Asymptomatic gastric heterotopia in the rectum with Helicobacter pylori infection.

Gastric heterotopia is very rare in the rectum - less than 50 cases have been reported so far. Only in six of them Helicobacter pylori has been observed in heterotopic mucosa. We report a case of a 58-year-old woman with asymptomatic gastric heterotopia in the rectum, incidentally revealed during colonoscopy as a small, sessile polyp. The presence of H. pylori was confirmed by immunohistochemistry. This finding supports the opinion that H. pylori may pass along the gastrointestinal tract in a viable form and that the fecal-oral route of transmission is possible.

Interactions of lymphocytes, thyrocytes and fibroblasts in Hashimoto's thyroiditis: an immunohistochemical and ultrastructural study.

BACKGROUND: The mechanism of autoimmune reaction, a diffuse process consisting of a combination of epithelial cell destruction, lymphoid cellular infiltration, and fibrosis in Hashimoto's thyroiditis, is not well known. The aim of this study was to analyse the cell subsets in thyroid tissue of patients with Hashimoto's thyroiditis. METHODS: We studied paraffin-embedded thyroid specimens obtained from children with Hashimoto's thyroiditis and children without an autoimmune thyroid disease. Mononuclear T cells were detected by means of CD3+, CD4+, CD8+ antibodies, B cells by CD79 alpha+ antibodies, and antigen-presenting cells by CD1a+ antibodies, and they were counted in every 1,000 cells. The specimens from each patient were routinely estimated and investigated under the electron microscope. RESULTS: In Hashimoto's thyroiditis, we observed a statistically significant increase in T suppressor/cytotoxic cells CD8+ (20.54 ± 0.68%) in comparison to the control group (0.65 ± 0.30%), simple goitre (4.01 ± 5.54%) and nodular goitre (8.53 ± 2.37%), and a statistically significant increase in plasma CD79 alpha+ cells (31.65 ± 9.11%) in comparison to the control group (4.11 ± 1.94%), simple goitre (1.83 ± 0.64%) and nodular goitre (5.22 ± 1.63%). Simultaneously, we observed a low number of CD4+ T helper cells in the thyroid gland (0.93 ± 0.99%) in Hashimoto's thyroiditis (0.19 ± 0.05% in the control group, 1.05 ± 2.71% in simple goitre, 2.03 ± 1.06% in nodular goitre). The ultrastructural investigations showed interactions between T cells, plasmocytes, fibrocytes and thyrocytes leading to apoptosis of thyrocytes. An immunological synapse between T cells, plasmocytes and thyrocytes in the thyroid gland was noticed. CONCLUSIONS: In Hashimoto's thyroiditis, autoantigen presentation in combination with a low number of CD4+ T helper cells and a high number of CD8+ cells and plasmocytes caused the development of a cytotoxic reaction against thyrocytes, leading to apoptosis of the thyrocytes.

A developmental anomaly of the mammary glands - gigantomastia. A case report.

Developmental anomalies of the breast are frequently observed in women. The most serious pathology is gigantomastia. This type of breast hypertrophy may be caused by hypersensitivity of the breast oestrogen and progesterone receptors, by disturbances of the normal balance of oestrogen and androgen hormones, by hyperthyroidism or by hormonal activity of the neoplasm. In most cases gigantomastia produces pathological changes in the vertebral column which become manifest as discopathia, scoliosis or scoliokyphosis. A case of gigantomastia treated with surgery is presented and the effect of plastic operation is demonstrated. Surgery may be recommended as an excellent therapeutic treatment of gigantomastia.

[Antibodies against TSH receptors (TRAb) as indicators in prognosing the effectiveness of Tiamazol therapy for Grave's Disease]. / Przeciwciala przeciw receptorom TSH (TRAb) jako wskaznik w prognozowaniu skutecznosci leczenia tiamazolem choroby Gravesa-Basedowa.

