Liver biopsy in the diagnosis of visceral leishmaniasis

Aim: To determine whether liver biopsy might be useful in the diagnosis of visceral leishmaniasis when bone marrow examination and serologic tests are inconclusive. Methods: Over a 10‐year period, liver biopsy was performed in five children with suspected visceral leishmaniasis when indirect hemagglutination tests and bone marrow aspirations were not diagnostic. Results: Leishmania amastigotes were seen in Kupffer cells in all patients. The accompanying liver histopathological findings were ischemic necrosis in two children, macrovesicular steatosis in two children, portal inflammatory inflammation in two children, and piecemeal necrosis in one child. During the study period, 32 additional pediatric visceral leishmaniasis cases were diagnosed by bone marrow examination. Conclusion: Liver biopsy can be recommended for diagnosing suspected visceral leishmaniasis in children when serology and bone marrow aspiration are inconclusive.     

河南省1例输入性内脏利什曼病的实验室诊断

目的　分析河南省1例输入性内脏利什曼病病例,探讨内脏利什曼病的实验室诊断方法。方法　分析患者的流行病学资料和临床资料,镜检观察骨髓涂片中杜氏利什曼原虫无鞭毛体;rK39试纸条检测血清中利什曼原虫抗体;用两对引物K13A?K13B和 LITSR?L5.8S分别扩增利什曼原虫动基体DNA和核糖体DNA内转录间隔区基因片段。结果　 该患者曾去过内脏利什曼病流行区,有不规则发热、脾肿大、全血细胞减少、白蛋白/球蛋白比例倒置等症状,骨髓涂片查见杜氏利什曼原虫无鞭毛体,rK39试纸条检测阳性,两对引物K13A?K13B和 LITSR?L5.8S分别扩增出87 bp和285 bp的片段。两片段序列与杜氏利什曼原虫相应序列的相似性分别为94%和100%。结论　结合患者的流行病学资料和临床表现以及实验室检测结果,确诊该病例为内脏利什曼病病例,病原体为杜氏利什曼原虫。     

河南省1例输入性内脏利什曼病的实验室诊断

目的　分析河南省1例输入性内脏利什曼病病例，探讨内脏利什曼病的实验室诊断方法。方法　分析患者的流行病学资料和临床资料，镜检观察骨髓涂片中杜氏利什曼原虫无鞭毛体；rK39试纸条检测血清中利什曼原虫抗体；用两对引物K13A?K13B和 LITSR?L5.8S分别扩增利什曼原虫动基体DNA和核糖体DNA内转录间隔区基因片段。结果　 该患者曾去过内脏利什曼病流行区，有不规则发热、脾肿大、全血细胞减少、白蛋白/球蛋白比例倒置等症状，骨髓涂片查见杜氏利什曼原虫无鞭毛体，rK39试纸条检测阳性，两对引物K13A?K13B和 LITSR?L5.8S分别扩增出87 bp和285 bp的片段。两片段序列与杜氏利什曼原虫相应序列的相似性分别为94%和100%。结论　结合患者的流行病学资料和临床表现以及实验室检测结果，确诊该病例为内脏利什曼病病例，病原体为杜氏利什曼原虫。     

骨髓穿刺与骨髓活检在结直肠癌贫血诊断中的临床意义

目的:探讨骨髓穿刺和骨髓活检在结直肠癌贫血中的诊断价值。方法:对257例结直肠癌患者行骨髓穿刺和骨髓活检,检测癌细胞浸润,分析其贫血状况。结果:结直肠癌贫血发生率为47.86%(123/257例)。右半结肠癌和直肠癌以缺铁性贫血为主(P0.05)。左半结肠癌以多因素贫血和巨幼细胞性贫血为主,差异有统计学意义(P0.05)。结直肠癌伴贫血患者中肿瘤骨髓侵润占8.13%,以低/未分化患者肿瘤骨髓侵润发生率较高(P0.05),骨髓穿刺与骨髓活检诊断符合率为70%,所有骨髓侵润患者均有不同程度的骨髓纤维组织增生。结论:骨髓穿刺和骨髓活检在结肠癌贫血的诊断中有重要临床意义。     

