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Petropoulou T, Theodoraki K, Kitsanta P, Amin S. Efficiency of the Robotic Platform in Improving the Rate of Sphincter Preservation in Patients With Mid and Low Rectal Cancer. World J Oncol 2023; 14:499-504. [PMID: 38022401 PMCID: PMC10681784 DOI: 10.14740/wjon1581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background The aim of this study was to investigate whether the robotic platform can have a positive impact on the rate of sphincter preservation in patients with rectal tumors, undergoing robotic total mesorectal excision (TME), in comparison with laparoscopic or open TME. We also analyzed and compared short-term outcomes. Methods A prospectively collected robotic database was reviewed and compared with the trust and national data. Three groups were designed according to the surgical technique: open, laparoscopic and robotic. This includes all resections for mid and low rectal cancer which were performed with the robotic platform, over a period of 4 years, versus the trust data for the same period. Results Two hundred ninety-seven patients with mid and low rectal cancers were analyzed. Demographics for the groups (gender, age, and body mass index) were similar but distance from anal verge was shorter in the robotic group (7 vs. 8.5 cm, P < 0.001). The percentage of abdominoperineal resection (APR) rate was significantly lower in the robotic group (13.5% vs. 39.6% vs. 52.4% for the open group, P < 0.001). Median length of stay, complication rate, and positive circumferential resection margin (CRM) rate for the robotic group were also statistically significantly lower than those for both laparoscopic and open groups. Conclusion Robotic surgery for mid and low rectal cancer is safe and feasible, and could help surgeons perform ultra-low anterior resections, rather than APRs and save patients' sphincters. Positive CRM is low, which could lead to improved oncological outcomes.
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Affiliation(s)
- Thalia Petropoulou
- Department of Colon & Rectal Surgery, Sheffield Teaching Hospitals, Sheffield, UK
- Department of Robotic Colon & Rectal Surgery, Euroclinic, Athens, Greece
| | | | | | - Shwan Amin
- Department of Colon & Rectal Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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2
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Putnam H, Turnbull A, Bangura J, Kitsanta P, Grobusch MP, Dubbink JH. Case Report: Acral Melanoma with Giant Local Recurrence in Rural Sierra Leone. Am J Trop Med Hyg 2022; 107:912-915. [PMID: 35995134 PMCID: PMC9651533 DOI: 10.4269/ajtmh.21-1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/13/2022] [Indexed: 11/07/2022] Open
Abstract
Malignant melanoma is rare in West Africa. Few cases of giant melanoma have been reported globally. We present a case of acral melanoma with giant local recurrence on the foot of a black-skinned woman from rural Sierra Leone, managed with below-knee amputation. Atypical, late presentation, poor access to diagnostics, and underreporting may contribute to underappreciation of melanoma as a healthcare problem in West Africa. This case highlights the need for improved cancer and skin health surveillance structures in West Africa-most importantly, increasing access to histopathology.
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Affiliation(s)
- Harry Putnam
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Alexandra Turnbull
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - James Bangura
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Panagiota Kitsanta
- Histopathology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Martin P. Grobusch
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan H. Dubbink
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
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3
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Brammar L, Bury J, Fisher P, Kitsanta P, Suvarna S, Taylor F, Toh EW, Saha S, Young R, Lloyd K. Assessment of turnaround times of molecular tests performed on lung samples for non-small cell lung cancer in a large teaching hospital. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Griffin J, Kitsanta P, Perunovic B, Suvarna SK, Bury J. Digital pathology for intraoperative frozen section diagnosis of thoracic specimens: an evaluation of a system using remote sampling and whole slide imaging diagnosis. J Clin Pathol 2019; 73:503-506. [PMID: 31806732 DOI: 10.1136/jclinpath-2019-206236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Digital pathology is now used for primary diagnostic work as well as teaching, research and consultation. In our multisite institution service reorganisation led to histopathology being located in a separate hospital from some surgical specialities. We implemented remotely supervised specimen sampling and frozen section diagnosis using digital pathology. In this study we assessed the concordance of glass and digital slide diagnosis using this system. METHODS We reviewed cases from the first 2 years of digital frozen section reporting at our institution. Cases with potential digital to glass slide discordance were reviewed by three experienced thoracic histopathologists. The reasons for discordance were determined and common themes identified. We also reviewed critical incidents relating to digital pathology during the study period. RESULTS The study population comprised 211 cases. Frozen section to final diagnosis concordance between digital and glass slide diagnosis was found in 196 (92.6%) cases. The 15 potentially discordant cases were reviewed. Intraobserver concordance between glass and digital slide review ranged from 9/15 to 12/15 cases across the three pathologists. Glass slide review diagnosis showed better concordance with ground truth in two cases; digital slide review was more accurate in two cases. One relevant critical incident was identified during the study period. DISCUSSION This is the largest study to examine digital pathology for thoracic frozen section diagnosis and shows that this is a safe and feasible alternative to glass slide diagnosis. Discordance between digital and glass slide diagnoses were unrelated to the processes of whole slide imaging and digital microscopy.
