Endoscopic biopsy is diagnostic in gastric antral vascular ectasia

Gastric antral vascular ectasia was endoscopically diagnosed in seven patients. Pathologic characteristics of this entity were defined retrospectively, by studying endoscopic pinch biopsy slides from these seven patients and antrectomy specimens from five patients. A scoring system was developed, and the seven patients were compared prospectively with various control groups. Abnormalities of mucosal vessels (fibrin thrombi and/or ectasia) consistently distinguished patients from control antrectomies, normal biopsies, acute gastritis biopsies and atrophic gastritis biopsies (P=0.02, all comparisons). Spindle cell proliferation into mucosa also was characteristic of gastric antral vascular ectasia, distinguishing this disease from normals, acute gastritis, and atrophic gastritis (P0.039, each comparison). The presence of abnormal mucosal vessels (fibrin thrombi and/or ectasia) and spindle cell proliferation was similar in patient antrectomies compared to patient endoscopic biopsies. Therefore, we conclude that endoscopic biopsies can reliably diagnose gastric antral vascular ectasia, a vascular disorder characterized by abnormal mucosal vessels and spindle cell proliferation.     

Endoscopic biopsy samples of naïve “colitides” patients: Role of basal plasmacytosis

BackgroundAlthough it is usually not difficult to diagnose inflammatory bowel disease (IBD) on surgical resection specimens, difficulties sometimes arise in differentiating these entities from other forms of colitis on endoscopic biopsy specimens. Basal plasmacytosis is considered as an early feature of IBD colitis, but it is rare in non-IBD colitides.AimsWe assessed the value of basal plasmacytosis as an individual variable in untreated patients with colitis.Patients and methodsArchival slides of patients with untreated colitis (66 IBD and 49 non-IBD) and 20 controls with complete (from the terminal ileum to the rectum) endoscopic biopsy sampling were evaluated blindly for the presence of basal plasmacytosis and a possible association with the presence of eosinophils in the same anatomical location.ResultsOverall, basal plasmacytosis was present in at least one anatomical segment in 58% of cases, and it was always present in patients with IBD, whereas it was sparsely found (9%) in patients with other colitides and in controls. Basal plasmacytosis in three or more segments had more than 80% probability for a patient to be classified as IBD, with the segmental distribution being different between ulcerative colitis and Crohn's disease. Additionally, basal plasmacytosis was always accompanied by eosinophils intermingled with plasma cells in the same anatomical position.ConclusionAs an individual feature, basal plasmacytosis (accompanied by eosinophils) is a strong feature suggesting IBD, particularly when present in three or more colonic segments. This fact may be useful in the evaluation of endoscopic biopsies from patients with “colitis”.     

Microscopic colitides: a single center experience in Mexico

Background/aim Microscopic colitis is characterized by chronic diarrhea and specific microscopic changes in a macroscopically normal colonic mucosa. In this paper, we report the clinical and histological features of a group of Mexican patients with microscopic colitis. Materials and methods Patients were identified from 10 years of data in the pathology database of our institution. A pathologist reassessed all biopsy material. We included only patients who met strict histopathological criteria. Clinical data were obtained from medical records. Results Microscopic colitis was diagnosed in 26 cases. The female/male ratio was 1.8:1. The median age at diagnosis was 56.5 ± 15.7 (range, 26–85) years. The most frequent symptoms were diarrhea in all, weight loss in 22 (84%), and abdominal pain in 18 (69%) patients. Sixteen (61%) patients reported associated diseases; autoimmune thyroid disorders were the most common. Drug-induced microscopic colitis was suspected in 12 (46%) patients. More than 80% of the treated patients improved or had clinical remission. Conclusion Microscopic colitis is an uncommon colonic disease at our institution, representing less than 1% of the final diagnoses in mucosal colonic biopsies. It is the largest case series of microscopic colitis in the Mexican population.     

Significance of early biopsy in pediatric kidney transplantation

Long-term renal allograft survival is limited mainly by the progressive process termed chronic allograft nephropathy (CAN) or chronic rejection. A pathological feature of CAN is characterized by progressive interstitial fibrosis. Transforming growth factor (TGF)-beta(1) plays an important role in fibrogenesis. We investigated whether the degree of TGF-beta(1) expression in early biopsy specimens routinely obtained from stable allografts at 100 days could predict fibrosis and graft dysfunction in the late phase by immunohistochemistry. Patients were children with a graft from related donors. We immunohistochemically determined intracellular and extracellular expression of TGF-beta(1) in the graft at 100 days using LC antibody (LC) for intracellular TGF-beta(1) and CC antibody (CC) for extracellular TGF-beta(1). We used the change in creatinine clearance between 100 days and 3 years after transplantation (Delta Ccr) as an index of long-term graft function. Image analysis was used to calculate the relative area involved by interstitial fibrosis in trichrome-stained sections of graft biopsy specimens at 100 days and 3 years, designating the change as Delta FI. Delta Ccr was - 4.2 +/- 9.4 mL/min in subjects with minimal early immunoreactivity for CC and - 20.5 +/- 5.9 mL/min in subjects with strong reactivity (p < 0.05). Delta Ccr was - 14.5 +/- 18.6 mL/min in subjects with minimal early immunoreactivity for LC and - 11.7 +/- 12.8 mL/min in those with strong reactivity. Delta FI in subjects with minimal CC reactivity (1.28 +/- 4.11 %) tended to be lower than in subjects with strong reactivity (8.45 +/- 15.47 %). Neither fibrosis at 100 days nor Delta FI differed between subjects with minimal and strong LC reactivity. Thus, extracellular TGF-beta(1) expression in grafts at 100 days after transplantation has an influence on long-term graft function and tends to be associated with increased graft fibrosis at 3 years.     

