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The term focal active colitis (FAC) is conventionally used to describe the presence of isolated cryptitis, characterized by an inflammatory infiltrate consisting of intraepithelial neutrophils and/or neutrophils invading the lumen of the criptae, with no other microscopic alteration of the colonic mucosa and, in particular, without the presence of signs of chronic inflammation. To date, only four studies, including one conducted in a pediatric population, have been performed to evaluate the clinical significance of this disease. The aim of this retrospective study on prospectively-collected data is to evaluate the clinical implications of the focal active colitis, since there still remains a marked uncertainty regarding this topic and about how often such a diagnosis will presage a diagnosis of inflammatory bowel disease (IBD). Clinical, endoscopic, and pathological data were retrospectively reviewed from 30 patients with focal active colitis, who had no other diagnostic findings on colorectal biopsy and no history of chronic inflammatory bowel disease. The histological findings were correlated with clinical diagnoses. Thirty patients (11 males, 19 females; age 24-80 years, median 56 years) (0.5%) out of 5,600 undergoing colonoscopy between January 2012 and December 2016 presented a definitive diagnosis of FAC. Follow-up ranged from 6 to 60 months (median 24 months). At endoscopy, 19 patients (63%) had mild and non-specific changes, such as mild mucosal erythema, while 11 (37%) had normal findings. Eight patients were documented as having irritable bowel syndrome, while nine cases could be attributed to the effects of drugs, five presented FAC as incidental finding, one a diagnosis of infectious colitis, and seven a diagnosis of IBD (4 with Crohn’s disease). FAC was confirmed to be a more significant predictor of IBD than the previous literature would indicate, even if larger prospective studies, targeted to study this relationship, are needed to understand more clearly its clinical significance.

Inflammatory Bowel Disease (IBD), which includes both Crohn's Disease (CD) and Ulcerative Colitis (UC), is a chronic idiopathic inflammatory disorder affecting the gastrointestinal tract. Extraintestinal manifestations (EIM) are common in patients with IBD, and occur in 6-47% of patients with CD or UC. EIM can involve organs other than the gastrointestinal tract such as skin, eyes, joints, biliary tract and kidneis. Renal and urinary involvement particularly occurs in 4-23% of patients with IBD. Among the renal complications of IBD, seconfary amyloidosis (AA-type, AAA) is a rare but serious complication. renal amyloidosis has been proven to be the most common lethal manifestation of IBD-associated amyloidosis, since renal involvement rapidly leads to end-stage renal failure. A few studies suggest that AAA is more prevalent in CD than in UC, mainly occurring in male patients with an extensive long-lasting and penetrating ddisease pattern. The therapeutic approaches of IBD-associated AAA are based both on control of the chronic inflammatory process that causes the production and storage of serum amyloid A (SAA), which is a precursor of the amyloid, as well as on destabilizing amyloid fibrils so that they can no longer maintain their pleated sheet configuration; however, in patients with end-stage renal disease, the only therapeutic options still available are hemodyalisis and renal transplantation. Whether effective treatment exists for AAA remain controversial.

Summary. Rectal leiomyomas are a rare conditions, with low reported incidence in literature and constitute about 0.1% of rectal tumours; in fact rectal leiomyomas occur in approximately 1 out of 2000-3000 rectal tumors. We report on a patient with a 3 cm semi-pedunculated colonic leiomyoma, which was successfully removed by endoscopic polypectomy after normal saline-epinephrine submucosal injection. When we encounter a tumor during a colonoscopic examination, we usually evaluate the tumor carefully and perform an endoscopic resection when we judge it is appropriate. When a symptomatic smooth muscle tumors smaller than 2 cm are incidentally found on colonoscopy, surgical resection is unnecessary. Furthermore, if a tumor can be lifted with a snare and it is either pedunculated or semi-pedunculated, endoscopic resection might be a safe option. For those tumors with wide-based or exoluminal growth, endoscopic removal should be avoided due to the higher risks of bleeding and perforation. The histological findings of the resected tumor are important. If there is any malignant element that can not be completely eradicated, we would suggest surgical treatment. We believe our process allows to avoid unnecessary surgery and reduces medical costs.

