Antigranulocyte monoclonal antibody immunoscintigraphy in inflammatory bowel disease in children and young adolescents.

AIM: Diagnostic delay for inflammatory bowel disease (IBD) is frequent, especially in paediatric patients. Scintigraphy with labelled leucocytes has been proposed as a very sensitive diagnostic tool for detecting bowel inflammation. The aim of this study was to evaluate the sensitivity and specificity of immunoscintigraphy in the diagnosis and follow-up of children with IBD and to compare this technique with other diagnostic techniques. METHODS: Sixty-six children with histologically confirmed IBD were enrolled in the study. Twenty-one children in whom IBD was suspected but subsequently not confirmed were used as controls. A total of 138 immunoscintigraphies were performed using 99mTechnetium-labelled monoclonal anti-granulocyte antibodies. Immunoscintigraphy was also compared with other diagnostic techniques. RESULTS: Overall sensitivity of monoclonal antibody immunoscintigraphy (MoAb-IS) in patients with clinically active disease was 94% for Crohn's disease (CD) and 85% for ulcerative colitis (UC). Ultrasonography, endoscopy and radiology were carried out at the same time in 29 patients with CD and in 6 patients with UC: sensitivity of IS was 90% compared with 76% of colonoscopy, 75% for enemas, and 55% for sonography. IS was negative (specificity) in 24% of patients with CD and in 67% of patients with UC during remission, and in 64% of controls with other causes of intestinal inflammation. Diagnostic delay was significantly shorter when compared with a historical cohort of patients. CONCLUSION: Immunoscintigraphy is a highly sensitive detector of intestinal inflammation in young patients with IBD and can be useful for reducing diagnostic delay. However, its specificity is low and all positive cases must be confirmed histologically.

Tamoxifen and malignant epithelial-nonepithelial tumours of the endometrium: report of six cases and review of the literature.

AIMS: To review the use of tamoxifen in malignant epithelial-nonepithelial tumours of the endometrium. Tamoxifen has been widely used for almost 20 years as adjuvant therapy for breast cancer. Large clinical trials have pointed out that long-term tamoxifen therapy increases the risk of uterine cancers. These tumours include endometrial carcinomas, stromal sarcomas, leiomyosarcomas as well as malignant mixed (epithelial-nonepithelial) tumours. METHODS: We report here six more cases of malignant epithelial-nonepithelial tumours which, in addition to those reported in the literature, makes a total of 36 presented cases. The pathogenesis of such tumours remains unclear, but it has been claimed that unopposed oestrogenic stimulation due to the agonistic effect of tamoxifen might be involved, as in the case of endometrial carcinomas. Pelvic irradiation has also been incriminated, especiallly in women under 55 years of age. RESULTS: Among 21 endometrial malignant epithelial-nonepithelial tumours associated with tamoxifen, seven occurred in women less than 55 years old. Five of them had previous pelvic irradiation. The data from the literature and from our series suggest that tamoxifen might favour the occurrence of malignant epithelial-nonepithelial tumours in women with breast cancer aged over 55 years, whereas in younger women both pelvic irradiation and tamoxifen might participate.

Sonography versus continuous 24 hours oesophageal pH-monitoring in the diagnosis of infant gastroesophageal reflux.

Forty infants with suspected gastroesophageal reflux (GOR) underwent continuous 24 hour esophageal pH-metry and sonography of the gastroesophageal junction. In 29 out of 40 cases (72.5%) GOR was confirmed by the 24 hour pH-monitoring, because of a percentage of total time of reflux of 10% or more. The positive and negative predictive value of sonography versus the result of continuous 24 hour pH-monitoring was 80% and 50% respectively. Sonography cannot be considered a faithful diagnostic tool in screening for GOR in infants.

Infantile hypertrophic pyloric stenosis and cow's milk intolerance.

Two cases of infantile hypertrophic pyloric stenosis in infants who were exclusively breastfed are reported. In both cases dietetic management succeeded in avoiding surgery. In one case human milk was substituted with casein hydrolysate formula, while in the other cow's milk was excluded from the diet of the mother. A possible casual relationship between cow's milk intolerance and infantile hypertrophic pyloric stenosis is discussed.

[Chronic X-linked recessive bulbospinal amyotrophy (Kennedy-Stefanis type). Apropos of a case]. / L'amyotrophie bulbo-spinale chronique de transmission récessive liée à l'X (type Kennedy-Stefanis). A propos d'une observation.

A new observation of chronic X-linked recessive spinal amyotrophy is reported. This series of cases fits the description of Kennedy-Stefanis chronic spinal amyotrophy, whose main characteristics are: sex-linked recessive inheritance, weakness and bulbo-spinal amyotrophy with proximal predominance, facio-lingual fasciculations, areflexia, gynecomastia in half of cases, very slowly progressive course, neurogenic EMG with normal nerve conduction velocities, and neurogenic muscle biopsy.

[Multiple splenic and renal abscesses caused by Candida albicans: a new diagnostic and therapeutic method using intraoperative echography and closure of the residual cavities with biological glue]. / Les abcès multiples spléniques et néphrétiques par Candida albicans: nouveau procédé diagnostique-thérapeutique par échographie intra-opératoire et fermeture des cavités restantes avec colle biologique.

The Candida albicans infection represents a rather frequent complication in immunodeficient patients, while the evolution towards the growth of multiple intraparenchymal abscesses constitutes a very rare event. The authors describe the diagnostic-therapeutic pathway chosen in a case regarding a young patient in treatment for leukemia , who was affected by multiple splenic and renal abscesses caused by Candida albicans. After a preoperative diagnosis through ultrasonography and C.A.T., a splenectomy was undertaken. Next the only healthy part of the spleen was removed and grafted into the omentum. By using the intraoperative ultrasonography on both kidneys, the abscess cavities were precisely located, aspirated and finally stuck with a human fibrin glue.