Full-thickness Biopsy Research Articles

Ex vivo comparison of full-thickness biopsy techniques in the equine small intestine.

To compare the practicability and tissue sample quality between different intestinal biopsy techniques. Experimental, randomized ex vivo study. Small intestine of nine horses. Four different biopsy techniques were evaluated in the aboral jejunum and the ileum within 1 h after euthanasia. One segment was used as control (C), and the applied techniques included an 8 mm biopsy punch (BP), transverse wedge resection (TW), longitudinal wedge resection with transverse closure (LW) and a longitudinal sample using Eppendorfer biopsy forceps (EF). Defects were closed using a single-layer continuous Lembert pattern. Duration of the procedure, intestinal diameter, contamination, and bursting pressure were determined. The quality of the obtained tissue samples for histological assessment was evaluated using a semiquantitative score. The jejunal and ileal samples were analyzed separately. All biopsy procedures including defect closure were completed within 5 min, with shorter closure times for BP (p = .03). Minimal contamination could be noted in 1/8 TW and 2/8 LW cases, without significant differences between the groups. Longitudinal closure techniques (BP, EF) showed more constriction than transverse closures (TW, LW) (p < .05). Bursting pressure was >75 mmHg in all cases. Technique BP showed significantly lower biopsy quality scores (p = .009). The tested biopsy techniques could all be applied effectively within a reasonable time frame, yet the biopsy punch was associated with significant artifacts and risk of missing mucosa. The findings provide insights into the possible advantages and limitations of the different techniques and alert the surgeon to potential issues with the quality of the tissue sample.

Novel multi-spectral short-wave infrared imaging for assessment of human burn wound depth.

Burn depth determination is critical for patient care but is currently lacking accuracy. Recent animal studies showed that Short Wave Infrared (SWIR) imaging can distinguish between superficial and deep burns. This is a first human study correlating reflectance of multiple SWIR bands using a SWIR assessment tool (SWAT) with burn depth classifications by surgeons and histology. Burns and adjacent normal skin in 11 patients with thermal injuries were imaged with visual and narrow bands centred at 1200, 1650, 1940 and 2250 nm and biopsies were taken from select areas. Reflectance intensities for each band in 273 regions of interest (ROI) were divided by the normal skin reflectance and combined into three Reflectance Indices (RIs). In addition, burns in ROIs and biopsies were classified by five surgeons and three pathologists, respectively, as superficial partial, deep partial, or full thickness. Results show that for burn depth increase classified by the surgeons, reflectance increased at 1200 and 2250, decreased at 1940, and didn't change at 1650 nm. In contrast, all three RIs increase with burn depth and predict the deep and full depths ROIs representing operable regions (Area Under Curve >0.6507, p < 0.0001). Pathologists' classification matched surgeons' classification of burn category only in eight of 21 biopsies (38.1%), but reflectance at all bands and one RI for all deep partial and full thickness biopsies were larger than in non-biopsy normal and superficial partial thickness ROIs (p < 0.0118). In conclusion, multi-spectral imaging with a new SWAT is a promising approach for evaluation of burn wound depth.

Analysis of Patients Who Undergo Index Arthroscopy With Biopsy but Not Implantation for Staged Chondrocyte Cell Transplantation.

Autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are 2-stage procedures requiring an index full-thickness cartilage biopsy. Only a portion of patients ultimately undergo second-stage ACI/MACI. To identify patients with articular cartilage defects who underwent arthroscopic debridement with biopsy for ACI/MACI and compare those who did with those who did not proceed with implantation within 2 years after biopsy. Additionally, the authors sought to identify why patients did not proceed with implantation. Case-control study; Level of evidence, 3. Patients who underwent arthroscopy and autologous chondrocyte biopsy from January 1, 2015, to December 31, 2019, and who had minimum 2-year follow-up data were grouped into those who proceeded with second-stage ACI/MACI (implant group; n = 97) and those who did not (biopsy group; n = 63). Demographic factors, cartilage defect characteristics, and preoperative International Knee Documentation Committee (IKDC) scores were analyzed. Patients in both groups were evaluated postoperatively using the IKDC, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, and patients who did not undergo implantation were asked for their reasoning. Body mass index (BMI) (P < .001) and Outerbridge grades at index arthroscopy (P = .047) were significantly higher for the implant group than the biopsy group. Both groups had significantly improved IKDC scores from their initial presentation to final follow-up (implant group: 46.4 ± 16.2 preoperative vs 69.6 ± 20.6 postoperative [P < .001]; biopsy group: 47.2 ± 15.9 preoperative vs 70.7 ± 19.1 postoperative [P < .001]); however, the level of improvement did not differ significantly between groups. Postoperative WOMAC, SANE, and VAS pain scores were also similar between groups. In the biopsy group, 23 patients (37%) cited symptom resolution or activity level improvement after initial arthroscopy as the reason for not proceeding with implantation. Patients who proceeded to the second stage of chondrocyte implantation via either ACI or MACI had higher-grade articular defects and higher BMI compared with those who underwent biopsy with concomitant debridement chondroplasty alone. Postoperative outcomes were similar between the groups.

Volumetric changes of the enteric nervous system under physiological and pathological conditions measured using x-ray phase-contrast tomography.

Full-thickness biopsies of the intestinal wall may be used to study and assess damage to the neurons of the enteric nervous system (ENS), that is, enteric neuropathy. The ENS is difficult to examine due to its localization deep in the intestinal wall and its organization with several connections in diverging directions. Histological sections used in clinical practice only visualize the sample in a two-dimensional way. X-ray phase-contrast micro-computed tomography (PC-μCT) has shown potential to assess the cross-sectional thickness and volume of the ENS in three dimensions (3D). The aim of this study was to explore the potential of PC-μCT to evaluate its use to determine the size of the ENS. Full-thickness biopsies of ileum obtained during surgery from five controls and six patients clinically diagnosed with enteric neuropathy and dysmotility were included. Punch biopsies of 1 mm in diameter and 1 cm in length, from an area containing myenteric plexus, were extracted from paraffin blocks, and scanned with synchrotron-based PC-μCT without any staining. The microscopic volumetric structure of the neural tissue (consisting of both ganglia and fascicles) could be determined in all samples. The ratio of neural tissue volume/total tissue volume was higher in controls than in patients with enteric neuropathy (P = 0.013). The patient with the longest disease duration had the lowest ratio. The assessment of neural tissue can be performed in an objective, standardized way, to ensure reproducibility and comparison under physiological and pathological conditions. Further evaluation is needed to examine the role of this method in the diagnosis of enteric neuropathy.

Anterior High-Resolution Optical Coherence Tomography in the Diagnosis and Therapeutic Monitoring of Ocular Surface Squamous Neoplasia.

Ocular surface squamous neoplasia (OSSN) is the most common tumor of the ocular surface, ranging from mild dysplasia to invasive squamous carcinoma. Traditionally, the diagnosis of OSSN relies on histopathological confirmation followed by a full-thickness biopsy. However, in the past two decades, the therapeutic approach to OSSN has shifted from surgical intervention to topical chemotherapy regimens in clinical settings. This shift emphasizes the need for less invasive or non-invasive methods to diagnose ocular surface pathologies. Among various imaging devices, commercially available high-resolution optical coherence tomography (HR-OCT) has emerged as a powerful tool for the characterization of OSSN. HR-OCT provides an in vivo, cross-sectional view of ocular surface lesions, offering an "optical biopsy" for OSSN with high sensitivity and specificity. It provides valuable information in differentiating intraepithelial or invasive OSSN from other benign lesions. Additionally, HR-OCT can be used to monitor the response to topical chemotherapy and to detect subclinical OSSN during follow-up visits. In this article, the scanning protocol for image acquisition is presented, and image interpretation for OSSN is outlined. This standardized, practical, and reproducible approach is recommended in clinical workflows and is expected to assist clinicians in the management of OSSN.