Report as contribution to the controversy between supporters of total thyroidectomy versus "less than total" thyroidectomy.42 patient operated on over six years; 35 treated with total thyroidectomy, 7 with lobohystmectomy.In the patients who underwent total thyroidectomy we observed recurrent nerve lesions in 5.7%, hypoparathyroidism in 14.3% and 1 lymph nodal relapse (it was a cancer stay III); in patients who underwent lobohystmectomy, we observed 1 temporary recurrent nerve palsy (14.2%) and 1 lymph nodal relapse (14.2%).The choice between total thyroidectomy and lobohystermectomy depends upon different goals: reduction in risk of relapse in total thyroidectomy, to minimize complications in lobohystmectomy. In our series the risk of lymph nodal relapse seems to depend more on biological characters of the tumour than surgical tech of lymphadenectomy; however, this occurrence does not change prognosis.In our experience, potential multifocality of the disease, low risk of hyatrogenic lesions and easy postoperatory management make total thyroidectomy the our preferred technique. Informed consensus is mandatory in order to involve the patients to the best choice.

Evaluation of total thyroidectomy, subtotal thyroidectomy and lobectomy in the management of multinodular non-toxic goitre.225 patients: 101 total thyroidectomies, 64 sub-total thyroidectomies, 29 lobo-hystmectomies. Hemorrages, recurrent nerve palsies, post-operatory hypocalcemias, clinical and ultrasonographic relapses, undesired effects of ormonal therapy and hypothyroidism after partial resection (considered risk factor for recurrence) have been pointed out.All three procedures showed a low incidence of recurrent nerve palsy; lobectomy didn't show post-operatory hypocalcemia, that appeared respectively in 26.6% and 23% after sub-total and total thyroidectomy. Recurrence's percentage in patients followed-up, was 18.2% after lobectomy and 12.2% after sub-total thyroidectomy, but in that group we observed 46.9% of hypothyroidism (vs. 9.1% after lobectomy) and 8.6% of undesired effects of therapy. Reoperations showed inferior laringeal palsy and post-operatory hypocalcemia significantly more elevated.Compared to lobectomy, total thyroidectomy showed higher risk of hypoparathyroidism; compared to subtotal thyroidectomy, it showed on all occasions less incidence of complications. Endocrinological follow-up is easier after total thyroidectomy.According to our results, we deem the indications for lobectomy have to be limited to the patients having solitary nodule, undoubtedly benign, without familiarity or other environmental risk factor of goitre.

Failure of tamoxifen treatment for unresectable hepatocellular carcinomas (HCCs) might be caused by variant estrogen receptors (ERs) in some of these tumors. We therefore planned a study in which antihormonal therapy was done with 80 mg/day tamoxifen or 160 mg/day megestrol according to the presence of wild-type or exon 5-deleted variant ER transcripts. Growth rate (evaluated by MRI) of HCCs characterized by variant ER transcripts was 4 times more rapid than that of HCCs with wild-type ERs. Tumor volume in all patients with wild-type ERs was halved after 9 months of tamoxifen treatment, whereas megestrol in patients with variant ERs only slowed down tumor growth. Choosing antihormonal treatment according to the presence of wild-type or variant ERs in the tumor definitely improves the response rate to tamoxifen; in patients with tumors bearing variant ERs, megestrol causes only a temporary inhibition of tumor growth.

The preferred surgical treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP) is represented by proctocolectomy with ileal pouch-anal anastomosis (IPAA). However, patients with UYC who have undergone IPAA are prone to develop several complications, which include surgery related/mecchanical complications; inflammatory or infectious disoreders; dysplasia or neoplasia; and systemic or metabolic disorders. Pouchitis, which is defined as the acute and/or chronic inflammation of the ileal reservoir, represent the most common long-term adverese sequela after IPAA. Gut microbiota play a pivotal role in the initiation and disease progression of pouchitis. Pouchitis can be classified according to the activity of the disease, the duration of the symptoms, the pattern of the disease or response to antibiotic therapy. Patients with IPAA for UC tend to experience a variety of symptoms that may eventually lead to pouch excision thereby necessitating the construction of a permanent ileostomy. To date, the ethiology, the diagnosis and the medical management of pouchitis represent a clinical challenge. In fact pouchitis range from a disease with an acute antibiotic-responsive presentation to a chronic antibiotic-refractory form, with subsequent different disease mechanism and clinical course. A tridimensional and multidisciplinar approach, including endoscopy, histology, and laboratory testing is widely helpful to identify the diferent phenotypes of the disease and to manage correctly its treatment.

