvement was achieved by a combination of diagnostic and therapeutic cholangiography. Despite adequate biliary decompression, the patient died from liver failure and biliary sepsis.

Safety and Efficacy of Anti-TNFα Treatment in Crohn's Disease Patients with Abdominal Abscesses.

BACKGROUND/AIMS: It is estimated that up to 30% of CD patients develop abdominal abscesses; the management of active luminal CD in such patients represents a clinical challenge. The aim of this study is to assess the safety of biologics in patients with Crohn's disease and abdominal abscesses treated with percutaneous drainage and/or broad-spectrum antibiotics. METHODOLOGY: We performed a retrospective review of the clinical charts of consecutive Crohn's disease patients with abdominal abscesses treated with anti-TNFα therapy attended in our institution. RESULTS: 12 patients were finally included in the study. All were treated with broad-spectrum antibiotic and biological therapy (anti-TNF); indication of anti-TNFα therapy was moderate to severe activity of CD in all of them. Percutaneous drainage of the abscess was performed in 7 of the 12 patients. No complications were observed during a mean follow-up of 37,8 (16-71) months, including abscess volume increase, enterocutaneous fistula, soft tissue infections, bacteraemia, or need for emergency surgery. CONCLUSIONS: In addition to conventional treatment, the use of anti-TNFα therapy in Crohn's disease patients with abdominal abscesses seems to be safe. Usefulness of this approach has to be validated in larger cohorts.

Diagnosis of venous access port colonization requires cultures from multiple sites: should guidelines be amended?

Data on microbiological management of withdrawn venous access ports (VAPs) are scarce. The aim of our study was to assess the validity of Gram stain and culture performed on VAPs to detect colonization and VAP-related bloodstream infection (VAP-RBSI). We prospectively performed cultures of the following: catheter tip (roll-plate and sonication), port content aspirate before and after sonication, port sonication fluid (PSF), and port internal surface biofilm (ISB). The gold standard of VAP colonization was positivity of at least 1 of the cultures mentioned above. We collected 223 VAPs in which no single culture had validity values reliable enough to predict colonization and VAP-RBSI. The best validity values were those obtained when cultures of catheter tip (roll-plate), PSF, and port ISB were combined. Cultures from several areas on the VAP are necessary to ensure suitable assessment of colonization and VAP-RBSI.

Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents.

PURPOSE: The aim was to compare the clinical and hemodynamic outcome between polytetrafluoroethylene (PTFE)-coated stent-grafts and bare stents in patients who required both elective and emergency transjugular intrahepatic portosystemic shunt (TIPS) placement due to portal hypertension related complications. MATERIALS AND METHODS: Retrospective analysis of all seventy patients with portal hypertension related complications who required TIPS placement in a referral hospital from September 1998 to May 2002 was done. Follow-up was extended until May 2003. PTFE-covered stent-grafts were used in the latter 20. Demographic variables, cirrhosis etiology and Child-Pugh class, indication of TIPS placement and clinical outcome were recorded. The following TIPS-related outcomes were registered: recurrent variceal bleeding and/or ascites, hepatic encephalopathy and mortality. RESULTS: Baseline characteristics, portacaval gradient (PCG) after TIPS placement and at 1 month angiographic revision were similar in both groups. At 6 month follow-up, PCG was significantly lower in patients with stent-grafts (14.2 mmHg (5.6 mmHg) versus 7 mmHg (1 mmHg), p<0.001). Overall, there were no cases of clinically relevant TIPS dysfunction in the coated stent group while 22% of patients in the bare stent group had recurrence of portal hypertension related complications (p=0.085). Actuarial probability of TIPS dysfunction in bare stents was 82% at 12 months compared to no episode in covered stent-grafts (p=0.03). Mean increase in total serum bilirubin was higher in the PTFE-coated stent group (6.7 mg/dl (14.4 mg/dl) versus 0.5 mg/dl (2.4 mg/dl), p=0.01) without differences in encephalopathy nor mortality rate. CONCLUSION: One year shunt patency rate is improved with placement of ePTFE-covered stent-grafts without a higher rate of encephalopathy. Further prospective trials are required.