Where is My Spleen? - A Case of Splenosis Diagnosed Years Later after Splenectomy.

Hepatic splenosis was first described in 1939 and is a rare condition that results from splenic trauma or splenectomy. A 43-year-old man with a past medical history significant for a prior splenectomy was admitted to the hospital due to right upper quadrant pain for two days. Magnetic resonance imaging (MRI) of the abdomen suggested features of hepatic adenoma, however, a percutaneous biopsy showed the mass within the liver to be a discrete collection of splenic tissue, apparently the result of a traumatic splenic rupture years ago. Hepatic splenosis is a rare entity, and due to the asymptomatic nature of this condition, most cases are found incidentally after different imaging modalities are done. The management of this entity is based on conservative measures. We report this case to emphasize that in the appropriate clinical setting, hepatic splenosis should be considered in the differential diagnosis of a patient with a homogenous well-circumscribed liver mass.

Primary Gastric Squamous Cell Carcinoma.

Primary gastric squamous cell carcinoma (PGSCC) is an extremely rare cause of gastric malignancy. We present a 66-year-old man with a past medical history of stage I left palpebral marginal zone lymphoma status post radiation. The patient was complaining of a two-year history of bloating and early satiety. An upper endoscopy was performed, showing a 2.5 cm polypoid lesion at proximal corpus; however, the cardia and esophagus were normal. Biopsies were positive for gastric squamous cell carcinoma. He underwent partial gastrectomy and was referred to oncology for treatment. In 2011, the Japanese Gastric Cancer Association proposed diagnostic criteria for the diagnosis of PGSCC. The clinical presentation of this malignancy does not differentiate from that of other types of gastric tumors. We report this case to highlight squamous cell carcinoma as a cause of primary gastric cancer. Gastroenterologists should be aware of this entity to facilitate prompt referral to specialized centers, where surgical resection can be done.

Osteopenia in Puerto Ricans with Crohn's disease

BACKGROUND: Osteopenia has been reported in association to Inflammatory Bowel Disease, and in particular Crohn's disease. The use of corticosteroids, resection of the ileum, malabsorption, poor calcium intake, and the effect of inflammatory cytokines have all been considered as contributing factors. As Crohn's disease is more prevalent in young people, when peak bone mass is achieved, the presence of osteopenia is especially significant. OBJECTIVES: The aim of this study was to evaluate the bone density of patients with Crohn's disease in the University of Puerto Rico IBD Clinic; to determine the prevalence of osteopenia in these patients and to correlate bone mineral density with risk factors for osteopenia. METHODS: Sixty-six patients, 30 males and 36 females were included. After informed consent, demographic, clinical and metabolic data was obtained. Serum albumin, calcium, inorganic phosphorus and alkaline phosphatase were measured. Body mass index (BMI) was calculated. Bone density was determined by DEXA of the lumbar spine and femur and expressed as the Z score (standard deviations from normal correlated with sex and age). Severe osteopenia was a Z score > or = -2 and osteopenia was Z < or = -1.99 or > or = 1.01. Results were expressed in means. Pearson correlation coefficient was used for quantitative variables and Pearson chi-square for categorical values. RESULTS: Osteopenia was present in the hip in 69 and in the lumbar spine in 68. Most patients had received steroids; the difference between treated and not treated patients was not significant. Osteopenia did not correlate with ileal resection, gender, BMI, disease characteristics or biochemical parameters. CONCLUSIONS: Low bone density was frequent in patients with Crohn's disease, but no specific risk factors could be identified. Bone density should be determined in patients with Crohn's disease in order to institute appropriate therapeutic measures.

Hepatitis C viral RNA amplification by the polymerase chain reaction allows detection of false positive HCV ELISAs among patients with non-A, non-B hepatitis

Serum from patients which tested positive for hepatitis C virus (HCV) by Enzyme Linked Immunosorbent Assay (ELISA) were analyzed for the presence of HCV RNA by nested Polymerase Chain Reaction (PCR) and for anti-HCV antibodies by Recombinant Immunoblot Assay (RIBA II). Total RNA was extracted from whole blood by a new procedure and subjected to reverse transcription of HCV RNA employing primers to the conserved 5' non-coding region of the HCV genome. PCR performed on these samples uncovered several false positive ELISAs. Reciprocal confirmation between PCR and RIBA II results was observed. These results substantiate this variation of the HCV PCR assay as a reliable alternative for routine confirmation of HCV serological tests

Hepatitis C antibody in health puertorican blood donors: prevalence, hepatic functional and histological abnormalities

The prevalence of hepatitis C antibody by ELISA I in 45797 consecutive Puertorican blood donors was 1.41 percent. 67 of these donors were fully evaluated and 31 underwent liver biopsy. Risk factors for hepatitis C were present in 71.6 percent, and 45 percent had elevated ALT. Of the 31 donors that underwent liver biopsy, 16 had elevated ALT and all had significant histologic abnormalities, while only one with normal ALT had Chronic active hepatitis. RIBA II was performed in 37 and only 20 (54 percent) were positive. Of the 17 RIBA II positive donor that underwent biopsy, 88 percent had evidence of chronic liver disease. Of 530 donors positive for hepatitis C antibody by ELISA in whom RIBA II was performed, 282 were negative, making the percentage of false positives 53.2 percent. We conclude that Puerto Rico has a high rate of hepatitis C infection, and that RIBA II positive and elevated ALT predict the presence of significant liver disease.