1,721,013 research outputs found
Screening for celiac disease in patients with chronic liver disease
No full textDear Sir:We read with interest the paper of Kaukinen et al. reporting anelevated frequency of celiac disease (CD) (4.3%) in patients with previousliver transplantation due to severe hepatic dysfunction.1However, wewould like to report our experience of the serologic assays for CDdiagnosis in patients with chronic liver disease and comment on thescreening methods for CD used in that study. Between January andOctober 2001, we studied 96 consecutive subjects (65 male, 31 female,age range 18–87 years, median 42) with chronic hypertransaminasemiawho were attending for thefirst time the outpatients clinic for liverdisease at the Internal Medicine Division of the University Hospital ofPalermo. All patients underwent a complete work-up including routineliver function tests, serologic screening for viral hepatitis, presence ofserum autoantibodies, copper- and iron-related indexes,1-antitrypsinlevels, liver ultrasonography, and percutaneous liver biopsy. We foundchronic hepatitis in 70 cases, liver cirrhosis in 20 patients, nonalcoholicsteatohepatitis in 3 patients, and primary biliary cirrhosis in 3 patients.In all cases, serological screening for CD was also performed by deter-mining the values of total immunoglobulin (to exclude selective IgAdeficiency), IgA class anti-endomysial antibody (EmA) using monkey’sesophagus as the substrate, and IgA class anti-human transglutaminaseantibody (Anti-tTG). Both the serum EmA and anti-tTG assays wereperformed with commercially available assays as previously described andthe threshold value for serum anti-tTG was7%.2We found 3 of 96patients positive for serum anti-tTG, but only one of them was positivefor serum EmA. This last patient, an 18-year-old girl, had mild chronichepatitis due to hepatitis B virus; she had never reported gastrointestinalsymptoms or anemia and her body mass index was normal. She under-went the duodenal biopsy and the histology study, performed as previ-ously described,3which showed severe atrophy of the mucosa (villi/cryptsratio 0.5) with an elevated intraepithelial lymphocytes count, thus con-firming the CD diagnosis. The 2 other patients, positive for serumanti-tTG but negative for EmA, had mild chronic hepatitis and livercirrhosis respectively, both due to hepatitis C virus infection. These 2patients accepted to undergo the intestinal biopsy but their intestinalhistology was normal (villi/crypts ratio3.5, normal intraepitheliallymphocytes count). Furthermore, both these patients were negative forthe presence of the HLA-DQ2 and HLA-DQ8 antigens, which charac-terize CD patients. The 2 patients with false positive anti-tTG results didnot differ from all the other subjects included in the study with regard toliver histology grading and staging, severity of liver function impair-ment, serum-globulin, and etiology of the liver disease. Furthermore,both were negative for serum auto-antibodies. In total, we consequentlyfound 1% frequency of CD and 2% of false positive anti-tTG results forCD diagnosis in our group of patients with chronic liver disease.Kaukinen et al. reported a much higher frequency of CD (4.3%)very probably linked to the high frequency of autoimmune liverdisease (primary biliary cirrhosis, primary sclerosing cholangitis, au-toimmune hepatitis) in their series.1However, although our dataindicated that the frequency of CD was lower in consecutive patientswith chronic liver disease, not including exclusively subjects withend-stage liver disease, we think that CD screening should be per-formed in any case as Kaukinen et al. clearly demonstrated thatdietary treatment in CD patients may prevent the progression tohepatic failure.1In regard to the serologic screening for CD, in theFinnish study there was a 2-fold higher frequency of false positiveanti-tTG results (8 of 185 cases, 4.3%) than in our study. This wasprobably in part due to the use of an anti-tTG ELISA based on tTGfrom guinea pig liver as the antigen4; in fact, we have previouslydemonstrated that in patients with chronic liver disease this systemgives a higher number of false positive results than the anti-tTGELISA based on human recombinant tTG as the antigen and shouldnot be used as a screening tool for CD.5However, our present dataunderlined that in patients with chronic liver diseases, false positiveanti-tTG results can also be observed using the anti-tTG assay basedon human antigen. Consequently, we suggest that when EmA assay doesnot confirm the positivity of the anti-tTG assay, determination of theHLA haplotype should be the subsequent step and only DQ2 or DQ8positive subjects should undergo intestinal biopsy for CD diagnosis
Extreme thrombocytosis as a sign of coeliac disease in the elderly: case report
No full textIncrease in the number of blood platelets to over
1 000 000/mm3 in elderly patients is generally considered
secondary to a myeloproliferative or neoplastic disease. To
report the case of an elderly woman hospitalized for
extreme thrombocytosis associated with severe anaemia,
who was found to be suffering from coeliac disease. The
patient, aged 83 years, was hospitalized presenting with
fatigue. Laboratory tests showed microcytic hypochromic
anaemia (haemoglobin 4 g/dl) and extreme
thrombocytosis (platelet count 1 400 000/mm3). Physical
examination was normal, with the exception of marked
thinness. There was no evidence of macroscopic bleeding
from the gastrointestinal or genitourinary tracts. She had
never suffered from gastrointestinal problems and had no
family history of gastroenterological diseases.