Comparative Evaluation of Simultaneous Bone Marrow Aspiration and Bone Marrow Biopsy: An Institutional Experience

Bone marrow aspirations and bone marrow biopsies are important diagnostic procedures. A comparative study of both the procedures done simultaneously was retrospectively reviewed in 160 cases where the clinical history is correlated with BMA and BMB results. The advantage of each method is analyzed. Correlation of our findings with that given in the literature is done to give a guideline for both techniques. We have found that 61.25% of the cases showed a positive correlation between bone marrow aspiration and bone marrow biopsy. However, we found that tuberculous granulomas and Hodgkin disease involvement of the marrow were detected better in bone marrow biopsies. The advantage of both the procedures done together provided more material and enabled us to study the cytomorphology of the cells, with the pattern of distribution of the cells depending on the cases. However, when both the procedures are done simultaneously, a proper technique is required so as to yield good diagnostic material.     

Validity of the polymerase chain reaction in the diagnosis of clinically suspected cases of American visceral leishmaniasis

To test the validity of the polymerase chain reaction for diagnosing American visceral leishmaniasis, 88 suspected cases were studied. Diagnosis was confirmed in 47 (53.5%) and ruled out in 41 (46.5%) patients. Samples of bone marrow and peripheral blood were processed by polymerase chain reaction to evaluate the sensitivity and specificity of the test and its agreement beyond chance with microscopy examination. The polymerase chain reaction was positive in bone marrow of 100% of the patients with amastigotes seen with microscopy examination, and in 59.5% in those where no parasite were seen. Agreement beyond chance between visualization of the parasite in bone marrow aspirates and polymerase chain reaction was considered weak (Kappa = 0.41). Concordance between polymerase chain reaction of bone marrow aspirates and of peripheral blood was considered excellent (Kappa = 0.88). The test turned out positive in all bone marrow aspirates of those with the disease and whereas the positivity rate was 58.5% among those without the disease, with specificity rate of 41.5%.     

Costs of patient management of visceral leishmaniasis in Muzaffarpur, Bihar, India

OBJECTIVES: To identify and quantify the direct and indirect economic cost of treatment for visceral leishmaniasis (VL) with conventional Amphotericin B deoxycholate, currently the first-line treatment in Muzaffarpur. METHODS: Costs of patient management for VL were estimated from a societal and household perspective by means of a questionnaire designed for this study, interviews and financial reports. RESULTS: The total cost of care per episode of VL from the societal perspective was estimated at US$355, equivalent to 58% of annual household income. The largest cost category was medical costs (55%), followed by indirect costs (36%) and non-medical costs (9%). The cost from the household perspective was equivalent to US$217. The largest cost category was indirect costs (59%), followed by medical costs (27%) and non-medical costs (15%). Loss of income because of illness and hospitalization and expenses for drugs were the largest cost components. CONCLUSIONS: The economic costs related to VL are substantial, both to society and the patient. Public health authorities in Bihar should focus on policies that detect VL in the early stage and implement interventions that minimize the burden to households affected by VL.     

骨髓活检在多发性骨髓瘤诊断中的价值

目的：探讨骨髓活检与骨髓涂片在多发性骨髓瘤(MM)诊断中的价值。方法：对29例MM患者骨髓活检采用石蜡薄切片苏木素伊红染色，骨髓涂片采用瑞特染色。结果：骨髓活检与骨髓涂片的增生程度相符者13例(44．8％)，骨髓活检增生程度高于骨髓涂片者12例(41．4％)，骨髓涂片高于骨髓活检者4例(13．8％)。骨髓涂片和切片相结合有助于MM的诊断和分型。结论：骨髓活检可作为MM的常规检查手段。     

Visceral leishmaniasis in pregnancy: a case report

Visceral leishmaniasis (VL) is endemic in the island of S?o Luis, State of Maranh?o, Brazil. Despite an increase in the number of VL cases, the frequency of the disease is low among pregnant women. We present here the case of a pregnant woman followed up by our group, who was treated with amphotericin B with excellent outcome.     

