A percutaneous cholangiogram confirmed the presence of a stricture and there was

a high level of CA19.9 in bile (50,000 U/L; range 0–39 U/L). However, the CA19.9 level in serum was within the reference range. He was treated surgically with a pancreaticoduodenectomy (Whipple’s procedure). Biopsies revealed chronic inflammation in the pancreas and bile duct consistent with autoimmune pancreatitis and cholangitis (Figure 2A) and there was positive staining for IgG4 in the bile duct (Figure 2B), pancreas (Figure 2C) and submandibular gland (Figure 2D). These manifestations form part of the spectrum of “IgG4-related autoimmune disease”. Contributed by “
“Squamous cell carcinoma (SCC) of the anal canal is an uncommon cancer of the digestive tract. Recently, two reports suggested the usefulness of narrow-band imaging (NBI) system in the diagnosis of anal canal cancer. R428 mouse Herein, we present a case of early-stage SCC of the anal canal diagnosed by NBI with magnification. A 67-year-old man underwent colonoscopy in the investigation of gastrointestinal blood loss. Conventional colonoscopy (H260AZI, Olympus Optical Co., Tokyo, Japan) showed a 20mm elevated tumor with central depression located close to the dentate

line of the anal canal (Figures 1a and b). The surface microvessels of the lesion were examined using an NBI system with magnification SP600125 cell line (Figure 2). The microvessels were similar to the irregular intraepithelial papillary capillary loops (IPCLs) seen in superficial 上海皓元 squamous cell carcinoma of the esophagus, that is, the papillae of the lamina propria were increased in length and the microvessels in the papillae were dilated and elongated. Based on these findings, the patient was diagnosed with superficial SCC of the anal canal, and a transanal resection was performed because the location of the lesion was close to the dentate line. Histological analysis of the resected specimen revealed a microinvasive squamous cell carcinoma with a diameter of 22 mm (Figure 3). No intravenous or lymphatic invasions was observed histologically.

The cancer cells were diffusely positive for P16 immunostaining, a molecular marker of human papilloma virus infection. In conclusion, IPCL-like irregular microvessels seen under NBI with magnification may contribute towards the diagnosis early stage SCC of the anal canal. Contributed by “
“The recent publication of “Drug Therapy: Rifaximin” by Bajaj and Riggio1 offers interesting observations by colleagues. They voice concern that continuous rifaximin administration “could have the potential to increase resistance to rifaximin,” but they cite no objective clinical data in support of their hypothesis. They also cite the two cases of Clostridium difficile in the rifaximin group reported in the registration study of rifaximin for the treatment of hepatic encephalopathy by Bass and colleagues,2 and they advise vigilance against C.