Ex vivo comparison of four different full thickness biopsy techniques in the equine small intestine

Ex vivo comparison of four different full thickness biopsy techniques in the equine small intestine

The diagnostic relevance of mesenteric lymph node biopsy in small intestinal lymphoma in cats.

Regional lymph nodes are frequently sampled in cats with suspected intestinal lymphoma; however, their diagnostic value has not been explored. To investigate whether histologic and immunohistochemical analysis of mesenteric lymph nodes correlates with the diagnosis of intestinal lymphoma in cats. One hundred 2 client-owned cats diagnosed with intestinal lymphoma. Retrospective study. The inclusion criteria required a full-thickness biopsy of the small intestine and concurrent excision of mesenteric lymph nodes. Histologic and immunophenotypic analyses were performed on intestinal biopsies and corresponding lymph nodes. Selected nodal samples diagnosed with reactive lymph nodes underwent clonality testing. Transmural T-cell lymphomas, encompassing small and large cell types, were predominant (64 cases, 62.7%), with large B-cell lymphomas being more frequently transmural (68.8%) than mucosal (31.2%). Among all lymph nodes examined, 44 (43.1%; 95% CI: 33.9%-52.8%) exhibited neoplastic infiltration. Among cases of small cell lymphoma, 51 out of 72 (70.8%; 95% CI: 59.4%-80.1%) showed no nodal involvement. Clonality results correctly identified 19/30 (63.3%; 95% CI: 45.5%-78.2%) reactive lymph nodes. Concerns were raised regarding clonal identification in the remaining cases and potential misdiagnoses based on phenotypic characteristics. The study underscores the potential drawbacks of relying solely on mesenteric lymph nodes for diagnosing intestinal lymphomas in cats, particularly small cell subtypes. It emphasizes the importance of full-thickness biopsies for assessing transmural infiltration and recommends caution when utilizing mesenteric lymph nodes for histologic, immunohistochemical and clonality evaluations in mucosal lymphomas. Despite limitations, this research highlights the need for comprehensive diagnostic strategies in cats with intestinal lymphoma.

Analysis of Enhanced Wound Closure Potential of ADSC-Derived Secretome Compared to Aquacel Extra in Diabetic Rats

Background: Diabetes Mellitus (DM) can lead to serious complications, such as Diabetic Foot Ulcers (DFUs). Currently, Aquacel Extra is one of the standard therapies for DFUs, but its efficacy has some limitations that may be overcome by alternative treatments, such as the secretome derived from Adipose-Derived Stem Cells (ADSCs). ADSC secretome has shown promising results in promoting wound healing by enhancing cell proliferation, collagen synthesis, and migration of fibroblasts. Aims: This study aims to compare the effect of the adipose-derived stem cell (ADSC) secretome to Aquacel Extra, a hydrofiber dressing containing gel-forming agents, on wound healing in a diabetic rat model. Aquacel Extra has sodium carboxymethylcellulose fibers, which contribute to its unique properties. Objective: The objective of this study is to compare the wound healing outcome of ADSC secretome and Aquacel Extra in streptozotocin-induced diabetic rats. Methods: Sprague Dawley rats received a single intravenous administration of streptozotocin to induce diabetes mellitus (DM). A full-thickness excisional circular wound was created at the dorsum aspect of the rats two weeks after diabetic induction. Rats were randomly divided into two groups: the Aquacel Extra group, which received the hydrofiber dressing Aquacel Extra containing gel-forming agents, and the secretome group, which received the ADSC secretome on days 0, 3, and 7. The gross examination was performed on days 0, 3, 7, and 14. On day 14, the rats were euthanized, and full-thickness skin biopsies of the wounds were taken for histological and immunohistochemical analysis. Results: The secretome group demonstrated accelerated cutaneous wound healing compared to the Aquacel Extra group, as indicated by faster wound closure (p &lt; 0.05). Hematoxylin and eosin staining revealed a thicker epidermal layer in the secretome group than in the Aquacel Extra group (p &lt; 0.05). The mean histological score of the secretome group was higher at 10 ± 1.73 compared to the score of 8.33 ± 1.52 in the Aquacel Extra group, indicating a more mature tissue architecture. Immunohistochemical analysis showed lower expression of α-smooth muscle actin (α-sma) in the secretome group than in the Aquacel Extra group, which correlated with reduced collagen secretion and deposition in the secretome group, as indicated by Masson’s trichrome staining. Conclusion: The ADSC secretome accelerated the healing of diabetic wounds compared to Aquacel Extra. However, as this study is preliminary, future studies should be conducted similar to this study with a larger sample and wound size. In addition, the optimal dosage of ADSC secretome and the components of the secretome that promoted wound healing should be determined to fully elucidate the clinical potential of ADSC secretome.