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Affiliation(s)
- Jon Griffin
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Panagiota Kitsanta
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Branko Perunovic
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Kim Suvarna
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan Bury
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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5
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Suvarna SK, Kitsanta P, Burton JL. The effects of postmortem CT scanning all cases entering a UK public mortuary: a 3-month pilot. J Clin Pathol 2017; 70:903-905. [PMID: 28743688 DOI: 10.1136/jclinpath-2017-204505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 11/03/2022]
Affiliation(s)
- S Kim Suvarna
- Histopathology Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Panagiota Kitsanta
- Histopathology Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Julian L Burton
- Academic Unit of Pathology, University of Sheffield, Sheffield, UK
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6
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Yu Y, Daly DM, Adam IJ, Kitsanta P, Hill CJ, Wild J, Shorthouse A, Grundy D, Jiang W. Interplay between mast cells, enterochromaffin cells, and sensory signaling in the aging human bowel. Neurogastroenterol Motil 2016; 28:1465-79. [PMID: 27206689 PMCID: PMC5053273 DOI: 10.1111/nmo.12842] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/22/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Advanced age is associated with a reduction in clinical visceral pain perception. However, the underlying mechanisms remain largely unknown. Previous studies have suggested that an abnormal interplay between mast cells, enterochromaffin (EC) cells, and afferent nerves contribute to nociception in gastrointestinal disorders. The aim of this study was to investigate how aging affects afferent sensitivity and neuro-immune association in the human bowel. METHODS Mechanical and chemical sensitivity of human bowel afferents were examined by ex vivo afferent nerve recordings. Age-related changes in the density of mast cells, EC cells, sensory nerve terminals, and mast cell-nerve micro-anatomical association were investigated by histological and immune staining. KEY RESULTS Human afferents could be broadly classified into subpopulations displaying mechanical and chemical sensitivity, adaptation, chemo-sensitization, and recruitment. Interestingly human bowel afferent nerve sensitivity was attenuated with age. The density of substance P-immunoreactive (SP-IR) nerve varicosities was also reduced with age. In contrast, the density of ileal and colonic mucosal mast cells was increased with age, as was ileal EC cell number. An increased proportion of mast cells was found in close apposition to SP-IR nerves. CONCLUSIONS & INFERENCES Afferent sensitivity in human bowel was reduced with advancing age. Augmentation of mast cells and EC cell numbers and the mast cell-nerve association suggest a compensatory mechanism for sensory neurodegeneration.
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Affiliation(s)
- Y. Yu
- Department of Biomedical ScienceUniversity of SheffieldSheffieldUK
| | - D. M. Daly
- Department of Biomedical ScienceUniversity of SheffieldSheffieldUK
| | - I. J. Adam
- Department of Colorectal Surgical UnitNorthern General HospitalSheffield Teaching HospitalSheffieldUK
| | - P. Kitsanta
- Department of HistopathologyNorthern General HospitalSheffield Teaching HospitalSheffieldUK
| | - C. J. Hill
- Department of Biomedical ScienceUniversity of SheffieldSheffieldUK
| | - J. Wild
- Department of Colorectal Surgical UnitNorthern General HospitalSheffield Teaching HospitalSheffieldUK
| | - A. Shorthouse
- Department of Colorectal Surgical UnitNorthern General HospitalSheffield Teaching HospitalSheffieldUK
| | - D. Grundy
- Department of Biomedical ScienceUniversity of SheffieldSheffieldUK
| | - W. Jiang
- Department of Biomedical ScienceUniversity of SheffieldSheffieldUK
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Abstract
BACKGROUND Cold snare techniques are widely used for removal of diminutive and small colorectal polyps. The influence of resection technique on the effectiveness of polypectomy is unknown. We therefore compared standard cold snare polypectomy with a newly described suction pseudopolyp technique, for completeness of excision and for complications. PATIENTS AND METHODS In this single-center study, 112 patients were randomized to cold snare polypectomy or the suction pseudopolyp technique. Primary outcome was endoscopic completeness of excision. Consensus regarding the endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp "fly away" and retrieval rates, early bleeding (48 hours), delayed bleeding (2 weeks), and perforation. RESULTS 148 polyps were removed, with size range 3 - 7 mm, 60 % in the left colon, and 90 % being sessile. Regarding completeness of excision (with uncertain findings omitted): endoscopically, this was higher with the suction pseudopolyp technique compared with cold snare polypectomy but not statistically significantly so (73/74 [98.6 %] vs. 63/68 [92.6 %]; P = 0.08). A trend towards a higher complete histological excision rate with the suction pseudopolyp technique was also not statistically significant (45/59 [76.3 %] vs. 37/58 [63.8 %]; P = 0.14). Polyp retrieval rate was not significantly different (suction 68/76 [89.5 %] vs. cold snare 64/72 [88.9 %]; P = 0.91). No perforation or bleeding requiring hemostasis occurred in either group. CONCLUSION In this study both polypectomy techniques were found to be safe and highly effective, but further large multicenter trials are required.Clinical trial registration at www.clinicaltrials.gov: NCT02208401.
