Videocapsule endoscopy is useful for the diagnosis of intestinal lymphangiectasia

We study two authentic cases of protein-losing enteropathy, the diagnosis of which was facilitated using Given M2A videocapsule endoscopy. The first case corresponded to a primary intestinal lymphangiectasia confirmed by jejunum biopsies and the second one to a protein-losing enteropathy with lymphatic abnormalities secondary to a chronic constrictive pericarditis. In the first case, the mucosa of jejunum presented with a diffuse oedematous aspect, whitish villi, white curved lines probably related to submucosal dilated lymphatics and lacteal juice. In the second case, capsule endoscopy showed oedematous aspect of jejunum mucosa associated with white curved lines similar to those observed in the first case. Videocapsule endoscopy is useful in cases of protein-losing enteropathy to identify presence of intestinal lymphangiectasia and to specify their localisation after ruling out other disorders liable to induce protein-losing gastrointestinal syndrome.     

Globin chain synthesis is a useful complementary tool in the differential diagnosis of thalassemias

The present study aimed at differentiating rare types of heterozygous beta-thalassemia (thal) with normal Hb A(2) values from alpha-thal in Iranian carriers by globin chain synthesis in addition to other hematological parameters. Our study groups consisted of 51 normal subjects, 24 heterozygous beta- thalassemic subjects with high Hb A(2), 62 alpha-thal-2 subjects, 34 alpha-thal-1 subjects, six Hb H disease thalassemic subjects, 14 silent beta-thal subjects with normal Hb A(2) values, five deltabeta-thal subjects and two subjects with an association of alpha- and deltabeta-thal (total = 198). Analysis of globin chains was performed by high performance liquid chromatography (HPLC). The results showed that the alpha/beta ratio averages were close to the ones in the published literature, but with a greater standard deviation and a wider range. Globin chain synthesis (GCS) could be valuable in differentiating between microcytosis produced by silent beta-thal (heterozygous beta-thal with a normal Hb A(2) level) and that caused by alpha-thal. Since the complex genotype/phenotype relationship can lead to diagnostic difficulties, GCS cannot be used as the only diagnostic tool for thalassemia carrier detection. Therefore, a combination of different tests for each patient is required.     

CT能谱成像鉴别肝癌和肝脏局灶性结节增生的临床价值

目的探讨CT能谱成像在鉴别肝癌和肝局灶性结节增生（FNH）中的应用价值。方法回顾性分析46例肝脏占位性病变患者（肝癌32例,FNH14例）行64层CT双期能谱扫描结果。测量病灶、正常肝组织和腹主动脉的能谱参数,对比分析两种占位性病变间不同能量水平下病灶-肝脏对比噪声比（CNR）、标准化碘浓度（NIC）、病灶与正常肝组织碘浓度比值（LNR）及病灶动脉期和门静脉期碘浓度的差异（ICD）等。结果除部分能量点外,肝癌和FNH在不同能量水平下的CNR随着单光子能量的增加而减小。肝癌和FNH的动脉期最佳CNR分别为3.6±1.1和8.3±2.7,门静脉期最佳CNR分别为1.8±0.3和1.1±0.2;肝癌和FNH动脉期NIC分别为0.3±0.1和0.4±0.1,门静脉期NIC分别为0.5±0.1和0.9±0.2;动脉期LNR分别为3.0±0.5和6.2±1.0,门静脉期LNR分别为1.0±0.1和1.2±0.3;动脉期和门静脉期ICD值分别为0.4±0.1g/L和1.2±0.3g/L。肝癌动脉期和门静脉期的NIC、LNR和ICD值均低于FNH,差异均有统计学意义（NIC比较,t值分别为-3.196、-6.518;LNR比较,t值分别为-12.911、-3.260;ICD比较,t值为-2.754,P均＜0.05）。动脉期LNR鉴别肝癌和FNH的敏感度和特异度最高,均为100%。结论 CT能谱成像分析对肝癌和FNH的检出和鉴别诊断有一定的价值,能提高检出效能和诊断准确性。     

