Diagnosis Of HP Research Articles

1070 Hip Fractures in Celiac Disease Patients: A Nationwide Analysis

INTRODUCTION: Autoimmunity associated with Celiac disease (CD) has previously shown to be associated with bone health and hip fracture risk. Literature also supports supplementation of Vitamin D in celiac disease patients to increase bone mineral density. Currently, there is no US national-level study to show the risk of hip fractures in CD patients. METHODS: We conducted a cross-sectional study using the National Inpatient Sample (2008 to 2014). We identified patients with a primary diagnosis of HP using diagnosis codes for the neck of femur, intertrochanteric and subtrochanteric fractures or procedure codes for interventions for hip fractures including total hip replacement. The primary outcome was the total number of hospitalizations with secondary outcomes including mortality, length of stay (LOS) and total hospitalization charges. We adjusted outcomes for confounding factors such as age, gender, race, and comorbidities by the univariate and multivariate regression model. RESULTS: From 2008-2012, a total of 32,96,442 hospitalizations were identified for hip fractures, of which 3614 (0.1%) had associated celiac disease. CD subgroup had significantly increased number of females, Caucasians, and elderly patients but no differences were noted in the total number of comorbidities. CD + HP was more common in hospitals situated in the northeastern states than only HP group but there were no differences noted in the teaching vs nonteaching hospitals or urban vs rural hospitals. Multivariate analysis with confounding factors showed that patients with CD were more likely to have HP with OR 1.08 (95%CI: 1.003-1.18; P = 0.041). There was no significant difference in mortality or mean length of stay. Patients with CD and hip fractures had higher incidence and odds ratio of osteoporosis than non-CD patients (29% vs 13.1%, OR: 3.71, P = 0.00). CONCLUSION: Our study showed that patients with CD are more likely to get hip fractures which is further supported by increased prevalence of osteoporosis in these patients. However, there is no difference in terms of in-hospital mortality and hospital resources utilization in comparison to patients without CD. Our study reinforces the necessity of addressing risk of osteoporosis risk in CD patients with Vitamin D and calcium supplementation, which can likely prevent a gravely morbid event like a hip fracture.

GastroPanel® Biomarker Assay: The Most Comprehensive Test for Helicobacter pylori Infection and Its Clinical Sequelae. A Critical Review.

Several clinical conditions seriously hamper the diagnostic accuracy of the commonly used tests for Helicobacter pylori (Hp), 13C-urea breath test (UBT) and stool antigen test (SAT). The present communication is a critical review of the potential limitations of UBT and SAT, and describes the approach on how these can be avoided. Drawbacks of the Hp tests: False-negative results are most often due to low bacterial load in the stomach due to: i) use of proton pump inhibitor medication; ii) use of antibiotics; iii) presence of atrophic gastritis and hypoacid stomach; iv); bleeding peptic ulcer; v) gastric cancer (GC) and vi) mucosal-associated lymphatic tissue lymphoma. The UBT also gives false-positive results when urease-producing bacterial species, other than Hp colonize an acid-free stomach. Importantly, neither UBT nor SAT are capable of diagnosing atrophic gastritis, thus missing the patients at highest risk for GC. GastroPanel® (Biohit Oyj, Finland) circumvents these shortcomings with a serological test consisting of a panel of stomach-specific biomarkers: pepsinogen I, pepsinogen II, gastrin-17 and Hp antibodies. GastroPanel® is a tool for non-invasive examination of i) dyspeptic patients for exclusion or diagnosis of Hp or atrophic gastritis, also disclosing the status of gastric acid output; ii) for screening of asymptomatic individuals at risk of GC; and iii) for comprehensive diagnosis of Hp infection. GastroSoft® application integrates the biomarker profile with the patient's medical information, accurately classifying the biomarker profiles into eight diagnostic categories. Given that Hp is the single most important risk factor of GC, the non-invasive diagnosis and screening of Hp should be based on more accurate and more comprehensive testing than UBT or SAT alone. The GastroPanel® is such test, being completely devoid of the known serious shortcomings of UBT and SAT.

