Faculty Bibliography

Tuberculosis remains a deadly global health problem, especially in developing nations. Extrapulmonary manifestations are prevalent in these endemic areas and on the contrary, are usually limited to the immunocompromised and immigrants in the Western world. In the United States, abdominal infection is even more exceptional, which can be problematic to clinicians in view of its non-specific presentation and investigatory findings. In this case, a 60-year-old Hispanic-American female presenting with a threemonth history of abdominal pain, nausea and vomiting who was referred for an elective screening colonoscopy. Her physical and laboratory studies were unremarkable and her chest x-ray was negative. Furthermore, the patient had negative PPDs on two separate occasions. Contrast computed tomography of the abdomen showed scarring of the right lung base and sigmoid diverticulosis. The screening colonoscopy revealed two polyps and a cecal ulcer. Histological studies of biopsy samples obtained from the cecal ulcer conclusively documented the existence of gastrointestinal tuberculosis. This case illustrates the subtle and indefinable course of abdominal tuberculosis. While it can commonly mimic diseases such as inflammatory bowel disease or colon carcinoma, it can also follow a more indistinct pattern as well, particularly in the acute stages

Small bowel neoplastic disease is a rare but dreaded occurrence in Crohn's disease (CD) and the diagnosis is often disguised by nonspecific and varied presenting symptoms mimicking active or obstructive CD. As such, the diagnosis is all too often delayed, typically detected at a late stage, and with a poor prognosis. CD has become a well-recognized risk factor for the development of small bowel adenocarcinoma. The data, however, are limited and based on case reports, retrospective studies, and review of the literature

As the baby-boomer generation enters the ranks of the elderly (defined as patients over 60 years of age), the increased burden of managing older inflammatory bowel disease (IBD) patients requires recognition of the impact of comorbid disease, polypharmacy, and surgical candidacy criteria. There is a surprisingly positive response to newer therapies and surgery, provided that a distinction is made between 'fit elderly' and 'frail elderly' patients. The former group should not be denied access to the newer biologics, clinical trials, or surgical alternatives on the basis of age alone. There is a need for clinicians caring for elderly IBD patients to be cognizant of the multiple and often disguised conditions contributing to disease management as well as the importance for careful allocation of health resources

Chromogranin A (CgA), originally identified in adrenal chromaffin cells, is a member of the granin family of acidic secretory glycoproteins that are expressed in endocrine cells and neurons. CgA has been proposed to play multiple roles in the secretory process. Intracellularly, CgA may control secretory granule biogenesis and target neurotransmitters and peptide hormones to granules of the regulated pathway. Extracellularly, peptides formed as a result of proteolytic processing of CgA may regulate hormone secretion. To investigate the role of CgA in the whole animal, we created a mouse mutant null for the Chga gene. These mice are viable and fertile and have no obvious developmental abnormalities, and their neural and endocrine functions are not grossly impaired. Their adrenal glands were structurally unremarkable, and morphometric analyses of chromaffin cells showed vesicle size and number to be normal. However, the excretion of epinephrine, norepinephrine, and dopamine was significantly elevated in the Chga null mutants. Adrenal medullary mRNA and protein levels of other dense-core secretory granule proteins including chromogranin B, and secretogranins II to VI were up-regulated 2- to 3-fold in the Chga null mutant mice. Hence, the increased expression of the other granin family members is likely to compensate for the Chga deficiency