The role of endoscopic and demographic features in the diagnosis of gastric precancerous conditions.

INTRODUCTION: The diagnosis of atrophic gastritis (AG) and intestinal metaplasia (IM) is a crucial screening and surveillance strategy for gastric adenocarcinoma. OBJECTIVES: The main objective was to assess the performance of endoscopic diagnosis of gastric precancerous conditions in a real­life scenario. PATIENTS AND METHODS: A total of 2099 gastroscopies with biopsy to evaluate gastritis performed in 3 endoscopic centers from March 2018 to October 2019 were retrospectively analyzed. Endoscopic data regarding gastritis, atrophy, and intestinal metaplasia were compared with histopathological reports. RESULTS: The endoscopic diagnosis sensitivity was 69.5% for AG and 19.4% for IM. The specificity of endoscopic detection of AG was 69.5% and of IM, 97.9%. The endoscopic detection of gastritis was a risk factor for AG and IM diagnosis (odds ratio [OR], 5.1; 95% CI, 1.9-14.1 and OR, 14.5; 95% CI, 5.9-35.8, respectively) and the patient's age was a risk factor for AG, IM, dysplasia, and advanced stage of AG (ASAG) diagnosis (OR, 1.05; 95% CI, 1.04-1.06; OR, 1.035; 95% CI, 1.03-1.04; OR, 1.04; 95% CI, 1.02-1.06; and OR, 1.05; 95% CI, 1.02-1.09, respectively). The age threshold of 45 or 40 years with endoscopically diagnosed gastritis for obtaining biopsy would result in 96.3% and 95% ASAG or dysplasia diagnosis sensitivity, and in the reduction of the number of biopsies by 20.2% and 20.5%, respectively. CONCLUSIONS: The application of the age threshold with or without an endoscopic diagnosis of gastritis could reduce the number of mapping biopsies to detect advanced stages of atrophic gastritis or dysplasia with high sensitivity.

Composite detection rate as an upper gastrointestinal endoscopy quality measure correlating with detection of neoplasia.

BACKGROUND: Esophagogastroduodenoscopy (EGD) is commonly used diagnostic method with no widely accepted quality measure. We assessed quality indicator-composite detection rate (CDR)-consisting of detection of at least one of the following: cervical inlet patch, gastric polyp and post-ulcer duodenal bulb deformation. The aim of the study was to validate CDR according to detection rate of upper gastrointestinal neoplasms (UGN). METHODS: It was a multicenter, prospective, observational study conducted from January 2019 to October 2019. The endoscopic reports from 2896 symptomatic patients who underwent diagnostic EGD were analyzed. The EGDs were performed in three endoscopy units located in tertiary university hospital, private outpatient clinic and local hospital. RESULTS: 64 UGNs were detected. The mean CDR was 21.9%. The CDR correlated with UGN detection rate (R = 0.49, p = 0.045). Based on CDR quartiles, operators were divided into group 1 with CDR < 10%, group 2 with CDR 10-17%, group 3 with CDR 17.1-26%, and group 4 with CDR > 26%. Detection rate of UGN was significantly higher in the group 4 in comparison to group 1 (OR 4.4; 95% CI 2.2 - 9.0). In the multivariate regression model, patient age, male gender and operator's CDR > 26% were independent risk factors of UGN detection (OR 1.03; 95% CI 1.01 - 1.05, OR 2; 95% CI 1.2 - 3.5, and OR 5.7 95% CI 1.5 - 22.3, respectively). CONCLUSIONS: The CDR is associated with the detection of upper gastrointestinal neoplasms. This parameter may be a useful quality measure of EGD to be applied in general setting.

Endometriosis of the Vermiform Appendix within a Hernia Sac Infiltrating the Pubic Bone.

Purpose. Appendicular endometriosis mimicking appendicitis is a rare finding. Inguinal tumor in the course of appendicular endometriosis located within an inguinal hernia sac and infiltrating the periosteum of the pubic bone has not yet been described. Case Report. This paper describes a case of a rapidly enlarging, solid, unmovable, very painful upon palpation inguinal tumor, in a 36-year-old nulliparous woman. During surgery, a hard (approximately 4 cm in diameter) tumor infiltrating the periosteum of the right pubic bone and continuous with the inguinal hernia sac was dissected. The distal segment of the vermiform appendix was an element of the dissected tumor. Histological examination revealed endometriosis of the distal vermiform appendix. After 6 months of hormone treatment, she was referred for reoperation due to tumor recurrence. Once again histological examination of the resected tissue revealed endometriosis. There was no further recurrence of the disease with goserelin therapy. In addition to the case report, we present a review of the literature about endometriosis involving the vermiform appendix and the inguinal canal (Amyand's hernia). Conclusion. This case expands the list of differential diagnoses of nodules found in the inguinal region of women.