NK and NKT cells in the diagnosis of diffuse lung diseases presenting with a lymphocytic alveolitis

BackgroundDiffuse lung diseases (DLD) are characterized by different immunophenotypes in the bronchoalveolar lavage fluid (BALF). We aimed to evaluate the diagnostic value of BALF NK and NKT cell counts of patients with DLD and lymphocytic alveolitis.MethodsWe assessed 202 patients with DLD, who underwent BALF immunophenotyping. Samples were routinely processed by flow cytometry and lymphocyte subsets were compared between patients with sarcoidosis (n = 106), hypersensitivity pneumonitis (HP; n = 53), and other DLDs (n = 43). We compared absolute counts and percentages of NK and NKT cells between patients with HP versus the remaining DLD patients. To assess the accuracy of BALF lymphocyte subsets in the diagnosis of HP, we calculated the respective areas under the receiver operating characteristic curves (AUC-ROC).ResultsPatients with HP had significantly higher numbers of BALF NK cells, and its percentage was significantly associated with a higher odds of HP, even after adjustment for the NKT and CD8+ cells. For the absolute number of BALF NK cells, we found an AUC-ROC of 0.76 (95%CI = 0.68–0.84) when comparing patients with HP versus the remaining DLD. The cut-offs of 2000 NK cells/mL and of 2.4% NK cells in the BALF had a specificity and a negative predictive value over 80% for the diagnosis of HP. BALF NK cells absolute counts were significantly higher in HP patients with a restrictive pattern. No such differences were observed for NKT cells.ConclusionsBALF NK immunophenotyping may be a helpful adjunct to the diagnostic work-up of DLD, particularly in the differential diagnosis of HP.

Application of Digestive Endoscopy in Diagnosis of Helicobacter Pylori Infection

Helicobacter pylori (Hp),a proven pathogen of digestive disease,is closely associated with gastrointestinal diseases including peptic ulcer,chronic active gastritis,stomach cancer,and stomach-associated lymphoid tissue lymphoma. Thus,precise and timely diagnosis of Hp is of great significance. In addition to 13C or 14C breath test,rapid urease test,and other commonly used Hp diagnosis methods,some new endoscopic techniques such as magnifying endoscopy,narrow-band imaging,confocal laser endomicroscopy,Fuji intelligent chromoendoscopy,and I scanning have been used for the direct observation of the fine-structure of stomach with Hp infection or for the identification of living Hp. This article reviews the application of digestive endoscopy in the diagnosis of Hp infection.

Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis.

Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. 155 patients were included in the study. 49% of patients who underwent BAL had a lymphocyte count > 20, 42% had a lymphocyte count > 30, and 34% had lymphocyte count > 40%. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40% was used as a cutoff was 52%. Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.

Abstract P3-14-04: Hepatic pseudocirrhosis in breast cancer – analyses of clinical and prognostic factors