Exploring the Influence of Cold Plasma on Epidermal Melanogenesis In Situ and In Vitro.

Epidermal melanin synthesis determines an individual's skin color. In humans, melanin is formed by melanocytes within the epidermis. The process of melanin synthesis strongly depends on a range of cellular factors, including the fine-tuned interplay with reactive oxygen species (ROS). In this context, a role of cold atmospheric plasma (CAP) on melanin synthesis was proposed due to its tunable ROS generation. Herein, the argon-driven plasma jet kINPen® MED was employed, and its impact on melanin synthesis was evaluated by comparison with known stimulants such as the phosphodiesterase inhibitor IBMX and UV radiation. Different available model systems were employed, and the melanin content of both cultured human melanocytes (in vitro) and full-thickness human skin biopsies (in situ) were analyzed. A histochemical method detected melanin in skin tissue. Cellular melanin was measured by NIR autofluorescence using flow cytometry, and a highly sensitive HPLC-MS method was applied, which enabled the differentiation of eu- and pheomelanin by their degradation products. The melanin content in full-thickness human skin biopsies increased after repeated CAP exposure, while there were only minor effects in cultured melanocytes compared to UV radiation and IBMX treatment. Based on these findings, CAP does not appear to be a useful option for treating skin pigmentation disorders. On the other hand, the risk of hyperpigmentation as an adverse effect of CAP application for wound healing or other dermatological diseases seems to be neglectable.

Jejunal strongyloidiasis mimicking crohn's colitis: A diagnostic dilemma!

We report an unusual case of jejunal strongyloidiasis presenting as chronic malabsorption and intractable small bowel diarrhea in an immunocompetent adolescent boy who posed a diagnostic challenge for pathologists, radiologists, and gastroenterologists. Histopathology revealed chronic active colitis and was consistent with the clinicoradiological diagnosis of Crohn's colitis but nonresponse to immunomodulators warranted full-thickness jejunal biopsy through laparotomy which showed numerous larvae and eggs of Strongyloides. There is a need to increase the awareness of Strongyloides colitis given its high rate of misdiagnosis and mortality as the correct diagnosis can avoid a fatal outcome of this curable disease.

Overview on Lumpy Disease: Pathogenesis, Sign and Symptoms, Risk Factor, and Treatment

