Erosive lesions in the gastroduodenal zone of patients with bronchial asthma

The purpose of the investigation was to study the frequency and clinicomorphological features of erosive lesions (EL) in the gastroduodenal zone (GDZ) of patients with bronchial asthma (BA). One hundred and sixty-three patients suffering from allergic BA of different degrees of severity were examined. The examination included clinical evaluation of the GDZ, esophagogastroduodenoscopy with gastric and duodenal mucosal biopsy, and subsequent analysis of the biopsy samples using histological, histochemical, morphometric methods, and electron microscopy. The frequency of EL in GDZ in BA patients was high (32.5%). The intensity of clinical symptoms, probably caused by concomitant gastroesophageal reflux disease, was low; dyspeptic syndrome prevailed. The morphological findings demonstrated the presence of gastric mucosal hyperergic inflammatory response to Helicobacter pylori infection, which was one of the factors determining the high frequency of EL in the pyloroantral zone in BA. The development of EL in the GDZ mucosa of BA patients was associated with parietal and endocrinal cell hyperplasia.     

Reliability of pressure ulcer classification and diagnosis

AIM: To assess the inter-rater reliability of the PRESSURE Trial pressure ulcer diagnosis (>/=Grade 2) and skin classification for all grades between the clinical research nurse (CRN) team leader and CRNs working across different hospital sites; and CRNs and ward-based nurses. BACKGROUND: The United Kingdom National Health Service Health Technology Assessment Programme has funded a multi-centre, randomized controlled trial to compare the clinical and cost-effectiveness of alternating pressure mattress overlays and mattress replacements - PRESSURE Trial. Outcome skin assessments were recorded by qualified ward-based nurses daily, and expert CRNs twice weekly. METHOD: Paired assessments were undertaken and skin assessed on seven body sites. The per cent agreement between nurses in the diagnosis of a pressure ulcer was determined and the Kappa statistic and confidence intervals calculated. Per cent agreement between nurses in classifying skin for all grades was also determined. RESULTS: Assessments were undertaken by 378 pairs: 16 paired patient assessments (107 site comparisons) by the CRN team leader and CRNs, and 362 paired patient assessments (2396 site comparisons) between CRNs and ward-based nurses. There was 100% agreement between the CRN team leader and CRNs in the diagnosis of a pressure ulcer, and the Kappa statistics indicated 'very good' agreement. There were only two (1.9%) disagreements in classifying skin for all grades between these nurses. The agreement in the diagnosis of a pressure ulcer between CRNs and ward-based nurses varied by skin site, ranging from 93.6% to 100%, with the Kappa statistics indicating 'good' and 'very good' agreement. However, there were 508 (21.2%) disagreements in classifying skin for all grades. CONCLUSIONS: Overall agreement and Kappa statistics indicated 'very good' and 'good' agreement between expert nurses, and between expert nurses and qualified ward-based staff, respectively. However, the high prevalence of normal skin concealed clinically important disagreements in both the diagnosis of pressure ulcers and skin classification for all grades.     

Efficiency of quamatel in combination with device sound stimulation of the gastroduodenal zone in ulcer patients

24-hour monitoring of gastric juice pH and esophagogastroduodenoscopy with biopsy and test for H. pylori (HP) were conducted in 117 patients with ulcer before and after treatment with famotidine (quamatel, Hungary) and device sound stimulation (DSS). Combined eradication therapy (quamatel 40 mg/day, metronidazole 500 mg 4 times a day, amoxicilline 750 mg 3 times a day, DSS) eradicated HP in 100% of patients with gastric ulcer and 91.7% of patients with duodenal ulcer. Scarring of the ulcer defect occurred for 11.8 +/- 1.1 and 15.3 +/- 1.4 days, respectively. These results are better than those of monotherapy with quamatel or DSS.     

