Search

Background Identifying the causes of acute liver failure (ALF) and predictors of death or liver transplantation (LTX) is crucial to decide its management. We aimed to describe features and outcome of ALF in Italian children. Methods Retrospective review of cases presenting between 1996–2012. ALF was defined by high transaminases, INR ≥2.0 regardless of hepatic encephalopathy (HE), no evidence of underlying chronic liver disease. Results 55 children (median age 2.6 years, range 0.1–15.1; M/F = 31/24) had ALF due to autoimmune hepatitis (AIH) in 10 (18%), metabolic disorders in 9 (17%), paracetamol overdose in 6 (11%), mushroom poisoning in 3 (5%), viral infection in 1 (2%), indeterminate in 26 (47%); 25/55 recovered with supportive management (45%); 28/55 underwent LTX and 2 died on the waiting list (55%). On multivariate analysis severity of HE grade 3–4 and bilirubin ≥12 mg/dl were independent predictors of death or LTX (p < 0.05). After a median follow up of 4 years (range 2–15.0 years) the overall survival rate was 93%. Conclusion Children with ALF can be managed successfully with combined medical treatment and transplantation, warranting a survival rate similar to children transplanted because of chronic conditions. In our cohort of patients severe HE and high bilirubin on admission were independent predictors of the need of LTX.

Background: Characteristics such as gender and lifestyle are not taken in account in colorectal cancer screening and surveillance recommendations. Aims: To identify factors associated with advanced neoplasia at initial and surveillance colonoscopy. Methods: In this observational study, 750 individuals with positive faecal occult blood test, aged 50-74 years, underwent a first screening colonoscopy in 2007-2009. We collected anthropometric data as well as data on physical activity, smoking and drinking habits, fruit and vegetable consumption and low-dose aspirin use through a questionnaire. Results: At initial colonoscopy advanced neoplasia (n = 399, 53.2%) was positively associated with age, male gender, smoking and alcohol drinking, and inversely associated with physical activity, fruit and vegetables consumption and long-term use of aspirin. These 7 factors were used to calculate a risk score, ranging from 0 (no unfavourable characteristics) to 7 (all unfavourable characteristics present), which was significantly associated with advanced neoplasia (odds ratio 1.55 for one point increase, P < 0.01). Among the 372 adenoma patients who returned for follow-up surveillance colonoscopy, the score remained associated with advanced neoplasia (odds ratio 1.28 for one point increase, P = 0.01). Conclusion: Besides age and gender, modifiable factors such as lifestyle and aspirin use were associated with the risk of advanced neoplasia at initial and surveillance colonoscopy.

Background Diagnosis and management of Barrett's oesophagus are controversial. Technical improvements in real-time recognition of intestinal metaplasia and neoplastic foci provide the chance for more effective target biopsies. Confocal laser endomicroscopy allows to analyze living cells during endoscopy. Aims To assess the diagnostic accuracy, inter- and intra-observer variability of endomicroscopy for detecting in vivo neoplasia (dysplasia and/or early neoplasia) in Barrett's oesophagus. Methods Prospective pilot study. Patients referred for known Barrett's oesophagus were screened. Endomicroscopy was carried out in a circular fashion, every 1–2 cm, on the whole columnar-lined distal oesophagus. Visible lesions, when present, were analyzed first. Targeted biopsies were taken. Confocal images were classified according to confocal Barrett classification. Endomicroscopic and histological findings were compared. Results Forty-eight out of 50 screened patients underwent endomicroscopy. Visible lesions were observed in 3 patients. In a per-biopsy analysis, Barrett's-oesophagus-associated neoplasia could be predicted with an accuracy of 98.1%. The agreement between endomicroscopic and histological results was substantial ( κ = 0.76). Conclusions This study suggests that endomicroscopy can provide in vivo diagnosis of Barrett's oesophagus-associated neoplasia. Because it allows for the study of larger surface areas of the mucosa, endomicroscopy may lead to significant improvements in the in vivo screening and surveillance of Barrett's oesophagus.