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Affiliation(s)
- Said Din
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Alex J Ball
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Stuart A Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Panagiota Kitsanta
- Department of Histopathology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Shawinder Johal
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
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8
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Abstract
BACKGROUND AND AIM Cold snare techniques are widely used for the removal of small and diminutive polyps. The influence of snare type on the effectiveness of cold snare polypectomy is unknown. METHODS Cold snare polypectomy of 3-7-mm polyps was undertaken using either a thin wire mini-snare (0.30 mm) or a thick wire mini-snare (0.47 mm). Primary outcome was endoscopic completeness of excision. Consensus regarding endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp 'fly away', polyp retrieval rate, early or delayed bleeding and perforation. RESULTS One hundred and fifty-seven polyps were removed ranging from 3 to 7 mm, 62% were situated in the left side of the colon and 89.4% were sessile. Endoscopic completeness of excision was significantly higher with the thin wire snare compared to the thick wire snare (90.2% vs 73.3%, P < 0.05). There was a numerical trend towards a higher complete histological excision rate with the thin wire snare, but this did not reach statistical significance (73.3% vs 65.2%, P = 0.4). There was a fair level of agreement (kappa = 0.36) between endoscopic and histological completeness of excision. Polyp 'fly away' occurred less often with the thin wire snare (14.6% vs 35.3%, P = 0.002), but there was no significant difference in polyp retrieval rate (84.3% vs 83.8%, P = 0.94). There were no complications with either snare. CONCLUSION Snare type appears to be an important determinant of completeness of excision when removing small polyps by the cold snare technique.
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Affiliation(s)
- Said Din
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology, University of Sheffield, Medical School, Sheffield, UK
| | - Alex J Ball
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology, University of Sheffield, Medical School, Sheffield, UK
| | - Stuart A Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Panagiota Kitsanta
- Department of Histopathology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Shawinder Johal
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
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9
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Abstract
A 69-year-old man presented to bowel cancer screening after testing for faecal occult blood. Initial colonoscopy had been limited by a sigmoid stricture and a barium enema had revealed a suspicious mass in the corresponding area. He was referred for repeat colonoscopy, which showed a hard structure crossing the mid sigmoid colon, with both ends impacted into the bowel wall. A CT scan revealed what appeared to be a small bone impacted in a diverticulum with evidence of recent inflammation and a sealed perforation. The patient had recently been managed conservatively for an episode of diverticulitis at his local hospital but was currently asymptomatic. Owing to the possibility of future complications he underwent a laparoscopic sigmoid colectomy to remove the offending foreign body.
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Affiliation(s)
- Nicolas Rabb
- Department of Cardiology, Northern General Hospital, Sheffield, South Yorkshire, UK.
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10
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11
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Abstract
Aggressive digital papillary adenocarcinoma and aggressive digital papillary adenoma are rare tumours of the sweat glands. They are most common in the most distal part of the fingers and are locally aggressive with a 50% local recurrence rate; 14% of tumours metastasize. We present two cases.
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Affiliation(s)
- Evangelos G Keramidas
- Department of Plastic and Reconstruction Surgery, Northern General Hospital, Sheffield, UK.
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12
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Stewart D, Kitsanta P, Hampton J, Shorthouse A. Asymptomatic isolated coccygeal metastasis in low rectal carcinoma. Tech Coloproctol 2009; 15:349-51. [PMID: 19609484 DOI: 10.1007/s10151-009-0508-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 02/14/2009] [Indexed: 11/27/2022]
Abstract
As well as being relatively rare, osseous metastases from colorectal cancer are frequently asymptomatic and represent a late manifestation of disease. We report a case of an unidentified, asymptomatic coccygeal metastasis discovered on histological processing of the resection specimen from a patient with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by radical abdomino-perineal resection with coccygectomy. The anatomical explanation for this finding may involve passage of tumour cells via the vertebral venous plexus.
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Affiliation(s)
- Duncan Stewart
- Department of Colorectal Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
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13
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Zakynthinos E, Tassopoulos G, Haritos C, Kitsanta P, Pyros J, Roussos C, Papiris SA. Huge Biatrial Primary Cardiac B-cell Lymphoma resulting in Bilateral Atrioventricular Valve Obstruction. Leuk Lymphoma 2009; 45:2339-42. [PMID: 15512827 DOI: 10.1080/10428190410001733754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report the case of a 48-year-old man with a clinical syndrome caused by both pulmonary and systemic venous congestion. Echocardiography indicated a huge tumor occupying both dilated atria almost completely, seeming to invade from the atrial septum. A test for HIV was negative. Our primary diagnosis was a biatrial myxoma. Urgent surgery was performed disclosing large cell B-cell primary cardiac lymphoma. The patient died 8 days later. Primary cardiac lymphoma is extremely rare in immunocompetent patients. Its rarity and heterogenous clinical presentation make diagnosis difficult. As tissue characterization is still beyond the capabilities of currently available echocardiography, a combination of examinations are indicated, when the clinical condition is relatively stable, in order to reach the exact diagnosis.
