Small bowel adenocarcinoma in Crohn's disease:A case report and review of literature

Small bowel adenocarcinomas are remarkable for their rarity, difficult diagnosis and poor prognosis. Here we report an unusual case of a 33-year-old patient in whom infiltrative adenocarcinoma of the small bowel was diagnosed after a 10-year history of Crohn＇s disease. In most previously reported cases, detection of Crohn＇s disease was subsequent tothat of carcinoma of the small bowel or the patients involved had an even longer history of the disease. Our literature review suggests that the risk of small bowel adenocarcinoma is higher in patients with Crohn＇s disease than in the overall population. We present details on epidemiology as well as clinical and diagnostic aspects of this rare disease entity.

Multidimensional assessment of neuro-psychiatric symptoms in patients with low-grade hepatic encephalopathy: A clinical rating scale

AIM： To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms. METHODS： Forty patients with liver cirrhosis （LC, with or without low-grade hepatic encephalopathy） were investigated using a clinical neuro-psychiatric rating scale based on a comprehensive list of neurological, psychomotor, cognitive, affective, behavioral symptoms, and symptoms of disturbed bioregulation. RESULTS： The analysis revealed that the majodty of cirrhotic patients showed, besides characteristic neurological symptoms of hepatic encephalopathy, various psychomotor, affective and bioregulatory symptoms （disturbed sleep and sexual dysfunction）. Patients were impaired in the following subscales： sleep and biorhythm disorder （75.0% of patients）, Parkinsonoid symptoms （25.0%）, affective symptoms （17.5%）, and psychomotor retardation （12.5%）. The increase of total neuro-psychiatric clinical score was significantly associated with the degree of hepatic encephalopathy. CONCLUSION： This study suggests that a substantial number of patients with LC and low-grade hepatic encephalopathy manifest various clinical neuro-psychiatric symptoms. The use of a rating scale, which explores clinical dimensions of hepatic encephalopathy, would improve the management of patients with LC.

Transjugular intrahepatic portosystemic shunt in liver transplant recipients

AIM： To evaluate the efficacy of transjugular intrahepatic portosystemic shunts （TIPSs） after liver transplantation （LT）. METHODS： Between November 1996 and December 2005, 10 patients with severe recurrent hepatitis C virus infection （n = 4）, ductopenic rejection （n = 5） or portal vein thrombosis （n = 1） were included in this analysis. Eleven TIPSs （one patient underwent two TIPS procedures） were placed for management of therapy-refractory ascites （n = 7）, hydrothorax （n = 2） or bleeding from colonic varices （n = 1）. The median time interval between LT and TIPS placement was 15 （4-158） mo. RESULTS： TIPS placement was successful in all patients. The mean portosystemic pressure gradient was reduced from 12.5 to 8.7 mmHg. Complete and partial remission could be achieved in 43% and 29% of patients with ascites. Both patients with hydrothorax did not respond to TIPS. No recurrent bleeding was seen in the patient with colonic varices. Nine of 10 patients died during the study period. Only one of two patients, who underwent retransplantation after the TIPS procedure, survived. The median survival period after TIPS placement was 3.3 （range 0.4-20） too. The majority of patients died from sepsis with multiorgan failure. CONCLUSION： Indications for TIPS and technical performance in LT patients correspond to those in non-transplanted patients. At least partial control of therapy-refractory ascites and variceal bleeding could be achieved in most patients. Nevertheless, survival rates were disappointing, most probably because of the advanced stages of liver disease at the time of TIPS placement and the high risk of sepsis as a consequence of immunosuppression.