Endomyocardial biopsy in childhood--experiences in 60 pediatric patients

In 60 pediatric patients, aged from 1 month to 22 years (median 3.54) and a bodyweight of 3 to 67 kg (median 12.6 kg) transvascular endomyocardial biopsy was performed from the right (35 patients) or left ventricle (30 patients). The specimens were investigated by light and electron microscopy. Immune serological investigations were performed in 22 patients, immune histological examinations in eight. There were three indications for biopsy: a. 29 children had a poorly functioning, dilated left ventricle. Of these, seven suffered from endocardial fibroelastosis, 16 from dilated cardiomyopathy, six (plus one control-biopsy) from healing/healed or chronic myocarditis. b. 17 children showed inadequate left ventricular hypertrophy. Of these, ten suffered from HCM, four from secondary hypertrophy, three from storage diseases. c. Various questions were answered in eight children - four with hypoxic, two with cytotoxic myocardial damage. There were five misindications, retrospectively. We observed no serious complications. Evaluation of biopsy revealed diagnostic findings in 11.7%, was helpful in 71.7% and of no help in 16.6%. Hence, even in childhood, endomyocardial biopsy is a diagnostic tool which can contribute useful information on the etiology or pathogenesis of the underlying myocardial disease.     

非甾体类抗炎药物致小儿胃窦溃疡及狭窄1例

对1例小儿因服用非甾体类抗炎药及地塞米松后引起胃窦溃疡及狭窄的病例进行分析,提示我们临床上这种情况虽然少见,但小儿应用此类药物后如果出现频繁呕吐等胃肠道症状,应高度重视,必要时可行胃镜检查。     

Open lung biopsy. Its effects on therapy in the pediatric patient

The records of 35 pediatric patients who had open lung biopsies at Columbus Children's Hospital, Columbus, Ohio, were analyzed to determine the results and the effects on therapy. Twenty-two (63 percent) of these patients were immunocompromised, and they are compared to the non-compromised group. A diagnosis was obtained in all cases. An infectious agent was identified in 13 (37 percent) of the patients. Ten of these were immunocompromised. In 43 percent (15 patients) of the total group and 55 percent (12 patients) of the immunocompromised group, the results of the biopsy effected a change in therapy. Five patients died, all of whom were immunosuppressed. None died as a direct result of the open lung biopsy. The total morbidity rate was 23 percent (eight patients). We concluded that open lung biopsy can be accomplished safely in the pediatric patient and that the results affect the therapeutic decision-making process a significant portion of the time.     

Endomyocardial biopsy findings in pediatric patients with post myocarditic state

Endomyocardial biopsy was performed on eight children 5 to 12 years old, who were in post myocarditic state. They were evaluated within 2 to 25 months (mean lyr and 1 m) after the onset of the symptoms. Two of the patients developed heart failure and six patients developed other cardiac manifestations such as syncope, palpitation or ECG abnormalities at onset. Definite elevation of viral antibody titer was observed in four patients. Radionuclide angiography was also performed in all eight patients. An abnormal perfusion area was observed in six patients as a focal hypoperfusion area by T1-201 myocardial imaging. Ejection fraction was examined by Tc-99m-HSA gated equilibrium ventriculography. LVEF was reduced in 3 patients and RVEF was reduced in 2 patients. Judging from the histopathological findings, these patients were divided into three categories: chronic or smoldering myocarditis (3 patients); healing or healed myocarditis (4 patients); and post myocarditic hypertrophy (1 patient). Measurement of left ventricular function was obtained by cardiac catheterization and left ventriculography (LVG), which revealed some abnormal findings such as increased left ventricular mass index, increased left ventricular end diastolic volume index (LVEDVI) and reduced left ventricular ejection fraction (LVEF). Therefore, endomyocardial biopsy findings of pediatric patients in a post myocarditic state reveal certain histopathological abnormalities even in the long-term follow-up period in the absence of cardiac dysfunction.     

