Crohn's disease activity assessed by Doppler sonography: the role of aortic flow parameters.

OBJECTIVES: Intestinal neovascularization and abnormal abdominal arterial flow rates have been reported in Crohn's disease. The aim of this study was to evaluate Doppler sonography as a method for assessing Crohn's disease activity based on changes in splanchnic hemodynamics. METHODS: Forty-eight patients with Crohn's disease, 22 healthy volunteers and 12 patients with irritable bowel syndrome were evaluated by Doppler ultrasound for flow parameters of the aorta and superior mesenteric artery. This evaluation included the cross-sectional area, maximum flow volume, peak systolic velocity, end diastolic velocity, resistance and the pulsatility index. Disease activity was classified according to the Crohn's disease activity index. RESULTS: Most measurements in the aorta and superior mesenteric artery were significantly different between Crohn's disease patients and both control groups. Only the aortic maximum flow volume (CC = 0.37, p = 0.009) and aortic peak systolic velocity (CC = 0.30, p = 0.035) showed a significant positive correlation with the Crohn's disease activity index. The determination of cut-off points for the aortic maximum flow volume and peak systolic velocity measurements increased the sensitivity (80 and 75% for flow volume and velocity, respectively), specificity (57 and 75%), accuracy (67 and 75%) and positive (57 and 68%) and negative (80 and 81%) predictive values. These cut-off values permitted the correct classification of most of the patients with Crohn's disease with respect to disease activity. None of the superior mesenteric artery measurements were able to discriminate patients in relation to disease activity. CONCLUSION: The aortic maximum flow volume and peak systolic velocity levels estimated by Doppler sonography reflected disease activity in Crohn's disease. Doppler sonography of the aorta is therefore a novel noninvasive adjunct method that may be useful in the clinical follow-up of patients with Crohn's disease.

Prognostic significance of p53 protein expression in early gastric cancer.

Mutations of the p53 tumor suppressor gene have been associated with abnormalities in cell cycle regulation, DNA repair and synthesis, apoptosis, and it has been implicated in the prognosis of advanced gastric cancer. The aim of this study was to evaluate the occurrence of p53 gene mutation and its possible prognostic implications in early gastric cancer. In a retrospective study, we studied 80 patients with early gastric cancer treated surgically between 1982 and 2001. Mutation of p53 gene was investigated in surgical gastric specimens by immunohistochemistry, and results were analyzed in relation to gender, age, macroscopic appearance, size and location of tumor, presence of lymph nodes, Lauren's histological type, degree of differentiation, and the 5-year survival. The expression of p53 was more frequent among the intestinal type (p = 0.003), the differentiated (p = 0.007), and the macroscopically elevated tumors (p = 0.038). Nevertheless, the isolated expression of p53 was not associated with the 5-year survival, or with the frequency of lymph node involvement. The degree of differentiation was detected as an independent factor related to the outcome of patients (0.044). Significantly shorter survival time was found in p53-negative compared with p53-positive patients, when considering the degree of differentiation of tumors, as assessed by Cox regression analysis (0.049). The association of p53 with the intestinal type, the degree of differentiation and morphological characteristics, may reflect the involvement of chronic inflammatory process underlying early gastric cancer. In this population sample, the expression of p53 alone has no prognostic value for early gastric cancer. However, the significant difference in p53 expression between subgroups of degree of differentiation of tumors can influence post-operative outcome of patients and may be related to possible distinct etiopathogenic subtypes.

Crohn's disease activity assessed by doppler sonography: the role of aortic flow parameters

OBJECTIVES: Intestinal neovascularization and abnormal abdominal arterial flow rates have been reported in Crohn's disease. The aim of this study was to evaluate Doppler sonography as a method for assessing Crohn's disease activity based on changes in splanchnic hemodynamics. METHODS: Forty-eight patients with Crohn's disease, 22 healthy volunteers and 12 patients with irritable bowel syndrome were evaluated by Doppler ultrasound for flow parameters of the aorta and superior mesenteric artery. This evaluation included the cross-sectional area, maximum flow volume, peak systolic velocity, end diastolic velocity, resistance and the pulsatility index. Disease activity was classified according to the Crohn's disease activity index. RESULTS: Most measurements in the aorta and superior mesenteric artery were significantly different between Crohn's disease patients and both control groups. Only the aortic maximum flow volume (CC = 0.37, p = 0.009) and aortic peak systolic velocity (CC = 0.30, p = 0.035) showed a significant positive correlation with the Crohn's disease activity index. The determination of cut-off points for the aortic maximum flow volume and peak systolic velocity measurements increased the sensitivity (80 and 75% for flow volume and velocity, respectively), specificity (57 and 75%), accuracy (67 and 75%) and positive (57 and 68%) and negative (80 and 81%) predictive values. These cut-off values permitted the correct classification of most of the patients with Crohn's disease with respect to disease activity. None of the superior mesenteric artery measurements were able to discriminate patients in relation to disease activity. CONCLUSION: The aortic maximum flow volume and peak systolic velocity levels estimated by Doppler sonography reflected disease activity in Crohn's disease. Doppler sonography of the aorta is therefore a novel noninvasive adjunct method that may be ...

