A short course of corticosteroids prior to surveillance colonoscopy to decrease mucosal inflammation in inflammatory bowel disease patients: Results from a randomized controlled trial

BackgroundInflammation is a known pitfall of surveillance colonoscopy for inflammatory bowel disease (IBD) as it is difficult to differentiate between inflammation and true dysplasia. This randomized controlled trial assessed the effectiveness of a low dose of corticosteroids prior to surveillance colonoscopy to decrease mucosal inflammation.MethodsIBD-patients scheduled for surveillance colonoscopy between July 2008–January 2010 were eligible to participate. Patients were randomized to either two weeks daily 20 mg prednisone and calcium plus vitamin D prior to surveillance colonoscopy or no treatment. All biopsies were reviewed by an expert gastrointestinal pathologist who was blinded for medication-use. Statistics were performed using chi-square tests, non-parametric tests and binary logistic regression.ResultsSixty patients (M/F 30/30, UC/CD 31/29) participated: 31 (52%) in the treatment arm and 29 (48%) in the control group. In the treatment arm, 247 biopsies were scored against 262 in the control group. In the treatment arm 27 out of 247 biopsies (10.9%) had a score > 1 on the Geboes scale, against 50 out of 262 biopsies (19.1%) in the control group, p = 0.013. In total, 58% of the treatment arm against 66% of the control group had endoscopic or histological mucosal inflammation (p = 0.6). There was a trend for patients in the treatment arm to have less severe inflammation compared with the control group, however this was not significant (p = 0.12).ConclusionsIn our cohort, a short course of corticosteroids decreases the overall histological disease activity in individual biopsies without major side-effects. Moreover, there is a trend for corticosteroids to decrease the maximum severity of both endoscopic and histological disease activity per patient.     

胃镜下黏膜染色对萎缩性胃炎及其癌前病变的诊断价值

目的:探讨内镜喷洒亚甲蓝对萎缩性胃炎并肠上皮化生以及不典型增生的诊断价值.方法:126例胃镜诊断为萎缩性胃炎的病例常规活检后予0.5%亚甲蓝作黏膜染色,对异常染色区追加活检,对比分析染色前后病理组织学检查结果.结果:①普通胃镜直视下诊断与病理诊断符合率为60.3%,染色胃镜直视下诊断与病理诊断符合率为75.4%;②染色后萎缩性胃炎伴肠上皮化生检出率77.8%,不典型增生检出率38.1%,均较染色前有所提高(P＜0.01).结论:染色胃镜对萎缩性胃炎及其癌前病变的诊断价值优于普通胃镜.     

粒细胞相关抗原(CD15)在胃癌及癌旁组织中的表达研究

粒细胞相关抗原（CD15）又称LIUM1，主要存在于何杰金病的R-S细胞中[1-6]。我们利用CD15抗体检测了65例胃癌及癌务组织，发现CD15的阳性表达与胃癌的分化程度、组织学类型有显著的相关性；65例胃癌的阳性表达率为66．15％（43／65）．癌旁异形增生腺体的阳性表达率为54．76％（23／42）；正常胃小凹粘膜表达阴性，前二者与后者间有显著的差异性。（P＜0．05）65例胃癌的阳性表达率以管状腺癌（高分化与中分化）为最高（88．46％），低分化腺癌次之（61．11％），以粘液腺癌又次之50％，以卵或细胞癌最低（36．36％）     

Renal,pancreatic and hepatic dysplasia sequence

A renal, pancreatic and hepatic dysplasia sequene (RPHD sequence) was found in a male premature baby who died a few minutes after birth. Autopsy documented multicystic dysplastic kidneys, a dysplastic pancreas with dilated ducts, cysts, fibrosis and inflammatory infiltrates, prominent portal tracts containing dilated bile ducts and hypoplastic lungs. Other organs were normal. This triad constitutes a dysplastic sequence and was first reported by Ivemark et al. [6] as familial dysplasia of kidneys, liver and pancreas. Since then, this combination of abnormalities has been named polycystic dysplasia [4] and renal-hepatic-pancreatic dysplasia [1], but mostly Ivemark syndrome [8], at the risk of being confused with asplenia-cardiac anomaly syndrome, which was reviewed by Ivemark et al. [5] and also bears Ivemark's name.Abbreviation RHPD renal pancreatic and hepatic dysplasia sequence     

An examination of calcium current function on heterotopic neurons in hippocampal slices from rats exposed to methylazoxymethanol

