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The impact of biopsy number and site on the accuracy of intestinal metaplasia detection in the stomach A morphometric study based on virtual biopsies.
No full textBackground. Intestinal metaplasia is a risk factor for gastric carcinoma. So far few studies have focused on the efficacy of endoscopic biopsies in detecting intestinal metaplasia in relation with the site and number of biopsies performed. The present study is aimed to assess the efficacy of single and multiple gastric biopsies in the detection and staging of intestinal metaplasia.
Material and methods. The studywas conducted on 455 gastrectomies.We defined the extent of intestinal metaplasia on surgical specimens sampled by the “Swiss roll” technique and assessed the efficiency of an increasing number of “virtual” biopsies performed on the same rolls in recognising the true extent of intestinal metaplasia in the antro-angular region.
Results. Seventy-four out of 455 cases showed intestinal metaplasia in more than 5% of the antro-angular mucosa. The correlation between antro-angular intestinal metaplasia on rolls and on virtual biopsies was always highly significant, both when a single biopsy was considered and when groups of multiple biopsies (from 2 to 6 samples) were taken into account (p≤0.0001 and rho ranging from 0.304 to 0.817). By increasing the number of biopsies (from 1 to 6) we observed an increase in the rate of correct estimations when 20% extent was used as a cut-off: the increase was statistically significant in both intestinal metaplasia ≥20% and intestinal metaplasia <20% groups (p < 0.0001). The
highest value of concordance between intestinal metaplasia extent in virtual biopsies and in rolls was recorded for a set of 4 antral + 1 angular biopsies whereas a set of 2 antral + 1 angular biopsies turned out to be the most effective in terms of number/efficacy.
Conclusions. A three biopsy set (2 antral + 1 angular) allows correct detection of intestinal metaplasia extent in 90% of cases
Proposal and Validation of the AST/ALT ratio for predicting the presence of significant fibrosis in patients with chronic hepatitis C.
No full text
Mucoepidermoid carcinoma of the thyroid gland arising from a papillary epithelial neoplasm.
No full textWe report a case of mucoepidermoid carcinoma of the thyroid gland. The simultaneous association of papillary and mucoepidermoid carcinoma in a Hashimoto's thyroiditis makes the present observation unusual. Surgery was limited due to local extension of the neoplasm. The patient consequently underwent external radiotherapy followed by radiometabolic therapy. The patient survived 11 months after diagnosis. As far as the histogenesis of the neoplasm is concerned, we believe that mucoepidermoid areas correspond to squamous and mucinous metaplasia of a preexisting papillary carcinoma. Transition areas between elements morphologically characteristic of both neoplasms were observed. Histochemical and immunohistochemical studies confirmed the diagnosis of a carcinoma with multiple aspects showing a focal positive reaction for thyroglobulin or keratin antisera. Therefore, this demonstrates different functional activities of the neoplastic cells. There is still debate about adjuvant therapies, the results of which appear for the moment very poor
Fine-needle aspiration cytodiagnosis: a simple and safe procedure for cancer of the pancreas.
No full textHistological determinants of monoethylglycinexylidide formation in patients with chronic hepatitis C
No full textLong-term follow up of chronic hepatitis C patients after alpha-interferon treatment: a functional study
No full textA simple approach to noninvasively identifying significant fibrosis in chronic hepatitis C patients in clinical practice
No full textAutoimmune intrahepatic cholangiopathy associated with antiphospholipid antibody syndrome
No full textWe report the case of a 26-year-old woman who developed thrombophlebitis in her left leg in 2002, followed by fever, asthenia and headache in 2004. Antinuclear antibodies, antimitochondrial antibodies, anti-liver kidney microsome, anti-Smith, antiphospholipid (aPL) and antineutrophil cytoplasmic antibodies, as well as lupus- anticoagulant activity were positive. Systemic lupus erythematosus (SLE) with aPL syndrome was diagnosed and the patient was treated with azathioprine and heparin. Symptoms persisted and itching arose in the following months. The patient was admitted to our department in January 2005 for jaundice and skin rash. Elevated levels of acute phase proteins and cholestasis and liver necrosis indexes were present. Antinuclear antibodies, aPL and antimitochondrial antibodies (M5) antibodies were positive. Liver histology showed minimal focal hepatocyte necrosis, intrahepatic biliary stasis and intralobular inflammatory cell infiltrate. The absence of clinical signs that are characteristic of SLE as well as the failure to confirm antiSmith antibody positivity led us to rule out a diagnosis of SLE. On the basis of clinical, immunological and histological data, autoimmune intrahepatic cholangiopathy associated with primary aPL syndrome was diagnosed. The patient was treated with intravenous methylprednisolone followed by oral prednisone, warfarin and ursodeoxycholic acid. Liver necrosis and cholestasis indexes rapidly improved within 1 month and progressively reached the normal range. To our knowledge, this is the first description of a patient with an association of intrahepatic cholangiopathy and aPL, thus suggesting that autoimmune liver disease might associate with aPL syndrome
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