Extent Of Mucosal Involvement Research Articles

Intramucosal Extent as a Marker for Advanced Disease and Survival in Gallbladder Adenocarcinoma.

Gallbladder cancer (GBC) is the most common biliary tract malignancy and has a poor prognosis. The clinical significance of focal vs diffuse GBC remains unclear. A retrospective review was conducted on all patients with non-metastatic GBC at a quaternary care center. Pathology was reviewed, and gallbladder cancer pattern was defined based on the extent of mucosal involvement; "diffuse" if the tumor was multicentric or "focal" if the tumor was only in a single location. Patients undergoing liver resection and portal lymphadenectomy were considered to have definitive surgery. The primary outcome was overall survival and assessed by Kaplan-Meier curves. 63 patients met study criteria with 32 (50.7%) having diffuse cancer. No difference was observed in utilization of definitive surgery between the groups (14 [43.8%] with focal and 12 [38.7%] with diffuse, P = .88). Lymphovascular invasion (P = .04) and higher nodal stage (P = .04) were more common with diffuse GBC. Median overall survival was significantly improved in those with focal cancer (5.1 vs 1.2years, P = .02). Although not statistically significant, this difference in overall survival persisted in patients who underwent definitive surgery (4.3 vs 2.4years, P = .70). Patients with diffuse involvement of the gallbladder mucosa likely represent a subset with aggressive biology and worse overall survival compared to focal disease. These findings may aid surgeons in subsequent surgical and medical decision-making for patients with GBC.

Mycoplasma-induced Stevens-Johnson syndrome/toxic epidermal necrolysis: Case-control analysis of a cohort managed in a specialized center

Mycoplasma pneumoniae (MP) infection is associated with extrapulmonary complications such as Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). We evaluated the differences in epidemiology, clinical characteristics, and disease outcomes between drug-induced and Mycoplasma-related SJS/TEN. All patients with SJS/TEN admitted to our center between 2003 and 2016 inclusive were treated under a standardized protocol. Comparative analysis was made between patients who tested positive for MP versus a control group with negative MP serology in the presence of high-notoriety drugs defined by an algorithm for assessment of drug causality in epidermal necrolysis >5. Of 180 cases of SJS/TEN patients treated in our institution, 6 had positive MP serologies and were compared to a control group of 71 cases of drug-induced SJS/TEN with an algorithm for assessment of drug causality in epidermal necrolysis score of >5. There were no significant differences in baseline characteristics, disease classification, body surface area involved, and extent of mucosal involvement. We found significant differences in mortality rates between the Mycoplasma and control groups on discharge (0% vs 22.5%, P<.001) and at 1-year follow up (0% vs 32.4%, P=.002), respectively. Retrospective design, small sample size. Although recent studies have shown that MP-induced SJS/TEN is morphologically different and deserves a separate classification system, this would need to be borne out in larger prospective studies.

Celiac Disease in Older Adults

Purpose: Celiac disease (CD) occurs in about 1% of US population (NIH Consensus Conference on CD 2004). It may be asymptomatic for many years or may present with diarrhea, abdominal pain, bloating, fatigue and weight loss. Common non-GI symptoms include anemia (iron deficiency and/or folate deficiency), arthritis and infertility. CD may remain latent for years and upto 20% of patients are older than 60 when CD is first diagnosed (Hankey GL. CD in elderly. Gut 1994; 35:65–67). CD is diagnosed by SB mucosal biopsy and serological testing of antibodies (IgA anti-tTG, IgA antiendomysial). WCE has provided us an opportunity to identify classical features of celiac disease and also to evaluate the nature, location and extent of mucosal abnormalities. Aim: The aim of this study is to identify various abnormalities in patients with CD with regard to their nature, location and extent of mucosal involvement in older adults.Table: Cases of Celiac disease in older adultsMethods: In this prospective study, patients presented for evaluation of CD underwent WCE according to standard protocols. Results: Total number of CD cases: 13, Older adults (Age above 60): 7 cases. (Males 2, Females 5) Common indications: Anemia, chronic diarrhea, abdominal pain and unexplained weight loss (More than one indication coexisted in some patients). Common findings: Scalloping, mucosal atrophy, layering or stacking of mucosal folds, mosaic pattern and nodularity (Multiple findings coexisted). Conclusions: 1) Anemia in the older adults (age > 60) may be the sole manifestation of CD and needs further evaluation to confirm the diagnosis. 2) WCE provides as valuable tool to visualize the entire small bowel mucosa and to identify the nature, location and extent of mucosal abnormalities seen in CD. 3) In CD the duodenum may be entirely normal by the EGD examination while the proximal and distal small intestine may show classic features of CD.

The clinical significance of heterotopic pancreas in the gastrointestinal tract.

A series of 34 histologically verified cases of pancreatic heterotopia in the records of the Department of Pathology at the University of Edinburgh between 1959 and 1979 has been analysed in order to determine the clinical significance of this unusual condition. In 13 patients (38 per cent) the heterotopic pancreatic tissue was symptomatic (i.e. the symptoms regressed completely on its removal). A correlation has been established between the presence of symptoms, the size of the lesion and the extent of mucosal involvement. Clinically significant lesions are greater than 1.5 cm in maximum diameter and are adjacent to or directly involve the mucosa.

Stevens-Johnson Syndrome After Immunization With Smallpox, Anthrax, and Tetanus Vaccines

Stevens-Johnson Syndrome After Immunization With Smallpox, Anthrax, and Tetanus Vaccines

A 10-year experience with toxic epidermal necrolysis.