The association between gastric carcinoma and lymphoma is rare. Confocal laser endomicroscopy is a new diagnostic tool that allows the identification of cellular and vascular architecture during endoscopy. This is the first report of an in vivo early gastric carcinoma diagnosis by confocal laser endomicroscopy in a patient successfully treated for a primary gastric diffuse large-B-cell lymphoma.

for diagnosis of SC in children through a retrospective case-control study. Patients and Methods: ERCs and MRCs of 7 children and adolescents (median age 9, range 7−20 years) with SC and 17 controls (median age 6, range 2 months to 29 years) with liver disease without macroscopic biliary abnormalities, were reviewed in a blinded, random and independent way. Only patients who underwent both examinations within a 6-months slot were included. One radiologist evaluated both ERCs and MRCs and one interventional endoscopist independently reviewed only ERCs. A common and previously validated classification system was used to score all records. Reviewers did not receive any demographic or clinical or laboratory information. Diagnosis of SC was established on the basis of history, laboratory data, radiologic examinations and clinical course and was used as gold standard to compare ERC and MRC diagnostic accuracy. Readers independently recorded: image quality, delineation of the first-, second-, third-, and fourth-order intrahepatic bile ducts, the extrahepatic bile duct, and the gallbladder (non depiction, fair for delineation of less than 90%, good for delineation of at least 90%, excellent for complete delineation); presence or absence of SC and their level of certainty for their diagnosis, recorded with the use of a 5-point rating system (definitely absent, probably absent, equivocal, probably present, definitely present); and they scored the bile duct images by using a classification system validated for PSC patients. Results: Overall image quality was graded as very good in 57% of MRC cases and in 71% of ERC cases; difference was not statistically significant (p = 0.24) although the probability for MRC to be diagnostic increased with age of patient. Depiction of first, second and fourth order intrahepatic bile ducts was better in ERC (p = 0.004, 0.02 and 0.023 respectively), while depiction of extrahepatic bile ducts was comparable (p = 0.052) and depiction of gallbladder was even better in MRCs. Diagnostic accuracy of MRC and ERC resulted very high, without statistically significant difference (p = 0.61). Agreement between MRC and ERC defined as Kendall’s tau-b value was considered good (0.65) even both interobserver readers of ERCs (0.61). Conclusion: Despite an overall better depiction of biliary tree in ERC, especially in younger age, ERC and MRC are comparable for the diagnosis of SC in children. These data support MRC as the first imaging approach in children with suspected SC.

cerevisiae (ASCA) and anti-neutrophil cytoplasmic (ANCA) antibodies were not increased. Abdominal ultrasound was normal. Computerized bowel tomography showed an abnormal terminal ileum and cecum with thickened bowel wall. These findings were confirmed by a duoble-contrast barium enema. The esophagogastroduodenoscopy was normal. Colonoscopy and videocapsule endoscopy showed intestinal multiple mucosal ulcerations, which were compatible with Crohn’s disease. The histopathology of the colon and terminal ileum showed inflammation extending through the muscolaris propria, with a predominance of plasma cells, lymphocytes, and eosinophils, but a paucity of neutrophils and no granuloma (probably caused by the impaired neutrophil extravasation). On the basis of clinical history, endoscopy, and extraintestinal manifestations (arthritis, ulcerative stomatitis), a Crohn’s disease was diagnosed and a course of prednisone (2 mg/kg/day) and mesalamine (70 mg/kg/day) was started and ibuprofen was discontinued. One month later the patient experienced a recurrence with abdominal pain, diarrhea, arthritis and worsening anemia. Thus prednisone and mesalamine were reducted and terapy with Infliximab was started. After the first infusion, her bowel and extraintestinal manifestations completely cleared up. After 6 months of treatment the child is still in clinical remission and no complications have appeared. To the best of our knowledge, gastrointestinal problems in LAD-1 consists of a few case reports including Hirschsprung disease, necrotizing enterocoitis, and chronic enterocolitis. The only previous report of IBD-like illness in LAD-1 was in a severely affected patient with a complitely resolution after bone marrow transplantation. In conclusion, disorders of leukocyte adhesion should be included in the differential disgnosis of pediatric Crohn’s disease, particularly in the presence of recurrent infections. Therapy with Infliximab appears to be effective in these patients.