Treatment of TIPS/biliary fistula-related endotipsitis with a covered stent.

"Infective endotipsitis" describes a recurrent bacteremia or fungemia in patients with a transjugular intrahepatic portosystemic shunt (TIPS) in place and no other identifiable source of infection. The present report describes a patient who developed polymicrobial endotipsitis 6 years after TIPS creation. Blood cultures remained positive for polymicrobial growth despite long courses of antibiotic therapy.

The effect of a low-carbohydrate, ketogenic diet on nonalcoholic fatty liver disease: a pilot study.

Nonalcoholic fatty liver disease is an increasingly common condition that may progress to hepatic cirrhosis. This pilot study evaluated the effects of a low-carbohydrate, ketogenic diet on obesity-associated fatty liver disease. Five patients with a mean body mass index of 36.

Utility of thiopurine methyltransferase genotyping and phenotyping, and measurement of azathioprine metabolites in the management of patients with autoimmune hepatitis.

Background/aims: Azathioprine is a key drug in the management of autoimmune hepatitis (AIH), with effects mediated via conversion to 6-thioguanine (6-TG) and 6-methylmercaptopurine (6-MMP), the latter controlled by thiopurine methyltransferase (TPMT). Our aims were to evaluate the role of TPMT genotyping and phenotyping and to examine 6-TG and 6-MMP metabolite levels in patients with AIH.

Methods: TPMT genotyping and phenotyping was performed on 86 patients with AIH, and metabolites evaluated in assessable patients.

Polycystic ovary syndrome and severe nonalcoholic steatohepatitis: beneficial effect of modest weight loss and exercise on liver biopsy findings.

Objective: To report a case of biopsy-documented nonalcoholic steatohepatitis (NASH), which improved appreciably through moderate exercise and weight loss in a young woman with polycystic ovary syndrome (PCOS) and insulin resistance.

Methods: We present a detailed case report, including laboratory and pathologic findings. In addition, we review the recent literature regarding the association of insulin resistance with NASH and PCOS.

Ischemic colitis: a clinical review.

Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow.

Acute intestinal ischemia and infarction.

Acute intestinal ischemia is a gastrointestinal emergency resulting from a sudden decrement in intestinal blood flow. It may occur as a consequence of mesenteric vascular occlusion and/or hypoperfusion and may involve the small intestine or colon. Bowel infarction, sepsis, and death may result, making prompt diagnosis and management imperative.