Toxic epidermal necrolysis is a devastating medication-induced desquamation disorder with a reported mortality rate of 30% to 60% in adults. Data from previously reported series suggest that age, delay in referral to a burn center, total body surface area (TBSA) involvement, and systemic steroid treatment are poor prognostic indicators. We reviewed the records of 39 patients treated in our burn center over the past 10 years and found that the mortality rate was significantly correlated with age, thrombocytopenia, and delay in presentation. Steroid treatment and TBSA involvement were not significantly related to the mortality rate. Thirty-nine adult patients with greater than 20% TBSA epithelial necrosis were cared for in our center from January 1987 to March 1998. Wounds were treated with topical antimicrobial medications and porcine xenografts in a bacteria-controlled nursing unit. We reviewed the records of these patients for 28 clinical characteristics and looked for clinical correlates of mortality by single analysis of variance. The mortality rate was 44% (17 of 39 patients); the cause of death was most commonly multiple-organ dysfunction syndrome, for which a microbial etiologic agent was not always identified. Autopsies were performed on 11 of the 17 patients who died; there was evidence of multiple-organ damage. The patients who survived and the patients who died did not differ significantly in TBSA epithelial necrosis (66%+/-6% vs 72%+/-5%, respectively), admission platelets, number of nosocomial infections, number of complications, preadmission exposure to steroids, or extent of mucosal involvement. When compared with the patients who died, the patients who survived were (1) 20 years younger (47.5+/-4.2 years vs 64.5+/-5.3 years), (2) admitted to the hospital sooner after the onset of their rash (3.5+/-0.4 days vs 5.9+/-1.0 days), (3) much less likely to experience early thrombocytopenia (platelet nadir, 154+/-24 vs 70+/-18), (4) more likely to be febrile on presentation, and (5) less likely to have been treated with antibiotics before referral to our unit. These differences were statistically significant. The most common etiologic agents were antibiotics, anticonvulsants, and nonsteroidal anti-inflammatory drugs. Our results for a group of older patients with toxic epidermal necrolysis with extensive skin involvement suggest that age, delay in hospitalization, thrombocytopenia, and early empiric antibiotic treatment are associated with a poor prognosis.

Circulating autoantibodies to tissue transglutaminase differentiate patients with dermatitis herpetiformis from those with linear IgA disease

Background: Dermatitis herpetiformis (DH) is highly associated with celiac disease. Recently, tissue transglutaminase (tTG) was identified as the autoantigen of IgA antibodies in celiac disease. The prevalence of antibodies to tTG in DH patients is not known. Objective: The purpose of this study was to determine whether DH patients show circulating IgA autoantibodies to tTG, to compare their serum levels with those from patients with other subepidermal autoimmune bullous diseases, and to correlate levels of antibodies to tTG with the extent of small bowel disease. Methods: Sera were obtained from consecutive patients with DH (n = 11), linear IgA disease (n = 15), bullous pemphigoid (n = 10), and epidermolysis bullosa acquisita (n = 6) and were studied by indirect immunofluorescence on monkey esophagus and NaCl-split human skin. IgA reactivity to tTG was measured by enzyme-linked immunosorbent assay. The extent of mucosal involvement in jejunal biopsy specimens was assessed according to the grading of Marsh. Results: All untreated DH patients showed circulating IgA autoantibodies to tTG. One DH patient already undergoing therapy, the 15 patients with linear IgA disease, and all other controls revealed no autoantibodies to tTG. In addition, serum levels of IgA anti-tTG antibodies reflected the degree of histopathologic changes in jejunal mucosa from biopsy specimens in DH patients. Conclusion: Our results show that circulating IgA autoantibodies to tTG are detectable in DH but not in linear IgA disease or other subepidermal autoimmune bullous diseases. The levels of IgA anti-tTG antibodies reflect the extent of histopathologic changes of the jejunal mucosa in DH. (J Am Acad Dermatol 1999;41:957-61.)

Malignant tumors of the vagina.

A retrospective analysis of 118 patients with malignant tumors of the vagina shows that the prognosis, following adequate irradiation, is similar to cornparable stages of carcinoma of the cervix. The 5-year absolute cure rate was 75% for Stage I, 50% for Stage JIA, and about 25% for Stages IIB, 111, and IV. The patients were retrospectively staged according to the system adopted by the International Federation of Gynecology and Obstetrics. It is proposed that the Stage I1 lesions be subdivided into IIA (paravaginal submucosal extension only) and IIB (parametrial extension), since the prognosis is distinctly different in these patients. Otherwise, the prognosis correlates well with the various clinical stages. Tumor control was excellent in the in-situ and early invasive lesions treated by radium alone or combined with external beam in Stage I lesions. Local and pelvic failures were more frequently seen in tumors more extensive than Stage IIA. Well-planned irradiation, with the aid of computer calculations, will significantly increase tumor control. This is best achieved by combining interstitial and intracavitary vaginal radium and external beam supervoltage irradiation to the pelvic and parametrial tissues. The importance of careful follow-up after irradiation and the early treatment of recurrent lesions is emphasized since a number of these patients can be salvaged by a subsequent surgical procedure. The most significant factor affecting the prognosis was the stage of the disease, which was related to the depth of infiltration of the tumor in the vaginal wall or adjacent tissues. Age of the patient, location, or extent of mucosal involvement did not significantly influence the prognosis.