Pancreatic Ductal Adenocarcinoma Associated with Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP), in contrast to other benign chronic pancreatic diseases, can be cured with immunosuppressant drugs, thus the differentiation of AIP from pancreatic cancer is of particular interest in clinical practice. There is the possibility that some patients with AIP may develop pancreatic cancer, and this possibility contributes to increasing our difficulties in differentiating AIP from pancreatic cancer. We herein report the case of a 70-year-old man in whom pancreatic adenocarcinoma and AIP were detected simultaneously. We must carefully monitor AIP patients for the simultaneous presence of pancreatic cancer, even when a diagnosis of AIP is confirmed

The influence of intra-daily activities and settings upon weekday violent crime in public space in Manchester, UK

People ebb and flow across the city. The spatial and temporal patterning of crime is, in part, reflective of this mobility, of the scale of the population present in any given setting at a particular time. It is also a function of capacity of this population to perform an active role as an offender, victim or guardian in any specific crime type, itself shaped by the time-variant activities undertaken in, and the qualities of, particular settings. To this end, this paper explores the intra-daily influence of activities and settings upon the weekday spatial and temporal patterning of violent crime in public spaces. This task is achieved through integrating a transient population dataset with travel survey, point-of-interest and recorded crime data in a study of Great Manchester (UK). The research deploys a negative binomial regression model controlling for spatial lag effects. It finds strong and independent, but time-variant, associations between leisure activities, leisure settings and the spatial and temporal patterning of violent crime in public space. The paper concludes by discussing the theoretical and empirical implications of these findings

The histological classification of Barrett's esophagus

La muqueuse de l'endobrachyœsophage est caractérisée par un large éventail d'aspects histopathologiques, soit chez un même patient, soit chez des patients différents. Ces variations conduisent à une mosaïque de types de muqueuses ou de cellules métaplasiques. En plus de cette mosaïque histopathologique, on observe fréquemment une architecture désorganisée caractérisée par une surface irrégulière et une distribution irrégulière des glandes et des cryptes. En outre, le diagnostic dépend également du site anatomique où le prélèvement d'épithélium cylindrique a été effectué. Pour cette raison, une collaboration étroite s'impose entre le pathologiste et le gastroentérologu

Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease?

To assess the value of adding ileoscopy with biopsy to colonoscopy, hence increasing the indications for ileoscopy in patients presenting with symptoms of inflammatory bowel disease. Two hundred fifty-seven patients with persistent diarrhea and 43 patients with sporadic colonic polyps were studied prospectively. The final diagnosis based on clinical and follow-up data, the histology of multiple ileal biopsies, and endoscopic findings were analyzed. Endoscopic lesions of the terminal ileum were found in 123 of 300 patients. In the 43 patients with colonic polyps, no ileal lesions were seen. Ileal disease without colonic involvement was present in 44 of 123 patients. Microscopic lesions of the ileum were present in 125 of 300, or in 125 of 257 (49%) with symptoms of diarrhea. Two of these had a normal endoscopy. Thirteen patients had a diffuse colitis and 11 had a predominantly left-sided colitis, both originally suggestive of ulcerative colitis. Crohn's disease was diagnosed in 88 patients and infectious disease in 17. Ileal biopsies were essential for the diagnosis in 15 patients and were contributive in 53. Granulomas, solitary giant cells, pseudopyloric gland metaplasia, eosinophils, and a disturbed villous architecture were the most important lesions observed in Crohn's disease and were contributive for this diagnosis. Ileoscopy with biopsy is useful in carefully selected patients presenting with symptoms of inflammatory bowel disease. The main indications are diagnosis of isolated ileal disease in the presence of a normal colon and differential diagnosis in patients with pancolitis and predominantly left-sided colitis. Multiple biopsy specimens show definite pathology in almost half of the patient