Abstract Background Hepatic pseudocirrhosis (HP) is a rare entity characterized by radiological changes in the liver resembling cirrhosis (lobular contour, nodularity, capsular retraction, and atrophy), reported most frequently in patients (pts) with treated metastatic breast cancer (BC). Cases in literature have been associated with poorer prognosis than true cirrhosis with fatal outcome nearly always in a few months. Little is known about factors which predispose to HP or influence its prognosis. Methods In this retrospective observational study, we reviewed abdominal radiology reports (CT, MRI, and ultrasound scans) of all our pts with BC diagnosed between 01/01/07 and 12/31/16, to identify those with HP. Cirrhosis on baseline imaging, pre-existing chronic liver disease, hepatitis B/C, and heavy alcohol use were exclusion criteria. Routine descriptive statistical measures were employed. Multiple regression was used to analyze factors affecting survival. p <0.05 was considered significant. Results We identified 86 pts with HP who satisfied inclusion/exclusion criteria. All were females, 89.5% were Caucasian. 83.7% of primary tumors were ER+, 58.1% were PR+ and 17.4% were HER2+. 25.6% had an invasive lobular component. The vast majority had distant metastases (mets) (97.7%) and liver mets (94.2%) at the time of diagnosis of HP, though 52.3% had stage I/II BC on initial presentation. Median size of the largest liver met was 30.0 mm and 87.2% pts had >10 liver mets. Most pts were heavily pre-treated before the manifestation of HP – 84.9% had received hormonal therapy (median cumulative duration of 35 months each of tamoxifen and aromatase inhibitors), 18.6% got anti-HER2 therapy (median duration of 15 months), and 96.5% received chemotherapy (81.4% had received ≥ 2 lines of chemotherapy). Median interval from diagnosis of BC to detection of HP was 6.3 years (IQR 2.9-9.6). 36% had ≥1 signs of portal hypertension (splenomegaly 15.1%, esophageal/gastric varices 18.6%, variceal bleeding 9.3% and ascites with high albumin gradient 34.9%), while 48.8% had ≥1 signs of hepatocellular failure (jaundice 47.7%, coagulopathy 30.2%, hepatic encephalopathy 14.0%). Detection of HP often led to changes in BC therapy – chemotherapy was changed in 46.5% pts, stopped in 24.4%, hormonal therapy was changed in 18.6%, stopped in 15.1%, and hospice care was initiated in 19.8% pts. Status of BC and liver mets at initial detection of HP were variable – 53.5% had disease progression while 45.3% had continued response; 40.7% had enlarging, 23.4% had stable and 30.9% had shrinking liver mets. Median survival after detection was HP was 3.6 months (1.1-11.5). Death was due to BC-progression in 83.4% pts and HP-related complications (GI bleeding, hepatic failure) contributed in 28.6% pts. Using multiple regression, lower albumin level and a higher number of metastatic sites at initial detection of HP were found to be independently associated with shorter post-HP survival (R2 16.6%, F(2,74) 7.37, p=0.001). Conclusions We report the largest series, till date, of BC patients with HP, an entity which can be complicated by portal hypertension and hepatocellular failure, and with marked impact on BC survival and management. Studies are needed to identify risk factors and management strategies. Citation Format: Gopalakrishnan D, Abraham J. Hepatic pseudocirrhosis in breast cancer – analyses of clinical and prognostic factors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-04.

Clinical features of diabetes mellitus in hereditary pancreatitis

Results Five patients were included. In 3 patients, the diagnosis of HP preceded that of DM, while in 2 the opposite occurred. The average time between diagnosis of HP and DM was 80±24 months (range: 60-180 months). All patients used insulin. The mean dose was 0.71±0.63 IU/kg (range: 0.27-1.76 IU/kg). In four patients, we observed the use of other drugs (Metformin and glibenclamide) before insulin therapy was started, for a mean time of 46±45 months

PTU-044 Is there any value in performing a clo test at endoscopy in patients previously having a stool antigen test?