The lumpy diseases is an infectious disease. It is caused by viruses (LSDV) of the family Capripoxvirus.An investigation on the risk variables linked to the proliferation of LSD in Ethiopia has been conducted through a cross-sectional questionnaire-based study LSD virus,virus has been detected in stomoxy calcitrans and Anopheles stephens. virus can survive in necrotic skin for about 33 days and remains viable for at least 18 days in air-dried skin lesions at room temperature. The virus has been reported to persist in necrotic skin nodules for up to 33 days or longer, in dried crusts for up to 35 days and at least 18 days in air-dried hides.LSD has gross lesions that are well-described. Skin nodules are typically elevated, hard, and spherical in shape, however some might fuse together to form enormous, uneven plaques with defined boundaries. Biphasic fever, a clinical symptom of LSD, is characterised by two episodes of fever that develop after a varying incubation period of 4–12 days (typically 7 days). The affected animals' body temperature rises to 40–41.5°C, and this can last for at least 6–72 hours and, in exceptional cases, up to 10 days.To guarantee sufficient defence against LSD, susceptible adult cattle should receive a yearly vaccination.To reduce the possibility of the disease spreading by vectors, cattle should get routine treatments with insect repellents. While not completely effective, this method can lower the likelihood of transmission..The first report of LSD's clinical symptoms was published in Zambia (Morris 1931 ) The affected animals displayed symptoms of nasal discharge, emaciation, necrotic plaques in the mouth and nose mucous membranes, and excessive salivation. The most popular technique for diagnosis is full-thickness skin biopsies or scabs with electron microscopy showing the presence of characteristic capripox virions.To identify the antigens, techniques such as ELISA, PCR, and viral neutralization test procedures are helpful. Doctors may administer vitamin injections, anti-inflammatory drugs, or antibiotics to treat secondary bacterial infection fever and inflammation.needed a full recuperation period of six months A27L, L1R, and a combination of the two LSDV antigens were included in the development of three vaccines. Insect repellents, disinfectant cleaning, proper disposal of contaminated areas, and awareness-raising are examples of preventive approaches.The economic impact of LSD was caused by both direct consequences, like control expenses, and indirect ones, including milk loss, mortality loss, and draft power loss.

Expression of Toll-like receptors in oral squamous cell carcinoma.

Almost 380,000 new cases of oral cancer were reported worldwide in 2020. Oral squamous cell carcinoma (OSCC) accounts for 90% of all types of oral cancers. Emerging studies have shown association of Toll-like receptors (TLRs) in carcinogenesis. The present study aimed to investigate the expression levels and tissue localization of TRL1 to TRL10 and NF-κB between OSCC and healthy oral mucosa, as well as effect of Candida colonization in TRL expression in OSCC. Full thickness biopsies and microbial samples from 30 newly diagnosed primary OSCC patients and 26 health controls were collected. The expression of TLR1 to TLR10 and NF-κB was analyzed by immunohistochemistry. Microbial samples were collected from oral mucosa to detect Candida. OSCC epithelium showed lower staining intensity of TRL1, TRL2 TRL5, and TRL8 as compared to healthy controls. Similarly, staining intensity of TRL3, TRL4, TRL7, and TRL8 were significantly decreased in basement membrane (BM) zone. Likewise, OSCC endothelium showed lower staining intensity of TLR4, TLR7 and TLR8. Expression of NF-κB was significantly stronger in normal healthy tissue compared to OSCC sample. Positive correlation was found between the expression of NF-κB, TRL9 and TRL10 in basal layer of the infiltrative zone OSCC samples (P = 0.04 and P = 0.002, respectively). Significant increase in TRL4 was seen in BM zone of sample colonized with Candida (P = 0.01). According to the limited number of samples, our data indicates downregulation of TLRs and NF-κB in OSCC, and upregulation of TLR4 expression with presence of Candida.

Intestinal full-thickness needle-core biopsy via laparotomy is safe, rapid, and effective and less invasive than standard incisional biopsy in dogs and cats.