十二指肠溃疡伴Hp~ 胃窦炎时胃窦生长抑素含量与mRNA表达

目的探讨十二指肠溃疡（DU）伴幽门螺杆菌（Hp）相关性胃窦炎时胃实生长抑素（SS）含量与mRNA表达方法采用放免法测定26例活动期DU（Hp检查均阳性）及24例非溃疡对照组（Hp检查6例阳性）胃窦粘膜组织SS含量，应用免疫组织化学方法检查D细胞的数量SSmRNA基因表达采用Northernblot和斑点杂交方法分析测量结果活动期DU26例，胃窦粘膜湿重组织SS含量为266ng／g±56ng／g±56ng／g，非溃疡对照组胃窦粘膜SS含量为335ng／g±110ng／g，两者相比差异非常显著（P＜0．01）活动期DU胃窦粘膜D细胞计数为36±13／mm2，明显少于非溃疡对照组59±42／mm2（P＜0．01）活动期DuSSmRNA水平（A）为0．52±0．11，较非溃疡对照组3．26±0．84显著降低（P＜0．01）．结论Hp感染引起中重度胃窦炎导致胃窦粘膜D细胞数量减少，同时SSmRNA基因转录及合成功能降抵，粘膜组织中SS含量减低，进一步可导致DU的发生．     

Comparison of biopsy urease test and histologic examination for detection of campylobacter pylori in duodenal, antral and fundic biopsies

The presence of Campylobacter pylori was investigated in duodenal, antral and fundic biopsies of 149 consecutive patients undergoing upper gastrointestinal tract endoscopy by biopsy urease tests (CLOtest; "CLO test") and histologic examination ("HIST") after modified Giemsa staining. Positive results were obtained rarely in the duodenum (4.7% and 12.8% by CLO test and HIST, respectively), but equally frequently in antral (48.3% and 62.4%) and fundic biopsies (55.0% and 54.4%). Using combined evaluations ("COMB") of both CLO test and HIST results, and disregarding isolated positive histologic grades "1" as C. pylori negative, the detection rates were 6.0, 53.0 and 56.4% in the above order and 63.1% overall at any of the biopsy sites. There was no close correlation between the rapidity of the color conversion of the biochemical test and the microscopic grading of C. pylori density. A positive CLO test in single antral biopsy specimens was an accurate predictor of the presence of C. pylori as compared with HIST (predictive value positive PVpos 0.97), while negative antral BUT results did not rule out C. pylori colonization of the upper GI tract (PVneg 0.52 compared with HIST). An additional negative CLO test from fundic biopsies increases the PVneg to 0.58.     

Repetitive percutaneous transhepatic access for myocardial biopsy in pediatric cardiac transplant recipients

Repetitive transhepatic access for myocardial biopsy in two pediatric cardiac transplant patients is described. Both have documented occlusion of the traditional percutaneous venous sites. Biopsy via the transhepatic route was performed in one patient 11 times and the second patient five times without any complications. The transhepatic approach can be safely used repetitively in pediatric transplant recipients when traditional venous access is not available. Cathet. Cardiovasc. Diagn. 45:167–169, 1998. © 1998 Wiley-Liss, Inc.     

Autoantibodies specific for villin found in patients with colon cancer and other colitides

We have sought evidence for blood-borne autoantigens from the apical regions of the intestinal epithelial cell that are associated with specific gastrointestinal diseases. While a wide range of brush border-specific proteins are antigenic in various disease states, significantly increased levels of autoantibody to villin, a 95-kDa protein microvillar actin-binding protein, were identified by western blot in colon cancer patients' sera. Examination of a population with a range of colonic diseases showed that anti-villin antibody is most prevalent in patients with colon cancer at significantly higher (P<0.005) levels=" than=" normal=" controls.=" we=" conclude=" that=" cryptic=" antigens=" within=" the=" brush=" border,=" specifically=" including=" villin,=" incite=" an=" active=" autoimmune=" response.=" the=" pathological=" significance=" of=" these=" antibodies=" remains=" to=" be=" determined.=" these=" anti-villin=" antibodies=" also=" may=" provide=" a=" unique=" noninvasive=" approach=" for=" the=" detection=" of=" gastrointestinal=">This work is supported by a Career Development Award from the Crohn's and Colitis Foundation of America (D.L.R.), and NIH grants DK43812 (J.S.M.) and DK25387 to Dr. M. Mooseker. This work was supported in part by a grant from the Lucille P. Markey Charitable Trust (J.M.A.).     

G-cell population in antral mucosa of the dog

The gastrin-cell (G-cell) population in the pyloric antrum of 8 dogs was studied quantitatively by immunofluorescence. The G-cell population was dense in the pyloric antrum and very few cells were seen in the antrocorporal junction. The estimated total number of G cells was (1.66±0.12)×10⁷ in the pyloric antrum and the greatest number of G cells per unit mucosal surface area was along the greater curvature of the pyloric antrum. Except along the greater curvature, G cells per unit mucosal volume were significantly greater in number (P<0.05) in the proximal antrum adjacent to the antrocorporal junction than in any other regions distal to it. Differences in mucosal thickness were considered as a causative factor for these differences.A preliminary report of a part of this work was presented at the 61st General Meeting, the Japanese Society of Gastroenterology, Kyoto, March 31, 1975.This study was supported in part by Grant in Aid for Developmental Scientific Research from the Japanese Education Ministry.