Peculiarities of ulcerous and erosive lesions of gastroduodenal zone in patients with arterial hypertension

The aim of the research was to evaluate peculiarities of ulcerous and erosive lesions of gastroduodenal zone (UELGDZ) in patients with arterial hypertension (AH). The authors studied clinical and endoscopic parameters in 442 patients with UELGDZ and AH, and 160 patients without AH (control group). The feature of the AH group was more frequent HP-invasion, aggravation of ulcerous process, development of complicated and atypical forms of the disease. In the patients with AH the clinical manifestations of chronic erosive gastritis were more diverse and severe; unfavorable clinical course prevailed. Risk of cardiovascular complications varied from low to very high, correlating with the severety of AH and UELGDZ.     

Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study

BACKGROUND AND STUDY AIMS: A newly developed narrow-band imaging (NBI) technique, in which modified optical filters were used in the light source of a video endoscope system, was applied during colonoscopy in a clinical setting. This pilot study evaluated the clinical feasibility of the NBI system for evaluating colorectal lesions. PATIENTS AND METHODS: A total of 43 colorectal lesions in 34 patients were included in the study. The quality of visualization of colorectal lesions and the accuracy of differentiation between neoplastic and non-neoplastic lesions using the NBI system were evaluated in comparison with results from conventional colonoscopy and with chromoendoscopy. RESULTS: For pit pattern delineation, NBI was superior to conventional endoscopy (P < 0.001), but inferior to chromoendoscopy (P < 0.05). NBI achieved better visualization of the mucosal vascular network and of the hue of lesions than conventional endoscopy (P < 0.05). However there was no significant difference between NBI and chromoendoscopy in differentiating neoplastic from non-neoplastic lesions (both techniques had a sensitivity of 100 % and a specificity 75 %). This was better than the results of conventional colonoscopy (sensitivity 83 %, specificity 44 %; P < 0.05 for specificity). CONCLUSIONS: These results suggest that in the examination of colonic lesions the NBI system provides imaging features additional to those of both conventional endoscopy and chromoendoscopy. For distinguishing neoplasms from non-neoplastic lesions, NBI was equivalent to chromoendoscopy.     

NSAIDs induced gastroduodenal ulcer in the aged

The main drugs causing gastroduodenal ulcers are NSAIDs, steroids, antibiotics and anticancer agents. Among these causative drugs, nonsteroidal antiinflammatory drugs (NSAIDs) ranked first, followed by steroids, antibiotics, anticancer agents and other drugs, including over the counter drugs for the management of pain and common cold. Mechanisms of mucosal injury of NSAIDs are mainly direct inhibition cyclooxygenase (COX), mucosal injury by free radicals and direct contact of a drug to mucosa according to high acidity and high osmotic pressure. Clinical features of NSAIDs induced gastric ulcers are below: ulcer location concentrated in the pyloric region to the antrum, comprising three-fourths of all cases, multiple ulcers are found in 24% of the subjects. The frequency of relatively small ulcers, surrounded by highly swollen mucosa, is high. Deeply dug ulcers and large, irregularly shaped ulcers are also characteristic findings. NSAIDs induced bleeding gastroduodenal ulcers are seen in 21% of bleeding gastric ulcers which are stopped by the hemostatic method using pure ethanol injection. More than 80% of the cases are in the aged. All cases are successfully stopped bleeding and treated conservatively.     

Molecular diagnosis and classification of inflammatory bowel disease

Introduction: Traditional diagnosis and classification of inflammatory bowel diseases (IBDs) have been based on clinical evaluation, laboratory testing, endoscopy, imaging, and histological examinations. With the advancement of medical technology, an increasing number of molecular surrogates are playing a key role in diagnosis, differential diagnosis, assessment of disease activity, prediction of clinical course, and therapeutic response of IBD.

Areas covered: The authors review roles of both existing and emerging surrogates including genetic, serological, histologic, and fecal markers in diagnosis and classification of IBD. Comparisons in advantages and disadvantages of different markers have also been discussed. In addition, this review underscores controversial and unclear aspects which need further study.

