Chronic gastritis associated with infection due to Helicobacter pylori in southern Appalachian veterans with dyspepsia.

A prospective study of infection due to Helicobacter pylori in 104 Southern Appalachian veterans with upper gastrointestinal symptoms revealed a prevalence of 67%. There was no age difference observed between those with and without H pylori. The organism was shown to be present in 12 of 13 patients with duodenal ulcer (92%), 6 of 10 with gastric ulcer (60%), and 52 of 81 with nonulcer dyspepsia (64%). Using culture as standard, the urease test showed a sensitivity of 76% and specificity of 100%, while the biopsy stain had a sensitivity of 97%. The presence of acute inflammation in the antrum and body of the stomach closely correlated with the presence of the organism. Somewhat at variance with previous studies, our study indicated that H pylori in the body mucosa was strongly associated with chronic superficial gastritis with and without acute inflammation. Such a finding may reflect the natural history of infection due to H pylori and the advanced age of our patients.

Study of Helicobacter pylori colonization of patches of heterotopic gastric mucosa (HGM) at the upper esophagus.

Helicobacter pylori (HP), known to cause active chronic gastritis, has primarily been found in gastric-type mucosa. Even in the duodenum, the organism was detected in islands of metaplastic gastric mucosa. HP has also been found in gastric metaplasia of Barrett's esophagus in 15-50%. The aim of our study was to determine: (1) the frequency with which HP is found on histopathological sections of heterotopic gastric mucosa (HGM) patch(es) at the upper esophagus, as compared to that of the stomach proper, and (2) the histopathological significance of infection in the HGM patches. From 63 patients with HGM patches at the upper esophagus, 48 patients were found to have concurrent adequate specimen from the stomach for modified Steiner's stain. In 22 patients (45.8%), pair sections from HGM and stomach were negative for HP. Of 26 patients (54.1%) HP-positive on sections from the antrum and/or body (both in 21 cases) nine patients (18.7%) demonstrated HP in the HGM patches. Whereas focal acute inflammatory changes on the H&E section of HGM was present in six patients, HP was detected in HGM only in one. Chronic inflammatory cell infiltration was detected in all nine HP-positive HGM patches and in 37 of 39 HP-negative patches. A mixed acute and chronic inflammatory cell infiltration was found in five of these 37 patients. Our data demonstrate that HP infection of HGM patches at the upper esophagus is part of the HP gastritis and an independent colonization of HGM patches without gastric infection does not occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence of heterotopic gastric mucosa in the upper oesophagus.

In a prospective study of the frequency and clinical importance of heterotopic gastric mucosa in the upper oesophagus, 634 consecutive veteran patients (98% male), undergoing endoscopy for various gastrointestinal complaints, were evaluated. Sixty four patients (10%) had heterotopic gastric mucosal patches varying in size from 0.2-0.3 cm to 3 x 4-5 cm often immediately below the upper oesophageal sphincter. Biopsies of these patches showed fundic type gastric mucosa with chief and parietal cells. The 10% prevalence is more than twice the highest reported prevalence rate of endoscopically detected patches in the upper oesophagus. The characteristic location of these patches at the sphincter area, their uniformly fundic type gastric mucosa, and their poor correlation with clinical and endoscopic evidence of gastro-oesophageal reflux support the hypothesis that they are congenital in nature.

Spreadsheet interface for transfer of drug-use data from a mainframe to a personal computer.

The development of spreadsheets and automated instructions for transfer of drug-use data from a hospital's mainframe computer to the pharmacy department computer is described. Drug-use data are down-loaded from the mainframe as an ASCII file on a floppy disk. Instructions within the spreadsheet ("macros") are used to import the data into the first spreadsheet, arrange the data to be compatible with the database portion of the spreadsheet, and transfer the data to another spreadsheet where drug use and cost are calculated and placed in the column for the appropriate month. A series of formulas are used to arrange the imported data to account for items that have not been used. By eliminating the need for manual data input into the spreadsheets, the macros and associated formulas saved pharmacists substantial time.

Disulfiram-induced hepatitis.

We reported a case of disulfiram-induced hepatitis with unique clinical features and compared our case with others in the literature. Our patient had headache, mild fever, nausea, vomiting, rash, and eosinophilia after 3 weeks of disulfiram therapy. Subsequent liver biopsy showed low-grade lobular hepatitis. After disulfiram therapy was discontinued, symptoms subsided and results of liver function tests returned to normal.

Methyltestosterone-induced cholestasis. The importance of disproportionately low serum alkaline phosphatase level.

We describe a 64-year-old man who developed cholestatic jaundice after receiving 20 to 40 mg of methyltestosterone daily for 6 months for impotence but failed to mention it as part of his drug history. He underwent endoscopic retrograde and papillotomy before a positive history for methyltestosterone ingestion could be obtained. Since methyltestosterone is most often used for sexual impotence, the patient may be quite reluctant to mention this hormone as part of his medication. A normal or mildly elevated alkaline phosphatase level, disproportionate to the level of hyperbilirubinemia seen in this patient and in all previous reports, appears to be characteristic of this phenomenon. This pattern of liver function abnormality can be a clue to suspect methyltestosterone as the causative agent and spare the patient unneeded expensive noninvasive and potentially harmful invasive procedures.

