Short-term corticosteroids for celiac crisis in infants.

We report two infants with celiac crisis who continued to have persistent secretory diarrhea despite gluten and lactose free diet and supportive parenteral nutrition. The children were given corticosteroid therapy. After a five-day oral prednisone in the dose of 2 mg/kg/daily, both patients rapidly recovered.

Histological features of gastric cardia in adults: an autopsy study.

BACKGROUND AND AIMS: The existence, histology and origin of gastric cardiac mucosa are controversial. The aim of the present study was to determine the existence, histological characteristics and length of cardiac mucosa and to correlate these features with the patients' age and the presence of inflammation in the gastric cardia and/or esophagus. METHODS; The cardiac mucosa within the whole esophagogastric junction was histologically analyzed in 38 consecutive autopsy specimens and measured in 24 cases. RESULTS: The cardiac mucosa was identified in all specimens from all cases, with a mean length of 6.7 mm, range 0.927-19.5 mm. In the majority of cases, the length of cardiac mucosa was less than 10 mm (87.5%) and greater than 5 mm (71%). Cardiac mucosa was composed of a combination of pure mucous glands and mucous glands with parietal cells in 74% of cases, and only of mucous glands with parietal cells in 26% of cases. Carditis was recorded in 23.7% cases and reflux esophagitis in 15.8%. The length of cardiac mucosa was not significantly different between cases with and without carditis (p>0.05), between those with and without esophagitis (p>0.05), and between age groups older and younger than 60 years (p>0.05). CONCLUSION: In the adult population, a short histological segment of gastric cardia was consistently present as a normal histological structure. The type, length and circumferential presence of cardiac mucosa were not significantly associated with carditis, esophagitis or age.

Influence of early feeding practices on celiac disease in infants.

AIM: To investigate whether duration of breastfeeding and timing of gluten introduction influence the age at diagnosis and severity of celiac disease. METHODS: Medical records of 89 infants (59 girls and 30 boys; mean age of 14.2 months, standard deviation 4.80) diagnosed with classic celiac disease at the University Children's Hospital in Belgrade from 2000 to 2008 were retrospectively analyzed to determine the duration of breastfeeding and timing of gluten introduction. The severity of celiac disease was assessed based on weight loss, longitudinal growth retardation, anemia, and secondary lactose intolerance. RESULTS: Longer breastfeeding significantly reduced the risk that celiac disease would manifest in the first year of life (odds ratio, 0.655; 95% confidence interval, 0.481-0.891; P=0.007), and duration of breastfeeding was the most significant predictor of developing celiac disease (B=0.49; 95% confidence interval, 0.131-0.768; P=0.007). There were no significant differences in age at diagnosis between infants who had started consuming gluten before the fourth month and those who had started between the fourth and sixth month. Neither breastfeeding nor timing of gluten introduction affected the severity of the disease. CONCLUSION: Longer breastfeeding and continuation of breastfeeding after gluten introduction delay the onset of classic celiac disease. On the other hand, neither breastfeeding nor the timing of gluten introduction affects the severity of celiac disease.

Activated liver stellate cells in chronic viral C hepatitis: histopathological and immunohistochemical study.

BACKGROUND: There is positive correlation between the number of activated hepatic stellate cells and necroinflammatory activity and/or the stage of liver fibrosis in viral hepatitis. No study has investigated such a relationship with regard to the activated hepatic cells within specified zones of liver tissue in chronic C hepatitis. The aim of the present study was to correlate the level of activated hepatic stellate cells within perivenular, intermediate, periportal, and portal tracts area and fibrous septa with stages of liver fibrosis and necroinflammatory activity in patients with chronic C hepatitis. METHODS: This retrospective study included 20 liver biopsy samples from patients with chronic C hepatitis and 10 normal liver biopsies. Biopsy specimens were processed routinely and stained with haematoxylin-eosin, periodic acid-Schiff, Masson;s trichrome, aldechide fuchsin, reticulin and iron (Pearls). Activated hepatic stellate cells were identified immunohistochemically using antibody to alpha-smooth muscle actin. Assessment of immunoreactivity was performed using a semiquantitative method. RESULTS: In chronic C hepatitis, a positive correlation between the stage of fibrosis and the number of activated hepatic stellate cells within portal spaces and fibrous septa was found. These cells were increased in number in other areas of liver tissue as well, but without statistical significance. There was no correlation between either the stage of fibrosis and necroinflammatory activity or the number of activated hepatic stellate cells and necroinflammatory activity. CONCLUSION: An increased number of activated hepatic stellate cells within portal spaces and fibrous septa may be a useful prognostic marker for the development of advanced fibrosis and cirrhosis in chronic C hepatitis.

[Multifocal Abrikossoff's granular cell tumour of the oesophagus--case report].

INTRODUCTION: Granular cell tumours, relatively uncommon soft tissue tumours, have been a matter of debate among pathologists regarding histogenesis for a long time. Less common locations are in the aerodigestive tract including the oesophagus. CASE OUTLINE: We have recently treated a rare case, a 37-year-old male, who was admitted due to dysphagia and a painful swallow with occasional pharyngo-nasal regurgitation followed with a mild loss of weight. Standard clinical examination including X-ray chest, ECG and laboratory tests did not show pathological findings. Barium contrast oesophagography demonstrated multiple ovoid defects in the wall of the oesophagus. CT scan of the chest confirmed luminal narrowing owing to the tumour of the upper oesophagus. Upper endoscopy showed unusual multifocal nodular lesions alongside the oesophageal axis covered by smooth mucosa. A primary biopsy specimen taken from the largest nodules confirmed an unusual pathological finding of the granular cell tumour. Subtotal, transpleural oesophagectomy was performed and reconstruction was derived by long colon segment interposition through the posterior mediastinum. The postoperative course was uneventful. The operative specimen consisted of four ovoid tumours alongside the oesophagus (the greatest diameter 0.5-1.8, average 1.25). All verified tumours histologicaly consisted of a spindle-shaped or polygonal cells containing small and large eosinophilic granules and central nuclei. Most tumour cells showed strongly positive immunohistochemical staining for S-100 protein. These tumour cells were partially positive for p-53 and Ki-67. No lymph node metastases were detected histologically. CONCLUSION: Multifocal granular cell tumour of the oesophagus is an unusual finding with low incidence, and rarely caused symptoms. Pathological features and multiplicity of such tumours emphasized malignant predisposition requiring surgical resection of the oesophagus.