Development of type I gastric carcinoid in patients with chronic atrophic gastritis

Background Long‐term observational studies assessing the incidence of type I gastric carcinoid (typeIGC) in patients with chronic atrophic gastritis are few. Aim To evaluate the occurrence of typeIGC at diagnosis and during follow‐up and to identify patient features associated with the presence of typeIGC in a cohort of chronic atrophic gastritis patients. Methods Three hundred and sixty‐seven chronic atrophic gastritis patients [245 women, age 54 (18–79) years] underwent regular follow‐up by gastroscopy. The incidence of typeIGC was determined in chronic atrophic gastritis patients with at least 2 years of follow‐up (n = 214). Baseline clinical and histological features were analysed as factors associated with the presence of typeIGC by univariate analysis. Results Type I gastric carcinoid was diagnosed in nine (2.4%) patients at the moment when chronic atrophic gastritis was diagnosed. After 1463 person‐years, six patients developed typeIGC with an annual incidence rate (person‐year) of 0.4%. Patients with typeIGC had significantly higher levels of gastrin, chromogranin A and more frequently the presence of body polyps and ECL‐dysplasia compared with chronic atrophic gastritis patients without typeIGC. Conclusions This cohort study shows that typeIGC is a rare complication in patients with chronic atrophic gastritis, and the presence of body polyps and ECL‐dysplasia at gastroscopic/histologic evaluation is strongly associated with the presence of typeIGC.     

Neuroendokrine Neoplasien des distalen Jejunums und Ileums

Neuroendocrine neoplasms (NEN) of the distal jejunum and ileum derive from serotonin-producing enterochromaffin (EC) cells. Due to their low proliferation rate and their infiltrative growth, they are often discovered at an advanced disease stage when metastasis has already occurred. The biology of these tumours is different from other NEN of the digestive tract. In order to standardise and improve diagnosis and therapy, the guidelines for the diagnosis and clinical management of jejuno–ileal NEN as well as for the management of patients with liver and other distant metastases from NEN were revised by the European Neuroendocrine Tumour Society (ENETS) in 2012. This review focuses on aspects relevant for surgical pathology.     

Clinical features of symptomatic uncomplicated diverticular disease: a multicenter Italian survey

Purpose

Clinical features of symptomatic uncomplicated diverticular disease are poorly investigated. Abdominal symptoms may be similar to those of irritable bowel syndrome. This survey aimed to assess clinical features associated with symptomatic uncomplicated diverticular disease.

Methods

This multicenter survey included consecutive outpatients with symptomatic uncomplicated diverticular disease to whom a detailed clinical questionnaire regarding demographic, lifestyle, and clinical features was administered. Diagnosis was based on the presence of diverticula and abdominal pain/discomfort. Irritable bowel syndrome and functional dyspepsia were assessed according to Rome III criteria.

Results

A total of 598 patients (50?% female, age 69?years), 71?% with newly diagnosed symptomatic uncomplicated diverticular disease and 29?% with history of colonic diverticula, were recruited. Diverticula were localized in the left colon in 78?% of the patients. Recurrent short-lived abdominal pain (<24?h) was present in 70?% (relieved by evacuation in 73?%), prolonged abdominal pain (>24?h) in 27?%, and recurrent abdominal bloating in 61?% of the patients. Normal, loose, or hard stools were reported by 58, 29, and 13?% of patients, respectively. Irritable bowel syndrome (IBS)-like and functional dyspepsia-like symptoms were recorded in 59 and 7?% of patients, respectively. IBS-like symptoms (odds ratio, 4.3) were associated in patients with prolonged abdominal pain.

Conclusions

Symptomatic uncomplicated diverticular disease is associated with a gender ratio of 1:1 and an unspecific clinical picture mainly characterized by normal stools, short-lived abdominal pain, abdominal bloating, IBS-like symptoms, while functional dyspepsia-like symptoms are not commonly present. These findings suggest that symptomatic uncomplicated diverticular disease often shows similar findings rather than overlaps IBS.     

Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players

Introduction

Femoroacetabular impingement (FAI) represents a novel approach to the mechanical etiology of hip osteoarthritis. The cam-type femoroacetabular impingement deformity occurs frequently in young male athletes. The aim of our study was to evaluate the prevalence of FAI in male semiprofessional soccer players using clinical examination and magnetic resonance imaging (MRI), compared to amateur soccer players. In MRI, the α angle of Nötzli is determined for quantifying FAI.

Materials and methods

According to power analysis, a total of 22 asymptomatic semiprofessional soccer players with a median of 23.3 years of age (range 18–30 years) and 22 male amateur soccer players with a median of 22.5 years of age (control group, range 18–29 years) underwent an MRI to measure the hip α angle of Nötzli. The α angle of the kicking legs of the semiprofessional group and the amateur group were analyzed. The study group was moreover evaluated by the Hip Outcome Score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests.

Results

In the semiprofessional group, 19 soccer players had a right kicking leg and 1 soccer player had a left kicking leg. 2 soccer players kicked with two feet. In the semi-professional group, the mean value of the α angle of the kicking leg (57.3 ± 8.2°) was significantly higher than in the amateur group (51.7 ± 4.8°, P = 0.008). In the semi-professional group, 15 (62.5 %) of 24 kicking legs had an increased α angle >55°, while 5 (27.3 %) kicking legs of the amateur group had an α angle >55°. Five semi professional soccer players had findings in clinical examination, whereof 4 had an increased α angle >55°. No participant of the amateur group showed pathological results in the clinical examination (P = 0.0484). Overall, semiprofessional soccer players had a higher proportion of an increased α angle than the amateur group.

Conclusions

Semiprofessional players have a higher prevalence of an increased α angle in the kicking leg than the amateur group at the same age. The kicking leg is predisposed for FAI.     

Completing the picture on student performances in OSCEs: A mixed-methods study on integration of a standardized patient rating

ObjectiveGood physician communication skills increase patient satisfaction and improve healing processes. Although physicians and patients appear to value communicative competencies differently, students are often evaluated solely by physicians. This study examines whether additional assessment of students by ‘standardized patients’ (SPs) is useful.MethodsDuring their Objective Structured Clinical Examination (OSCE) 238 medical students were additionally rated by SPs at 9 stations according to two items that defined the ‘physician–patient relationship’ and ‘communication’. SPs were informed that their assessment was for research purposes only, with no impact on the assessment of the students. SPs also had the opportunity to comment on their rating of the students.ResultsThe SPs rated the communicative competencies of students differently than physicians. The two parts of the SP rating are closely related. Inclusion of SP rating in the OSCE would provide higher measurement precision, with more students failing. SPs considered five factors relevant in their rating: ‘human connection’, ‘information flow’, ‘professionalism’, ‘competence’, and ‘exam situation’.ConclusionOur study suggests inclusion of SP rating as additional assessment of student communication skills.Practice ImplicationsAddition of SP rating in assessments is worthwhile, as it appears to complete the picture of the student performance in their OSCEs.