Immunologic markers in the differential diagnosis of non-Hodgkin's lymphomas

Summary To improve the classification of the phenotypes of the various types of non-Hodgkin's lymphoma (NHL), 250 cases of NHL were analyzed with immunologic and enzyme cytochemical techniques. The results confirmed previous findings. Chronic lymphocytic leukemia of B-cell type (B-CLL) is characterized by a small amount of surface immunoglobulin (SIg), a predominance of C3d receptors, a large number of mouse erythrocyte receptors, and a low T-cell content. Chronic lymphocytic leukemia of T-cell type (T-CLL) has at least two subtypes: one shows a dot-like reaction product in cells stained with acid nonspecific esterase and the other does not. In prolymphocytic leukemia, there is a constantly high percentage of SIg-positive cells and a large amount of SIg on each positive cell; C3b receptors usually preponderate over C3d receptors; and there is a large number of IgG-Fc receptors. The surface marker phenotype of hairy-cell leukemia is similar to that of prolymphocytic leukemia except that hairy cells are devoid of C3 receptors and usually show a high density of IgM-Fc receptors. T-zone lymphoma usually contains both T cells and B cells. The T cells are capable of binding sheep erythrocytes only at 4 °C and can be identified cytologically as the tumor cells. In contrast, the B cells stem from residual follicles, which are often present in T-zone lymphoma at the time of the first biopsy. Three types of lymphoplasmacytic/-cytoid lymphoma (LP immunocytoma) are distinguished on the basis of morphologic features. The marker constellation of the lymphoplasmacytic subtype resembles that of centroblastic-centrocytic lymphoma. The lymphoplasmacytoid subtype and borderline cases between this subtype and B-CLL show the same markers as does B-CLL. The third subtype of LP immunocytoma, the polymorphic subtype, differs in its marker profile from all other types of NHL. The three types of lymphoma derived from germinal center cells resemble each other in the expression of nearly equal numbers of C3b and C3d receptors and a low percentage of IgG-Fc receptors. Centrocytic lymphoma is distunguished from centroblastic-centrocytic lymphoma by a large proportion of cells bearing SIg and C3 receptors and by the absence, or small proportion, of T cells and cells rosetting with mouse erythrocytes. Centroblastic lymphoma shows a marker profile that is similar to that of centroblastic-centrocytic lymphoma. The Burkitt type of lymphoblastic lymphoma shows a unique marker profile, with a high percentage of SIg-positive cells and no other markers. Analysis of lymphoblastic lymphoma of the convoluted-cell type (including cases of acute lymphoblastic leukemia with a focal acid phosphatase reaction) revealed four phenotypes. Cases with the first phenotype show C3 receptors (usually both subtypes) and a lack of sheep erythrocyte receptors. In cases with the second phenotype, the cells express both C3 receptors and sheep erythrocyte receptors. Cases with the third phenotype lack C3 receptors but contain cells rich in receptors for sheep erythrocytes that bind at 37°C. Nearly all of the cases with these three phenotypes are devoid of acid nonspecific esterase. Cases with the fourth phenotype lack C3 receptors, exhibit sheep erythrocyte receptors that bind only at 4°C, and show a focal acid nonspecific esterase reaction. Eight of nine cases of immunoblastic lymphoma showed SIg and were thus identified as B-cell derived. The ninth case was of T-cell type, as indicated by the capacity of the tumor cells to form rosettes with sleep erythrocytes.Supported by the Deutsche Forschungsgemeinschaft, SFB 111, project no. CL 1     

The efficacy of autofluorescence imaging in the diagnosis of colorectal diseases

Image-enhanced endoscopy (IEE) has been developed and is applied in the clinical setting throughout the world. Most reports regarding IEE have evaluated the efficacy of narrow-band imaging (NBI) in the diagnosis of gastrointestinal disorders. Although autofluorescence imaging (AFI) is a form of IEE, its usefulness remains unclear. The present review focused on the efficacy of AFI in the diagnosis of colorectal disease, particularly neoplasia and ulcerative colitis (UC). AFI-based diagnoses are made via the subjective judgment of the color on the monitor. The efficacy of AFI in detection and differentiation in patients with colorectal neoplastic lesions remains controversial, which may be dependent on the study design and the diagnostic procedures. Although the number of the reports related to UC is very small, most suggest that AFI is effective in UC patients. AFI is distinct from other modalities in that it can quantitatively assess the lesion based on the fluorescence intensity without any morphological assessments. AFI could be useful for patients with colorectal disease.     

Pseudo-obstruction chronic disease, lymphoid hyperplasia of the gastrointestinal tract and intestinal endometriosis

Nodular lymphoid hyperplasia of the gastrointestinal tract associated to endometriosis is an uncommon cause of chronic pseudo-obstruction and malabsortion. The case of a 32-year-old woman who suffered from this syndrome for one a half years is described. Diagnosis was achieved by laparotomy, which disclosed swelling and inflammation of the 30 cm terminal yeyunal portion. Removal of the involved intestine and side-to-side anastomosis were performed. The pathological findings were: follicular lymphoid hyperplasia with mucosal ulcers an fissures inflammatory pseudo-polyps, chronic deep enteritis and areas of endometriosis. A favourable outcome followed surgery.     

The differential diagnosis of intestinal amebiasis

Differential diagnosis of intestinal amebiasis (106 patients), acute Flexner's dysentery (105 patients) and nonspecific ulcerative colitis (31 patients) based on the clinical data and rectoromanoscopic findings is described. Rapidly and gradually progressing in the first 7 days intestinal amebiasis is characterized by a gradual onset, normal t0 with mounting general weakness, celiectasia, diarrhea with hyaloid mucus, focal catarrh-hemorrhagic changes and appearance of individual oval transversal ulcers on the colon mucosa.     