<h3>Introduction</h3> <i>Helicobacter pylori</i>(HP) infection is causally associated with gastritis, peptic ulcer disease, mucosal associated lymphoid tissue and gastric malignancy. Current ‘test and treat’ guidelines for dyspepsia recommend the non-invasive testing by way of stool antigen test (SAT) for diagnosis of HP, prior to eradication therapy. We observed that in clinical practice most patients attending upper gastrointestinal endoscopy for dyspepsia have HP testing at endoscopy by way of CLO (<i>Campylobacter</i>-Like-Organism) test. There is increasing evidence, however, that the CLO test has lower diagnostic accuracy (sensitivity 80%, specificity 90%) in comparison to the SAT (sensitivity 96%, specificity 98%). We hypothesised that there was no additional diagnostic value in a CLO test, if a patient had already undergone stool antigen testing prior to endoscopy. <h3>Method</h3> A single centre (north London endoscopy unit), retrospective analysis of 98 consecutive patients who had undergone stool antigen testing prior to a CLO test at OGD, for the investigation of dyspeptic symptoms was undertaken. The electronic patient record was scrutinised to compare the result of the CLO test and SAT in these patients. Of those who were stool antigen positive, it was noted whether they were documented to have received eradication therapy prior to their endoscopy. <h3>Results</h3> A total of 81 out of 98 patients tested (82.7%), were SAT negative. Within the cohort of stool antigen negative patients, 98.8% were also CLO test negative (80/81). CLO testing in the presence of a negative SAT detected one additional case of <i>H. Pylori</i>infection (1.2%, 1/81). Within the cohort of SAT positive patients (17/98 total patients), 35.3% (6/17) were CLO test positive. Only one of these patients had not been documented to receive eradication therapy prior to their CLO test. <h3>Conclusion</h3> In our study, 96 of 98 patients (98.0%) did not directly benefit from CLO testing, following stool antigen testing. CLO testing provided new diagnosis of <i>H.pylori</i>infection in only 1 out of the 98 cases, where SAT had already been undertaken. This study proves our hypothesis to be valid in 99.0% of the cases reviewed. We recommend that a CLO test should not be performed at endoscopy, if the SAT result is already available. This will help reduce the financial cost of obtaining the CLO test (biopsy NHS tariff plus CLO test cost, equating to £40 per patient) and also reduce the administration time associated in documentation of the CLO test result. <h3>Disclosure of interest</h3> None Declared.

Histological identification ofH. pyloristained by hematoxylin-eosin and Giemsa: review for quality control

Introduction: Several special staining methods are available for H. pylori (Hp) identification in histological sections of chronic gastritis (CG), including the routine hematoxylin-eosin (HE) method. Some reports suggest that ancillary stains are not always needed to establish the diagnosis of Hp infection. In addition, the benefit of using them, when biopsies show minimal inflammation, is not clear. Objective: We performed a retrospective study to compare the usefulness of HE with Giemsa method for the histopathological diagnosis of Hp in tissue sections. Methods: Histological sections from 390 consecutive patients were reviewed. The patients were registered in the histopathology laboratory of Instituto Alfa de Gastroenterologia, Hospital das Clinicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brasil. They were divided in 4 groups according to the gastric inflammatory changes as follows: Group I, gastric mucosa with normal morphology or minimal inflammatory changes (n = 146); Group II, chronic gastritis (CG) with mild inflammatory activity (n = 101); Group III, CG with patent inflammatory activity (n = 123); Group IV, patients with atrophic body gastritis (n = 20). All histological sections were carefully evaluated by 2 examiners at the oil immersion objective (1000×). Results: The identification of Hp was positive by Giemsa and HE, respectively at: Group III, 111 (90.2%) and 93 (75.6%) patients (p < 0.01); Group II, 43 (42.6%) and 29 (28.7%) patients (p < 0.05). Hp was negative in Groups I and IV. Conclusion: The results show that Giemsa stain is superior to HE for histological identification of Hp in CG. Although Hp could be identified by HE stain in the majority of CG cases, a significant number of infected patients may be neglected, regardless the intensity of the inflammatory response.

