Jejunal villous changes associated with farmer's lung

Eighty-one patients with farmer''s lung were screened for evidence of coeliac disease by assessing their clinical features, haemoglobin indices, serum vitamin B₁₂ and folic acid levels. HLA typing was carried out and the frequency of antireticulin and other auto-antibodies was determined. Two out of 21 patients selected for jejunal biopsy had subtotal villous atrophy, a further 6 had partial villous atrophy and 8 out of 21 had increased lamina propria cellularity. The group as a whole had an increased number of intra-epithelial lymphocytes in the jejunal musosa. Sera of 7 out of 81 patients contained antireticulin antibody compared with 2 of 81 control subjects, a difference without significance. Other autoantibodies were not more frequent in the patient than in the control group and were of normal incidence. HLA antigens were also similar in both groups.     

Angioimmunoblastic lymphadenopathy, sulphasalazine exposure and villous atrophy

A woman with inflammatory lesions in the terminal ileum was treated with sulphasalazine. Nine months later she developed angioimmunoblastic lymphadenopathy and was found to have intestinal villous atrophy. Her systemic illness partially responded to oral steroids but a gluten free diet restored clinical and biochemical well being coincident with a return of her villous pattern.     

雌激素受体与孕激素受体在葡萄胎组织中的表达及临床意义

目的:探讨雌激素受体(ER)、孕激素受体(PR)在葡萄胎组织中的表达及临床意义。方法:采用免疫组织化学(SP)法,检测20例早孕正常绒毛、20例流产绒毛水肿、28例部分性葡萄胎、35例完全性葡萄胎、9例侵袭性葡萄胎组织中ER、PR的表达情况。结果:在正常绒毛、流产绒毛水肿、部分性葡萄胎、完全性葡萄胎、侵袭性葡萄胎组织中ER的阳性率为90.0%、95.0%、67.9%、65.7%、22.2%。随着滋养细胞恶性程度的增加,ER染色阳性细胞数及染色强度降低且差异有统计学意义(P<0.05);PR在正常绒毛、流产水肿绒毛、部分性葡萄胎、完全性葡萄胎、侵袭性葡萄胎组织的阳性率为5.0%、10.0%、3.6%、2.9%、0%。PR在正常绒毛、流产水肿绒毛、葡萄胎组织中表达很少,在侵袭性葡萄胎组织中无表达。PR染色阳性细胞数及染色强度与滋养细胞恶性程度无关,差异无统计学意义(P>0.05)。结论:ER可作为正常绒毛、流产水肿绒毛、葡萄胎及侵袭性葡萄胎的辅助诊断及鉴别诊断的有效指标。     

Restorative Proctocolectomy with Ileo-anal Reservoir,a Histopathological,Histochemical, and Electron Microscopic Study

This study was conducted to investigate the nature of colonic metaplasia in ileo-anal pouches and incidence/frequency of pouchitis in the same. Biopsy specimens from 8 patients with functioning ileal pouches were studied using routine histology, mucin histochemistry and electron microscopy, over a 2 – year period. All 8 patients had villous abnormalities in the form of blunting of villi and sub total or partial villous atrophy. 6 patients had an increase in the goblet cell population and Paneth cell hyperplasia. These changes were supported by electron microscopic findings of a decrease in number and flattening of ileal type microvilli and their transformed morphologic resemblance to colonic type microvilli. All the ileal pouches also had acquired colorectal type sulphomucin, when sections stained with Alcian-blue and High Iron Diamine – Alcian blue, were studied. However, no case of pouchitis as defined in literature, was found in this study.Key Words: Colonic phenotypic change, Ileal pouch-anal anastomosis, Pouchitis     

Hyperinfection syndrome with Strongyloides stercoralis.

A case is reported of hyperinfection syndrome with Strongyloides stercoralis, with symptoms, signs and radiological appearances which led to a diagnosis of duodenal ulcer.     

