Immunoglobulin G4 related pancreaticobiliary disease: Report of two cases highlighting the diagnostic criteria

Two cases of immunoglobulin (IgG4)-related biliary and pancreaticobiliary disease are reported to define its diagnostic features. Case 1 presented with obstructive jaundice and showed IgG4-related disease (RD) involving right and left hepatic duct, common bile duct and gallbladder. Case 2 presented as periampullary mass. Both patients underwent surgical intervention. However, certain clinical and radiological features were present in these cases indicative of the possibility of IgG4-RD.

Hallazgos citológicos y factores de riesgo en citología cervical anormal en mujeres de pescadores del norte peruano, 2015 / Cytological findings and risk factors in abnormal cervical cytology in female fishermen from northern Peru, 2015

Introducción: El cáncer de cuello uterino es un problema de salud pública mundial, y es la segunda causa de muerte en el Perú; su estudio se ha realizado más en poblaciones de grandes ciudades, dejando de lado otras poblaciones que podrían tener un riesgo significativo. Objetivo: Determinar la prevalencia y los factores asociados a los hallazgos citológicos anormales de cuello uterino en las mujeres de pescadores de una ciudad del norte peruano. Métodos: Investigación transversal analítica de datos secundarios, se realizó un muestreo por conveniencia en las mujeres con vida sexual activa de una población semi urbana del norte peruano. La variable principal fue el hallazgo de lesiones pre invasoras e invasoras del cuello uterino según la citología observada, se cruzó con otras variables sociales, ginecológicas y sexuales; encontrando estadísticos de asociación crudos y ajustados. Resultados: De las 144 encuestadas, el 20% tuvo una alteración citológica y el 26% no se habían realizado la prueba hace más de 3 años. El 14% fue positivo para lesión escamosa intra epitelial de bajo grado, el 1% tuvo un carcinoma escamoso invasor. Al realizar el análisis multivariado, se obtuvo una asociación entre lesión citológica y VPH (p<0,001), el tener inflamación severa (p<0,001), el tener un germen (p=0,001) y el haber iniciado las relaciones sexuales a los 14 años o menos (p=0,024), ajustado por el usar anticonceptivos y el haberse realizado un Papanicolaou. Conclusiones: Se reporta algunos factores asociados en una población sexualmente activa, que reflejan una gran prevalencia de lesiones asociada a factores que deben ser intervenidos.

Introduction: Cervical cancer is a global public health problem, and is the second leading cause of death in Peru; the study was conducted more in populations of large cities, leaving aside other populations that could have a significant risk. Objective: To determine the prevalence and factors associated with abnormal cervical cytologic findings in women of fishermen in a city in northern Peru. Methods: Cross-sectional analytical research of secondary data, convenience sampling was performed in women with active sex life in a semi urban population of northern Peru. The principal variable was the finding of pre invasive and invasive cervical lesions observed by cytology, crossed with other social, gynecological and sexual variables; statistical finding of crude and adjusted association. Results: Of the 144 respondents, 20% had a cytological alteration and the 26% had not taken the test over 3 years ago. 14% were positive for squamous intra epithelial lesion low grade, 1% had an invasive squamous carcinoma. When performing multivariate analysis, an association between cytological lesion and HPV (p<0.001), having severe inflammation (p<0.001), having a germ (p=0.001) and initiating sexual intercourse at age 14 or less (p=0.024), adjusted for contraceptive use and Pap tests have been done. Conclusions: Some associated factors in a sexually active population, reflecting a high prevalence of injury associated with factors that have to be operated.

Clinico-Histopathological Analysis In Patients With Abnormal Uterine Bleeding.