ALTHOUGH the individual steps in the absorptive process of cholesterol have been studied in great detail in recent years,1 , 2 there is still relatively little information on the factors regulating and influencing cholesterol absorption. Recent studies have shown that in certain guinea pigs that are resistant to the pathologic effect of dietary cholesterol, intestinal transit time is more rapid than in other guinea pigs that become hypercholesterolemic, suggesting that intestinal transit time allows less absorption of cholesterol in the former group, thus limiting cholesterol accumulation in body tissues.3 In view of these findings, it seemed of interest to investigate the relation . . .

A polymerase chain reaction protocol consisting of a multiplex to identify the cpa, cpb1, cpetx, cpi genes and a duplex to identify the cpe and cpb2 genes encoding for alpha, beta1, epsilon, eta, enterotoxin and beta2 toxins, respectively, was applied to DNA extracted from two collections of Clostridium perfringens strains. The first collection involved 19 isolates from rabbits. The second collection of 41 isolates came from routine necropsies. The cpa gene alone, or in association with the cpb2 gene, was detected in all DNA samples examined. The cpa gene, together with cpb2 gene, were detected in seven of the rabbit C. perfringens strains (36.8%) and in nine isolates from necropsies (21.9%). The cpa gene was found in 63.2% of rabbit strains and 76.9% of strains from other animal species. In rabbits, the pathological lesions associated with C. perfringens detection were predominantly forms of non-inflammatory enteropathies. In other species, C. perfringens was mainly associated with congestive-haemorrhagic enteropathy, but also with fatal traumatic lesions, degenerative diseases and organs with post-mortem autolysis. No clear correlation was observed between detection of beta2 toxin gene and species-specific pathological features.

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years, 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p &lt, 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p &lt, 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.

Primary thyroid schwannomas are extremely rare tumors and there are very few reports of such tumors in the literature. This report presents a rare case of schwannoma involving the isthmus of the thyroid in a 47-year-old male, presenting as a symptomatic predominating cold nodule within a multinodular goiter. The patient underwent total thyroidectomy. The histological examination indicated an Antoni A-type schwannoma. The clinical, radiological and pathological findings of the tumor are discussed, emphasizing the difficulty in reaching a correct preoperative diagnosis. Only 18 cases of primary schwannoma of the thyroid gland have so far been described in the literature and, this is only the second report of thyroid schwannoma localized in the isthmus.

Background: self-expandable metallic stents (SEMS) are employed as the preferred non surgical palliative treatment for gastric outlet obstruction due to malignancies. Metallic stents are often employed to treat malignant anastomotic obstructions after surgicsl interventions as esophagojejunostomy, gastrojejunostomy and esophagogastrojejunostomy. Methods: this case series reports prospectively the clinical outcomes of SEMS in the palliative care of malignant anastomotic strictures caused by the recurrence gastric cancer follwing gastric surgery as oncological curative treatment, in a series of nine consecutive patients, treated between January 2009 and december 2012 in our center. Results: Nine patients (M:F=8:1) were enrolled in the study. The operation was a total gastrectomy with esophagogastrojejunostomy (n=4), subtotal gastrectomy with Bilroth-II reconstruction (n=4), subtotal gastrectomy with Billroth-II reconstruction (n=3), and subtotal gastrectomy with esophagogastrostomy (n=2). The technical success rate was 88,9%, and the clinical success rate was 88.9%. The reostruction of the stent, due to the ingrowth of the tumor, occurred in 1 patient (11,1%) within 1 month after stent placement. the migration of the stent occurred after the placement of a covered stent in 1 patient who underwent a subtotal gastrectomy (with Billroth-II reconstruction). A case o partial stent dislodgement was treated with the placement of a second stent. The median survival period was 180 days (range, 30-240 days) and the median stent patency was 45 days 8range, 30-90 days). Conclusions: Although the number of the patients treated with SEMS results, in this series, almost small to certainly judge the safety and feasibility of SEMS, we believe that the endoscopic insertion of SEMS seems to be a safe, easily feasible, and effective treatment in the palliative care of malignant anastomotic strictures caused by the recurrence of gastric cancer following gastric surgery. The technical and clinical success, and the onset of complications of this procedure are influenced by several factors, such as the type of anastomosis, the technical features of the stent, and the extent of the underlying tumor.

