Relationship between clinical factors and severity of esophageal candidiasis according to Kodsi's classification.

Severe Candida esophagitis (CE) may lead to development of strictures, hemorrhage, esophagotracheal fistula, and a consequent decrease in quality of life. Although the severity of CE has been classified based on macroscopic findings on endoscopy, the clinical significance remains unknown. The aim of the study was to elucidate the predictive clinical factors for endoscopic severity of CE. Patients who underwent upper endoscopy and answered questionnaires were prospectively enrolled. Smoking, alcohol, human immunodeficiency virus (HIV) infection, diabetes mellitus, chronic renal failure, liver cirrhosis, systemic steroids use, proton pump inhibitor use, H2 blocker use, and gastrointestinal (GI) symptoms were assessed on the same day of endoscopy. GI symptoms including epigastric pain, heartburn, reflux, hunger cramps, nausea, dysphagia, and odynophagia were assessed on a 7-point Likert scale. Endoscopic severity was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of 1855 patients, 71 (3.8%) were diagnosed with CE (mild, n = 48; severe, n = 23). In the CE patients, 50.0% (24/48) in the mild group and 23.1% (6/23) in the severe group did not have any GI symptoms. In HIV-infected patients (n = 17), a significant correlation was found between endoscopic severity and declining CD4 cell count (Spearman's rho = -0.90; P < 0.01). Multivariate analysis revealed that GI symptoms (odds ratio [OR], 3.32) and HIV infection (OR, 3.81) were independently associated with severe CE. Patients in the severe group experienced more epigastric pain (P = 0.02), reflux symptoms (P = 0.04), dysphagia (P = 0.05), and odynophagia (P < 0.01) than those in the mild group. Of the GI symptoms, odynophagia was independently associated with severe CE (OR 9.62, P = 0.02). In conclusion, the prevalence of CE in adults who underwent endoscopy was 3.8%. Silent CE was found in both mild and severe cases. Endoscopic severity was associated with characteristic GI symptoms and comorbidity of HIV infection. A decline in immune function correlated with CE disease progression.

Correlation of Indocyanine Green Angiography Findings and Expression of Vascular Endothelial Growth Factor in Surgically Excised Age-related Macular Degeneration-related Choroidal Neovascular Membranes.

Purpose: We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes.Subject and Methods: The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF.Results: VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV.Conclusion: Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.

Indocyanine green angiography and histopathology of choroidal neovascular membrane in age-related macular degeneration.

PURPOSE: Histopathological investigation of the choroidal neovascular membrane (CNM) in age-related macular degeneration (AMD) patients who showed various findings in indocyanine green angiography (IA). METHODS: Before surgery, 20 eyes of 20 patients were classified into four types based on IA findings (Type I: both early and late phase hyperfluorescence; Type II: hyperfluorescence only in the early phase; Type III: hyperfluorescence only in the late phase; Type IV: virtually no hyperfluorescence in any phase). Seventeen surgically excised specimens stained with hematoxylin-eosin and azan, were examined by light microscopy. Three other specimens were examined by electron microscopy. RESULTS: Type I membrane showed many vascular channels not present in the surrounding retinal pigment epithelium (RPE) cells, and little fibrous tissue. Type II membrane had many vascular channels but RPE cells surrounded the CNM. Type III membrane showed few vascular channels and RPE cell proliferation. Type IV membrane showed dense fibrous tissue. CONCLUSION: The IA findings in AMD agreed with the CNM membrane structure in regard to the number of vascular channels, maturity of vessels, the extent of envelopment of RPE cells and the amount of fibrous tissue.

[Correlation of indocyanine green angiography findings and expression of vascular endothelial growth factor in surgically excised age-related macular degeneration-related choroidal neovascular membranes].

PURPOSE: We investigated the relationship between clinical classification by indocyanine green angiography (IA) and pathologic findings including the expression of vascular endothelial growth factor (VEGF) in age-related macular degeneration-related choroidal neovascular membranes. SUBJECT AND METHODS: The subjects were 15 patients with age-related macular degeneration who underwent surgical excision for choroidal neovascular membrane. The patients were classified into 4 types: Type I, hyperfluorescence in both early and late phases (n = 7); Type II, hyperfluorescence in the early phase only (n = 2); Type III, hyperfluorescence in the late phase only (n = 3); and Type IV, no hyperfluorescence in any phase (n = 3). The excised choroidal neovascular membranes were fixed and stained by hematoxylin-eosin and azan. They were also examined by immunohistochemical staining for VEGF. RESULTS: VEGF was expressed markedly in vascular endothelial cells and fibroblast-like cells of interstitial tissue of Types I, II and III. Its expression was weak in Type IV. CONCLUSION: Clinical classification by IA for age-related macular degeneration is consistent with the pathologic findings including the expression of VEGF.