Background: Menstrual disturbance is one of the commonest gynecological problems for the curettage or hysterectomy specimen received by pathologist. During reproductive age group, approximately 9-30% of women suffer from menorrhagia or abnormal uterine bleeding & the incidence increases as age advances. Being most common gynecological problem, present study is aimed to know full spectrum of AUB and its pathological aspects. Methods: 200 cases were taken from NHL Municipal Medical College, Ahmedabad over a period of 3 years. Clinical history and radiological findings of cases of abnormal uterine bleeding were noted. Histopathological analysis was done. Data were analyzed and correlation between clinical and histopathological findings were studied. Results: Maximum numbers of patients were in 41-50 years (41.5%) of age group and next are in 31-40 years (38%) of age group. Proliferative pattern (24%) was most common pattern in non-structural causes of AUB and Leiomyoma (22.5%) was the most common structural cause of AUB. Pregnancy related causes of AUB were common in less than 40 years of age group. Malignancy was more common in more than 50 years of age group. Atrophic endometrium (33.33%) was the most common cause of post-menopausal bleeding. Conclusion: Endometrial specimen examination by histopathological evaluation is gold standard procedure to know the exact pathology for AUB and for further management of patients.[Falguni S NJIRM 2016; 7(5):14-17]

Histological Findings in Korean Patients with Rosacea / 대한피부과학회지

BACKGROUND: Rosacea is characterized by erythema of the face that persists for several months or longer. Rosacea is usually diagnosed based on clinical presentation and a biopsy is rarely performed for diagnostic purposes. However, a biopsy may be helpful when the symptoms are atypical. OBJECTIVE: We identified commonly appearing histological characteristics of rosacea such as inflammation, sebaceous hyperplasia, granulomatous reaction, epidermal hyperplasia, Demodex, pustules, and fibrosis. In addition, we evaluated these according to clinical subtype. METHODS: We examined the histological findings of 200 rosacea patients who visited our hospital. Histological findings were evaluated according to clinical subtype. The standard classification and staging method published by the National Rosacea Society was used for clinical classification. RESULTS: The erythematotelangiectatic and papulopustular types of rosacea were the most common. Mild inflammation was found in 56.0% of the patients (1 and 1+) and 49.0% showed inflammation greater than 2 degrees. The most commonly observed histological features across all subtypes were sebaceous hyperplasia followed by epidermal hyperplasia and Demodex. However, sebaceous hyperplasia and Demodex were not observed in ocular rosacea. CONCLUSION: Some histological findings such as inflammation, granulomatous reaction, sebaceous hyperplasia, pustule, Demodex, epidermal hyperplasia, and fibrosis were commonly observed in rosacea. There were no distinctive subtype-specific characteristics, but various histological characteristics were observed in a single clinical subtype.

Clinical Features and Histological Findings of 17 Patients with Chronic Actinic Dermatitis / 고신대학교의과대학학술지

OBJECTIVES: This study was designed to evaluate the clinical, histological and immunohistochemical findings and treatment of chronic actinic dermatitis in Korean patients. METHODS: Seventeen Korean patients with chronic actinic dermatitis were enrolled for this study. The clinical and histological findings and the results of phototest were reviewed with medical records, clinical photographs and pathologic slides. We also reviewed the effectiveness of the treatments in all patients with chronic actinic dermatitis. RESULTS: In all patients with chronic actinic dermatitis, pruritus was severe, and the patients present in the early stages with erythemas on the face, neck and the back of the hands. As the eruption progresses, it became lichenified and scaly plaques and papules developed. The face, upper extremity and neck were most commonly affected. The most common abnormal results of the phototests were decreased MED-UVB alone. In 8 patients with actinic reticuloid, histopathologic findings showed irregular acanthosis, parakeratosis, spongiosis, atypical hyperchromatic cells with cerebriform nuclei, epidermotropism, Pautrier-like microabscess, deep perivascular lymphocytic infiltrates, vertically-streaked collagen in the papillary dermis, stellate and multinucleated fibroblasts. Treatment includes topical tacrolimus and corticosteroid, oral corticosteroid, azathioprine and cyclosporine. CONCLUSIONS: Our study showed classic clinical and histological findings. The most common abnormal results of the phototests were decreased MED-UVB alone. Topical steroid, tacrolimus and systemic cyclosporine, azathioprine are effective in treating chronic actinic dermatitis.

Hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos CAG A y VAC A en pacientes con dispepsia: Servicio de Gastroenterología Hospital Central Universitario “Antonio María Pineda” Barquisimeto Estado Lara / Clinical, endoscopic and histological findings associated with helicobacter pylori infection considering genotypes CAG A and VAC A in patients with dyspepsia: Gastroenterology Department Hospital Central Universitario

La dispepsia afecta la calidad de vida de muchos pacientes y en muchos casos está asociada a la infección por Helicobacter pylori. Esta bacteria es reconocida como el agente causal de la gastritis crónica, se asocia al desarrollo de úlceras gástrica y duodenal y está relacionada con el desarrollo de cáncer gástrico. Como objetivo primario se planteó establecer los hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos cag A y vac A en pacientes con dispepsia que acudieron al Servicio de Gastroenterología del Hospital Central Universitario “Antonio María Pineda”. Se trata de un estudio epidemiológico descriptivo de corte transversal. La población estuvo conformada por los pacientes con dispepsia que acudieron al servicio y el muestreo fue de tipo no probabilístico intencional, puesto que se tomó a la población que consultó con síntomas dispépticos y que cumplieron con los criterios de inclusión y exclusión establecidos. Dichos pacientes se interrogaron sobre síntomas dispépticos, se les realizó endoscopia digestiva superior, se describieron los hallazgos endoscópicos y se les tomó muestra para estudio histológico y de genotipificación. Se encontró una incidencia de infección por H. pylori de 98,5%, la infección predominó en el sexo femenino, los genotipos cag A positivos y las formas alélicas m1/s1 son los más frecuentes en la población estudiada y, los mismos se asocian con gastritis crónica, úlceras gástricas y metaplasia intestinal incompleta...

Dyspepsia affects quality of life for many patients and often is associated with Helicobacter pylori infection. This bacterium is recognized as the causative agent of chronic gastritis, is associated with development of gastric and duodenal ulcers and, with the development of gastric cancer. Primary objective was raised to establish the clinical, endoscopic and histological findings associated with Helicobacter pylori infection considering genotypes cag A and vac A in patients with dyspepsia who attended the Gastroenterology Service of Hospital Central Universitario “Antonio María Pineda”. This is a cross-sectional descriptive epidemiological study. The population consisted of patients with dyspepsia who attended the gastroenterology service. The sampling was intentionally non-probabilistic, since we only took the people who consulted with dyspeptic symptoms and met the established criteria of inclusion and exclusion. These patients were questioned about dyspeptic symptoms, underwent upper gastrointestinal endoscopy, endoscopic findings were described and samples were taken for histology and genotyping. We found an incidence of H. pylori of 98.5%, infection prevailed in females, the genotypes cag A positive and m1/s1 allelic forms are most frequent in the population studied and, the same is associated with chronic gastritis, gastric ulcers and intestinal metaplasia incomplete...

Insuficiencia renal crónica terminal y hemodiálisis: Alteraciones endoscópicas e histológicas del tracto gastrointestinal

Objetivos: Determinar la frecuencia de alteraciones endoscópicas e histológicas del tracto digestivo en pacientes con IRC-T en hemodiálisis. Determinar la relación entre la presencia de síntomas y los hallazgos endoscópicos. Métodos: Estudiamos 55 pacientes con IRC-T en hemodiálisis en protocolo pretrasplante renal y 55 pacientes de la consulta de gastroenterología. Se realizó EDS y colonoscopia, con toma de biopsia independientemente de la presencia o no de lesiones. Se utilizó el X2 para las variables cualitativas con un valor de p<0.05, se realizó el cálculo del 95% intervalo de confianza. Resultados: De los 110 pacientes 70% presentó alteraciones en la EDS, de éstos 44.5% eran pacientes con IRC-T y 25.5% eran controles. La diferencia fue estadísticamente significativa (p<0.0001). El hallazgo histológico más frecuente fue gastritis crónica activa. Predominaron los cambios inflamatorios de la mucosa sobre la enfermedad ulcerosa. No hubo diferencia significativa en la EDI. Los pólipos de colon y adenomas tubulares fueron más frecuentes en los pacientes con IRC-T. Conclusiones: Las lesiones gastrointestinales son más frecuentes en pacientes con IRC-T. Es necesaria la realización de estudios endoscópicos pre-transplante renal.