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Affiliation(s)
- Epaminondas Zakynthinos
- Department of Critical Care and Pulmonary Services, National and Kapodistrian University of Athens, Athens, Greece.
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14
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Triantafyllou K, Kitsanta P, Karamanolis DG, Kittas C, Ladas SD. Epithelial cell turnover, p53 and bcl-2 protein expression during oncogenesis of early and advanced gastric cancer in a Western population. Dig Liver Dis 2008; 40:39-45. [PMID: 18063429 DOI: 10.1016/j.dld.2007.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 07/23/2007] [Accepted: 09/19/2007] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate epithelial cell turnover alterations, and p53, bcl-2 protein expression during development of early and advanced gastric cancer in a Western population. METHODS We investigated cell apoptosis and proliferation rates, p53 and bcl-2 protein expression in 17 early and 34 advanced gastric carcinomas and in the adjacent non-dysplastic mucosa. Cell proliferation, p53 and bcl-2 expression were detected immunohistochemically using MIB-1, anti-p53 and anti-bcl-2 monoclonal antibodies. Apoptosis was measured by TUNEL. The rate of the positive stained cells (labelling index) was count using image analysis technique. RESULTS No difference was observed of either apoptotic (10 vs. 11) or proliferation (35 vs. 25) index between early and advanced cancers. However, the apoptotic index was significantly higher in intestinal type advanced tumors. While both apoptotic and proliferation indices were significantly higher in tumors than in the adjacent mucosa, no difference was observed of either apoptotic (2 vs. 2) or proliferation (8 vs. 13) index between the tissues adjacent to early and advanced tumors. p53 protein expression was significantly higher in advanced cancers (7 vs. 5, p=0.001) and in the non-dysplastic tissue adjacent to advanced tumors (3.5 vs. 2, p=0.001). bcl-2 labelling index was significantly higher in the mucosa adjacent to advanced carcinomas (15 vs. 5, p=0.016) but this difference did not reach significance in the tumors (20 vs. 15, p=0.37). CONCLUSIONS Our data indicate similar cell turnover during tumorigenesis of early and advanced cancer. p53 and bcl-2 protein accumulation is more intense in gastric mucosa adjacent to advanced tumors and p53 immunoreactivity peaks in advanced carcinomas.
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Affiliation(s)
- K Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, Medical School, Athens University, 1 Rimini Street, 12462 Haidari, Athens, Greece.
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15
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Abstract
BACKGROUND Clinically apparent cytomegalovirus (CMV) disease is uncommon in the immunocompetent host, despite the high seroprevalence rate of CMV in the general population. CASE REPORT Here, we report the case of CMV colitis in an immunocompetent elderly woman who developed a large pulmonary embolism during her illness. DISCUSSION The diagnosis of CMV colitis is made on histological examination of biopsy specimens obtained at sigmoidoscopy or colonoscopy. Extensive CMV disease can be accompanied by vascular thrombosis.
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Affiliation(s)
- M Rose Lockwood
- Department of Health Care for the Elderly, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
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16
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Stratopoulos C, Papakonstantinou A, Terzis I, Spiliadi C, Dimitriades G, Komesidou V, Kitsanta P, Argyrakos T, Hadjiyannakis E. Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg 2005; 15:1154-60. [PMID: 16197789 DOI: 10.1381/0960892055002239] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonalcoholic steatohepatitis (NASH) is common in morbid obesity. Our goal was to evaluate the alterations in liver histology and biochemistry before and after weight loss in 51 morbidly obese patients following Mason's vertical banded gastroplasty. METHODS Two biopsies were performed (on entry and after an average of 18 months), while 16 of these subjects had a third biopsy 17 months after the second. RESULTS On entry, steatosis and steatohepatitis (mostly grade 3) were present in 98.0% and fibrosis (mostly stage 2) in 94.1% of the subjects. After an excess weight loss of 66%, steatosis and steatohepatitis improved significantly (P<0.001). Although a significant overall decrease in fibrosis occurred (P=0.002), 21 patients (41.1%) did not change and only 6 patients (11.7%) increased in fibrosis. None developed cirrhosis. The decrease in steatohepatitis was significantly correlated (P=0.011) with the reduction of BMI. Fasting serum glucose, lipids, lipoproteins, transaminases, gamma-glutamyl transpeptidase, alkaline phosphatase and fibrinogen were also significantly improved at the time of the second biopsy. The third biopsy performed in 16 of the subjects showed further significant improvement in liver histology. CONCLUSION NASH improved significantly with massive weight loss in non-diabetic, non-alcoholic, morbidly obese subjects, while fibrosis improved in nearly half of the patients.