Disseminated atypical molluscum contagiosum as a presenting symptom of HIV infection.

Atypical forms of molluscum contagiosum may be challenging to diagnose and are found in immunocompromised patients where they indicate severe impairment of cellular immunity. We report a case of disseminated atypical molluscum contagiosum which was the first sign of HIV infection and AIDS disease in a 38-year-old male patient. The lesions - painless, flesh-colored and violaceous papules and nodules - spread systematically for previous 3 years. They were located on the face, forearms, in the groins and in the genital region. Serologic tests for HIV-1 and hepatitis C virus were positive. CD4+ T-cells count was 80/mm(3). The skin biopsy showed intracytoplasmic molluscum bodies. Atypical, recalcitrant, disseminated or facial molluscum contagiosum requires immediate HIV testing. In our patient, both the opportunity for early diagnosis and the institution of effective therapy were missed.

B-cell lymphoma in a 70 year-old male patient with a cardiac tumour.

We present a case of a 70 year-old male with B-cell lymphoma of which the first clinical presentation was cardiac infiltration. The patient underwent full chemotherapy with complete tumour regression. Kardiol Pol 2011; 69, 10: 1063-1065.

[Carbamazepine-induced systemic lupus erythematosus--a case report]. / Przypadek tocznia rumieniowatego ukladowego po leczeniu karbamazepina.

Epileptic seizures may be an early symptom of systemic lupus erythematosus, while at the same time some of the epileptic drugs, namely carbamazepine (CBZ), phenytoin (PHT), valproic acid (VPA), ethosuximide (ETM), primidone (PRM), lamotrigine (LTG), zonisamide (ZNS) can cause lupus. A separate clinical problem is the fact that few cases of systemic lupus have as yet been identified by giving antiepileptic drug. We present the case of a 30-year-old woman with frequent simple partial seizures and few secondarily generalized seizures since the age of 18. She was treated with VPA for three years. Then, because of side effects the drug had to be withdrawn and was replaced by CBZ. After eight months duration of the treatment with CBZ, the dose was increased because a secondarily generalized seizure occurred again. After another two months, painful swelling of all joints and leucopenia were observed. During additional studies, LE cells and high titer of ANA antibodies were found. Systemic lupus erythematosus was diagnosed and prednisone therapy was introduced. In spite of the withdrawal of CBZ, the increased titer of ANA antibodies persisted for several years and skin and muscle biopsy performed five years from the onset of clinical symptoms disclosed inflammatory infiltration and presence of IgG and IgM deposits in skin and vessel walls. Control serological examinations, skin and muscle biopsy carried out after eight years of observation and lack of clinical manifestations permitted to exclude a connective tissue disease in our patient.

[Macular corneal dystrophy including histologic and ultrastructural changes]. / Dystrofia plamkowata rogówki z uwzglednieniem zmian histopatologicznych i ultrastrukturalnych.

PURPOSE: The study reports the results of a histological and ultrastructural examination of the corneal button, obtained during penetrating keratoplasty from patient with clinically recognized macular corneal dystrophy. MATERIAL AND METHODS: 34-year-old male patient suffering from macular corneal dystrophy (MCD) has been treated on corneal epithelium defect and photophobia since his early childhood. Visual acuity was decreased on the Snellen test chart to 0.02. Slit-lamp examination, and ultrasonographical measurement of the cornea's thickness were performed. Removed during penetrating keratoplasty corneal button was divided into two pieces. One of them was prepared in standard procedure for histological examination in the light microscopy after having been stained with hematoxylin and eosin, alcian blue and paS-method. From the other part, slides for ultrastructural examination in the transmission electron microscopy were prepared with the use of standard method. The family history from the patient was also taken, and available relatives have undergone examination in search of typical MCD symptoms. RESULTS: Slit-lamp examination findings revealed diffuse, from limbus to limbus, stromal opacification. In measurement by pachymeter cornea's thickness was reduced. In the light microscopy, in typical stained slides, delaminations within stroma and deficit of endothelial cells were observed. After being stained with alcian blue, dark blue deposits in the places of delamination became visible. By transmission electron microscopic examination, intracellular and extracellular deposits were detected in the stroma, Descemet membrane and endothelium. Distended keratocytes with enormous vacuoles containing abnormal material were found. Pedigree was typical for autosomal recessive inherited disease. CONCLUSIONS: Histological and ultrastructural diagnosis is a basis of recognition of macular corneal dystrophy. Analysis of the pedigree as well as ultrasonographical measurement of the cornea's thickness is very helpful to establish the right diagnosis.