Oesophagogastroduodenoscopy and histology of the
gastric and duodenal mucosa evidenced atrophic gastritis
and an adenomatous polyp. The duodenal mucosa showed
total villous atrophy, suggesting the diagnosis of coeliac
disease. Antiendomysial IgA and anti-transglutaminase IgA
antibodies were also positive. Colonoscopy was negative.
An ultrasound examination of the abdomen was normal,
and the spleen was within the normal range. A peripheral
blood smear showed no alterations in erythrocyte
morphology typical of hyposplenism due to coeliac
disease. The platelet count decreased rapidly after blood
transfusions, when both serum iron and ferritin levels were
still below normal limits. Furthermore, we observed a
significant inverse correlation between the platelet count
and haemoglobin concentration (r 20.94, P < 0.003).
Platelet count and red blood cell count normalized after
2 months of a gluten-free diet; the haemoglobin
concentration was also normal at this time. After 1 year of
following a gluten-free diet, the patient remained well and
had no complaints. There were no gastrointestinal
disturbances. All haematological parameters were within
normal limits. Intestinal biopsies showed normal villi and
crypts without inflammatory infiltration of the lamina
propria. This case shows that the association of
haematological signs – extreme thrombocytosis and
severe anaemia – considered in an elderly patient to be
typical of myeloproliferative disorders or neoplastic
conditions can be due to coeliac disease; thus, coeliac
disease must also be considered among the possible
diagnoses
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Acute pancreatitis in children. An Italian multicentre study
Full text linkAIM:
To evaluate the clinical, morphological and aetiological aspects of acute pancreatitis in children in Italy.
PATIENTS:
The hospital records of 50 consecutive patients with acute pancreatitis observed in 5 Italian Pediatric Departments were reviewed.
RESULTS:
A total of 25 males and 25 females (median age 10.5 years, range 2-17) were studied. Of these patients, 48 (96%) had abdominal pain. The pancreatitis was associated with biliary disease in 10 patients (20%); it was due to viral infection in 6 patients (12%), pancreatic duct abnormalities in 4 (8%, familial chronic pancreatitis in 3 (6%), trauma in 5 (10%) and other causes in 5 (10%); the pancreatitis was of unknown origin in 17 patients (34%). Previous attacks of the disease had occurred in 14 patients. A diagnosis of mild pancreatitis was made in 41 patients (82%) and of severe disease in 9 (18%). One patient with severe pancreatitis died from multiorgan failure. Patients with severe pancreatitis had significantly higher serum concentrations of C-reactive protein than patients with mild pancreatitis. Hospital stay was similar for patients with the mild form and those with the severe form of the disease.
CONCLUSIONS:
In Italian children, acute pancreatitis is of unknown origin in about one-third of the children and is recurrent in 28% of the cases. The disease is severe in 18% of the case
Autoimmune enteropathy and colitis in an adult patient
No full textThe presence of circulating autoantibodies to gut enterocytes has been very rarely described in adults and is considered a possible cause of refractory sprue. Our aims was to describe the case of an adult patient with serum anti-enterocyte autoantibodies associated with a clinical picture characterized by involvement of both the small intestine and colon. A female, age 50, had suffered from diarrhea with mucus and blood, abdominal pain, thinness, anemia, and leukopenia since the age of 20. She also suffered from HCV infection and had mild chronic hepatitis. Family history was positive for autoimmunity. Symptoms were reported to worsen after eating gluten-containing foods, but anti-transglutaminase and anti-endomysial antibodies were negative. Intestinal histology showed mild, patch villous atrophy with a high intraepithelial lymphocyte count, but a normal number of intraepithelial lymphocytes carrying the gamma/delta+ receptor. HLA was: A11, A31 (19), B52 (5), DR 15 (2), DR 14 (6), DR 51, DR 52, DQ1. Colonoscopy did not show ulcerations or erosions and colon histology showed a moderate inflammatory infiltrate without minor crypt distortion or granuloma. RAST tests were positive for lactalbumin, lactoglobulin, casein, egg, and gliadin. After commencement of an oligoantigenic diet, stool frequency initially decreased, but the presence of mucus in the stools persisted, with episodes of bloody diarrhea. After one year of diet, nutritional parameters were low and anemia associated with a low leukocyte count persisted. Upper and lower gastrointestinal endoscopy and histology of the small intestine and colon were virtually unchanged. Consequently, natural autoantibodies and enterocyte autoantibodies were assayed. The patient was positive for IgG class enterocyte autoantibodies at a titer of 1:34. No other organ-specific or non-organ-specific autoantibodies were positive. Prednisolone treatment was started and the symptoms improved. After one year of this treatment plus elimination diet she was reevaluated. Bowel movement frequency was normal, body weight increased, and the asthenia had completely regressed. IgG anti-enterocyte autoantibodies were absent. Histology of the distal duodenum showed a normal villus/crypt ratio and IEL infiltration was reduced. Colon histology showed a reduction in inflammatory infiltrate in the lamina propria. In conclusion, we report a case of generalized gut disorder in an adult patient, affecting both the small intestine and the colon and characterized by the presence of circulating anti-enterocyte autoantibodies. Systematic testing for enterocyte autoantibodies should be performed not only in patients with refractory sprue, but also in subjects with upper and lower intestinal symptoms who have not been definitively diagnosed
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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