磷脂酰肌醇蛋白聚糖3在肝穿刺活检标本中鉴别诊断的意义

目的:探讨磷脂酰肌醇蛋白聚糖3(GPC3)在肝细胞癌(HCC)等不同肝病组织中的表达情况及其对肝癌早期诊断的意义.方法:采用免疫组织化学方法检测126例肝穿刺活检标本(包括13例极早期HCC、44例早期HCC、16例不典型增生、29例肝硬化和24例肝炎)及57例中晚期HCC手术标本中GPC3和甲胎蛋白(AFP)的表达,...     

非疫源地黑热病2例资料分析

分析2例非疫源地黑热病病历资料。2例患者均有黑热病疫区生活史,且长期不规则发热,脾脏呈进行性肿大,肝脏肿大,白细胞计数降低,贫血,血小板减少等症状;骨髓检查显示网状吞噬型细胞多见,吞噬细胞内外可见利杜体,因此确诊为黑热病。予以对症治疗和葡萄糖酸锑杀虫治疗,患者发热症状消失,血细胞数回升,脾脏回缩,肝功能恢复,2例患者痊愈出院。     

我国非流行省内脏利什曼病病例流行病学分析

目的 了解2004-2010年我国非流行省区输入性内脏利什曼病病例状况.方法 从中国疾病疫情监测信息网获取非流行省报告的内脏利什曼病病例信息,以电话、信函等形式进行个案调查,对获取的资料描述性分析其地区,时问和人群性别、年龄、职业分布情况.结果 2004-2010年间,全国共有13个非流行省区有输入性内脏利什曼病病例报...     

71例慢性乙型肝炎患者肝活检病理学分析

目的探讨肝穿刺活检对慢性乙型肝炎诊断的临床意义。方法对71例慢性乙型肝炎患者行经皮肝穿刺活体组织检查,分析临床诊断与病理学诊断的准确性。结果在71例慢性乙型肝炎患者中,病理学诊断为G1为9.9%,G2和G3为59%,而G4为31%,诊断纤维化分期S1～S4分别为29%、25%、13%和32%,而临床诊断的灵敏度、阳性似然比、阳性预测值、Youden指数均偏低。结论临床诊断慢性乙型肝炎病情程度的分度还不够准确,肝穿刺活检对诊断、治疗和预后判断等仍有着极其重要的意义。     

阿图什市2005-2011年内脏利什曼病病例流行病学分析

目的 了解新疆阿图什市内脏利什曼病流行现状.方法 通过疾病疫情监测信息网报告系统获得2005- 2011年阿图什市内脏利什曼病病例信息,使用SPSS12.0软件统计分析病例的时间、空间和人群分布.结果 2005-2011年阿图什市共发生内脏利什曼病病例66例,各年的病例数依次为19、15、11、4、8、7和2例.全市7个乡和市区均有病例发生,但主要发生在阿扎克乡(45.45％)、松塔克乡(19.70％)和市区(15.15％).各年龄组均有病例发生,但以15岁及以下年龄为主(77.37％).男女病例之比为1.54∶1.结论 阿图什市内脏利什曼病发病率呈逐年下降之势     

Stainable iron in aspirated and needle-biopsy specimens of marrow: a source of error.

