Hepatic MRI and ultrasound are both useful in identifying heavy fat accumulation associated with nonalcoholic fatty liver disease. MRI is superior to ultrasound in detecting and quantifying minor degrees of fatty metamorphosis in the liver.

Aims The objective of this study was to investigate sacral electrical stimulation (SES) and gastric electrical stimulation (GES) by comparing upper and lower gastrointestinal (GI) and genitourinary (GU) symptoms and quality of life, before treatment and in the long term after treatment. We hypothesized that dual-device treatment would greatly improve upper and lower gastrointestinal and genitourinary symptoms, as well as quality of life. Methods Fifty-four patients who underwent dual-device treatment (GES and SES) were enrolled in this study. Patients who had surpassed 24 months since the second-device insertion were included. Patients were evaluated before and after both devices were implanted and given a symptom questionnaire regarding their upper GI, lower GI, and GU symptoms and their quality of life. Results With combined treatment, a statistically significant improvement was seen in upper GI, lower GI, and GU symptoms and quality of life. However, fecal incontinence and fecal urgency improvements did not reach statistical significance, likely due to the small sample size. Conclusion The implantation of two stimulators appears to be safe and effective to improve patients’ quality of life for those with upper GI symptoms, bowel problems, and bladder dysfunction.

The usual manifestation of histoplasmosis is in the form of respiratory illness. We report the case of a 67-year-old man who presented with chronic diarrhea and did not respond to the conventional treatment, including that for Clostridium difficile. He was found to have isolated colonic histoplasmosis infection, which was treated with itraconazole. There was no evidence of any disseminated disease. His only immunocompromised state was end-stage renal disease, for which he was on chronic hemodialysis. Although it is well documented as a part of disseminated histoplasmosis, our extensive review of the literature did not reveal any reported case of isolated colonic histoplasmosis in a patient on hemodialysis.

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Introduction:  Gastric Electrical Stimulation (GES) is available as a Humanitarian Use Device for patients with the symptoms of gastroparesis and is effective in reducing gastrointestinal symptoms. We have previously shown that patients with gastric motor disorders often have co‐existing abnormalities of the genitourinary system (Gastroenterol 112: A737, 1997), which may now be treated with sacral electrical stimulation (SES), resulting in similar improvements in genitourinary symptoms. Patients:  We compared the results of therapy with GES and SES in 13 patients who were implanted with both devices. Patients were 11 f, 2 m, mean age of 41 years, who had documented gastroparesis as well as bladder or other pelvic floor dysfunction. All 13 patients had received their GES before the SES. Methods:  Patients were evaluated at baseline and latest follow up (median 4 years for GES and 2 years for SES), according to previously standardized scores of GI (GI: 0–4, TSS max 20) and GU (GU: 0–3, UTSS, max 12) function. Results were compared by paired t‐tests and reported as mean ± SE. Results:  All 13 patients improved both GI and GU symptoms and the improvement in all parameters as nausea, vomiting, anorexia, bloating, abdominal pain and gastric total symptom score (TSS), leakage, urgency, voiding difficulty, number of pads used and urinary total symptom score (UTSS) were statistically significant (see table below). Conclusions:  The combination of GES and SES appears to be both safe and effective for patients with con‐comitant gastroparesis and bladder dysfunction and the existence of a stimulator for one disorder does not preclude another stimulator. Vomiting Nausea Anorexia Bloating Abd. Pain TSS Before2.75 ± 0.623.96 ± 0.133.46 ± 1.083.57 ± 03.79 ± 0.1116.00 ± 1.05After0.63 ± 0.181.03 ± 0.071.63 ± 0.071.89 ± 0.361.29 ± 0.256.64 ± 0.94P.Value<0.001<0.001<0.001<0.002<0.001<0.001 Leakage Urgency Voiding Difficulty #Pads UTSS Before1.33 ± 0.492.0 ± 0.512.43 ± 0.430.83 ± 0.486.5 ± 1.28After00.67 ± 0.420.5 ± 0.3101.4 ± 0.75P.Value<0.0010.0070.0020.007<0.001