Microalbuminuria in inflammatory bowel diseases using immunoturbidimetry and high-performance liquid chromatography.

BACKGROUND AND STUDY AIMS: To measure urinary albumin excretion using immunoturbidimetry (IT) and high-performance liquid chromatography (HPLC) in inflammatory bowel diseases. PATIENTS AND METHODS: A cross-sectional study was carried out on 60 selected patients with Crohn's disease (CD), 57 with ulcerative colitis (UC) and 22 healthy volunteers, as controls. Urinary albumin excretion was measured by IT and HPLC, and albumin-creatinine ratio was calculated. This ratio was compared in patients with active and inactive CD and UC and in healthy volunteers. RESULTS: Patients with CD and UC had higher albumin-creatinine ratio compared to controls using both IT and HPLC (p < 0.05). We measured higher albumin-creatinine ratio in patients with active compared to inactive CD (p < 0.05). Albuminuria did not correlate with disease duration of CD or UC, but patients with more extended CD according to the Montreal classification had higher HPLC-albumin-creatinine ratio. In CD, we found a significant correlation between HPLC-albumin-creatinine ratio and some inflammatory markers i.e. white blood cells (p < 0.05) and erythrocyte sedimentation rate (p < 0.05). In UC, there was no significant correlation between HPLC-albumin-creatinine ratio and the above markers of systemic inflammation or activity of UC. Albumin-creatinine ratio measured by HPLC was higher in both active and inactive CD and UC groups than albumin-creatinine ratio measured by IT. Using a receiver operating characteristics curve analysis, in case of HPLC-albumin-creatinine ratio cut-off values of the activity of CD were 2.46 mg/mmol for men, 5.30 mg/mmol for women. CONCLUSIONS: HPLC-urinary albumin-creatinine ratio is associated with the clinical and laboratory disease activity indices in CD, but not in UC. Using HPLC we found a more sensitive method compared to IT to measure albuminuria that would be a sensitive activity marker in CD.

[Osteomalacia with fatal outcome in an elderly patient]. / Zum Tod führende Osteomalazie bei einer älteren Kranken.

HISTORY AND ADMISSION FINDINGS: A 63-year-old woman was admitted with diffuse bone pain, chest deformity and orthopnea. She had previous prolonged periods of bed rest and decreased sunlight exposure after several bone fractures. INVESTIGATIONS: Laboratory tests showed hypocalcemia, hypophosphatemia with secondary hyperparathyroidism. The 25-hydroxy-D-vitamin level was too low for measurement. Radiological investigations raised the possibility of metabolic bone disease with secondary fracture. (99m)Tc-MDP bone scintigraphy demonstrated pathological isotope accumulation in places typical for osteomalacia. The histological investigation of the bone showed a thickening of the osteoid substance. DIAGNOSIS, TREATMENT AND COURSE: Osteomalacia was diagnosed. Two weeks of administering of daily 3000 I.U. vitamin D and 1500 mg calcium normalised the serum level of calcium and phosphate. Because of orthopnea and bone pain the patient stayed in the bed, and had to be given her nadroparin calcium. After six weeks heart and respiratory failure occurred. The patient died from a subtotal pulmonary embolism, which was a consequence of a deep vein thrombosis of the leg. CONCLUSION: In elderly people chronic and serious vitamin D deficiency can cause a life-threatening condition which can be prevented by vitamin D and calcium administration.

Fatal scleroderma renal crisis caused by gastrointestinal bleeding in a patient with scleroderma, Sjögren's syndrome and primary biliary cirrhosis overlap.

A 57-year-old female patient presented with a long history of overlapping autoimmune disease, including limited cutaneous systemic sclerosis, Sjögren's syndrome and primary biliary cirrhosis. Another unusual finding was that the mild skin involvement (limited cutaneous systemic sclerosis, subcutaneous calcinosis) was combined with serious internal organ involvement, including honeycombing and finally scleroderma renal crisis. The most important finding was, that two decades later she developed severe telangiectasia of the gastrointestinal and urinary tract. Furthermore, a specific type of vascular malformation, i.e. gastric watermelon stomach was also found. The chronic gastrointestinal bleeding primarily derived from a watermelon stomach caused protein overload, which provoked the onset of the scleroderma renal crisis that finally led to the patient's death.

[The "watermelon" stomach as a rare cause of upper gastrointestinal bleeding]. / A görögdinnyegyomor, mint a felsó gastrointestinalis vérvesztés ritka oka--sikeres hormonterápia.

The watermelon stomach is a rare subtype of the gastric vascular malformations of unknown origin. It can usually be observed with autoimmune diseases, but in can be associated with other conditions. It is significant, since it can cause chronic iron-deficiency anaemia or sometimes serious acute blood loss. The typical endoscopic picture is linear red streaking of the antrum with convergence at the pylorus with visible tortuous small vessels. Histological examination is frequently not diagnostic. It demonstrates specific features including dilated mucosal capillaries with focal thrombi, dilated submucosal venous plexus and fibromuscular hyperplasia of the lamina propria. Therapy mostly is endoscopic, but some medical possibilities are also known. In their paper they report two cases of watermelon stomach, the lesions were successfully treated with oestrogen-progesterone compounds.

[Barrett esophagus in systemic sclerosis]. / Barrett-oesophagus szisztémás sclerosisban.

Systemic sclerosis is a generalized systemic autoimmune disorder frequently involving the oesophagus causing reflux oesophagitis in the majority of patients. Barrett's oesophagus is one of the most serious complication of the reflux oesophagitis, in which the normal oesophageal squamous epithelium is partially replaced by metaplastic columnar epithelium. The clinical significance of Barrett's oesophagus is the significantly increased risk of developing the adenocarcinoma. In our paper, the authors present 5 cases with Barrett's oesophagus among their 52 examined patients with scleroderma.

[Granular cell tumor of the esophagus]. / Granularis sejtes tumor a nyelócsóben.

Granular cell tumor is a relatively rare, mostly benign lesion, that can be found in almost every organ, however, only 2% of the cases is oesophageal. It is named after the eosinophilic S-100 protein positive granula in the cytoplasm of the tumor cells. Since patients with oesophageal granular cell tumor are mostly symptomless, the tumor is usually found accidentally. Even in patients with dysphagia, contrast radiograph and gastroscopy show an atypical picture, therefore, the diagnosis is based on the histological examination. Therapy is usually conservative, but surgical treatment might be necessary sometimes. A patient with severe dysphagia is reported here. She was diagnosed with a granular cell tumor in the oesophagus, and the tumor was surgically removed.