Prospective assessment of serum periostin as a biomarker for diagnosis and monitoring of eosinophilic oesophagitis.

BACKGROUND: Periostin is highly expressed in eosinophilic oesophagitis (EoE), but has not been extensively studied as a non-invasive biomarker. AIM: To assess whether serum periostin distinguished EoE from controls at baseline, had utility for monitoring treatment response, or was associated with IL-13 levels. METHODS: This was a sub-analysis of a prospective cohort study of adults undergoing out-patient upper endoscopy. Incident cases of EoE were diagnosed per consensus guidelines. Controls were subjects with either GERD or dysphagia without EoE. EoE patients were treated with swallowed/topical steroids and had repeat endoscopy/biopsy. Serum periostin levels for cases and controls were compared at baseline, and pre/post-treatment levels were compared for cases. Serum IL-13 and tissue expression of periostin were also assessed. RESULTS: A total of 61 incident EoE cases and 87 controls were analysed. Despite a marked increase in tissue periostin expression in cases, the median baseline serum periostin level was only slightly higher in cases than controls (22.1 ng/mL vs. 20.7; P = 0.04); there was no change in post-treatment levels. There was also no difference in serum periostin for cases by histologic response or atopic status. There was a strong trend towards higher serum IL-13 levels in cases in the highest periostin quartile (57.1 pg/mL vs. 2.6; P = 0.07). CONCLUSIONS: Serum periostin levels were similar in cases and controls, and there were no changes post-treatment. Given elevated IL-13 levels in the EoE patients with the highest periostin levels, future studies could explore periostin as a biomarker in EoE, perhaps in the setting of anti-IL-13 therapy.

Short-term endobiliary stenting results in chronic inflammation of the porcine extrahepatic biliary system.

This study reports the histologic changes seen in the biliary ductal system and pancreas as a result of endobiliary stenting. Ten mini pigs underwent endoscopic placement of suprapapillary endobiliary stents. The animals were killed and the liver, biliary tree, and pancreas were resected en bloc and prepared for histologic examination. Endobiliary stenting was found to result in significant chronic inflammation in the biliary system within 4 weeks of stent placement. These changes were present throughout the entire extrahepatic biliary ductal system and persisted throughout the 15-week study period. There was no significant acute inflammation in the biliary tree nor acute or chronic inflammation in the pancreatic duct. Further study is indicated to determine whether these changes will result in fibrosis and stricture.

The 1998 Wendell Hughes Lecture. Evisceration: is sympathetic ophthalmia a concern in the new millennium?

PURPOSE: To investigate a possible relationship between evisceration and sympathetic ophthalmia. METHODS: Data from Mt. Sinai Medical Center and University Hospitals of Cleveland were collected and histopathologic specimens were reviewed for 51 of 90 patients who underwent evisceration between 1980 and 1996 and who returned for follow-up examinations. Additionally, a survey was sent to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, the Uveitis Society, and the Eastern Ophthalmic Pathology Society to determine the number of enucleations and eviscerations performed and the documented incidence of sympathetic ophthalmia after evisceration. RESULTS: No clinical or histopathologic evidence of sympathetic ophthalmia after evisceration was found among patients treated at the two medical centers. The collective surveys showed a strong preference for enucleation over evisceration, but did not document evidence of sympathetic ophthalmia after evisceration. CONCLUSIONS: Evisceration is an effective and safe procedure with a low risk for sympathetic ophthalmia.

Pretreatment with allopurinol diminishes pancreatography-induced pancreatitis in a canine model.

BACKGROUND: The role of oxygen-derived free radicals in the pathogenesis of pancreatitis has been supported by data from previous studies using animal models. This study was conducted to determine whether prophylaxis with the xanthine oxidase inhibitor allopurinol would decrease the incidence and severity of pancreatography-induced pancreatitis in a canine model. METHODS: Thirty-two dogs were randomized to receive either placebo or oral allopurinol 1 hour before the procedure. A laparotomy and duodenotomy were performed and a pancreatogram was obtained. Postoperatively, pancreatic enzymes were drawn for 5 days. The animals were then euthanized, and the pancreas was weighed and evaluated histologically. RESULTS: The histologic incidence of pancreatitis was significantly reduced in the allopurinol pretreatment group (6.7%) as compared with the placebo group (41.2%, p < 0.01). A significant decrease in postoperative serum amylase levels among dogs pretreated with allopurinol was also noted. A similar trend was observed in lipase levels. The pancreas weight index was decreased in the allopurinol pretreatment group as well (control = 0.00246 vs. allopurinol = 0.00195, p < 0.02). CONCLUSIONS: Pretreatment with oral allopurinol decreases the incidence of pancreatography-induced pancreatitis. These results support the role of xanthine oxidase inhibitors in the prevention of endoscopic retrograde cholangiopancreatography-induced pancreatitis.