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17
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Papiris SA, Kollintza A, Kitsanta P, Kapotsis G, Karatza M, Milic-Emili J, Roussos C, Daniil Z. Relationship of BAL and lung tissue CD4+ and CD8+ T lymphocytes, and their ratio in idiopathic pulmonary fibrosis. Chest 2005; 128:2971-7. [PMID: 16236974 DOI: 10.1378/chest.128.4.2971] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Surgical biopsy specimens have shown that T lymphocytes (TLs) infiltrate lung parenchyma in patients with idiopathic pulmonary fibrosis (IPF) and might play a pathogenetic role. BAL, a far less invasive technique, has also been used for the investigation of IPF pathogenesis. However, controversy exists whether the BAL fluid cellular profile reflects the cellular composition of the lung parenchyma. STUDY OBJECTIVE To compare infiltrating TLs subpopulations (CD4+, CD8+, and CD4+/CD8+ ratio) in lung tissue and BAL fluid. PATIENTS AND METHODS Immunohistochemistry was performed according to the streptavidin-biotin method on the surgical biopsy specimens of 12 untreated patients with IPF. The number of CD3+, CD4+, and CD8+ TLs was determined by observer-interactive computerized image analysis (SAMBA microscopic image processor; Meylan, France). In BAL fluid, the same TLs subpopulations were evaluated by flow cytometry. RESULTS In lung tissue, CD3+ TLs accounted for a mean (+/- SEM) of 28.8 +/- 7% of total cells, CD4+ TLs accounted for 14.5 +/- 4% of total cells (50.1 +/- 4% of CD3+ TLs), and CD8+ TLs accounted for 13.8 +/- 4% of total cells (47.4 +/- 4% of CD3+ TLs). In BAL fluid, lymphocytes accounted for 9.8 +/- 2.5% of total cells, CD4+ TLs accounted for 51.8 +/- 4% of CD3+ TLs, and CD8+ TLs accounted for 42.2 +/- 4% of CD3+ TLs. Tissue CD4+ and CD8+ TLs (expressed as a percentage of CD3+ TLs) correlated significantly with the number of CD4+ and CD8+ TLs in BAL fluid (r = 0.846 and p = 0.001 vs r = 0.692 and p = 0.013, respectively). A significant positive correlation was also found between the mean CD4+/CD8+ ratio found in tissue and BAL fluid (1.05 +/- 0.21 and 1.5 +/- 0.27, respectively; r = 0.832; p = 0.01). CONCLUSION The results suggest that in patients with IPF, the TL subpopulations in BAL fluid reflect the pattern of lymphocytic infiltration in pulmonary parenchyma.
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Affiliation(s)
- Spyros A Papiris
- Department of Critical Care and Pulmonary Services, National and Kapodistrian University of Athens, 45-47 Ipsilantou St, "Evangelismos" Hospital, GR 10675, Athens, Greece.
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18
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Papiris SA, Kollintza A, Kitsanta P, Kapotsis G, Karatza M, Milic-Emili J, Roussos C, Daniil Z. Relationship of BAL and Lung Tissue CD4+ and CD8+ T Lymphocytes, and Their Ratio in Idiopathic Pulmonary Fibrosis. Chest 2005. [DOI: 10.1016/s0012-3692(15)52722-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Georgopoulos SD, Triantafyllou K, Fameli M, Kitsanta P, Spiliadi C, Anagnostou D, Ladas SD. Molecular analysis of B-cell clonality in Helicobacter pylori gastritis. Dig Dis Sci 2005; 50:1616-20. [PMID: 16133959 DOI: 10.1007/s10620-005-2905-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 01/13/2005] [Indexed: 12/20/2022]
Abstract
The aim of our study was to identify PCR-detectable clonal B-cell population in Helicobacter pylori gastritis and assess their relation to the Wotherspoon-Isaacson (W-I) grade for gastric lymphoid infiltrates. Amplified DNA was obtained from thirty four H. pylori positive gastritis dyspeptic patients and thirty four H. pylori negative matched controls. Clonal bands were observed in 6 (2/17 W-I Grade 1, 2/13 W-I Grade 2, and 2/4 W-I Grade 3 lesions) and polyclonal smears in 24 cases (15 W-I Grade 1, 7 W-I Grade 2, and 2 W-I Grade 3). Four additional W-I Grade 2 samples with clonal bands were associated with background polyclonal smear and were not reproducible. Clonal bands were not recorded in controls. B-cell clonality was not related to W-I grades. We conclude that certain H. pylori positive gastritis patients show PCR-detectable monoclonality, which is independent of the W-I grade of gastritis and cannot be taken as evidence of an existing neoplastic lesion.
