A comparative study of two histological techniques for the identification of cytomegalovirus infection in colorectal biopsies from patients with chronic inflammatory bowel disease.

BACKGROUND: the role that cytomegalovirus (CMV) plays in inflammatory bowel disease (IBD) is controversial. The diagnosis of CMV infection in IBD depends on viral identification with hematoxylin-eosin (HE) or immunohistochemistry (IHC). Our aim was to compare the sensitivity of HE and IHC for this diagnosis in IBD patients. PATIENTS AND METHODS: a case-control study. Our database was searched for IBD patients with HE- or IHC-based CMV-positivity from 1997 to 2007. Controls were selected among IBD inpatients matched for age and year of diagnosis with CMV. Their clinical characteristics were analyzed. HE and IHC were performed on biopsies from cases and controls at 6 months before and after inclusion in the study. In the statistical analysis, p values below 0.05 were considered significant. RESULTS: ten IBD patients with CMV infection were identified. IBD-CMV patients were more steroid-resistant or steroid-dependent (p = 0.03), and underwent a higher number of colonic biopsies (p = 0.03). From 97 biopsies analyzed, 12 were HE-negative and IHC-positive, and 3 showed reversed results. The sensitivity of HE was 58.6%, 95% CI (38.9-78.3), and that of IHC was 89.7%, 95% CI (76.8-100). We did not find a good level of agreement between both techniques: kappa value 0.55, 95% CI (0.36-0.75). CMV positivity with IHC was associated with the use of more than one immunosuppressant drug, OR 13.5, 95%CI (1.2-152.2). Antiviral treatment was useful for CMV patients with steroid-dependent and steroid-refractory IBD. CONCLUSIONS: IHC shows a 30% higher sensitivity than HE for the diagnosis of CMV infection in IBD patients. There is no good level of agreement between both histological techniques.

Estudio comparativo entre dos técnicas histológicas para el diagnóstico de infección por citomegalovirus en biopsias colorrectales de pacientes con enfermedad inflamatoria intestinal crónica idiopática / A comparative study of two histological techniques for the identification of cytomegalovirus infection in colorectal biopsies from patients with chronic inflammatory bowel disease

Introducción: el papel que el citomegalovirus (CMV) juega enla enfermedad inflamatoria intestinal (EII) es controvertido. Eldiagnóstico de infección por CMV en estos pacientes reside en suidentificación en el tejido colónico mediante hematoxilina-eosina(HE) o inmunohistoquímica (IHC). Nuestro objetivo fue compararla sensibilidad de ambas técnicas histológicas para establecer estediagnóstico.Pacientes y métodos: estudio caso-control, identificando enel periodo 1997-2007 aquellos pacientes CMV positivos con HEo IHQ. Sus controles fueron apareados por edad y año de diagnósticode CMV en los casos. Se realizaron ambas técnicas en lasbiopsias de casos y controles obtenidas 6 meses antes y tras su inclusiónen el estudio. En el análisis estadístico consideramos significativoslos valores de p < 0,05.Resultados: encontramos infección por CMV en 10 pacientes.Estos sujetos presentaban más frecuentemente una EII resistenteo dependiente de esteroides (p = 0,03) y un mayor númerode biopsias de colon (p = 0,03). De 97 biopsias analizadas, 12fueron HE-negativas e IHC-positivas y 3 mostraron resultados inversos.La sensibilidad de HE fue 58,6% IC95 (38,9-78,3) y paraIHQ 89,7% IC95 (76,8-100). No encontramos una buena concordanciaentre ambas técnicas histológicas: kappa 0,55 IC95(0,36-0,75). La positividad para CMV se asoció al uso de más deun fármaco inmunosupresor, OR 13,5 IC95 (1,2-152,2). El tratamientoantiviral fue útil en la EII refractaria o dependiente de esteroides.Conclusiones: la IHQ posee una sensibilidad superior a HE(30%) para el diagnóstico de infección por CMV en la EII, no existiendobuena concordancia entre ambas técnicas histológicas(AU)