A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis

Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestonelike mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.     

Dynamic computer tomography is useful in the differential diagnosis of juxtaglomerular cell tumor and renal cell carcinoma.

We compared dynamic computer tomographic CT images of 3 cases of juxtaglomerular (JG) cell tumor with those of 8 cases of renal cell carcinoma (RCC). The JG cell tumor was visualized as a low- to high-density area in case 1, a low-density area in case 2, and a low- to iso-density area in case 3 before contrast enhancement. None of the JG cell tumors were stained during the early phase (1 min), but all were stained moderately during the late phase (5 min) after contrast enhancement. Although all cases of RCC were visualized as a low- to iso-density area before contrast enhancement, they were intensely stained during the early phase with significant washout during the late phase. The present results suggest that the dynamic CT scan is useful in the differential diagnosis of the JG cell tumor and RCC.     

Isolation of peptides useful for differential diagnosis of Crohn's disease and ulcerative colitis

BACKGROUND: Phage displayed random peptide technology has been utilised to identify binding epitopes of antibodies or receptor ligands. Aim: To isolates peptides from a phage library which are specifically recognised by antibodies in serum from patients with Crohn's disease (CD). METHODS: A phage displayed random peptide library composed of nine amino acids was established and sequentially screened using serum immunogloblin G obtained from CD patients. RESULTS: Five different CD specific peptides were isolated from the phage library. No homology in amino acid sequences was observed among four (CDP-1, -3 to -5) of the five peptides exhibiting different binding characteristics with each CD patient's serum. In contrast, two peptides (CDP-1 and -2) had similar amino acid sequences and similar binding characteristics. Four multiple antigenic peptides (MAP, CDP-1, -3 to -5) were synthesised, and an enzyme linked immunosorbent assay (ELISA) using the four peptides was developed to detect serum antibodies against them. Fifty two of 92 CD patients (56.5%) were detected by ELISA, none of 20 ulcerative colitis (UC) patients, only one of 25 duodenal ulcer patients, and only three of 48 healthy subjects. CONCLUSIONS: ELISA using the four peptides isolated in this study may be useful for the differential diagnosis of CD and UC.     

A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastric cancers

BACKGROUND: Image quality of the prior autofluorescence (AF) imaging systems, including the fiber-optic endoscope, was not feasible for general clinical use. The use of AF image alone resulted in low specificity. The objective of the study was to evaluate the resolution and the sensitivity of the novel videoendoscopy system by using AF and reflectance imaging (AFI) in the diagnosis of early esophagogastric cancers. METHODS: This was a case series study. The setting was a pretreatment examination at a cancer center. Five patients with superficial esophageal cancers (SEC) and 21 patients with 22 early gastric cancers (EGC) were included in the study. The extent of the tumors was diagnosed by white light (WL), AF and chromoendoscopic observations. The main outcome measurement was the diagnostic accuracy of each observation in relation to the histologic mapping as a criterion standard. RESULTS: Two of 5 SECs (40%) were correctly diagnosed in the WL image and all (100%) in the AF image as purple or magenta color in a green background. EGCs in atrophic mucosa were observed as purple or magenta areas in a green background, while diffuse-type EGCs in fundic mucosa were observed as green areas in a purple background. Of the 22 EGCs, diagnostic accuracy of WL, AF, and chromoendoscopic observations were 36%: 95% CI [16%, 56%], 68%: 95% CI [49%, 88%], and 91%: 95% CI [79%, 100%], respectively. AFI could reveal flat or isochromatic extensions that were not detected in the WL images. The limitations of the study were ulcerations or inflammation that caused overdiagnosis in the AF observation. CONCLUSIONS: The resolution of the AFI at present is limited, but the image quality was acceptable. The current system of AFI does not equal to chromoendoscopy in sensitivity but has an advantage over standard WL videoendoscopy.     

Mesenteric node enlargement as a cause of intestinal variceal hemorrhage in nodular lymphoid hyperplasia

Jejunal varices were a cause of recurrent gastrointestinal hemorrhage in an 18-year-old man with common variable immunodeficiency and nodular lymphoid hyperplasia of the small intestine. Despite numerous procedures, including upper gastrointestinal endoscopy, colonoscopy, arteriography, and exploratory laparotomy no active bleeding site was identified until superior mesenteric angiography demonstrated thrombosis of the superior mesenteric vein with an extensive collateral circulation through mesenteric varices. At laparotomy, mesenteric lymph nodes up to 4 cm in diameter seemed to be compressing the superior mesenteric vein. Histological examination of a node revealed reactive hyperplasia with prominent germinal centers. After resection of varices in a 20-cm length of proximal jejunum, there has been delayed, but complete resolution of bleeding in a 17-month follow-up.