Expert commentary: IBD is characteristic of chronicity, relapse-remission and destructiveness. It is of great importance for clinicians to make an accurate diagnosis and classification. Current and new molecular markers perform well with acceptable sensitivity and specificity. The use of molecular markers in clinical practice needs to be further explored and then generalized. More work is warranted to identify novel useful markers and elucidate how to apply them together with current markers in clinical settings.     

Chronotherapy approaches in the treatment of gastroduodenal ulcer

Each patient with ulcer has his/her own 24-h biorhythm of acid production, features of food alkalization, duration of duodenogastric and gastroesophageal reflux. Pharmacological test conducted in prolonged 24-h pH-metry helps to select the most effective antisecretory drug, while analysis of 24-h biorhythm of acid production--optimal time for drug intake and number of its daily doses.     

超声BI-RADS分级在乳腺肿块诊断中的应用

目的 探讨超声BI-RADS分级对乳腺肿块的诊断价值.方法 对在本院术前经超声检查发现肿块、并行手术活检、病理证实的514例女性患者乳腺肿块进行回顾性分析,比较分析其超声BI-RADS分级评估与病理检查结果,计算超声诊断的乳腺良、恶性肿块的恶性肿瘤百分率,并比较不同年龄段乳腺恶性肿瘤的百分率.结果 514例患者中,超声诊断恶性肿块132例,其中78例病理诊断为恶性肿瘤,54例病理诊断为良性病变;超声诊断良性肿块382例,其中8例病理诊断为恶性肿瘤,374例病理诊断为良性病变.计算得出超声BI-RADS分级对乳腺肿块诊断的灵敏度、特异度、正确率、阳性预测值、阴性预测值分别为90.7％、87.4％、87.9％、59.1％、97.9％.本研究514例患者中,超声2～5级病变者中恶性肿瘤的百分率分别为：0％ （0/58）、2.5％ （8/322）、27.8％ （20/72）、93.5％ （58/62）.不同年龄段中,年龄＜40岁恶性肿瘤百分率为39.5％,年龄≥40岁恶性肿瘤百分率为60.5％.结论 超声BI-RADS分级能够对乳腺肿块进行较准确的评估,对规范诊断与临床处理有较高的参考价值,对乳腺癌的早期诊断也有重要意义.     

State of the microcirculation and its relation to gastric function and structural changes in the gastroduodenal zone in recurrent peptic ulcer

A total of 108 patients with peptic ulcer were entered into the study. Examination of the microcirculation in the eye conjunctiva and microvessels of biopsy specimens of the mucous membrane taken from ulcerous areas revealed that disease relapses were marked by pronounced disorders of the end blood flow. The extent of the disorders was found to be determined by the activity and localization of the pathological process, structural alterations in the mucous membrane of the gastroduodenal area, and by gastric functions.     

细胞内镜系统在消化道黏膜病变诊断中的应用初探

目的 初步研究细胞内镜（EC）系统在消化道黏膜病变诊断中的应用。方法 对消化道黏膜病变先使用EC诊断,再行大体组织病理学诊断,判断内镜诊断与病理诊断是否相符。结果 所选病例EC诊断与大体组织病理学结果均一致。结论 EC可达到组织病理学诊断效果,但其应用价值、具体评价体系和应用范围尚需进一步研究。     

窄带成像国际结直肠内镜分型在结直肠病变诊治中的价值*

目的评价非放大内镜下窄带成像(NBI)国际结直肠内镜分型(NICE)实时预判结直肠病变性质并指导治疗的价值。方法对结直肠隆起或扁平隆起性的黏膜病变采用NICE分型进行实时预判分类和处置建议,依据活检、内镜或外科手术后的病理结果评价NICE分型的敏感性、特异性、准确性、阳性预测值和阴性预测值。进行观察一致性检验。结果共计241例患者307处病变被纳入分析。其中非肿瘤性病变12.07%、腺瘤性病变82.07%、癌5.86%,病变直径0.1~6.0 cm。NICE分型预判肿瘤性及非肿瘤性病变的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.04%、89.19%、96.09%、98.50%和80.49%。一致性检验,判断肿瘤性病变和非肿瘤性病变的Kappa值为0.795,判断黏膜下深层病变和黏膜下浅层以上病变的Kappa值为0.875,总的Kappa值为0.814。结论 NICE分型能较准确地实时预判结直肠病变的性质并指导治疗,有利于推广仅将肿瘤性病变纳入内镜下切除或外科手术的适度治疗模式。     

