Screening for variants in TPMT did not reduce the proportions of patients with hematologic ADRs during thiopurine treatment for IBD. However, there was a 10-fold reduction in hematologic ADRs among variant carriers who were identified and received a dose reduction, compared with variant carriers who did not, without differences in treatment efficacy. ClinicalTrials.gov number: NCT00521950.

Background:The optimal treatment of desmoid tumours is controversial. We evaluated desmoid management in Dutch familial adenomatous polyposis (FAP) patients.Methods:Seventy-eight FAP patients with desmoids were identified from the Dutch Polyposis Registry. Data on desmoid morphology, management, and outcome were analysed retrospectively. Progression-free survival (PFS) rates and final outcome were compared for surgical vs non-surgical treatment, for intra-abdominal and extra-abdominal desmoids separately. Also, pharmacological treatment was evaluated for all desmoids.Results:Median follow-up was 8 years. For intra-abdominal desmoids (n=62), PFS rates at 10 years of follow-up were comparable after surgical and non-surgical treatment (33% and 49%, respectively, P=0.163). None of these desmoids could be removed entirely. Eventually, one fifth died from desmoid disease. Most extra-abdominal and abdominal wall desmoids were treated surgically with a PFS rate of 63% and no deaths from desmoid disease. Comparison between NSAID and anti-estrogen treatment showed comparable outcomes. Four of the 10 patients who received chemotherapy had stabilisation of tumour growth, all after doxorubicin combination therapy.Conclusion:For intra-abdominal desmoids, a conservative approach and surgery showed comparable outcomes. For extra-abdominal and abdominal wall desmoids, surgery seemed appropriate. Different pharmacological therapies showed comparable outcomes. If chemotherapy was given for progressively growing intra-abdominal desmoids, most favourable outcomes occurred after combinations including doxorubicin.

Two patients in one hospital room acquired pseudomembranous colitis, one shortly after the other. The DNA restriction patterns of isolates from the patients and of four isolates from the environment were indistinguishable from one another and differed from isolates of other patients. Restriction endonuclease digest analysis appears to be a useful method for studying the epidemiology of Clostridium difficile. Clostridium difficile is now well recognized as the etiologic agent of pseudomembranous colitis (PMC) and appears also to be responsible in part for antibiotic-associated diarrhea (1, 6, 8, 13, 20). A clustering of cases suggests that the organism may be transmitted from person to person or from exogenous sources in the environment (4, 7, 9-11, 15, 16, 18). In long-term-care facilities, C. difficile seems to be endemic, but the reason is unknown (2). Recently, two female patients who had undergone abdominal surgery developed PMC, one shortly after the other (12). Patient A was a 63-year-old woman who was hospitalized for anal surgery. Ten days after the operation she developed * Corresponding author.

ERC is a safe and reliable way of diagnosing common bile duct stones, and ES is a very efficient way of treating them. Morbidity and mortality are low, and the long-term results are very good.

Background/Aims: 150 cases of Brunner’s gland hamartoma (BGH) have been reported in the literature. BGHs are benign and are thought not to cause bile obstruction. Methods: In this case report, a 60-year-old male is presented with unexplained obstructive jaundice who was also known for over 17 years with diffuse adenomatous hyperplasia of Brunner’s glands in the duodenum. Despite the benign preoperative diagnosis, the choice of treatment was Whipple’s procedure due to suspicion of a coexisting malignancy. Results: Pathological analysis of the resection specimen revealed multiple BGHs and an adenocarcinoma of the papilla of Vater (PoV). Molecular pathology using loss of heterogeneity analysis was used to confirm that both were different entities. Conclusion: It is likely that previous reports of malignant degeneration of BGHs may actually have been cases involving the coexistence of a PoV adenocarcinoma. Physicians need to be alert when a patient presents with BGH accompanied with obstructive jaundice for simultaneously occurring PoV adenocarcinoma.