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Affiliation(s)
- Sotirios D Georgopoulos
- Gastroenterology Unit, Evangelismos General Hospital, Athens University, Medical School, Greece
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Daniil Z, Kitsanta P, Kapotsis G, Mathioudaki M, Kollintza A, Karatza M, Milic-Emili J, Roussos C, Papiris SA. CD8+ T lymphocytes in lung tissue from patients with idiopathic pulmonary fibrosis. Respir Res 2005; 6:81. [PMID: 16042790 PMCID: PMC1199622 DOI: 10.1186/1465-9921-6-81] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 07/24/2005] [Indexed: 01/12/2023] Open
Abstract
Background Several studies have implicated a role of inflammation in the pathogenesis of lung damage in idiopathic pulmonary fibrosis (IPF). Parenchymal lung damage leads to defects in mechanics and gas exchange and clinically manifests with exertional dyspnea. Investigations of inflammatory cells in IPF have shown that eosinophils, neutrophils and CD8+ TLs may be associated with worse prognosis. We wished to investigate by quantitative immunohistochemistry infiltrating macrophages, neutrophils and T lymphocytes (TLs) subpopulations (CD3+, CD4+ and CD8+) in lung tissue of patients with IPF and their correlation with lung function indices and grade of dyspnoea. Methods Surgical biopsies of 12 patients with IPF were immunohistochemically stained with mouse monoclonal antibodies (anti-CD68 for macrophages, anti-elastase for neutrophils, and anti-CD3, anti-CD4, anti-CD8 for CD3+TLs, CD4+TLs, and CD8+TLs respectively). The number of positively stained cells was determined by observer-interactive computerized image analysis (SAMBA microscopic image processor). Cell numbers were expressed in percentage of immunopositive nuclear surface in relation to the total nuclear surface of infiltrative cells within the tissue (labeling Index). Correlations were performed between cell numbers and physiological indices [FEV1, FVC, TLC, DLCO, PaO2, PaCO2 and P(A-a)O2)] as well as dyspnoea scores assessed by the Medical Research Council (MRC) scale. Results Elastase positive cells accounted for the 7.04% ± 1.1 of total cells, CD68+ cells for the 16.6% ± 2, CD3+ TLs for the 28.8% ± 7, CD4+ TLs for the 14.5 ± 4 and CD8+ TLs for the 13.8 ± 4. CD8+TLs correlated inversely with FVC % predicted (rs = -0.67, p = 0.01), TLC % predicted (rs = -0.68, p = 0.01), DLCO % predicted (rs = -0.61, p = 0.04), and PaO2 (rs = -0.60, p = 0.04). Positive correlations were found between CD8+TLs and P(A-a)O2 (rs = 0.65, p = 0.02) and CD8+TLs and MRC score (rs = 0.63, p = 0.02). Additionally, CD68+ cells presented negative correlations with both FVC % predicted (rs = -0.80, p = 0.002) and FEV1 % predicted (rs = -0.68, p = 0.01). Conclusion In UIP/IPF tissue infiltrating mononuclear cells and especially CD8+ TLs are associated with the grade of dyspnoea and functional parameters of disease severity implicating that they might play a role in its pathogenesis.
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Affiliation(s)
- Zoe Daniil
- Department of Critical Care and Pulmonary Services, National and Capodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | | | - George Kapotsis
- Department of Critical Care and Pulmonary Services, National and Capodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | | | - Androniki Kollintza
- Department of Critical Care and Pulmonary Services, National and Capodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | | | - Joseph Milic-Emili
- Meakins-Cristie Laboratories, McGill University, Montreal, Quebec, Canada
| | - Charis Roussos
- Department of Critical Care and Pulmonary Services, National and Capodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | - Spyros A Papiris
- Department of Critical Care and Pulmonary Services, National and Capodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
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Kitsanta P, Triantafyllou K, Chatziargyriou M, Barbatzas C, Ladas SD. Gastric mucosa epithelial cell kinetics are differentiated by anatomic site and Helicobacter pylori infection. Dig Dis Sci 2005; 50:1087-91. [PMID: 15986859 DOI: 10.1007/s10620-005-2709-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Changes in epithelial cell turnover related to Helicobacter pylori infection may contribute to gastric cancer development. The response of different anatomic sites of the gastric mucosa to H. pylori is not known. We studied apoptosis and cell proliferation at the grater and lesser curvature of the antrum and corpus, the fundus, and the cardia from 9 H. pylori gastritis patients and 11 H. pylori-negative controls with normal histology. Proliferation was highest at the major curve of the antrum and lowest at the fundus, and apoptosis was highest at the cardia and lowest at the major curve of the antrum in both H. pylori gastritis and normal mucosa. Proliferation was significantly higher at all anatomic sites, while apoptosis was significantly lower only at the major and lesser curve of the corpus in H. pylori gastritis compared with normal controls. Our data suggest that gastric mucosa epithelial cell kinetics is differentiated by the anatomic site and H. pylori infection.