To describe the intestinal full-thickness needle-core biopsy technique via abdominal laparotomy outcomes and compare the histopathological and immunohistochemical diagnosis with standard incisional intestinal biopsy technique in dogs and cats. 3 dogs and 17 cats. Client-owned dogs and cats were prospectively enrolled if intestinal full-thickness biopsies were indicated for the diagnosis of diffuse chronic intestinal diseases following ultrasonography. The study period extended from June 2021 to December 2022. All animals underwent intestinal biopsies with both techniques (needle-core biopsy and standard incisional biopsy) via abdominal laparotomy. Data collected included clinical signs, biopsy collection times, complications, and histopathologic and immunohistochemical findings. A minimum follow-up of 14 days was required. The main clinical sign at presentation was chronic vomiting (65%). Mean needle-core biopsy collection time (262 seconds) was significantly shorter than standard incisional biopsy collection time (599 seconds; P < .000001). The incidence of minor complications was 10% (inflammation of the skin surgical site secondary to licking). One catastrophic complication occurred on a standard incisional biopsy site in 1 cat in a context of bile peritonitis (5% of all cases). There were no complications associated with the needle-core biopsy. All but 1 cat were discharged, with a median of 2 days (range, 1 to 4 days) after surgery. The diagnoses resulting from both techniques were 100% concordant for the distinction between inflammatory bowel disease and intestinal lymphoma via histopathology and immunochemistry. Needle-core biopsy is safe, rapid, and effective and is less invasive than standard incisional biopsy.

Menetrier's disease - press review and summary of current knowledge

Introduction&#x0D; Menetrier's Disease is a rare and mysterious stomach disorder characterised by giant gastric folds, excessive mucus production, and protein loss. This comprehensive research article examines Menetrier's Disease, focusing on its clinical features, diagnosis, and available treatment options. The article aims to provide a complete understanding of Menetrier's Disease, fill the knowledge gap, and encourage improved clinical management.&#x0D; Description of the State of Knowledge&#x0D; Menetrier's Disease is a rare condition, and its cause is still unknown, though it may be linked to previous viral and bacterial infections and increased expression of transforming growth factor-alpha (TGF-α). Diagnosis can be established by endoscopic examination and histological analysis of material from a full-thickness mucosal biopsy. Treatment options are limited and concentrated on symptom relief, while the outcome of the therapy may vary.&#x0D; Summary&#x0D; Menetrier's Disease presents significant difficulties in both diagnosis and treatment. This review outlines the clinical features, classification, diagnostic approaches, available treatment options, and prognosis for healthcare professionals and researchers seeking to understand this disease better. Better understanding of Menetrier's Disease is crucial to improve patient care and explore new, potential therapeutic avenues.

Clinical insights to address canine strongyloidosis in daily practice

Canine strongyloidosis by Strongyloides stercoralis is a parasitic disease emerging in Europe, which represents both a veterinary clinical issue and a public health challenge because of the zoonotic potential. The disease, not yet frequent in Europe, could induce severe clinical signs in dogs; thus, an early diagnosis and appropriate treatment are desirable. The aim of the present work is to retrospectively investigate the clinical and paraclinical findings in sick dogs naturally infected by S. stercoralis, with particular attention to ultrasound (US) changes at the gastrointestinal level. Twelve dogs were included in the study. The diagnosis was made by means of larval morphological identification on faecal samples and PCR. Most dogs presented with gastrointestinal signs; diarrhea and weight loss were the most common presenting complaint. Only one dog showed respiratory signs, associated to a parasitic cutaneous nodule. Hypoproteinaemia, anaemia, leucocytosis and an increase in alpha2-globulin fraction at serum protein electrophoresis were common (>50%) but not constant findings. The most reported US picture was a fluid-filled, distended, atonic small intestine mostly associated with altered wall layering, while the wall thickness commonly associated with chronic enteritis was only rarely reported. These changes, associated with other clinical and paraclinical alterations, could increase the suspicion of canine strongyloidosis and may direct clinicians to include strongyloidosis in the differential diagnosis of dogs with diarrhea. The histological examination at the intestinal level, available in five dogs, revealed the presence of parasites from the full-thickness biopsy, but not from the endoscopic biopsy. The critical points of diagnosis in clinical practice are also discussed.