Background: the role that cytomegalovirus (CMV) plays in inflammatorybowel disease (IBD) is controversial. The diagnosis ofCMV infection in IBD depends on viral identification with hematoxylin-eosin (HE) or immunohistochemistry (IHC). Our aim wasto compare the sensitivity of HE and IHC for this diagnosis in IBDpatients.Patients and methods: a case-control study. Our databasewas searched for IBD patients with HE- or IHC-based CMV-positivityfrom 1997 to 2007. Controls were selected among IBD inpatientsmatched for age and year of diagnosis with CMV. Theirclinical characteristics were analyzed. HE and IHC were performedon biopsies from cases and controls at 6 months beforeand after inclusion in the study. In the statistical analysis, p valuesbelow 0.05 were considered significant.Results: ten IBD patients with CMV infection were identified.IBD-CMV patients were more steroid-resistant or steroid-dependent(p = 0.03), and underwent a higher number of colonic biopsies(p = 0.03). From 97 biopsies analyzed, 12 were HE-negativeand IHC-positive, and 3 showed reversed results. The sensitivityof HE was 58.6%, 95% CI (38.9-78.3), and that of IHC was89.7%, 95% CI (76.8-100). We did not find a good level of agreementbetween both techniques: kappa value 0.55, 95% CI (0.36-0.75). CMV positivity with IHC was associated with the use ofmore than one immunosuppressant drug, OR 13.5, 95%CI (1.2-152.2). Antiviral treatment was useful for CMV patients withsteroid-dependent and steroid-refractory IBD.Conclusions: IHC shows a 30% higher sensitivity than HEfor the diagnosis of CMV infection in IBD patients. There is nogood level of agreement between both histological techniques(AU)

Insuficiencia hepática fulminante secundaria a infiltración hepática difusa por melanoma coroideo / Acute liver failure secondary to malignant infiltration by melanoma

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[A brain tissue bank in a neuropathology laboratory. Basic methodology]. / Banco de tejidos Neurológicos en el Laboratorio de Neuropatología. Organización básica.

The Meixoeiro Hospital Brain Bank (BB) was established at the end of 2002. A BB is a tissue collection and storage system, established under the best conditions to carry out prospective morphological, biochemical or molecular studies. The BB should ideally be supported by a donor program, although samples may also be obtained from autopsy material from patients with neurodegenerative diseases. Recruitment of control cases from brains without neurological diseases is basic. The main goal of a BB is to provide brain tissue for research. Each case requires accurate clinical data, a definite diagnosis and optimal conditions of tissue preservation. The use of protocols to standardize the handling and processing of tissues, data recruitment and neuropathological diagnosis is fundamental to assure the quality and homogeneity of samples. Close collaboration between neuropathologists, neurologists and other specialists is essential in all the process. Although important advances in the tissue banking field have been achieved, the number of donors in Spain still remains low. Stronger institutional support as well as public awareness through better diffusion of the information is necessary to increase the number of donors and improve BB development.

Banco de Tejidos Neurológicos en el Laboratorio de Neuropatología. Organización básica / A Brain Bank in a Neuropathology Laboratory. Basic methodology

El Banco de Tejidos Neurológicos (BTN) del Hospital Meixoeiro se implantó a finales del año 2002. Un BTN es un sistema prospectivo de almacenamiento y conservación de tejidos en condiciones óptimas que permitan la realización de cualquier estudio morfológico, bioquímico o molecular. Su funcionamiento debe estar basado en un programa de donación, aunque las muestras pueden proceder tanto de donantes como de autopsias clínicas de pacientes con enfermedades neurodegenerativas. Es importante la obtención de cerebros de personas sin enfermedad neurológica para casos control. El objetivo principal de un BTN es el de proporcionar tejido nervioso para la investigación. Los casos deben tener una buena información clínica, un diagnóstico definitivo y unas condiciones de conservación idóneas. Para asegurar la calidad y homogeneidad de las muestras hay que estandarizar, mediante protocolos, los métodos de obtención, extracción y procesamiento del tejido, la recogida de la información y el diagnóstico neuropatológico. La colaboración multidisciplinar entre neuropatólogos, neurólogos y otros especialistas es básica en todo el proceso. Aunque se están realizando grandes avances en el campo de los Bancos Tisulares, el número de donaciones en España es aún muy bajo. Para estimular las donaciones y potenciar el desarrollo de los BTN, hay que conseguir un mayor apoyo institucional y una mayor concienciación de la sociedad mejorando la información (AU)