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Affiliation(s)
- Panagiota Kitsanta
- Histopathology Department, Sheffield Teaching Hospitals, Sheffield, United Kingdom
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Abstract
Serrated adenomas of the colon are characterized by epithelial neoplasia combining the architectural features of hyperplastic polyps and the cytological features of adenomas. Cell turnover, which is related to the malignant potential of these polyps, has not been thoroughly investigated. The aim of this study was to investigate epithelial cell proliferation, apoptosis, and oncoprotein expression in serrated adenomas. Twenty-five hyperplastic polyps, 25 serrated adenomas, and 25 tubulovillous adenomas resected from the colons of 75 patients were studied by immunohistochemical staining using monoclonal antibodies against MIB-1, Bcl-2, Bax, p53, and the TUNEL method for the detection of apoptosis. In serrated adenomas, the proliferation rate was significantly lower than in tubulovillous adenomas in both the lower and the upper parts of the crypts, and higher than that of hyperplastic polyps. Apoptosis was also significantly lower in serrated than in tubulovillous adenomas, but higher than in hyperplastic polyps. p53 oncoprotein expression was significantly greater in both serrated and tubulovillous adenomas than in hyperplastic polyps. bcl-2 protein expression was higher only in tubulovillous adenomas. Bax index was significantly different between tubullovillous and serrated adenomas, but the lowest values were observed in hyperplastic polyps. Serrated adenomas are highly proliferative polyps. They should be considered a biologically different entity from hyperplastic polyps. The intermediate features between serrated adenomas, hyperplastic polyps, and tubulovillous adenomas using the antibodies analysed in this study could have implications for the rate or the mechanism of development of malignancy in this type of polyp.
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Affiliation(s)
- Spiros D Ladas
- Gastroenterology Unit, Second Department of Internal Medicine, Athens University, Attikon University Hospital, Athens, Greece
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Affiliation(s)
- Hal Spencer
- Department of Gastroenterology, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
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Affiliation(s)
- Hal Spencer
- Department of Gastroenterology, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
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Kotanidou A, Xagorari A, Bagli E, Kitsanta P, Fotsis T, Papapetropoulos A, Roussos C. Luteolin reduces lipopolysaccharide-induced lethal toxicity and expression of proinflammatory molecules in mice. Am J Respir Crit Care Med 2002; 165:818-23. [PMID: 11897650 DOI: 10.1164/ajrccm.165.6.2101049] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Luteolin is a flavonoid that has been shown to reduce proinflammatory molecule expression in vitro. In the present study, we have tested the ability of luteolin to inhibit lipopolysaccharide (LPS)- induced lethal toxicity and proinflammatory molecule expression in vivo. Mice receiving LPS (Salmonella enteriditis LPS, 32 mg/kg, intraperitoneally) exhibited high mortality with only 4.1% of the animals surviving seven days after the LPS challenge. On the contrary, mice that had received luteolin (0.2 mg/kg, intraperitoneally) before LPS showed an increased survival rate with 48% remaining alive on Day 7. To investigate the mechanism by which luteolin affords protection against LPS toxicity we measured intercellular adhesion molecule-1 (ICAM-1) and tumor necrosis factor-alpha (TNF-alpha) production in response to LPS in the presence or absence of luteolin pretreatment. Treatment of animals with LPS increased serum TNF-alpha levels in a time-dependent manner. The increase in peak serum TNF-alpha levels was sensitive to luteolin pretreatment. Luteolin pretreatment also reduced LPS-stimulated ICAM-1 expression in the liver and abolished leukocyte infiltration in the liver and lung. We conclude that luteolin protects against LPS-induced lethal toxicity, possibly by inhibiting proinflammatory molecule (TNF-alpha, ICAM-1) expression in vivo and reducing leukocyte infiltration in tissues.
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Affiliation(s)
- Anastasia Kotanidou
- George P. Livanos Laboratory, Evangelismos Hospital, Department of Critical Care and Pulmonary Services, University of Athens, Athens, Greece
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Ladas SD, Malamou H, Giota G, Varzakakos I, Kitsanta P, Georgopoulos S, Spiliadi C, Raptis SA. Prospective evaluation of a whole-blood antibody test (FlexPack HP) for in-office diagnosis of Helicobacter pylori infection in untreated patients. Eur J Gastroenterol Hepatol 2000; 12:727-31. [PMID: 10929897 DOI: 10.1097/00042737-200012070-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Rapid, reliable in-office tests are needed for applying the adopted screen-and-treat strategy in Helicobacter pylori-positive young dyspeptic patients. DESIGN We have evaluated the performance characteristics of a whole-blood antibody (WBA) test for the detection of H. pylori infection under in-office conditions. METHODS In a prospective double-blind study, 183 untreated patients referred to a tertiary centre for endoscopy because of dyspepsia were studied. Patients were defined as H. pylori-positive if two out of three tests (histology, rapid urease test, Gram staining of biopsy smears) were positive, and H. pylori-negative if all three tests were negative. An in-office test detecting IgG antibodies to H. pylori (FlexPack HP, Abbott Diagnostics) was used with capillary blood and compared with an ELISA detecting IgG (quantitative) and IgA (qualitative) H. pylori serum antibodies. RESULTS Of the 183 patients, 139 were defined as H. pylori-positive. The in-office test had 79% sensitivity, 95% specificity, 98% positive and 59% negative predictive value. The respective values for IgG serum antibodies were 94, 70, 91 and 79% and those for IgA antibodies were 86, 82, 94 and 64%. About 50% of the false-negative in-office tests had a serum IgG antibody titre > 100 units. Co-evaluation of our data with published reports suggested that both the median sensitivity and negative predictive value of the kit are significantly inferior when performed with whole-blood (five studies) compared with serum (nine studies) (82 versus 92% and 82 versus 93% respectively, P < 0.035). CONCLUSIONS Improvement of the performance characteristics of FlexPack HP in-office test is needed. However, the test may be a useful tool for identifying H. pylori-positive patients in younger age groups who could be managed without upper gastrointestinal endoscopy.