Diagnostic accuracy of barium enema versus full-thickness rectal biopsy in children with clinically suspected Hirschsprung's disease: Acomparative cross-sectional study.

Hirschsprung's disease (HSD) remains a common cause of pediatric intestinal obstruction. Barium contrast enema (BE) is the primary imaging modality for the evaluation of clinically suspected cases. Here, we aimed to assess the diagnostic accuracy of BE in children with clinically suspected HSD when compared to a gold standard full-thickness rectal biopsy (FTRB). We recruited and consecutively enrolled children with clinically suspected HSD at two tertiary teaching hospitals. Participants underwent BE imaging and two radiologists interpreted the findings independently. Participants further underwent FTRB by pediatric surgeons as the confirmatory test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC) with the area under the curve (AUC) were calculated on Stata version 14.2, taking FTRB as the standard. We enrolled 55 cases, of which 49 completed the evaluation and were included in the final analysis. The median age was 9.4 months (interquartile range: 2-24], with a male-to-female ratio of 4.4:1. The sensitivity, specificity, PPV, and NPV of BE were 0.95 (95% confidence interval [CI][0.81-0.99]), 0.73 (95% CI [0.39-0.94]), 0.92 (95% CI [0.82-0.97]), and 0.80 (95% CI [0.50-0.94]), respectively. On AUC, the diagnostic accuracy of BE compared to the confirmatory FTRB was 0.84 (95% CI [0.69-0.98]). The diagnostic accuracy was higher in neonates (ROC: 1.00) when compared to infants (ROC: 0.83) or those above 1 year of age (ROC: 0.798). HSD-suggestive BE findings were associated with absence of ganglion cells on FTRB (χ 2 = 23.301, p < 0.001). Inverted rectosigmoid ratio and transition zone were more sensitive in detecting HSD of 0.92 (95% CI [0.74-0.98]) and 0.81 (95% CI [0.63-0.92]), respectively. BE is sufficiently accurate in the diagnosis of children with HSD, suggesting BE would likely be used to inform surgical management in settings where confirmatory biopsy is lacking. However, clinical judgment is warranted in interpreting negative BE findings.

Time is Gut. Approaching Intestinal Leiomyositis: Case Presentation and Literature Review.

T-lymphocytic intestinal leiomyositis is a rare cause of "pediatric intestinal pseudo-obstructions." Diagnosis may be difficult and requires full-thickness bowel biopsies during laparotomy or laparoscopy with possible enterostomy. Currently, immunosuppressive therapy is the only available treatment. A delay in diagnosis and therapy may negatively affect the prognosis because of ongoing fibrotic alterations; therefore, early diagnosis and consequent treatment are crucial. This review summarizes the available information on the nosology, diagnostic steps, and treatment modalities. Here, we report the youngest case of enteric leiomyositis reported in the last two decades and analyze its management by reviewing previous cases.

Concurrence of Hirschsprung disease and annular pancreas: a rare case report

Hirschsprung’s disease (HD) and annular pancreas are both uncommon congenital gastrointestinal malformations. Although additional abnormalities are associated with 18% of HD cases, there is limited evidence of concomitant HD and annular pancreas. We present a full-term, two-day-old male with abdominal distended, and failure to pass first stool after 3 days of observation and rectal washout the abdominal X-rays showed a double bubble appearance. Intraoperative finding, the patient had pancreas annulare (PA). Colonic aganglionosis was discovered using full-thickness rectal biopsies (FTRB). At the age of seven months, a transanal endorectal pull-through was performed without complications. Although the diagnosis of these conditions might be difficult due to their clinical similarities, appropriate diagnosis, and surgical management are possible and can dramatically minimize morbidity and death in the newborn.