Objectives: To determine the frequency of endoscopic and histological changes in the digestive tract in patients with CRF-T in hemodialysis treatment and, to determine the relationship between the presence of symptoms and endoscopic findings. Methods: 55 patients in hemodialysis were studied with T-IRC on pre - kidney transplant protocol and, 55 patients from the gastroenterology unit. Upper endoscopy (UE) and colonoscopy with biopsy samples were performed, regardless of the presence of injuries. X2 was used for qualitative variables with a p-value <0.05, with 95% confidence interval. Results: Of 110 patients 70% had UE abnormalities, of which 44.5% were IRC - T patients and 25.5% were controls. The difference was statistically significant (p <0.0001). The most common histological finding was active chronic gastritis. Inflammatory changes of the mucosa predominated over ulcerative disease. There were no significant differences regarding colonoscopy. Colon polyps and tubular adenomas were more common in patients with CRF-T. Conclusions: Gastrointestinal lesions are more common in patients with CRF-T. Endoscopic evaluation in Pre - renal transplant patients are necessary.

Revisión de hallazgos histológicos de biopsias obtenidas por endoscópia digestiva superior de mayo 2006-2007

Introducción: Helicobacter pylori (HP), gastritis atrófica, metaplasia intestinal, displasia, carcinoma gástrico, son patologías gástricas, cuyo diagnóstico es histológico. Objetivo: Revisión de hallazgos histológicos obtenidos por biopsias del tracto digestivo superior en el Servicio de Gastroenterología "Dr. Simón Beker" en el Hospital General del Oeste "Dr. José Gregorio Hernández" Mayo 2006 - 2007. Pacientes Y Métodos: Se revisaron los archivos de biopsias del servicio, estudio retrospectivo, corte transversal, descriptivo. Análisis estadístico de las variables, cálculo de la media aritmética, mediana y desviación estándar y chi cuadrado. Resultados: 599 pacientes, 67,4% femenino, 32,5% masculino, edad promedio de 47,3 años, se encontró: gastritis crónica 49,4%, HP 37,6%, cardioesofagítis crónica 4,8%, duodenitis crónica 4,5%, esófago de Barrett 1,7%, esofagítis crónica 1,4%, duodenitis parasitaria 0,5%, metaplasia intestinal gástrica completa 1,1% e incompleta 1,8%, ADC poco diferenciado 0,9% y bien diferenciado 0,08%, hiperplasia foveolar 0,7%, pólipo hiperplásico esofágico y papiloma escamoso ulcerado 0,08. De 571 pacientes con gastritis crónica, 434 (76%) presentaron infección por HP, con una asociación estadísticamente significativa. Conclusión: gastritis crónica e infección por HP son los hallazgos histológicos más frecuentes en nuestro centro.

Introduction: Helicobacter pylori (HP), intestinal atrophic gastritis, intestinal methaplasy, dysplasia and gastric carcinoma are gastric pathologies that depend on a histological diagnosis. Objective: Revision of histological findings obtained by biopsies of the upper digestive tract in the "Dr. Simón Beker" Gastroenterology Service in the Hospital General del Oeste "Dr. Jose Gregorio Hernandez" May 2006 - 2007. Patients and Methods: Biopsies records of the Service were reviewed, a retrospective, cross sectional, descriptive study was performed; with statistic analysis of the variables, calculations of the arithmetic mean median, standard deviation and chi square. Results: 599 patients, 67.4% female, 32.5% male, mean age of 47.3 years, were found: chronic gastritis 49.4%, HP 37.6%, 4.8% chronic cardioesophagitis, chronic duodenitis 4 5%, 1.7% BarrettÊs esophagus, chronic esophagitis 1.4%, 0.5% duodenitis, complete gastric intestinal methaplasy 1.1% and incomplete 1.8%, poorly differentiated ADC 0.9% and well differentiated 0.08%, 0.7% foveolar hyperplasia, esophageal hyperplasic polyps and ulcerated squamous papilloma 0.08. Of 571 patients with chronic gastritis, 434 (76%) were infected by HP, with a statistically significant association. Conclusion: chronic gastritis and infection by HP are the histological more frequent findings at our center.

