IgG4 Levels in Bile for Distinguishing IgG4-Associated Cholangiopathy from Other Biliary Disorders: A Single Blinded Pilot Study

BACKGROUND/AIMS: Immunoglobulin G4 (IgG4)-associated cholangiopathy (IAC) is an inflammatory disease and may mimic primary sclerosing cholangitis (PSC), cholangiocarcinoma (CCA), or pancreatic cancer on cholangiography. We investigated whether IgG4 levels in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP) can distinguish IAC from PSC, CCA, and pancreatic cancer. METHODS: Bile was aspirated directly from the common bile duct during ERCP in patients with IAC prior to steroid therapy. For control purposes, bile was obtained from patients with PSC, CCA, pancreatic cancer, and benign biliary conditions (sphincter of oddi dysfunction/choledocholithiasis). RESULTS: Biliary IgG4 levels were measured in 54 patients. The median bile IgG4 levels were markedly elevated in patients with IAC (5.5 mg/dL; interquartile range [IQR], 5.1 to 15.6) as compared to patients with benign biliary conditions (0 mg/dL; IQR, 0 to 0.1; p=0.003). The median biliary IgG4 levels in PSC, CCA, and pancreatic cancer were 1.2 (IQR, 0.2 to 3.8), 0.9 (IQR, 0.2 to 3.4), and 0.2 mg/dL (IQR, 0.1 to 0.8), respectively. A cutoff value of 3.8 mg/dL distinguished IAC from PSC and CCA patients with 100% and 76.9% sensitivity and specificity, respectively. CONCLUSIONS: The results of this pilot study suggest that measurement of biliary IgG4 levels may have clinical value in distinguishing patients with IAC from biliary disorders that can mimic IAC.

Analysis of short-term results of monsieur's tunica albuginea urethroplasty as a definitive procedure for pan-anterior urethral stricture

Long anterior urethral strictures are fairly common in developing world and the treatment is equally challenging To assess the results and efficacy of Monsieur's Tunica Albuginea Urethroplasty [TAU] for anterior urethral stricture. We analyzed the results in 10 consecutive patients with pan-anterior urethral stricture, who underwent Monsieur's urethroplasty. The procedure involves mobilization of strictured urethra and laying it open with a dorsal slit. Edges of the slit-open urethra are sutured to edges of the urethral groove to the tunica of corporal bodies with catheter in situ. Results were assessed postoperatively 3, 6, 9 and 12 months. Patients were categorized as success and failure by comparative analysis of patient satisfaction along with urethroscopy, retrograde urethrogram, uroflowmetry. All patients were taken for post-operative urethroscopic analysis at 6 months to allow better understanding of both successful and failed cases. Mean follow-up of 15.2 [11-19] months showed an 80% success rate. Mean uroflow rate showed Qmax 24.5 cc/sec with 8 cases showing no residual or recurrent stricture. Two cases failed and required intervention. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra appearing epithelized over roof formed by tunica albuginea of the corpora cavernosa in successful cases. Monsieur's TAU is effective technique in treatment of anterior urethral stricture especially cases with unavailable buccal mucosa, with results fairly acceptable at the end of one year

case of solitary fibrous tumor of the kidney

A solitary fibrous tumor [SFT] is an unusual spindle cell neoplasm that usually occurs in the pleura but has recently been described in diverse extrapleural sites. Urogenital localization is rare and to our knowledge, only 39 cases of SFT of the kidney have been described. Although SFT of the kidney is extremely rare, this tumor must be included in the differential diagnosis, whenever a renal tumor consisting of mesenchymal elements is encountered. We report a case of a large SFT of the right kidney which was clinically and radiologically thought to be renal cell carcinoma and a final diagnosis of SFT was made only after immunohistochemical study