滋养叶细胞增殖基因及间质细胞凋亡检测在水泡状胎块诊断中的价值

目的探讨滋养叶细胞增殖相关基因及间质细胞凋亡检测在水泡状胎块（HM）病理诊断中的价值。方法应用免疫组织化学标记技术,检测100 例HM（其中完全性HM 61 例,部分性HM 39 例）及40 例绒毛水肿的病理组织标本滋养叶细胞的Ki67、Livin与Bcl-2 的表达,并应用TUNEL法对绒毛间质凋亡细胞进行原位观察。结果Ki67 阳性表达在绒毛水肿组、部分性HM 组、完全性HM 组趋势呈逐渐增强,各组间比较均差异有统计学意义（P <0.05）;绒毛水肿组及HM 组绒毛间质内AI指数比较,差异有统计学意义（P <0.05）;Livin 及Bcl-2 表达差异无统计学意义（P >0.05）;Ki67 表达与AI 指数呈正相关（P <0.05）。结论间质细胞凋亡联合滋养叶细胞中Ki67 表达检测可用于HM的诊断与分型,也可用于鉴别HM 与绒毛水肿。     

Small bowel biopsy for malabsorption: comparison of the diagnostic adequacy of endoscopic forceps and capsule biopsy specimens

Biopsy specimens of the small bowel were obtained from 40 patients suspected of having malabsorption. Four different techniques were used at a single session--namely, endoscopic biopsy of the descending duodenum using paediatric and standard size forceps and suction capsule biopsy of the descending duodenum and the proximal jejunum. Specimens were compared for size, adequacy, and ability to confirm or exclude mucosal abnormality. Fourteen patients had villous atrophy. In all patients four biopsy specimens were obtained with paediatric endoscopic forceps and four with standard endoscopic forceps. No capsule biopsy specimen was retrieved from the duodenum in three patients and from the jejunum in five patients. Specimens were considered to be adequate in 36 patients when paediatric forceps were used, in 39 when standard forceps were used, in 28 on duodenal capsule biopsy, and in 32 on jejunal capsule biopsy. This study indicates that the most reliable method for diagnosing or excluding villous atrophy is endoscopic forceps biopsy of the descending duodenum, provided that at least four specimens are obtained with standard size forceps.     

Effective diagnostic tests and anthelmintic treatment for Strongyloides stercoralis make community control feasible

Strongyloides stercoralis is endemic in tropical and subtropical countries, and is prevalent particularly in economically impoverished people. Although an estimated 30 to 100 million people world-wide suffer from S. stercoralis infection and it is a life-long disease, it remains a neglected tropical disease. Faecal testing for S. stercoralis is very insensitive. The prevalence of S. stercoralis in Indigenous Australians (up to 60%) is much higher than previously thought, and its prevalence in Papua New Guinea is likely to be much higher than currently believed. When S. stercoralis and the HTLV-1 virus coexist in the one person, both diseases progress more quickly than when either infection is on its own. When people become infected with S. stercoralis, they develop acute strongyloidiasis which may be life threatening. At any time during the course of the disease, if the immune system is suppressed, most often by corticosteroid drugs, infected people may develop hyperinfective strongyloidiasis and they will die unless the underlying S. stercoralis infection is effectively treated. The use of serology for diagnosis, together with ivermectin treatment, has revealed that it is possible to eradicate S. stercoralis from the patient, and serology can also define the effectiveness of treatment. The reservoir of infection is humans; the free-living stages are short-lived. Mass treatment may be effective at eliminating S. stercoralis from a community. Safe water and effective sanitation alone do not lead to elimination of S. stercoralis. Up-to-date knowledge of S. stercoralis has been revealed through the workshops of the National Strongyloides Working Group in Australia and is summarized here. Much of this information is now available on the world wide web, and the addresses of relevant web sites are given.     

Comparative virulence of different bovine rotavirus isolates

Intestinal loops, ligated in colostrum-deprived calves were used to compare the virulence of four isolates of bovine rotavirus. Histopathological studies were carried out on infected and control loops and measurements of villous length, crypt depth, villus:crypt ratio and crypt mitotic index were recorded. Pathological changes associated with the rotaviruses included villous atrophy, flattening of absorptive epithelium and reduced villus:crypt ratios. The changes were confined to infected intestinal loops in which the presence of virus was demonstrated by specific immunofluorescence. Consistent differences in the measured histopathological changes suggested differences in virulence among the rotavirus isolates tested. The least virulent rotavirus isolate had a polypeptide electrophoretic pattern that differed from the other three more virulent isolates.     