Marrow iron was assessed in needle biopsy sections and in simultaneously obtained aspirated smears and aspirated clot sections from 251 patients. Significantly different amounts of stainable iron were observed in needle biopsy sections and aspirated smears in 15% of the specimens. The usual difference consisted of significantly less stainable iron in needle biopsy sections as compared to the aspirated smears (13%). Of clinical importance was the finding of absent stainable iron in 8% of the needle biopsy sections, in contrast to the definite deposits observed in the corresponding aspirated smear. Of similar interest was the observation that 6% of the needle biopsy sections had significantly less stainable iron than corresponding hemosiderotic smears. The amounts of stainable iron in needle biopsy sections were similar to the amounts observed in the corresponding aspirated clot sections. Evaluation of marrow iron using needle biopsy sections as well as aspirated clot sections differs from results observed in aspirated smears and could be a source of significant error in the assessment of iron stores.     

Serological and entomological survey in a zoonotic visceral leishmaniasis focus of North Central Anatolia, Turkey: Corum province

In the present study, we aimed to carry out an epidemiological and entomological survey on a visceral leishmaniasis (VL) focus located on the northern central part of Anatolia, Turkey. Five villages of Corum province, where five confirmed cases of human visceral leishmaniasis (HVL) (one patient/village) were reported between June 1998 and August 2001 were included in the study. A total of 625 children and 131 dogs were sampled and the physical examination was carried out by authorized physicians and veterinarians. An indirect fluorescent antibody test (IFAT) was performed by standard procedures for human and dog sera, while the direct agglutination test (DAT) was only performed for dog sera. Sand fly collection was performed in three villages by CDC miniature light traps. Hepatosplenomegaly and hepatomegaly were detected in two and eight children, respectively. The seropositivity rate among children was found to be 0.16% (1/625) in the region. The seroprevalence of canine infection in these five villages ranged between 0.0% and 28.26%. In two villages, named Ahlatcik and Asagifindikli, no seropositive dogs were found. A total of 1218 sand flies were collected throughout the study. Six species of Phlebotomus were identified: P. transcaucasicus, P. neglectus, P. halepensis, P. tobbi, P. papatasi, and P. jacusieli. P. transcaucasicus was found to be the predominant species in Cevizli (47.44%; 343/723) and Ucoluk (79.95%; 351/439) villages, while P. tobbi was abundant in Kucukerikli (42.85%; 24/56).     

Liver biopsy:analysis of results of two specialist teams

AIM:To analyze the safety and the adequacy of a sample of liver biopsies(LB)obtained by gastroenterologist(G)and interventional radiologist(IR)teams.METHODS:Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease,both in the setting of day hospital and regular admission(RA) care,were retrieved and the data entered in a database.Patients were divided into two groups:one undergoing an ultrasonography(US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team.For the first group,an intercostal approach(US-assisted) and a Menghini modified type needle 16 G(length 90 mm) were used.The IR team used a subcostal approach(US-guided) and a semiautomatic modified Menghini type needle 18 G(length 150 mm).All the biopsies were evaluated for appropriateness according to the current guidelines.The number of portal tracts present in each biopsy was assessed by a revision performed by a single pathologist unaware of the previous pathology report.Clinical,laboratory and demographic patient characteristics,the adverse events rate and the diagnostic adequacy of LB were analyzed.RESULTS:During the study period,226 patients,126 males(56%) and 100 females(44%),underwent LB:167(74%) were carried out by the G team,whereas 59(26%) by the IR team.LB was mostly performed in a day hospital setting by the G team,while IR completed more procedures on inpatients(P 0.0001).The groups did not differ in median age,body mass index(BMI),presence of comorbidities and coagulation parameters.Complications occurred in 26 patients(16 G team vs 10 IR team,P = 0.15).Most gross samples obtained were considered suitable for basal histological evaluation,with no difference among the two teams(96.4% G team vs 91.5% IR,P = 0.16).However,the samples obtained by the G team had a higher mean number of portal tracts(G team 9.5 ± 4.8; range 1-29 vs IR team 7.8 ± 4.1; range 1-20)(P = 0.0192) and a longer mean length(G team 22 mm ± 8.8 vs IR team 15 ± 6.5 mm)(P = 0.0001).CONCLUSION:LB can be performed with similar outcomes both by G and IR.Use of larger dimension needles allows obtaining better samples,with a similar rate of adverse events.     