Chronic Spinal Epidural Hematoma due to Repeated Epidural Block: A Case Report

A case of a patient diagnosed as the chronic spinal epidural hematoma in the lumbar region is reported. There was no history of trauma except the repeated epidural block for controlling the lower back pain at the pain clinic. The symptoms were occurred after epidural block and were exaggerated by repeated injections. Magnetic resonance imaging showed a spinal epidural mass located dorsolaterally at the level of L3-L4. After removal of the hematoma, the symptoms were completely relieved. The diagnosis of a chronic spinal epidural hematoma was confirmed with both operative and histological findings.

Effect of Kyuki-kyogai-to on Stopping Dysfunctional Uterine Bleeding. Comparison with Occidental Hematostatic Drug / 日本東洋医学雑誌

We investigated the number of days necessary to stop bleeding in a total of 183 cases of dysfunctional uterine bleeding in mature women (average age 41.3+/-7.2). We compared 93 cases given Kyuki-kyogai-to extract with 90 cases given the occidental hematostatic drug, Transamin (tranexamic acid in tablet form) plus Ophthalm K tablets (carbazochrom+VitaminK+Vitamin C) for 7 days from the first day of medical examination until the diagnosis of endometrium was determined by histologic examination. The total number of days required for the bleeding to stop showed a mean of 4.29+/-1.54 days in the Kyuki-kyogai-to administration group and 5.54+/-2.13 days in Transamin and others group. The bleeding was stopped significantly faster in the Kyuki-kyogai-to group than in the Transamin group (P<0.01 to χ² calibration [chi-square test]). The effective rates were 94.6% and 72.2% respectively. Considering the Kyojitsusho (condition of excess or deficiency), this was significant in Kyosho (condition of deficiency) and Kyojitsu-kansho (condition of between deficiency and excess), but not significant in Jitsusho (condition of excess). In terms of histological findings of endometrium, this was significant in the proliferation stage and in simple hyperplasia, but not significant in the stillness stage with an atrophic pattern, the stage of intermingled proliferation and secretion, or the secretion stage. The action mechanism of bleeding cessation remains unclear. However, it seems that Kyuki-kyogai-to is an effective herbal medicine to stop bleeding in dysfunctional uterine.

Effect of Physical Exercise on Experimental Steroid-Induced Myopathy

BACKGROUND: Steroid myopathy is an unexpected side effect to the prolonged therapeutic use of steroids. To treat steroid myopathy, the followings are recommended; reduction of the steroid dose, usage of a nonfluorinated steroid, and conversion to an alternate day regimen. As muscle loading is encouraged in maintaining normal muscle properties, it is also apparent that physical exercise may be useful in the prevention and treatment of steroid myopathy. METHOD: The experiment was designed to investigate the effects of exercise on steroid myopathy. Rats being treated with triamcinolone acetonide (TA) (5 mg/kg/day) for 7 days exercised on a treadmill (speed 20m/min, 30 min/day, 3 days/week) for 2 weeks. The extensor digitorum longus (EDL) and soleus were then examined histochemically and ultrastructurally. RESULTS: Rats treated with TA showed significant loss of body and muscle weight. In the TA treated group, cross-sectional areas of type II fibers of both EDL and soleus were decreased in comparison with the controls. Necrotic changes were found only in type II fibers of the soleus. Recovery from the weight loss with type II fiber atrophy was more pronounced in the exercise group than that of the sedentary group, but was not significant statistically. Ultrastructural abnormalities, that consisted of subsarcolemmal mitochondrial accumulation, mitochondrial vacuolation, increased number of mitochondria in autophagic vacuoles, and dilatation of sarcoplasmic reticulum, were seen in TA treated muscles. These injuries were significantly reduced by the exercise, however, complete recovery could not be seen. CONCLUSIONS: These results suggest that treadmill exercise for 2 weeks partially ameliorate steroid myopathy in.