A new cause of `non-responsiveness' in coeliac disease?

A 42 year old man presented with gluten-responsive coeliac disease and secondary pancreatic insufficiency. Subsequently his symptoms relapsed and repeat small intestinal biopsy showed villous atrophy and infiltration by leukaemic cells, despite continuation of a gluten-free diet. Serious causes of relapse and non-responsiveness in coeliac disease include enteropathy-associated T-cell lymphoma, ulcerative jejunitis and an end-stage hypoplastic mucosa. This is the first report of non-responsiveness due to infiltration by leukaemia.     

Muscle spasms associated with Sudeck's atrophy after injury

Four patients developed abnormal involuntary movements of a limb after injury. All subsequently developed sympathetic algodystrophy with Sudeck's atrophy and then abnormal muscle spasms or jerks of the affected limb, lasting years. Sympathetic block in three patients did not relieve the abnormal movements. Two patients obtained partial recovery spontaneously, but the other two required surgery for relief. The pathophysiology of this condition remains to be determined but the evidence suggests that it is a distinct, disabling clinical syndrome.     

多系统萎缩16例临床分析

目的：探讨多系统萎缩（MSA）的临床特点、影像学特征,以利于早期诊断,减少误诊率。方法：回顾性分析16例MSA患者临床资料。结果：拟诊MSA 11例,可能MSA 5例,其中橄榄桥脑小脑萎缩（MSA-OPCA）9例,纹状体黑质变性（MSA-SND）4例,ShyDrager综合征（MSA-SDS）3例,MRI表现上OPCA患者以小脑、脑桥、延髓萎缩为主,SND主要病变在壳核,SDS个别有小脑萎缩。结论：临床表现和MRI结合可提高MSA的诊断率。     

张珍玉诊疗经期延长的辨证及用药规律研究

目的:基于中医传承辅助系统软件,分析张珍玉治疗经期延长的辨证和用药规律。方法:筛选张珍玉1997~2005年应用中药治疗经期延长处方47首,将辨证和处方用药录入中医传承辅助平台,对处方进行组方用药规律分析。结果:肝气郁结是张珍玉辨证经期延长的主证;处方涉及中药41味,用药频次前6位为:砂仁、人参、当归、柴胡、炒白芍、炒白术,处方中常用药对组合前5位为:人参、砂仁,人参、当归,当归、砂仁,炒白芍、柴胡,人参、炒白芍。结论:张珍玉治疗经期延长以疏肝解郁、健脾益气为主,体现了张珍玉"从肝论治"的诊疗思维。     

Coeliac disease and small bowel carcinoma

Small bowel carcinoma can occur in association with villous atrophy in the jejunum. In most reported cases there is doubt as to which of these represents the primary lesion. These cases are reviewed here. A further case is reported in which a carcinoma developed in a patient known to be suffering from coeliac disease for some years, although he was not on a gluten-free diet for the time preceding the diagnosis of carcinoma. On dietary restriction he remains well at 2-year follow-up. Possible aetiological factors are discussed.     

Intestinal Helminths in relationship to Chronic Diarrhoea in Human Immunodeficiency Virus-Seropositive Adults in Enugu

Human immunodeficiency virus (HIV) infection and intestinal helminthiasis are common conditions in Nigeria. Chronic diarrhoea is a common manifestation of acquired immune deficiency syndrome ( AIDS). Helminths such as Strongyloides stercoralis and Trichuris trichiura may cause chronic diarrhoea especially in immunocompromised individuals. In order to determine whether any relationship exists between HIV infection and intestinal helminthiasis, stool samples from all HIV seropositive adults (with or without diarrhoea) admitted to the medical wards of the University of Nigeria Teaching Hospital, Enugu from August 1996 to October 1998 were examined microscopically for helminths. Out of 383 HIV-seropositive patients studied, 181 (47.26%) presented with chronic diarrhoea whereas 202 (52.74%) had no diarrhoea. The overall prevalence rate of gut helminths was 17.74%. The prevalence rate in the patients with chronic diarrhoea was 19.34% and that of those without chronic diarrhoea was 16.34%. The difference was not statistically significant. The helminths identified were Ascaris lumbricoides, Hookworm, Strongyloides stercoralis and Trichuris trichiura but there was no statistically significant difference in the two groups of patients. The study showed that there may be no clearcut relationship between gut helminths and HIV infection.     