The value of Chiba fine-needle aspiration biopsy in the diagnosis of hepatic malignancy: a comparison with Menghini needle biopsy.

The detection or exclusion of metastatic liver involvement is critical in the management and prognosis of patients with malignant disease. Noninvasive imaging modalities such as computed tomography, ultrasound, and technetium colloid liver scan are highly sensitive but nonspecific. Serum alkaline phosphatase is of similar value. A blind liver biopsy by the Menghini technique is often done to confirm the diagnosis, but its yield is low. We prospectively evaluated 74 patients using blind Menghini needle biopsy and concurrent Chiba fine-needle aspiration biopsy (FNAB) techniques. A positive diagnosis of malignancy was made in 30 patients (41%). In only 25 (34%) was the diagnosis made by Menghini biopsy, while Chiba FNAB confirmed the diagnosis in all 30 patients. Thus, concurrent use of both needles increased the diagnostic accuracy by 7%. Seven additional patients, considered to have one or more contraindications for the Menghini biopsy, underwent Chiba FNAB alone; the diagnosis was confirmed in all without complication. We conclude that FNAB alone or in combination with Menghini biopsy is valuable and safe in the diagnosis of metastatic liver disease.

False-positive diagnosis in fine-needle aspiration of an atypical Warthin's tumor: histochemical differential stains for cytodiagnosis.

Cytologic smears of a Warthin's tumor (WT) typically consist of sheets of oncocytic (oxyphilic) cells and scattered lymphocytes. Reparative foci within this neoplasm can occur, which may give rise to exfoliated, malignant-appearing, squamous-like cells. A false-positive diagnosis of squamous carcinoma can occur when these atypical cells dominate the cytologic aspirate. Histochemical and immunoperoxidase stains may aid in diagnosing an atypical WT when the usual cytologic features are absent.

Condyloma acuminata presenting as rectal polyps in a heterosexual man: importance of CT scan of the pelvis.

Condyloma acuminata generally occur in and outside the anal canal of young homosexual men who practice anal coitus. We report the occurrence of large condyloma acuminata in the rectum of an elderly heterosexual man. Its characteristic endoscopic, pathological and CT scan features are discussed. CT scan may be invaluable in assessing local infiltration.

Squamous cell carcinoma of the esophagus: continuing poor prognosis among veterans.

A retrospective analysis of 26 patients with squamous cell carcinoma of the esophagus treated at our center over a five-year period showed that the prognosis of this condition was still poor, with a mean length of survival of only 29 weeks after diagnosis; 88% of this period was spent in the hospital. The one-year survival rate was 23%. There were no two-year survivors. No major difference in survival based on method of treatment was evident though the groups were not truly comparable. We believe that a more thorough initial work-up including computerized tomography (CT) of the chest and upper abdomen in all cases would be invaluable in more accurately assessing the degree of spread. More frequent use of dilation and stents for palliation, rather than gastrostomy or jejunostomy will improve both survival and the quality of remaining life.

The incident at Tuol Chrey: pathologic and toxicologic examinations of a casualty after chemical attack.

The results of the pathologic and toxicologic examinations of specimens from a casualty who died several weeks after a chemical attack in Kampuchea are discussed. While the effects of tricothecene mycotoxins have been described in domestic and experimental animals, there is a paucity of information about the pathologic effects of these toxins in humans. The possible effects of endemic diseases such as falciparum malaria, viral hepatitis, and nutritional deficiencies, as well as of the sudden, unexpected death syndrome among refugees from Southeast Asia, have been reviewed. If the results of the histologic examinations in this case are considered alone, it is not possible to establish a cause-effect relationship. However, the circumstances of injury, the relationship of pathologic findings to the studies of experimental animals, and the results of the toxicologic examinations of environmental and biologic specimens indicate that the combinations of tricothecene mycotoxins detected are not consistent with natural occurrence and provide evidence that the pathologic effects are related to a toxic agent.

Ovarian carcinoma presenting as a cervical metastasis.

An unusual presentation of an ovarian carcinoma masquerading as a primary cervical malignancy is reported with comprehensive review of the literature regarding metastatic disease to the cervix.

Cellular atypia in a rheumatoid nodule: a diagnostic pitfall of aspiration biopsy.

A 63-year-old cachectic white male developed subcutaneous scalp nodules. Clinically these were felt most likely to represent metastatic tumor, although the patient was known to have rheumatoid arthritis. Aspiration cytology was interpreted as malignant due to the presence of atypical cells, but tissue biopsies demonstrated necrotizing palisading granulomas. The diagnostic hazard of cellular atypia in rheumatoid nodules is discussed.

Acute hepatitis associated with campylobacter colitis.

A patient with proven campylobacter fetus ss. jejuni acute colitis developed hepatocellular dysfunction, which paralleled the course of the colitis. Liver biopsy showed nonspecific reactive hepatitis. Other causes of acute hepatocellular damage were excluded. The patient made a complete recovery.