Journal of gastrointestinal and liver diseases : JGLD, 2017
Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended ... more Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed. A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples wa...
A 76-year-old female patient was admitted to our department for a 12-hour history of acute inferi... more A 76-year-old female patient was admitted to our department for a 12-hour history of acute inferior dysphagia after a consistent meal. The patient had a history of post-caustic stricture in the distal third of the esophagus 15 years before. The stricture was efficiently dilated at that moment, the patient being free of symptoms until the current admission. The upper endoscopy examination revealed in the middle third of the esophagus a food bolus impaction that was successfully removed using an endoscopic retrieval net. A short large fibrotic stenosis that was easily overpassed with the endoscope was described in the distal part of the esophagus. The stomach revealed multiple small sessile whitish areas highly suggestive of intestinal metaplasia of the stomach (Fig. 1). Multiple biopsies from the antrum and gastric body were performed. The histopathology examination of the gastric biopsies confirmed the presence of a moderate gastric atrophy with intestinal metaplasia (Fig. 2, H&E, x50). Furthermore, teardrop shaped Giardia trophozoites were described at the surface of the mucosal layer (Fig. 3, H&E, x400). No Helicobacter pylori microorganisms were detected in the biopsy specimens. Giardia duodenalis (also known as G. intestinalis or G. lamblia) is a protozoan parasite especially common in areas with poor sanitary conditions, capable of producing sporadic or endemic diarrheal illness [1]. The prevalence rates vary between 2% to 7% in developed countries to over 30% in developing countries [2, 3]. The diagnostic tests include antigen detection assays, nucleic acid detection assays, and stool examination [4]. IMAGE OF THE ISSUE Giardia is usually found attached to the mucosa of the duodenum and proximal jejunum, but in abnormal circumstances such as chronic atrophic gastritis and intestinal metaplasia, can be found in gastric biopsy specimens [5].
Journal of gastrointestinal and liver diseases : JGLD, 2011
Esophageal xanthoma is a very rare lesion which can be incidentally discovered during endoscopy. ... more Esophageal xanthoma is a very rare lesion which can be incidentally discovered during endoscopy. Only eleven cases have been reported, including ours. We present two new cases of esophageal xanthoma localized in the lower esophagus in a 56-year-old woman and a 62-year-old man. Endoscopically, esophageal xanthoma appears as yellowish granular spots or a slightly elevated lesion. Microscopically, it consists of fat accumulation in foamy histiocytes beneath the squamous epithelium. The clinical and pathological importance of these lesions and what they mean in patients is discussed, along with a review of the literature.
Confocal LASER endomicroscopy (CLE) is a newly developed endoscopic technique which allows subsur... more Confocal LASER endomicroscopy (CLE) is a newly developed endoscopic technique which allows subsurface in vivo histological assessment during ongoing endoscopy and targeted biopsies. Ultrasound endoscopy (EUS) is a useful tool in staging upper GI malignant lesions. We describe for the first time the use of both techniques during the same endoscopic session, in a pilot study, in order to increase the diagnostic yield of histological assessment and provide the staging of the gastric neoplastic lesions thus decreasing the time to therapeutic decision. CLE has been performed with the Pentax EG-3870CIK confocal endomicroscope after a 5 ml intravenous 10% fluorescein injection; EUS has been performed subsequently, during the same endoscopic Propofol sedation session, using a standard radial EUS-scope. Eleven patients have been investigated, 4 females, 7 males, mean age 59.7 +/- 12.3 years. The indication of CLE/EUS exploration was the presence of a gastric polypoid lesion in 37% of cases, ...