Vasoactive Intestinal Polypeptide Plays a Key Role in the Microbial-Neuroimmune Control of Intestinal Motility

Background and AimsAlthough chronic diarrhea and constipation are common, the treatment is symptomatic as their pathophysiology is poorly understood. Accumulating evidence suggests that the microbiota modulates gut function but the underlying mechanisms are unknown. We therefore investigated the pathways by which microbiota modulates gastrointestinal motility in different sections of the alimentary tract. MethodsGastric emptying, intestinal transit, muscle contractility, acetylcholine release, gene expression and vasoactive intestinal polypeptide (VIP) immunoreactivity were assessed in wild-type and Myd88-/-Trif-/- mice in germ-free, gnotobiotic and SPF conditions. Effects of transient colonization and antimicrobials, as well as immune cell blockade were investigated. VIP levels were assessed in human full thickness biopsies by Western blot. ResultsGerm-free mice had similar gastric emptying but slower intestinal transit compared with SPF mice, or mice monocolonized with Lactobacillus rhamnosus or Escherichia coli, the latter having stronger effects. While muscle contractility was unaffected, its neural control was modulated by microbiota by upregulating jejunal VIP, which co-localized with and controlled cholinergic nerve function. This process was responsive to changes in the microbial composition and load, and mediated through TLR signaling, with enteric glia cells playing a key role. Jejunal VIP was lower in patients with chronic intestinal pseudo-obstruction compared with control subjects. ConclusionMicrobial control of gastrointestinal motility is both region- and bacteria-specific, it reacts to environmental changes, and is mediated by innate immunity-neural system interactions. Small intestinal VIP, by regulating cholinergic nerves, plays a key role in this process, thus providing a new therapeutic target for patients with motility disorders.

Efficacy of Toluidine Blue Staining in Rectal Biopsy with Patients of Hirschsprung Disease

Background: The diagnosis of Hirschsprung disease (HD) is dependent on the histological study of rectal biopsy for ganglion cells and nerve fibers. Hematoxylin and Eosin (H&amp;E) stain is commonly used. However, diagnosis is not possible with H&amp;E staining every time, because staining has limitations in the diagnosis of immature ganglion cells in neonates and in the submucosal area where the ganglion cells are small in number. Using Toluidine blue (Tb) stain it has become easier to identify ganglion cells.Objective: To find out the efficacy of toluidine blue staining in the diagnosis of Hirschsprung disease.Materials and Methods: A cross-sectional descriptive observational study was carried out with the histological findings of 60 rectal punch biopsies and 60 full-thickness rectal biopsies from the corresponding same patients from March 2018 to February 2020. Ten cases of inadequate punch biopsy were excluded from the study. After paraffin embedding, slides were stained with H&amp;E and Tb stains. Then stained sections were examined for the presence or absence of ganglion cells and hypertrophic nerve fibers in the submucosa and in between muscle layers. Result: Out of 50 punch biopsy cases, 33(66.0%) cases with H&amp;E stain and 35(70.0%) cases with Tb stain showed presence of hypertrophic nerves (HN). In Non-HD cases, with H&amp;E stain 11(22.0%) cases showed somewhat easy to identify ganglion cells. By using Tb stain ganglion cells were easy to identify in 4(8.0%) cases and somewhat easy to identify in 8(16.0%) cases. Out of 60 full-thickness rectal biopsy 38(63.30%) cases showed presence of hypertrophic nerves in both H&amp;E and Tb stains. In Non-HD cases with H&amp;E stain ganglion cells somewhat easy to identify in 8(13.3%) cases; easy to identify in 9(15.0%) cases and very easy to identify in 2(3.3%) cases. By using Tb stain, the identification of ganglion cells were 1(1.7%), 9(15.0%) and 9(15.0%) respectively. Study showed Tb stain was superior to H&amp;E in the identification of ganglion cells and hypertrophic nerves.Conclusion: Toluidine blue stains should be used as the routine stain in adjunct to H&amp;E stain to highlight ganglion cells in suspected Hirschsprung disease.KYAMC Journal Vol. 14, No. 02, July 2023: 69-73.