Evaluation of the new giant-biopsy forceps in the diagnosis of mucosal and submucosal gastric lesions

In order to improve the diagnosis of gastric disorders on the basis of biopsy material, we devised larger biopsy forceps (5 mm X 2.5 mm in inside dimensions) which fit into the newer fibergastroscope, GIF-1T (Olympus). Samples from 116 cases yielded 276 specimens; 179 specimens (64.8%) showed the full-thickness of the mucosa with muscularis mucosae, and approximately one-third of the total specimens included a considerable amount of submucosal tissue, but none of them contained parts of muscularis propria. In 4 out of 36 gastric carcinoma cases there was inconsistency between endoscopic and histological recognition of the proximal border of carcinomatous infiltration. Differentiation between adenoma and IIa, and benign and malignant lymphoma were more feasible with our forceps. No complications apart from minor bleeding were seen.     

重视感染性肉芽肿性病变的病理诊断

慢性肉芽肿性病变是许多感染性疾病共同的特征性改变.感染性肉芽肿的病理诊断首先要注意与其他非感染性内芽肿性病变的区分;其次有必要对具体致病因素进行确定,这是目前病理诊断的难点,值得重视和加强.不同类型的感染性肉芽肿在组织学上存在相似性.不同类型的感染也存在着区别,把握其特点有助于确定相应的致病因素.本文对临床病理诊断中常见的感染性肉芽肿(如结核、真菌、梅毒以及寄生虫感染等)进行分析,对其组织学特征、特殊染色及诊断思路进行分析,提出结合组织学特征及特殊染色方法、临床病史、影像学检查、必要的免疫血清学指标是判断感染性肉芽肿的基本方法,同时有必要开展病原学相关的免疫荧光和原位分子杂交技术,这是目前感染性肉芽肿病变确诊的重要手段.     

Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer

BACKGROUND AND STUDY AIMS: The aims of this study were to identify risk factors for recurrence of hemorrhage in bleeding gastroduodenal ulcers after endoscopic injection therapy, and to develop a simple and relevant prognostic score which could be used to assess the early risk of recurrence and the residual risk of rebleeding. PATIENTS AND METHODS: A prospective study was conducted from January 1995 to December 1998, in 738 patients who were admitted to our department for acute bleeding peptic ulcer and who underwent endoscopic examination. Ulcers with active bleeding or signs of recent bleeding were treated with injection therapy using epinephrine (1/10,000) and 1% polidocanol. RESULTS: Multivariate analysis revealed that liver cirrhosis, recent surgery, systolic blood pressure below 100 mmHg, hematemesis, Forrest classification, and ulcer size and site were significantly predictive variables for the recurrence of hemorrhage. Among these, Forrest classification was the most important. The overall accuracy of the predictive model was 71% (95% CI = 63 - 79%). The model showed a better sensitivity of 90% for early rebleeding (< 48 hours) than for late rebleeding (> or = 48 hours) where the sensitivity was 65 %. A prognostic score was obtained and patients were classified into four risk classes: very low (VL), low (L), high (H), and very high (VH). The rebleeding rates for the four classes were 0%, 7.9%, 31.8% and 67.9%, and the mortality rates were 5.9%, 8.6%, 13.9% and 35.7%, respectively. The residual risk of rebleeding after 48 hours was 0%, 3.3%, 10.4%, and 14.3% in the VL, L, H and VH classes, respectively. After 5 days the residual risk was under 4% in all classes. CONCLUSIONS: This study demonstrates that the proposed prognostic score, which is easily obtained after emergency endoscopy, is useful in clinical practice because it can identify patients with different levels of rebleeding risk. It can be helpful in patient management and decision making for discharge.