Objective: To develop the Leuven Itch Scale (US), which measures itching through evaluation of the dimensions of the itch experience; and to provide evidence of the validity, reliability, and responsiveness of the LIS.Materials and methods: A clinimetric study using a longitudinal design. Patients with burns (n = 46), atopic dermatitis (n = 63), or chronic urticaria (n = 41) were included. Evidence for validity (based on test content, relations with other variables and internal structure), reliability and responsiveness of the US was evaluated.Results: Validity evidence based on test content was demonstrated by very low percentages of invalid scores for most items. Validity evidence based on relations with other variables was found, because all hypotheses that were put forward could be accepted. With respect to validity evidence on internal structure, a significant moderate positive correlation was found between itch frequency and itch distress, and between itch frequency and severity. As hypothesized, itch severity and distress were strongly correlated. Test-retest reliability showed a moderate to almost perfect agreement for about half of the items. However, the remaining items could be subject to changes in the itch, rather than reflecting instability of the Leuven Itch Scale. In terms of responsiveness, the Leuven Itch Scale did not suffer from floor or ceiling effects and could detect changes in itch frequency in patients with burns.Conclusion: The Leuven Itch Scale is a useful and clinimetrically sound instrument to measure pruritus in different patient populations affected by itching. (C) 2011 Elsevier Ltd and ISBI. All rights reserved.

Background/Aims: Biliary mucinous obstruction is a complication of intraductal papillary mucinous neoplasms (IPMN). Surgery with resection of the tumour or with biliary bypass is generally recommended. It is our aim to report a patient with IPMN complicated by biliary mucinous impaction in whom surgery was not possible because of extensive collateral circulation. Repeated insertions of plastic and of single covered metallic stents were unsuccessful due to mucus-induced migration of these stents. Methods: Three metallic uncovered stents were inserted in the bile duct alongside each other in order to fill the bile duct up with stent material. Results: Whereas previous insertions of single plastic or covered metallic stents were invariably followed by recurrence of cholestasis by spontaneous stent migration, insertion of three uncovered metallic stents was followed by absence of any cholestatic symptoms during a follow-up period of at least 4 years. Conclusion: In patients with IPMN complicated by biliary mucus impaction, the insertion of multiple uncovered metallic stents seems the endoscopic method of choice to prevent mucus-induced spontaneous stent dislocation.

BACKGROUNDA detailed analysis of the costs of ERCP is needed to provide medical staff, hospital administrators, and health care insurers with a solid basis for decision making.METHODSAn incremental cost analysis was performed from the hospital perspective. Cost calculations were based on a prospective registration of materials, labor time, and equipment needed to perform 204 ERCPs in a tertiary care center.RESULTSAnnual fixed cost related to the organization of the ERCP-unit amounted to $136,213. Variable costs per procedure, including labor and material costs, amounted to $344 and $961 for diagnostic and therapeutic procedures, respectively. Average reimbursement was $221. For the actual situation in our unit, with about 900 procedures yearly and a ratio diagnostic versus therapeutic procedures of 35 to 65, a net yearly loss because of the performance of ERCP activities amounts to $608,038. Theoretical measures to decrease costs could reduce this loss to $394,798, with an average loss of $439 per procedure.CONCLUSIONSThis analysis of costs related to performance of ERCPs clearly shows that ERCP is not sufficiently reimbursed. From our model, it appears that increasing the reimbursement rate for therapeutic procedures to $600 per procedure would generate a net positive balance.

Bowel rest during treatment of acute pancreatitis deprives the gut of nutrients and affects its structure and function. Enteral feeding is usually performed late in the course of acute pancreatitis and therefore cannot prevent intestinal barrier dysfunction and possible bacterial translocation. To assess the effect of early enteral nutrition we performed a prospective study on 21 patients (11 males/10 females) presenting with severe acute pancreatitis (13 biliary, 6 alcoholic, and 2 miscellaneous). Severity was established by a mean Ranson score of 3.57. All but one patient could be fed through a double-lumen nasogastrojejunal tube within 60 h after admission. No significant complication of the technique was observed. We conclude that early jejunal feeding can be used safely in severe acute pancreatitis. Further comparative studies are necessary to demonstrate any superiority to total parenteral nutrition.

A 28-year-old man with poorly controlled juvenile-onset diabetes mellitus presented with jaundice and type 5 hyperlipoproteinemia. A liver biopsy showed fatty liver hepatitis (steatonecrosis). This case represents one end in a spectrum of lipid disorders and liver disease in diabetes mellitus. With increasing insulin deficiency, liver steatosis and the more common type 4 hyperlipoproteinemia pattern may progress to fatty liver hepatitis and type 5 hyperlipoproteinemia.