The aim of the study was to evaluate the usefulness of TRAb determinations in prognosing and monitoring the efficacy of conservative treatment in Graves' disease. The examinations were performed in 54 patients. During the 18-month observation all the patients were treated with Tiamazol. The control group consisted of 20 healthy volunteers. The TRAb levels were determined before as well as 12 and 18 months after thyrostatic treatment. Simultaneously, the levels of TSH and FT4 were analysed. Moreover, all the patients underwent ultrasound examinations to assess the size of the thyroid gland. The findings of the 18-month follow up showed that in 31 patients (57%) the thyroid function became normal (group I--euthyreosis), in 23 patients (43%) hyperactivity persisted (group II--hyperthyreosis). The TRAb levels were analysed in both groups of patients. An increased initial level of TRAb was found in the hyperactivity group mean -54.39 + 31.21 U/l which was statistically significantly different from the TRAb levels in the euthyreosis group mean -29.13 +/- 19.14 U/l and in controls mean -2.75 +/- 2.06 U/l (p < 0.001 for both parameters). After 12-month treatment increased values of antibodies were still observed in this group of patients (mean -39.96 +/- 33.40 U/l) in comparison with the euthyreosis group (mean -9.87 +/- 8.33 U/l) and controls (mean -2.75 +/- 2.06 U/l) (p < 0.001 for both parameters). After 18-month treatment the TRAb levels in group II remained increased (mean -40.17 +/- 33.06) while in group I normal levels were achieved. The sizes of the thyroid gland were compared between the individual groups. In the hyperactivity group after 18-month treatment, the thyroid size was the biggest (mean -41.09 +/- 13.94 ml) and was statistically significantly different when compared to the average size in the euthyreosis group mean -31.65 +/- 11.74 ml (p < 0.01) and in controls mean -14.45 +/- 2.37 ml (p < 0.001). The levels of antibodies against TSH receptors are useful parameters in prognosis and monitoring the treatment effectiveness in Graves' disease. High initial levels of antibodies are the poor prognostic factors. The TRAb determinations are of some prognostic value not only before but also 12 months since the onset of therapy. The lack of antibody level normalization during treatment is connected with persisting hyperactivity. The TRAb concentration correlates with the thyroid size.

[Thyrotropin receptor antibodies (TRAb) as a test of surgical treatment effectiveness in Graves-Basedow's diseases]. / Przeciwciala przeciw receptorom TSH jako test skutecznosci leczenia operacyjnego w chorobie Gravesa-Basedowa.

The aim of the study was to assess the relations between the concentration of antibodies against TSH receptors (TRAb) and the outcome of the surgical treatment in Graves-Basedow's disease. The studies were performed in 30 patients (age range--18-50, mean -37) operated on for Graves-Basedow's disease and in 20 healthy controls. In control group, the TRAb concentration was mean -2.75 +/- 2.06 U/l, the TSH mean -1.06 +/- 0.53 mlU/l, and FT4 mean -14.71 +/- 2.15 pmol/l. The thyroid volume was mean -14.45 +/- 2.37 ml. In the group operated on antibody concentration was determined before and 12 months after the surgery. The TSH and FT4 concentrations were also determined before and 12 months after the operation. Moreover, the size of the thyroid remnant was assessed ultrasonographically 12 months after the procedure. The results showed the effectiveness of the surgical treatment, i.e. hyperthyroidism was not observed in 22 out of 30 patients. Among these 22 patients, euthyreosis was found in 14 cases (46%) and hypothyreosis was observed in 8 cases (27%). In the euthyreosis group, the pre-operative TRAb concentration was mean -24.00 +/- 11.04 U/l. 12 months after the operation, the decreased levels of antibodies were found in 13 patients (mean -6.14 +/- 5.71 U/l). In the hypothyreosis group, the pre-operative TRAb concentration was mean -24.50 +/- 10.43 U/l. After the surgical procedure, TRAb levels were normal in all patients, the average values being 2.13 +/- 1.34 U/l. In 8 patients with recurrent hyperthyroidism (27%), TRAb concentration before the surgery was higher, mean -107.25 +/- 56.69 U/l. 12 months after subtotal strumectomy, the patients in this group still did not show normal TRAb levels (mean -54.25 +/- 51.61 U/l). Moreover, the relations between the size of the thyroid remnant and the TRAb level were evaluated. In the group with recurrent hyperthyroidism and high TRAb levels, the thyroid size (volume) left was mean -12.10 +/- 6.25 ml, in the euthyreosis group mean -5.54 +/- 2.23 ml, while in the hypothyreosis group it was mean -4.86 +/- 1.14 ml.