Acinar Cystic Transformation of the Pancreas: Report of Three Cases.

Acinar cystic transformation (ACT) of the pancreas is a rare non-neoplastic cystic lesion. It is most frequently observed in the head of the pancreas. Despite advances in radiologic imaging methods, preoperative diagnosis of acinar cystic transformation is difficult, it is often confused with other cystic lesions. Here, we report three cases of acinar cystic transformation, one of which showed diffuse involvement of the pancreas, and the remaining two were multilocular localized cystic lesions. We analyzed their histomorphologic and immunohistochemical features. The patients' ages ranged between 15 and 43 years and the ratio of females to males was 2:1. On microscopic examination, the cysts were lined by a single layer of flattened-cuboidal or columnar epithelial cells. The epithelial cells were diffusely positive with trypsin and keratin 7, but patchy with keratin 19. Due to its rarity and lack of radiologic and clinical awareness compared with other pancreatic cystic lesions, preoperative diagnosis of acinar cystic transformation is difficult and not definitive. All cases reported to date have been clinically benign and there is no evidence of recurrence or malignant transformation. The optimal treatment and whether to perform surgery remain controversial.

Gastrointestinal findings in 26 adults with common variable immunodeficiency: The fickle nature of the disease manifests in gastrointestinal biopsies.

BACKGROUND/AIMS: The aim of the present study was to demonstrate the histopathological findings in gastrointestinal (GI) biopsies in adults with common variable immunodeficiency (CVID). MATERIALS AND METHODS: A total of 172 GI biopsies of 26 patients with CVID obtained over a 16-year period were reevaluated. Findings were analyzed using descriptive analyzes and χ2 test. RESULTS: Female-to-male ratio was 1.36. The median age at diagnosis was 36±13.94 (16-72) years. Chronic esophagitis was noted in 3 patients. The absence of plasma cells in the stomach, duodenum, and colon was observed in 16, 14, and 9 patients, respectively. Divergent results for the presence of plasma cells in concurrent stomach and duodenum samples were found in 11 (44%) patients. Nodular lymphoid hyperplasia (NLH) was notable in the duodenum (56%). The mean number of eosinophils in one high-power field was significantly higher in duodenal biopsies with NLH (27.21 vs. 14.37, p=0.002). Active inflammation was more prominent in the colon (91%) than in the stomach (65%) and duodenum (60%). Helicobacter pylori infection was found in 57.6%, including a case with persistent infection by the coccoid form. Celiac-like villous blunting and increased intraepithelial lymphocytes were seen in 40% and 24%, respectively. In addition, 23% had giardiasis associated with acute duodenitis and duodenal NLH (p<0.05). CONCLUSION: CVID gastroenteropathy is a challenging entity, and due to the heterogeneity in the presence and distribution of plasma cells throughout the GI tract and diverse disease course, multiple concurrent biopsies may be needed for tissue diagnosis. Duodenal CVID may present with villous alterations and giardiasis, and NLH appears to be an important clue in the duodenum. The association between duodenal NLH and eosinophil infiltration deserves further investigation.

Prevention of pressure ulcers: a descriptive study in 3 intensive care units in Turkey.

PURPOSE: The aim of this descriptive study was to describe the level of preventive care provided to intensive care unit (ICU) patients at risk for development of pressure ulcers (PU). SETTING AND SUBJECTS: Our study population comprised 126 nurses working at coronary ICU, cardiovascular surgery ICU, or a gastroenterology ICU of State Hospital in the Republic of Turkey. The study sample consisted of 30 nurses selected from these units using a layered sampling method. INSTRUMENTS: Data were collected using the following 4 forms: (1) ICU evaluation form, (2) demographic questionnaire form, (3) Braden Scale, and (4) observation form. The observation form was developed by the investigator to record PU prevention interventions made by the study nurses. METHODS: Nurses were observed while giving care to patients at risk according to Braden Scale scores and each action of the nurses to prevent PU was recorded. Data were collected until 90 observations (3 observations with each of 30 nurses) were completed. RESULTS: Nurses did not consistently engage in interventions recommended for prevention of PU. Subjects did not consistently use the risk-evaluation scale, document position changes on the appropriate form, and train auxiliary personnel about PU prevention. The most frequently fulfilled behaviors for PU prevention were avoiding hot water when cleansing the skin, helping the patient eat, avoiding placing the patient directly on a trochanter, refraining from using improper support material, and use of pressure-redistribution surfaces. The least fulfilled behaviors were (1) application of a skin barrier or protectant on moist skin and (2) application of a moisturizer to dry or compromised skin, protecting the skin during patient transfer, repositioning, and documenting prevention interventions. CONCLUSION: This study demonstrates that critical care nurses do not consistently provide preventive care for PU.