PURPOSE: To study voltage-dependent calcium currents (VDCCs) on hippocampal heterotopic neurons by using whole-cell patch-clamp techniques in brain slices prepared from methylaxozymethanol (MAM)-exposed rats. METHODS: Whole-cell voltage-clamp recordings were obtained from visually identified neurons in acute brain slices by using an infrared differential interference contrast (IR-DIC) video microscopy system. Heterotopic neurons were compared with normotopic pyramidal cells in hippocampal slices from MAM-exposed rats or CA1 pyramidal neurons in slices from controls. RESULTS: Heterotopic neurons expressed a prominent VDCC, which exhibited a peak current maximum around -30 mV (holding potential, -60 mV) and an inactivation time constant of 48.2 +/- 2.4 ms (n = 91). VDCC peak current and inactivation time constants were similar for normotopic (n = 92) and CA1 pyramidal cells (n = 40). Pharmacologic analysis of VDCC, on heterotopic, normotopic, and CA1 pyramidal cells, revealed an approximately 70% blockade of peak Ca2+ current with nifedipine and amiloride (L- and T-type channel blockers, respectively). Inhibition of VDCC, for all three cell types, also was similar when more specific Ca2+ channel antagonists were used [e.g., omega-conotoxin GVIA (N-type), omega-agatoxin KT (P/Q-type), and sFTX-3.3 (P-type)]. VDCC modulation by norepinephrine (NE) or adrenergic receptor-specific agonists [clonidine (alpha2), isoproterenol (beta), and phenylephrine (alpha1)] was similar for heterotopic and CA1 pyramidal cells. CONCLUSIONS: Heterotopic neurons do not appear to exhibit Ca2+ channel abnormalities that could contribute to the reported hyperexcitability associated with MAM-exposed rats.     

Increased excitability and decreased sensitivity to GABA in an animal model of dysplastic cortex

PURPOSE: Cortical dysplasia (CD) is associated with epilepsy in both the pediatric and adult populations. The mechanism underlying seizures with cortical malformations is still poorly understood. To study the physiology of dysplastic cortex, we developed an experimental model of CD. METHODS: Pregnant rats were given intraperitoneal injections of carmustine (1-3-bis-chloroethyl-nitrosourea; BCNU) on embryonic day 15 (E15). Cortical histology was examined in the resulting pups at P0, P28, and P60. In addition, evoked and spontaneous field potential recordings were obtained in cortical slices from adult control and BCNU-exposed rats. Finally, we used whole-cell recordings to compare physiologic properties of pyramidal neurons and gamma-aminobutyric acid (GABA) responses in control and BCNU-treated animals. RESULTS: Features characteristic of CD were found in the offspring, including laminar disorganization, cytomegalic neurons, and neuronal heterotopias. Dysplastic cortex also contained abnormal clusters of Cajal-Retzius (CR) cells and disruption of radial glial fibers, as demonstrated with immunohistochemistry. Under conditions of partial GABAA-receptor blockade with 10 microM bicuculline methiodide (BMI), slices of dysplastic cortex demonstrated a significant increase in the number of spontaneous and evoked epileptiform discharges. Individual pyramidal neurons in dysplastic cortex were less sensitive to application of GABA compared with controls. CONCLUSIONS: BCNU exposure in utero produces histologic alterations suggestive of CD in rat offspring. Dysplastic cortex from this model demonstrates features of hyperexcitability and decreased neuronal sensitivity to GABA. Such physiologic alterations may underlie the increased epileptogenicity of dysplastic cortex.     

伴颅内疾患语前聋病人的人工耳蜗植入术(附3例报告)

目的探讨伴有颅内疾患的聋儿人工耳蜗植入术候选者的手术和术前评估的问题.方法总结在我院发现的3例伴有颅内疾病的语前聋病人,3例都已经实施了人工耳蜗植入术.结果3例病人均在术前的磁共振检查发现了合并有颅内疾病,手术后病人均成功重建了听力.结论对于伴有颅内疾病的人工耳蜗植入术候选者在经过术前全面评估和审慎观察后可以实施手术;术前磁共振检查是发现大脑疾病的重要手段.     

胃粘膜异型增生上皮p53蛋白和PCNA的表达意义

 目的 探讨胃粘膜中－重度异型增生组织 ｐ５３蛋白和 ＰＣＮＡ的表达意义。方法 应 用免疫组化 ＳＡＢＣ法对 ７９例常规胃镜活检的胃粘膜中－重度异型增生组织行 ｐ５３蛋白和 ＰＣＮＡ 同步检测并进行了 ５年随访。结果 胃粘膜中增生重度异型增生组织 ｐ５３蛋白阳性表达者５年癌 检出率明显高于ｐ５３蛋白阴性表达者。ＰＣＮＡⅢ～Ⅳ级者癌检出率明显高于Ⅰ～Ⅱ级者。ｐ５３蛋 白阳性并 ＰＣＮＡⅢ～Ⅳ级者，其癌检出率最高。结论 ｐ５３蛋白和 ＰＣＮＡ是预测胃粘膜中－重度异 型增生生物学持性有价值的指标。