Intratumoral heterogeneity of DNA ploidy in breast carcinomas: a flow cytometric assessment of sampling techniques.

Intratumoral heterogeneity of DNA ploidy has been identified in breast carcinomas; however, optimal sampling methods have not been determined. In this study of 28 invasive breast carcinomas measuring more than 1.4 cm in greatest dimension, two different techniques for obtaining cells for flow cytometric DNA ploidy analysis were compared. Two solid pieces of tissue were taken from opposite halves of the tumor. A third sample was obtained by scraping multiple cut surfaces of the tumor. Heterogeneity of DNA ploidy was detected in 43% of cases. Most cases demonstrating heterogeneity contained multiple aneuploid populations. However, in five cases classification of the tumors as either DNA euploid or DNA aneuploid differed among samples. A total of 39 non-diploid populations were detected in 23 of the cases. Thirty-three (85%) were detected by scraping and 35 (90%) were detected in either one or both tissue pieces. Intratumoral DNA heterogeneity emphasizes the need for adequate sampling. The scraping technique was as effective in identifying aneuploid cell populations as the combined results of the two pieces of tissue and better than sampling a single piece of tissue. Scraping also offers the advantage of tissue conservation which may be critical when various analytic studies are performed.

Giant nonfunctioning islet cell tumor requiring pancreaticoduodenectomy and complete liver revascularization.

Pancreaticoduodenectomy with revascularization of the hepatic artery and portal vein was performed on a 17-year-old girl with giant nonfunctioning islet cell tumor of the pancreas. She had a remote history of neonatal hypoglycemia leading to mental retardation and a right Wilms' tumor resected at 8 months. Serum pancreatic polypeptide levels were elevated. Her postoperative course was complicated by an ischemic perforation of the colon, which did not infect her prosthetic vascular grafts. The relationship between her neonatal hypoglycemia, Wilms' tumor, and subsequent islet cell neoplasm is unclear.

Intraoperative surgical specimen evaluation: frozen section analysis, cytologic examination, or both? A comparative study of 206 cases.

Having recently become aware of the merits of cytologic preparations, histopathologists are focusing their attention on cytologic examination as a means of intraoperatively evaluating surgical specimens. This study compares the diagnostic accuracy and quality of frozen-section (FS) and cytologic preparations from 206 surgical specimens. The quality of cytologic preparations was significantly superior to that of FSs (P = 0.0001). With the use of a three-level accuracy scale suited to the practical demands of intraoperative evaluation, there was no significant difference between the accuracy of diagnosis by FS analysis compared with that achieved by cytologic examination (P = 0.35). More importantly--except in one case--whenever one technique did not correctly distinguish benign from malignant disease, the other technique yielded an essentially correct diagnosis. With the use of both techniques, 99.5% of cases were interpreted correctly, at least in regard to benign versus malignant diagnoses. Because significant additional time, equipment, stains, laboratory space, or personnel are not needed to implement intraoperative cytologic studies in a routine anatomic pathology laboratory, the authors advocate the simultaneous use of FS and cytologic studies in the specified context.

Tract formation following percutaneous endoscopic gastrostomy in an animal model.

Complications of percutaneous endoscopic gastrostomy (PEG) have often been related to the application of excessive traction to the gastrostomy tube in an attempt to achieve immediate juxtaposition of the gastric and abdominal walls. Recent clinical reviews have suggested that complication rates can be reduced by avoiding such traction and leaving a longer tract between these structures. Laboratory evaluation of tract development has been lacking. The present study was designed to evaluate tract formation in an animal model. Eight mongrel dogs underwent PEG placement using silastic (n = 4) or latex (n = 4) catheters. Two animals from each group were subsequently sacrificed at 1 week and the remaining animals, at 2 weeks. In each animal, 6 cm catheter length was left between the gastric and the abdominal walls. This distance was assured by crossbar and suture fixation of the catheter at the skin entry site. Complete tract formation was evident in all animals at the time they were sacrificed, with no significant gross or histologic differences being noted between the silastic and the latex groups. Increased collagen deposition was noted at 2 weeks in comparison with that observed at 1 week. In an additional three animals, the same procedure was performed, but the catheter was not secured to the abdominal wall at the site of skin penetration. In these animals, tract formation was incomplete as late as at 2 weeks, but there were no associated complications. We conclude that early PEG tract formation is not dependent on the immediate proximity of the gastric and abdominal walls. The type of catheter used does not dictate the time course of early tract development.(ABSTRACT TRUNCATED AT 250 WORDS)

A severe fibrotic reaction after cosmetic liquid silicone injection. A case report.