Transmissible gastroenteritis in feeder swine: clinical, immunofluorescence and histopathological obervations

Eight feeder swine (four to six months of age) were inoculated orally with 200,000 to 500,000 pig infectious doses (PID) of the Purdue strain of transmissible gastroenteritis (TGE) virus. Biopsies obtained from their small intestines were examined histopathologically and by fluorescent antibody tissue section technique at intervals that included 24, 48, 72 and 96 hours postexposure, and similar examinations were carried out at necropsy 168 hours postexposure. Evidence of virus infection was demonstrated in all segments of the small intestine except the upper duodenum and the viral antigen was found only in the cytoplasm of the absorptive cells covering the villi. Although six of the eight pigs failed to show clinical signs of TGE, typical microscopic lesions of villous atrophy with replacement of columnar absorptive cells by cuboidal cells were observed in seven pigs, and TGE virus antigen was demonstrated in the intestinal cells of four of eight pigs during the first week postexposure. The infection was usually mild to moderate and focal in the pigs without clinical signs of the disease and more severe and extensive in the pigs with clinical signs of the disease variable in severity. It was concluded that TGE virus probably replicated in all feeder swine exposed, and that the presence or absence of clinical signs of TGE in these pigs was related to the severity and extent of the villous atrophy and columnar cell replacement induced in their small intestines.     

Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy

Coeliac disease is underdiagnosed partly because of insufficient recognition of more subtle presentations and partly because of the relative difficulty of jejunal biopsy. We have compared new case detection of small intestinal villous atrophy in the 5 years following changing to endoscopic multiple biopsy with our preceding 9 year experience utilizing jejunal capsule suction biopsy. The detection rate for small intestinal disease doubled while the number of patients investigated by small bowel biopsy increased threefold. We recommend that endoscopic duodenal biopsy replace jejunal biopsy for routine diagnostic purposes.     

Chronic ulcerative jejunitis without symptoms.

A patient is presented who, in addition to subtotal villous atrophy, had superficial ulcers of the jejunum, as well as a wide band of granulation tissue deep to the crypts suggesting recurrent past ulceration. In spite of these changes she had no intestinal symptoms at the time of her presentation with reflux oesophagitis, and her only nutritional abnormality was a mild folate deficiency. Withdrawal of dietary gluten produced some improvement of the jejunal mucosa but this was not sustained on continued low-grade ingestion. She has containued to be virtually symptom-free over a 3-year period of follow-up.     

Recurrent acute renal failure due to a rectal villous adenoma

A case is reported in which a rectal villous adenoma was complicated by severe fluid and electrolyte depletion producing recurrent renal failure. The pathophysiology of the depletion syndrome and its complications are discussed. Successful management by acute haemodialysis and early surgical resection of the tumour is described.     

Experimental transmission of intestinal coccidiosis to piglets: clinical, parasitological and pathological findings

Twenty-eight piglets coming from a "specific pathogen free" herd were inoculated at three days of age with 50 000 or 100 000 sporulated oocysts of Isospora suis. Fecal samples were examined for oocyst shedding daily and several clinical parameters were recorded. Ten piglets were used as normal controls. Groups of piglets were euthanized from three days to 12 days postinoculation and routine necropsies were performed. Bacteriological, virological, parasitological and histopathological examinations were made on the intestinal tracts. The incubation period was four to five days. Clinical signs and microscopic intestinal lesions observed in the experimentally infected animals were similar to those reported in spontaneous cases of porcine neonatal coccidiosis. Lesions of villous atrophy in the small intestine seemed to result from the destruction of villous epithelial cells mainly during the peak of asexual reproduction which occurred around four to five days postinoculation. Intracellular coccidial organisms were difficult to find during the late atrophic and villous regrowth stages of the intestinal lesions. The prepatent period varied from four to seven days and the most common was five days. Eighty percent of the piglets kept alive more than four days postinoculation have shed oocysts. Piglets dosed with old sporulated oocysts (ten months old) shed many more oocysts than those infected with a fresh inoculum (less than two months old). The patent period was not determined precisely with the design of the experiment but some of the infected piglets shed oocysts for at least five days.