Immunohistochemical study of intestinal eosinophils in inflammatory bowel disease.

BACKGROUND: Eosinophil accumulation and activation are characteristic features of inflammation in allergic diseases and in host defense against parasites. GOALS: To investigate the involvement of eosinophils in inflamed and noninflamed mucosa of patients with inflammatory bowel disease (IBD). STUDY: Specimens of inflamed colonic mucosa from 15 patients with ulcerative colitis (UC) and inflamed and noninflamed colonic mucosa from 15 patients with Crohn's disease (CD) were submitted to histologic and immunohistochemical studies. Twelve patients with irritable bowel syndrome were studied as controls. Sirius red was used to label eosinophils in tissue. EG1, EG2, and anti-hIL-5 were used as primary antibodies in an indirect alkaline phosphatase-labeled immunostaining protocol. Both positive and negative lamina propria cells were assessed by a quantitative grading system and the results expressed as cell numbers per mm. RESULTS: Increased proportions of eosinophils stained with Sirius red, EG1, EG2, and anti-hIL-5+ cells were found in the colon of patients with UC and in inflamed and noninflamed colon of CD patients as compared with controls. Crohn's disease patients showed increased proportions of EG1+ and EG2+ cells as compared with those with UC. Increased proportions of IL-5+ cells were detected in UC patients as compared with those with CD. CONCLUSION: Quantitative eosinophil alterations and IL-5+ cells may indicate enhanced cellular activation with degranulation, which is implicated in the pathogenesis of IBD. Increase in IL-5+ cells may reflect a predominant local Th2 response in UC as compared with CD.

Estudo das imunoglobinas intestinais na estrongiloidíase / Intestinal immunoglobulin study in clinical strongyloidiasis

Foram selecionados 32 pacientes infectados pelo Strongyloides stercoralis, sem imunodeficiência prévia ou outra doença associada. Foram divididos em três grupos: assintomáticos, sintomáticos leves e sintomáticos graves, com o objetivo de estudar a resposta imunológica do hospedeiro ao parasita. Os pacientes do grupo sintomático grave apresentavam esteatorréia, emagrecimento acentuado, albuminemia menor que 3 por cento e alteraçöes radiológicas. Doze voluntários sadios, sem verminose, formaram o grupo controle. A biópsia peroral do intestino delgado foi o método utilizado para obtençäo de fragmento da mucosa intestinal, ao nível do ângulo de Treitz. O estudo da concentraçäo das imunoglobulinas locais (IgA, IgC e IgM), pela técnica da imunofluorescência direta, demonstrou diminuiçäo significativa da concentraçäo de IgA nos pacientes sintomáticos graves e diminuiçäo da concentraçäo de IgM nos três grupos, quando comparados ao grupo controle. Näo houve alteraçöes da concentraçäo da concentraçäo de IgC

Hiperparatireoidismo primário, úlcera péptica e pancreatite: uma associaçäo pouco freqüente; relato de um caso / Primary hyperparathiroidism, peptic ulcer and pancreatitis: a rare association; a case report

É relatado um caso de hiperparatireoidismo primário concomitante a úlcera duodenal e pancreatite. Esta associaçäo, considerada muito rara, é descrita neste artigo, juntamente com revisäo atualizada do assunto. Exames laboratoriais afastaram a possibilidade de ser um caso de síndrome de Zollinger-Ellison. Adenoma único de paratireóide foi, provavelmente, responsável por todo o quadro clínico apresentado pelo paciente. Após ablaçäo cirúrgica deste adenoma, o paciente evoluiu para a normalizaçäo dos exames laboratoriais e tornou-se clinicamente assintomático

Doença de Crohn e gravidez / Crohn disease and pregnancy

Durante um levantamento realizado sobre doença de Crohn no Hospital Universitário, teve-se o interesse despertado pelo binômio doença de Crohn-gravidez. Fez-se uma revisäo bibliográfica e estudaram-se 11 pacientes do sexo feminino, concluindo que, pelo menos em duas pacientes, houve uma relaçäo entre o período grávido-puerperal e a eclosäo da doença

Doença de Crohn e o sistema imunológico: apenas uma teoria? / Crohn's diseases and the immunological system: only a theory?

É examinada a base da teoria imunológica e apresentada uma revisäo dos estudos mais recentes sobre os processos imunológicos na doenca de Crohn

Experiência com biopsia peroral do intestino delgado no Hospital Universitário - UFRJ / Experience with small bowel peroral biopsy at the University Hospital - UFRJ

É apresentada experiência com 103 biopsias perorais do intestino delgado realizadas no Hospital Universitário da Universidade Federal do Rio de Janeiro, no período de janeiro de 1983 a junho de 1985. A eficiência do método e o baixo índice de complicaçöes säo discutidos, além de ser ressaltada sua utilidade diagnóstica e valor na área da pesquisa das afecçöes intestinais

Degeneraçäo hepato-lenticular (doença de Wilson): quatro casos entre irmäos / Hepatolenticular degeneration (Wilson's disease): 4 cases among siblings

Säo relatados quatro casos de doença de Wilson entre irmäos com comprometimento hepático grave