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
To evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in ... more To evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in patients with chronic hepatitis or compensated liver cirrhosis HDV and predictive factors of response to treatment. Prospective study that enrolled 50 patients with chronic hepatitis or compensated cirrhosis HDV between the 1st of January 2011 - 3st of December 2011. The diagnosis of chronic HDV infection was made based on the presence of detectable anti HDV IgG antibodies and HDV-RNA. Patients were evaluated at baseline by CBC, liver function tests, HBV profile, HDV RNA, and by liver biopsy/Fibrotest for evaluating fibrosis and necroinflammatory activity. At 24 weeks CBC (count blood cells), liver function tests, quantitative HBsAg and at 48 and 72 weeks biochemical tests, HDV RNA, HBV DNA, quantitative HBsAg, were performed. Adverse reactions to the treatment were recorded. SVR (sustained virologic response) was recorded in 12 patients (24%) and biochemical response in 28 patients (56%...
Pituitary adenomas are fully characterized only by immunohistochemistry. The technical limitation... more Pituitary adenomas are fully characterized only by immunohistochemistry. The technical limitations, gaps and peculiarities influence the pathology diagnosis. More and more data shows that clinically nonfunctioning pituitary adenomas could synthesize or secrete hormones or their subunits. The tumor pathology is monomorphous or polymorphous, difficult to differentiate from normal adjacent tissue. Light microscopy (LM) qualitative analysis using basic or special stains can differentiate between tumor and normal tissue and allows elimination of artifacts. Electron microscopy (EM) completes the diagnosis in selected cases. Pituitary adenomas immunohistochemistry was done by LM in 120 cases (84-clinically nonfunctioning adenomas-NFA and 36 acromegalics with or without PRL secreting adenomas-ACM) using the avidine-biotin complex method. In 26 cases we determined by EM the immunoreactive cells (17 NFA and 9 ACM) using the immunogold method. We observed high tumor immunoreactivity (mono or plurihormonal) in 43/84 (51%) NFA, 13/36 (36%) ACM respectively. Serum excess hormones and tissue immunoreactivity were significantly concordant for prolactin in NFA cases and for GH, in ACM cases (p<0.05). Mute pituitary adenomas have no clinical expression of hormonal products either they produce biologically inactive components or they synthesize but do not secrete hormones in sufficient amounts to increase serum level and to determine a systemic response. A concordance between LM and EM immunoreactivity was observed only for GH in ACM patients group (p<0.05). The differences could be due to dimensions of the samples or the number of granules inside of the cells (sparsely granulated adenomas are negative or low immunoreactive at the LM level). EM evaluation of NFA identified 2 oncocytomas and 4 null cell adenomas. The complete evaluation of pituitary adenomas includ a qualitative and quantitative analysis at the LM level using special methods, validated at the EM level in order to identify clinically mute immunoreactive cells-a possible target for specific drugs therapies in the future.
Journal of gastrointestinal and liver diseases : JGLD, 2009
Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challengi... more Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4 +/- 0.7 years and 69% patients were...
Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-pr... more Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or m...
S115 included. Portal hemodynamics were assessed indirectly by measurement of HVPG, vWF-Ag levels... more S115 included. Portal hemodynamics were assessed indirectly by measurement of HVPG, vWF-Ag levels were measured by ELISA. Results: Sixty five patients had clinically significant portal hypertension (CSPH) (i.e. HVPG 10). In these patients HVPG was 19 mmHg (mean, 95% CI: 18−20 mmHg), and in sixteen patients without PH HVPG was 5 mmHg (mean, 95% CI: 5−7 mmHg). VWF-Ag was significantly increased in patients with CSPH: 355% (322-388%) compared to vWF-Ag in patients without CSPH: 210% (176-243%); p < 0.001. Further, HVPG correlated significantly with vWF-Ag (R = 0.64; p < 0.0001). For a vWF-Ag value of 264 the sensitivity for CSPH was 83% and specifity 94%. The positive predictive value (PPV) for CSPH was 99%, whereas the negative predictive value (NPV) was 54%. Conclusion: In patients with liver cirrhosis vWF-Ag is elevated and can discriminate between patients with clinically significant portal hypertension and those without with a cutoff vWF-Ag 264%. This cut off of value for vWF-Ag level as a non invasive parameter indicating clinically significant portal hypertension has to be confirmed in an independent larger patient sample.