Serum amyloid A and haptoglobin levels in crossbred cows with endometritis following different therapy

Aim: To determine the serum variations of two major acute phase proteins, serum amyloid A (SAA) and haptoglobin (Hp) levels in crossbred endometritis cows following pre and post immunomodulation therapy. Materials and Methods: 21 endometritis cows were randomly assigned to three groups (n=7) and treated with three different immunomodulators while seven healthy cows served as control. Uterine flushing collected from all animals was subjected to bacteriological study and serum samples were analyzed for SAA and Hp by sandwich ELISA method. Results: Escherichia coli was most prevalent Gram-negative bacteria (6.02 × 106 CFU/ml) while Staphylococcus (0.86 × 106 CFU/ml) and Streptococcus (0.52 × 106 CFU/ml) were most predominant Gram-positive species isolated from uterine flushing. The pre-treatment SAA values (μg/ml) varied significantly (p<0.01) between the treatment groups whereas no difference was observed in post-treatment groups. No significant difference (p<0.01) was observed for Hp values between the treatment groups, but the mean SAA (μg/ml) and Hp (μg/ml) levels were significantly (p<0.01) higher in pre-treatment when compared to post-treatment within the groups. Conclusion: In the diagnosis and monitoring of bovine endometritis, both SAA and Hp might serve as reliable biomarkers.

659 Hypoparathyroidism and Pseudo-Hypoparathyroidim: About 9 Cases

IntroductionHypoparathyroidism(HP) is an uncommon disorder of calcium metabolism characterized by hypocalcemia and hyperphosphatemia due to impaired parathyroid hormone (PTH) secretion. The pseudo-hypoparathyroidism(PHP) is characterized by a high level of PTH...

Lycopene an Adjunctive Therapy for Helicobacter Pylori Eradication: a Quasi-Control Trial

Although some herbal remedies in association with vitamin therapy have been investigated in eradicating HP, no research has been done to investigate the effects of lycopene it. Our aim was to understand if lycopene could be effective in eradication of HP. In this parallel group quasi-control trial, a total of 54 patients whose diagnosis of HP had been confirmed by rapid urease test (RUT) were enrolled. Group 1 received the standard 4-drug therapy to eradicate HP (Metronidazole 500 mg/BD, Amoxicillin 1g/BD, Omeprazole 20mg/BD, and Bismuth 240 mg/BD) and group 2 received the same regimen in association with Lycopene (30 mg/daily). One month after the initiation of the treatment, the patients were evaluated for HP eradication by RUT. Although eradication rate was higher in the second group, bivariate analysis showed no significant statistical difference between the two groups. In contrast with other nutrients, it seems that Lycopene does not have any significant effects on eradicating HP in comparison with the standard antibiotic therapy. The prevalence of HP is in association with socioeconomic situation, so the patients in different studies should be paid more attention about their own life style. We recommend that more studies can be designed by considering control group and placebo administration.

Sa1641 Endoscopic Treatments for Gastric Antral Vascular Ectasia Associated With Chronic Liver Disease

upper gastrointestinal endoscopy in China. However, the endoscopic diagnosis and appropriate patient management have not been thoroughly investigated. We aimed to retrospectively review our experience on HP with emphasis on diagnosis and management. Patients and Methods: We searched the medical and pathologic records for the final diagnosis of HP over the period of January 2004 through August 2010 at the Nanjing Drum Tower Hospital in China. Clinical, pathological, and surgical therapy data on cases with HP were reviewed. Results: We identified 30 consecutive patients with HP. Patients’ median age was 43 (range: 15-67) with a slight female (53%) predominance. As a submucosal lesion, HP was found predominantly in the stomach (53%), and some in the duodenum (10%), the jejunum (23%), the lesser omentum (7%), and the mesenterium (7%). Of the 30, 43% were detected incidentally during other operative procedures, 23% were revealed endoscopically with a clinical misdiagnosis of different diseases, and the remaining 33% diagnosed correctly at endoscopy. Before 2007, almost all (10/11, 91%) were found incidentally as a palpable submucosal mass during open surgical procedures for other conditions. However, in the 19 cases diagnosed after January 2007, only 3 (16%) were incidental findings and the majority (84%) were endoscopically identified, either incorrectly or correctlydiagnosed, which was significantly higher than that identified before 2007 (84% vs. 9%, p 0.05). Among the 7 mis-diagnosed HP lesions, 4 were as GISTs, 2 as gastric polyps, and 1 as a tumor of the Vater’s papilla with malignant potential. In the 17 cases recognized endoscopically, the patients presented with symptoms including, in the descending order, abdominal distention (65%) or pain (29%), weakness (18%), melena (6%), and jaundice (6%), nausea and vomiting (6%), anorexia (6%), and weight loss (6%). HP in the majority cases (82%) was located in the stomach, a few in the duodenum (12%) or the proximal jejunum (6%). The therapeutic management of these 17 cases consisted of ligation-assisted endoscopic mucosal resections (59%), laparoscopic or open local resections (24%), laparoscopy or open distal gastrectomy (12%), and open pancreaticoduodenectomy (6%). Conclusion: HP can be detected more frequently at endoscopy in the upper gastrointestinal tract with the stomach as the predominant site. The endoscopist’s awareness of and understanding of the non-specific clinical presentations and endoscopic characteristics of HP is essential for correct diagnosis and appropriate patient management.

