Colocolonic fistulas are usually a complication of an inflammatory or neoplastic process. However, she had no prior history of any of the predisposing factors related to colocolonic fistulas. A thorough search of English literatures revealed only two cases of sigmoidocecal fistula due to sigmoid diverticulitis or granulomatous colitis. A radiologic

study with contrast media is usually used to diagnose intra-abdominal fistulas. In addition, the primary role of colonoscopy may selleck chemicals directly visualize the lesion that caused the fistula, and if needed, confirm through histopathologic review. In this case, chromoendoscopy was utilized to prove the presence of the sigmoidocecal fistula during the colonoscopy. Contributed by “
“To the Editor: We read with great interest the article in HEPATOLOGY by Nolan on the role of lipopolysaccharide (LPS) in liver injury.1 This review, written by a pioneer of this approach, details the main studies that progressively established gut-derived LPS as a key cofactor in acute and chronic liver disease in the last half-century and more recent studies

that tried to prevent LPS-induced damages by reducing find more or by neutralizing plasma LPS or proinflammatory cytokines. However, we think some important recent studies should have been discussed in this review. Among the studies exploring possibilities to neutralize LPS, those which assessed the effects high-density lipoprotein (HDL) have not been mentioned.2-4 medchemexpress HDL particles are multifunctional lipoprotein complexes that transport lipids and have several anti-inflammatory properties. In cirrhosis, HDL plasma concentrations are decreased and could impair the host’s ability to neutralize LPS.3 In cirrhotic rats with ascites, two recent studies have shown that HDL administration reduced the effects of LPS on tumor necrosis factor-α

production2, 4 and systemic hemodynamics, restoring liver endothelial nitric oxide synthase activity and decreasing portal pressure.2 These studies suggest that the excessive proinflammatory response to LPS in cirrhosis may be attributable, at least in part, to reduced LPS neutralization by HDL. Incubation of whole blood with reconstituted HDL prevents LPS-induced tumor necrosis factor-α and interleukin-6 overproduction by monocytes of patients with cirrhosis.3 Therefore, we believe that restoring HDL content in patients with cirrhosis may be a research avenue to follow in the future. We are conscious that mentioning all the studies related to this crucial subject is very difficult, but we think that the studies we report here are worth being cited in such a review. “
“A teenager, aged 18, was referred for evaluation because of elevated serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for 16 years. There were no significant abdominal or other symptoms. However, on physical examination, he had a large spleen, 8 cm below the left costal margin. Routine blood tests showed anemia, leucopenia and thrombocytopenia.