Journal of gastrointestinal and liver diseases : JGLD, 2017
Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended ... more Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed. A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples wa...
A 76-year-old female patient was admitted to our department for a 12-hour history of acute inferi... more A 76-year-old female patient was admitted to our department for a 12-hour history of acute inferior dysphagia after a consistent meal. The patient had a history of post-caustic stricture in the distal third of the esophagus 15 years before. The stricture was efficiently dilated at that moment, the patient being free of symptoms until the current admission. The upper endoscopy examination revealed in the middle third of the esophagus a food bolus impaction that was successfully removed using an endoscopic retrieval net. A short large fibrotic stenosis that was easily overpassed with the endoscope was described in the distal part of the esophagus. The stomach revealed multiple small sessile whitish areas highly suggestive of intestinal metaplasia of the stomach (Fig. 1). Multiple biopsies from the antrum and gastric body were performed. The histopathology examination of the gastric biopsies confirmed the presence of a moderate gastric atrophy with intestinal metaplasia (Fig. 2, H&E, x50). Furthermore, teardrop shaped Giardia trophozoites were described at the surface of the mucosal layer (Fig. 3, H&E, x400). No Helicobacter pylori microorganisms were detected in the biopsy specimens. Giardia duodenalis (also known as G. intestinalis or G. lamblia) is a protozoan parasite especially common in areas with poor sanitary conditions, capable of producing sporadic or endemic diarrheal illness [1]. The prevalence rates vary between 2% to 7% in developed countries to over 30% in developing countries [2, 3]. The diagnostic tests include antigen detection assays, nucleic acid detection assays, and stool examination [4]. IMAGE OF THE ISSUE Giardia is usually found attached to the mucosa of the duodenum and proximal jejunum, but in abnormal circumstances such as chronic atrophic gastritis and intestinal metaplasia, can be found in gastric biopsy specimens [5].
Journal of gastrointestinal and liver diseases : JGLD, 2011
Esophageal xanthoma is a very rare lesion which can be incidentally discovered during endoscopy. ... more Esophageal xanthoma is a very rare lesion which can be incidentally discovered during endoscopy. Only eleven cases have been reported, including ours. We present two new cases of esophageal xanthoma localized in the lower esophagus in a 56-year-old woman and a 62-year-old man. Endoscopically, esophageal xanthoma appears as yellowish granular spots or a slightly elevated lesion. Microscopically, it consists of fat accumulation in foamy histiocytes beneath the squamous epithelium. The clinical and pathological importance of these lesions and what they mean in patients is discussed, along with a review of the literature.
Confocal LASER endomicroscopy (CLE) is a newly developed endoscopic technique which allows subsur... more Confocal LASER endomicroscopy (CLE) is a newly developed endoscopic technique which allows subsurface in vivo histological assessment during ongoing endoscopy and targeted biopsies. Ultrasound endoscopy (EUS) is a useful tool in staging upper GI malignant lesions. We describe for the first time the use of both techniques during the same endoscopic session, in a pilot study, in order to increase the diagnostic yield of histological assessment and provide the staging of the gastric neoplastic lesions thus decreasing the time to therapeutic decision. CLE has been performed with the Pentax EG-3870CIK confocal endomicroscope after a 5 ml intravenous 10% fluorescein injection; EUS has been performed subsequently, during the same endoscopic Propofol sedation session, using a standard radial EUS-scope. Eleven patients have been investigated, 4 females, 7 males, mean age 59.7 +/- 12.3 years. The indication of CLE/EUS exploration was the presence of a gastric polypoid lesion in 37% of cases, ...