Comparación entre las biopsias gástricas sin fijar 24 horas frente a la biopsia convencional para el diagnóstico de Helicobacter pylori en un hospital de referencia de Perú

Objectives. To compare gastric biopsies immediately fixed with 10% formalin with biopsies fixed after 24 hours for the detection of Helicobacter pylori (Hp) in a reference hospital in Peru. Materials and methods. A diagnostic test study on gastric biopsies from 72 patients attending the Gastroenterology service of hospital Essalud Alberto Sabogal in Callao was performed. Samples from each patient were divided into two glass jars, one of which was fixed immediately with 10% formalin and the other was fixed after 24 hours. Both groups of samples were processed with the conventional technique of paraffin embedding and staining with hematoxylin-eosin. Results. Hp was found in 56.9% of the group of biopsies which were inmediatly fixed and in 79.2% of the group of biopsies fixed after 24 hours, showing statistical difference (p <0.001). Conclusions. There is an increased frequency of diagnosis of Hp in the samples that were fixed after 24 hours, which may suggest that this would act as a biological culture for Hp, which would facilitate its diagnosis.

Development and validation of a SYBR Green I–based real‐time polymerase chain reaction method for detection of haptoglobin gene deletion in clinical materials

Anhaptoglobinemic patients run the risk of severe anaphylactic transfusion reaction because they produce serum haptoglobin (Hp) antibodies. Being homozygous for the Hp gene deletion (HP(del)) is the only known cause of congenital anhaptoglobinemia, and clinical diagnosis of HP(del) before transfusion is important to prevent anaphylactic shock. We recently developed a 5'-nuclease (TaqMan) real-time polymerase chain reaction (PCR) method. A SYBR Green I-based duplex real-time PCR assay using two forward primers and a common reverse primer followed by melting curve analysis was developed to determine HP(del) zygosity in a single tube. In addition, to obviate initial DNA extraction, we examined serially diluted blood samples as PCR templates. Allelic discrimination of HP(del) yielded optimal results at blood sample dilutions of 1:64 to 1:1024. The results from 2231 blood samples were fully concordant with those obtained by the TaqMan-based real-time PCR method. The detection rate of the HP(del) allele by the SYBR Green I-based method is comparable with that using the TaqMan-based method. This method is readily applicable due to its low initial cost and analyzability using economical real-time PCR machines and is suitable for high-throughput analysis as an alternative method for allelic discrimination of HP(del).