A case of a severe, locally aggressive fibroblastic reaction to cosmetic silicone injection involving the orbital cone and anterior cranial base is presented. Included is a brief history and description of silicone injection and its complications. Though many facts remain to be discovered, speculation into the possible pathogenesis, with a review of the literature, shows that while silicone continues to be a useful tool for the plastic surgeon, an awareness of the risks, as well as a search for clues to avoid complications, must continue before further liberal use of this material is encouraged.

Paracortical immunoregulatory subpopulations in lymph nodes from homosexual men with persistent generalized lymphadenopathy.

Homosexual patients with persistent generalized lymphadenopathy usually show an abnormal expansion of paracortical T8+ lymphocytes relative to T4+ cells in lymph nodes with reactive follicular hyperplasia (RFH). This study was designed to characterize further the paracortical lymphocyte population in homosexual men with reactive follicular hyperplasia, because T8+ lymphocytes are antigenically and functionally heterogeneous. Frozen lymph node tissue from 10 patients was evaluated. Monoclonal antibodies to T8, Leu-15, NKH-1, Leu-7, and HLA-DR antigens were employed in the avidin-biotin complex immunoperoxidase technique. With digitized morphometry, positively stained cells for each marker were counted in five 0.145-mm2 microscopic fields. Four tonsils with RFH were used as controls. Most paracortical cells were T8+ (median, 4182 T8+ cells/five fields), and values were significantly higher than those for controls (median, 1518 T8+ cells p less than 0.006). In every case there were markedly fewer Leu 15-, NKH-1, Leu 7-, and HLA-DR-positive cells than T8+ cells (median values per five fields: Leu-15, 144; NKH-1, 12; Leu-7, 3; HLA-DR, 195). Moreover, these values were not significantly different from control values. Our findings suggest that the expanded paracortical T8+ population comprises cells with the immunophenotype of cytotoxic Leu-15-, T8+ lymphocytes, rather than natural killer or Leu-15+, T8+ suppressor cells.

Intestinal adenocarcinomas metastatic to the ovaries. A clinicopathologic evaluation of 22 cases.

The most common secondary ovarian neoplasm to mimic an ovarian primary tumor is metastatic large intestinal adenocarcinoma. Even after histologic examination, metastases often are mistaken for primary adenocarcinomas, especially endometrioid carcinoma. We analyzed the clinical and pathologic features of 22 cases of documented large intestinal carcinoma metastatic to the ovary. Patients' ages ranged from 42 to 76 years. None of the intestinal primary tumors were Dukes stage A, 32% were Dukes B, and 68% were Dukes C. In nine patients (41%), the intestinal carcinomas had been resected previously from 4 to 60 months before removal of the ovarian metastases. Both ovaries were involved in 43% of the cases. Histologically, 19 cases were classified as pseudoendometrioid type, two as mucinous type, and one as mixed pseudoendometrioid-mucinous type. The most characteristic microscopic features of the ovarian metastases were garland and cribriform growth patterns, intraluminal "dirty" necrosis, segmental destruction of glands, and absence of squamous metaplasia. Special stains for mucosubstances were variable and not helpful in differential diagnosis. Immunohistochemical staining for carcinoembryonic antigen (CEA) was strongly positive. Recognition of these distinctive histologic features is crucial to proper identification of the intestinal origin of these ovarian tumors. Inappropriate treatment as primary ovarian carcinomas thereby is avoided, and more accurate assessment of prognosis is achieved.

Partial mastectomy: pathologic findings and prognosis.

In an attempt to identify patients best suited for limited surgery as well as those at risk for recurrence and increased mortality, the authors reviewed the clinical and pathologic features of 130 patients who had undergone partial mastectomy as primary treatment for breast cancer (adjuvant therapy was administered only after disease recurrence). Patients were followed up for 57 to 128 months (mean, 85 months). Univariate and multivariate analyses were performed for the entire group and repeated for the large subgroup of patients with infiltrating ductal cancer, not otherwise specified. Three features were independently significant in correlating with poor survival and/or tumor recurrence: lymph node metastasis, mitotic rate, and nuclear atypia. Combinations of these factors further separated survivors from non-survivors. These prognostically significant pathologic features may be helpful in both selecting patients for partial mastectomy and identifying those who may require adjuvant therapy.