Bilateral renal vein thrombosis in a twin newborn without known risk factors.

Neonatal renal vein thrombosis (RVT) is associated with neonatal stress, catheters and genetic prothrombotic risk factors. In an unusual case of bilateral RVT a twin newborn showed initial good adaptation at birth (weight 2,720 g). The placenta was monochorionic, diamnionic. The infant (gestational week 37) exhibited a severe macrohematuria within 24 hours after birth. Sonography of the kidneys showed a dense cortical parenchyma, loss of cortico-medullary differentiation and negative diastolic flow in both renal arteries and veins, while no thrombus in the main renal veins could be detected. No prothrombotic blood parameters and positive infection serology were detected. Because of acute renal failure peritoneal dialysis was necessary for 6 weeks. The patient was treated by heparinization for 5 days. Interestingly, it was kidney biopsy which confirmed the diagnosis of RVT in addition to the clinical presentation, whereas sonography was unspecific. Histology exhibited the picture of an ischemic contracted kidney with numerous siderophages. At present (age 19 months), the patient suffers from chronic renal failure (calculated glomerular filtration rate according to Schwartz 12 ml/min/1.73 m2). In conclusion, our case teaches that, despite the lack of a clinically obvious shock event, absence of known risk factors and indirect ultrasound findings, renal vein thrombosis should be considered in a macrohematuric newborn with renal failure. For clinical suspicion of RVT correct therapy was initiated, however, the diagnosis remained unclear until a renal biopsy was performed.

[Virtual microscopy: first applications]. / Virtuelle Mikroskopie. Erste Anwendungen.

Only recently fast-paced developments in computer technology allowed for the digitization of complete histologic slides. The resulting virtual slides may be viewed via webbrowser by any number of pathologists or students independent of time and location. Usage of a virtual microscope simply requires a computer workstation with a fast internet connection, which opens this technology to a broad public. A virtual microscopy system consists of three components: acquisition, server and client. Such systems are under development by different commercial and academic bodies worldwide. We have developed a virtual microscope system called vMic (http://www.vmic.unibas.ch) which provides virtual slides of very high image quality. Several successfully held online slide seminars and a histology course for students in dentistry are freely accessible in the internet. With the commercial availability of ultra rapid and easy-to-use slide scanners and the fast improvements of technology virtual microscopy will offer many applications in teaching, research and diagnostics. Thanks to additional functionalities, real microscopes will most likely be replaced by computer workstations in a couple of years.

Henoch-schonlein purpura associated with esophagus carcinoma and adenocarcinoma of the lung.

Henoch-Schönlein purpura (HSP) is known to exist in association with a variety of malignant diseases including squamous and small cell lung cancer and hematological malignancies. We report the first cases of HSP associated with carcinoma of the esophagus and adenocarcinoma of the lung, respectively. We compare the main features of our patients with 23 previously published cases. We recommend that patients with HSP, especially men over 40 years of age, should undergo screening for occult neoplasia.

[Web-based learning tools in pathology]. / Webbasierte Lernwerkzeuge für die Pathologie.

Pathology is an image based discipline and therefore well suited for web-based teaching. PathoBasiliensis (http://www.unibas.ch/patho/) is a freely accessible internet site addressing various target groups. The site consists of various complementing and constitutive teaching- and information modules. The image database PathoPic represents the central element of the teaching modules. Based on this database teaching modules and learning games have been and are being developed allowing users to exercise diagnostic skills adapted to the individual learning process. Development and evaluation of the online histopathology course HiPaKu and the game Matching pair are presented.

Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults.

BACKGROUND & AIMS: In developing countries where Helicobacter pylori infection is widespread, posttherapeutic recurrence rates may be high. Many of the limited studies available have methodological problems and show varied recurrence rates. We determined late recrudescence rates, true reinfection, and ulcer recurrence. METHODS: One hundred five Bangladeshi patients with H. pylori infection and duodenal ulcer disease were treated with a triple therapy. Follow-up included 13C-urea breath tests, endoscopy, and biopsy-based tests. In reinfected patients, genomic typing compared pretherapeutic and posttherapeutic strains. RESULTS: Recrudescence, associated with nitroimidazole-based treatment, occurred in 15 of 105 patients (14%) within the first 3 months, but only 8 of 105 patients tested positive 4 weeks after therapy ended. True reinfection was diagnosed in 11 of 105 patients between 3 and 18 months after therapy. The annual reinfection rate was 13%, based on a total follow-up of 84.7 patient years. Ulcer relapse occurred in 2 of 15 (13%) recrudescence cases and in 6 of 11 (55%) reinfection cases, but also in 4 of 73 (5%) H. pylori-negative patients. CONCLUSIONS: In Bangladesh, late recrudescence of H. pylori after eradication therapy occurs within the first 3 months. The reinfection rate is high and might influence cost-benefit analyses for determining diagnostic and therapeutic procedures.