Haemosuccus pancreaticus: diagnostic and therapeutic challenges

BackgroundHaemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. The objective of our study was to highlight the challenges in the diagnosis and management of HP. MethodsThe records of 31 patients with HP diagnosed between January 1997 and June 2008 were reviewed retrospectively. ResultsMean patient age was 34 years (11–55 years). Twelve patients had chronic alcoholic pancreatitis, 16 had tropical pancreatitis, two had acute pancreatitis and one had idiopathic pancreatitis. Selective arterial embolization was attempted in 22 of 26 (84%) patients and was successful in 11 of the 22 (50%). Twenty of 31 (64%) patients required surgery to control bleeding after the failure of arterial embolization in 11 and in an emergent setting in nine patients. Procedures included distal pancreatectomy and splenectomy, central pancreatectomy, intracystic ligation of the blood vessel, and aneurysmal ligation and bypass graft in 11, two, six and one patients, respectively. There were no deaths. Length of follow-up ranged from 6 months to 10 years. ConclusionsUpper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. Diagnosis is based on investigations that should be performed in all patients, preferably during a period of active bleeding. These include upper digestive endoscopy, contrast-enhanced computed tomography (CECT) and selective arteriography of the coeliac trunk and superior mesenteric artery. Contrast-enhanced CT had a high positive yield comparable with that of selective angiography in our series. Therapeutic options consist of selective embolization and surgery. Endovascular treatment can control unstable haemodynamics and can be sufficient in some cases. However, in patients with persistent unstable haemodynamics, recurrent bleeding or failed embolization, surgery is required.

Fulminant Multisystem Non–Langerhans Cell Histiocytic Proliferation With Hemophagocytosis

Abstract Hemophagocytosis (HP), a feature seen in malignant histiocytosis and infection- and lymphoma-associated disorders, has not been previously emphasized in Erdheim-Chester disease (ECD). Generally, ECD is recognized as a rare, systemic, non–Langerhans cell histiocytosis with a variable clinical course. Herein, we describe a unique case of multisystem non–Langerhans cell histiocytic proliferation with a fulminant clinical course (death occurred within 3 months of presentation) that showed prominent HP and extensive involvement of multiple organs, including the lungs, resulting in respiratory failure. Hemophagocytosis led to severe anemia that required transfusion and thrombocytopenia. Antemortem lung and bone marrow biopsy specimens revealed involvement by a histiocytic infiltrate with features highly suggestive of ECD and HP. Furthermore, the autopsy documented the presence of HP and the histiocytic infiltrate in multiple other organs. This case is best categorized as a variant form of ECD. Recognizing this variant has the following important implications: (1) HP may be a marker for fulminant clinical course in ECD, (2) the presence of HP does not exclude a diagnosis of ECD, and (3) ECD should be considered in the differential diagnosis of HP.

Possible prodromes of human papillomavirus uterine cervix infection

We present two case reports and mention four others with similar clinical, pathological and laboratory findings which suggest that viremia could possibly occur in some human papillomavirus (HPV) infections. Fever, general indisposition or arthralgia associated with micturition difficulties or dysuria appear to be the symptoms accompanying this viremia. After a period of time these symptoms disappear and the infection shows typical HPV uterine cervix symptoms. The diagnosis of HP V infection was confirmed by histological analysis and DNA hybridization of biopsy material from the cervical lesions. These clinical findings may introduce a new avenue for the investigation of viral physiopathology.

EXCESSIVE THYROTROPIN RESPONSE TO THYROTROPIN RELEASING HORMONE (TRH) IN PSEUDOHYPOPARATHYROIDISM (PHP) AND HYPOPARATHYROIDISM (HP)

In all of 10 cases with PHP (3 adults, 3 adolescents and 4 children from 5 families) intravenous TRH evoked excessive plasma thyrotropin responses as seen in mild primary hypothyroidism. A similar response was found in 4 among 6 cases with HP (1 adolescent and 5 children from 5 families). In none except 2 cases were clinical signs or other laboratory data suggestive of hypothyroidism. The diagnosis of PHP or HP was ascertained by the determination of immunoreactive serum parathyroid hormone and/or of urinary cyclic adenosine 3' 5' -monophosphate after intravenous infusion of parathyroid extract. TRH did not induce significant changes of serum parathyroid hormone concentration in any of 8 cases (6PHP, 2HP) tested.