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Affiliation(s)
- S D Ladas
- 2nd Department of Internal Medicine, Athens University, Evangelismos Hospital, Greece.
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Ladas SD, Rokkas T, Georgopoulos S, Kitsanta P, Liatsos C, Eustathiadou P, Karameris A, Spiliadi C, Raptis SA. Predictive factors and prevalence of follicular gastritis in adults with peptic ulcer and nonulcer dyspepsia. Dig Dis Sci 1999; 44:1156-60. [PMID: 10389688 DOI: 10.1023/a:1026624206987] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Follicular gastritis is an important histological entity, because it may progress to overt gastric MALT lymphoma. However, there is no universal agreement on whether there is any correlation of follicular gastritis with histological features of the antral mucosa or on the prevalence of follicular gastritis. To shed further light on these issues, we studied antral biopsies obtained from 735 adult patients, who had participated in six consecutive clinical trials. They included 348 patients with duodenal ulcer, 82 with gastric ulcer, and 305 with nonulcer dyspepsia. The Sydney classification system of gastritis was used, using a score of 0-3 to grade degree and activity of inflammation, gland atrophy, intestinal metaplasia, and H. pylori colonization density. Follicular gastritis was defined as prominent lymphoid follicles with no lymphoepithelial lesion. None of the H. pylori-negative patients (N = 159) had follicular gastritis. Among H. pylori-positive patients, 80/340 (23.5%) with duodenal ulcer, 5/77 (6.5%) with gastric ulcer, and 20/159 (12.6%) with nonulcer dyspepsia had follicular gastritis (P < 0.001). Multivariate discriminant analysis selected the following four significant predictor variables for follicular gastritis (Wilks lambda = 0.91, chi2 = 70.6, df = 4, P < 0.001): gastritis sum score, atrophic gastritis, age of the patient, and disease. The prevalence of follicular gastritis was linearly correlated (gamma = 24.55 - 0.98chi, r = -0.62, F1,11 = 6.12, P = 0.03) with the age groups of the 576 H. pylori-positive patients studied. In conclusion, follicular gastritis is highly correlated with H. pylori-caused severe, active gastritis. It is mostly prevalent in the young H. pylori-infected patients with duodenal ulcer.
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Affiliation(s)
- S D Ladas
- Second Department of Internal Medicine, Evangelismos Hospital, Athens University, Greece
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Kordossis T, Paikos S, Aroni K, Kitsanta P, Dimitrakopoulos A, Kavouklis E, Alevizou V, Kyriaki P, Skopouli FN, Moutsopoulos HM. Prevalence of Sjögren's-like syndrome in a cohort of HIV-1-positive patients: descriptive pathology and immunopathology. Rheumatology (Oxford) 1998; 37:691-5. [PMID: 9667626 DOI: 10.1093/rheumatology/37.6.691] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aims of the study were (a) to investigate the prevalence of Sjögren's-like syndrome (SLS) in an unselected population of HIV-1-positive patients and (b) to describe the pathology and immunopathology of the labial minor salivary gland biopsy. Seventy-seven HIV-1-positive patients were asked to answer the validated questionnaire of the European preliminary criteria for the classification of Sjögren's syndrome on oral and ocular sicca symptoms. Twenty-six patients gave one positive answer to both ocular and oral symptoms, and of these 14 (hepatitis C virus negative) consented to participate in the study (patients group). Ten age- and sex-matched HIV-1-positive patients with a negative questionnaire constituted the control group. Patients and controls had: (a) Schirmer's test and slit-lamp examination after Rose Bengal staining; (b) parotid gland scanning with technetium; (c) detection of autoantibodies in sera to Ro/SSA and La/SSB; (d) labial salivary gland biopsy (patients group only). The control group gave negative parotid gland scanning and only one gave a positive Rose Bengal staining test. In the patients group, parotid gland enlargement was manifested by three patients and only one gave positive Rose Bengal staining test. Six out of the 14 patients had biopsies identical with Sjögren's syndrome and five of these gave positive parotid gland scanning. In the biopsies of four other patients, mucoid degeneration of the stroma was found. Immunopathology revealed that the predominant cells were T cells with the CD8 phenotype. None of the patient and control sera had autoantibodies to Ro/SSA and La/SSB, whereas all patients had hypergammaglobulinaemia. The overall prevalence of possible SLS in a mixed population of HIV(+) patients (88.3% men and 11.7% women) was 7.79% which is >2.5 times higher than that observed in normal Greek adult females.
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Affiliation(s)
- T Kordossis
- Department of Pathophysiology, Medical School, National University of Athens, Greece
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