妊娠期急性脂肪肝12例临床分析

目的探讨妊娠期急性脂肪肝(AFLP)的临床特点及诊治方法。方法回顾性分析2012年4月-2017年3月于华中科技大学同济医学院附属同济医院感染科诊治的12例AFLP患者的临床资料,对其基本信息、临床表现、相关实验室检查指标、影像学检查、治疗及预后进行分析。结果 12例AFLP患者均发生于妊娠晚期,临床表现以消化道症状、肝功能衰竭、黄疸和凝血功能障碍为主,12例均给予护肝、改善凝血、抗感染等综合治疗,11例行剖宫产终止妊娠,6例使用了血液滤过,5例行血浆置换治疗,孕产妇死亡1例,病死率8.3%,围生儿死亡5例,病死率35.7%。结论针对AFLP患者,早诊断、及时终止妊娠、最大限度地对症支持治疗、控制感染,并联合人工肝支持系统治疗是改善母婴预后的关键。     

Intravascular large B cell lymphoma: proposed of the strategy for early diagnosis and treatment of patients with rapid deteriorating condition

We summarize our experience and propose methods for early diagnosis and treatment of intravascular large B cell lymphoma (IVL). A total of 16 patients with IVL between 1994 and 2007 were included and analyzed in this study. Predicted survival durations were short until September 2003. However, there have been marked improvement since the introduction of rituximab, and all patients responded to treatment and survived for more than 1 year following diagnosis of IVL. We propose an early clinical diagnostic strategy for starting treatment for IVL patients with quite poor performance status (PS) and in whom time is a limiting factor: (1) age >40 years, (2) fever above 38°C with poor PS (ECOG 2-4), (3) lactate dehydrogenase (LDH) more than twice the upper limit of the normal level and/or sIL2R >5,000 IU/ml in serum, (4) worsening PS and/or elevation of serum LDH on a daily basis, and (5) confirmation of pathological lymphoid cells in peripheral blood or bone marrow smear and/or flow cytometry. Although accurate pathological diagnosis is quite important, time is a limiting factor for most of IVL patients. In such cases, we can start chemotherapy based on early clinical diagnostic strategy with high sensitivity and obtain good clinical outcome.     

Prognostic relevance of histological findings on bone marrow biopsy in myelodysplastic syndromes

Summary Bone marrow biopsy (BMB) has aroused growing interest as a possible aid in the diagnostic and prognostic evaluation of myelodysplastic syndromes (MDS). Previous reports have pointed out that MDS patients with blastic aggregates or severe bone marrow (BM) fibrosis are characterized by a worse clinical outcome. BMBs of 106 MDS patients were retrospectively reviewed, and relationships among the different histological parameters as well as clinicopathological correlations were looked for. Three patterns of BM blastic infiltration (diffuse, cluster, and large) were recognized. Overt leukemic transformation and overall survival were selected as prognostic end points. BM infiltration was diffuse in 18, cluster in 48, and large in 40 cases. RAEB-t patients accounted for about half of the large cases, and none had a diffuse pattern (p<0.01). Nineteen patients showed extensive BM fibrosis; most of them were characterized by cluster blastic infiltration and megakaryocyte hyperplasia. Leukemic transformation occurred in 67% of large cases (p<0.001) and in none of the cluster cases with severe BM fibrosis (p<0.01); however, survival was equally poor in these two groups because of early leukemic transformation (large cases) and BM failure (cluster cases). The FAB classification did not significantly correlate with prognosis. Patients with cluster BM infiltration and severe fibrosis can be regarded as a true separate MDS subset characterized by unique clinicopathological and prognostic features. Because of the subacute clinical behavior of most cases, and the poor performance status of many elderly patients, there is still controversy as to the best therapeutic approach in MDS. Histological analysis allowed two groups of MDS patients to be identified, both characterized by poor life expectancy, who could benefit from early aggressive chemotherapy.