It is essential to reach a better understanding of "flat epithelial atypia/columnar cell lesions" (FEA/CCLs) in breast core biopsies. Our aim was to explore their biological nature, in order to predict the likelihood of an upgrade to carcinoma. "Cytological grading" has been specially focused, in view of its possible utility in the choice of management. One hundred thirty of a total of 900 cases core needle (CN)/vacuum-assisted biopsies (VABs), with diagnoses of "hyperplasia" and "atypia" were retrospectively re-evaluated. Pathological findings of further excision biopsies (FEBs) performed in 40/75 patients with follow-up were compared with the previous diagnoses. In all cases, both Ki-67 and c-kit immunoreactivities were explored and compared with both normal breast tissues and subsequently documented cancers, with special reference to the hyperplastic FEA/CCLs, with "mild" atypia (FEA/CCHAm). Sixteen cases were re-diagnosed as "usual ductal hyperplasia" (UDH), 60 as "columnar cell hyperplasia" (CCH), and 54 as FEA/CCHA, 30 of which FEA/CCHAm and 24 FEA/CCHAh (with high atypia). Significantly, the Ki-67 index proved to be on the increase and c-kit expression on the decrease in FEA/CCHA lesions, mainly in the FEA/CCHAh group and in the subsequently observed cancers, compared with either benign tissues or the FEA/CCH cases. It was also significant that most of the carcinomas were found in FEBs within the FEA/CCHAh group. In this study cytological grading, together with Ki-67 and c-kit indices, proved to be helpful in FEA/CCLs evaluation. With regard to FEA/CCHAm lesions, an adequate surveillance appears to be a more appropriate management tool than FEB, as a result of their biological nature and behavior.

BACKGROUND. Patients with small papillary thyroid carcinoma (PTC) may have a high incidence of regional lymph-node (LN) metastases at presentation, and these are considered to be an independent risk factor for tumor recurrence. A mutated transketolase transcript (TKTL1) has been found up-regulated in different human malignancies, and strong TKTL1 protein expression has been associated with aggressiveness and poor patient survival in several epithelial cancers. METHODS. TKTL1 protein expression was analyzed in 256 consecutive cases of PTCs ≤1.5 cm by immunohistochemistry with a specific anti-TKTL1 antibody. RNA analysis was performed by real-time polymerase chain reaction (PCR) in all cases for which frozen material was available, which resulted in 55 fragments of PTC. RESULTS. Increased levels of TKTL1 transcript were detected in 50 of 55 analyzed tumors compared with their corresponding normal tissues. Significant differences in TKTL1 transcript levels were found between cases of PTC with and without LN metastases. In primary tumors, immunoreactivity for TKTL1 was detected in the majority of cases, ranging from 0% to 95.0% (mean, 50.11% ± 27.75%). A significant association was found between TKTL1 protein expression and the presence of multifocality, bilaterality, extrathyroidal extension, vascular invasion, sclerosis, and LN metastases. In cases with LN metastases, a positive correlation was found between the TKTL1 protein expression in primary tumors and the number of metastatic LNs as well as the diameter of the largest metastatic area in LNs. CONCLUSIONS. These findings suggest that TKTL1 overexpression in PTC ≤1.5 cm may be considered a factor that facilitates tumor growth and progression. Cancer 2008. © 2008 American Cancer Society.