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
To evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in ... more To evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in patients with chronic hepatitis or compensated liver cirrhosis HDV and predictive factors of response to treatment. Prospective study that enrolled 50 patients with chronic hepatitis or compensated cirrhosis HDV between the 1st of January 2011 - 3st of December 2011. The diagnosis of chronic HDV infection was made based on the presence of detectable anti HDV IgG antibodies and HDV-RNA. Patients were evaluated at baseline by CBC, liver function tests, HBV profile, HDV RNA, and by liver biopsy/Fibrotest for evaluating fibrosis and necroinflammatory activity. At 24 weeks CBC (count blood cells), liver function tests, quantitative HBsAg and at 48 and 72 weeks biochemical tests, HDV RNA, HBV DNA, quantitative HBsAg, were performed. Adverse reactions to the treatment were recorded. SVR (sustained virologic response) was recorded in 12 patients (24%) and biochemical response in 28 patients (56%...
Pituitary adenomas are fully characterized only by immunohistochemistry. The technical limitation... more Pituitary adenomas are fully characterized only by immunohistochemistry. The technical limitations, gaps and peculiarities influence the pathology diagnosis. More and more data shows that clinically nonfunctioning pituitary adenomas could synthesize or secrete hormones or their subunits. The tumor pathology is monomorphous or polymorphous, difficult to differentiate from normal adjacent tissue. Light microscopy (LM) qualitative analysis using basic or special stains can differentiate between tumor and normal tissue and allows elimination of artifacts. Electron microscopy (EM) completes the diagnosis in selected cases. Pituitary adenomas immunohistochemistry was done by LM in 120 cases (84-clinically nonfunctioning adenomas-NFA and 36 acromegalics with or without PRL secreting adenomas-ACM) using the avidine-biotin complex method. In 26 cases we determined by EM the immunoreactive cells (17 NFA and 9 ACM) using the immunogold method. We observed high tumor immunoreactivity (mono or plurihormonal) in 43/84 (51%) NFA, 13/36 (36%) ACM respectively. Serum excess hormones and tissue immunoreactivity were significantly concordant for prolactin in NFA cases and for GH, in ACM cases (p<0.05). Mute pituitary adenomas have no clinical expression of hormonal products either they produce biologically inactive components or they synthesize but do not secrete hormones in sufficient amounts to increase serum level and to determine a systemic response. A concordance between LM and EM immunoreactivity was observed only for GH in ACM patients group (p<0.05). The differences could be due to dimensions of the samples or the number of granules inside of the cells (sparsely granulated adenomas are negative or low immunoreactive at the LM level). EM evaluation of NFA identified 2 oncocytomas and 4 null cell adenomas. The complete evaluation of pituitary adenomas includ a qualitative and quantitative analysis at the LM level using special methods, validated at the EM level in order to identify clinically mute immunoreactive cells-a possible target for specific drugs therapies in the future.
Journal of gastrointestinal and liver diseases : JGLD, 2009
Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challengi... more Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4 +/- 0.7 years and 69% patients were...
Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-pr... more Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or m...
S115 included. Portal hemodynamics were assessed indirectly by measurement of HVPG, vWF-Ag levels... more S115 included. Portal hemodynamics were assessed indirectly by measurement of HVPG, vWF-Ag levels were measured by ELISA. Results: Sixty five patients had clinically significant portal hypertension (CSPH) (i.e. HVPG 10). In these patients HVPG was 19 mmHg (mean, 95% CI: 18−20 mmHg), and in sixteen patients without PH HVPG was 5 mmHg (mean, 95% CI: 5−7 mmHg). VWF-Ag was significantly increased in patients with CSPH: 355% (322-388%) compared to vWF-Ag in patients without CSPH: 210% (176-243%); p < 0.001. Further, HVPG correlated significantly with vWF-Ag (R = 0.64; p < 0.0001). For a vWF-Ag value of 264 the sensitivity for CSPH was 83% and specifity 94%. The positive predictive value (PPV) for CSPH was 99%, whereas the negative predictive value (NPV) was 54%. Conclusion: In patients with liver cirrhosis vWF-Ag is elevated and can discriminate between patients with clinically significant portal hypertension and those without with a cutoff vWF-Ag 264%. This cut off of value for vWF-Ag level as a non invasive parameter indicating clinically significant portal hypertension has to be confirmed in an independent larger patient sample.
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