Isolated gastric Crohn's disease.

Crohn's disease (CD) is a chronic idiopathic inflammatory disease of gastrointestinal tract characterized by segmental and transmural involvement of gastrointestinal tract. Ileocolonic and colonic/anorectal is a most common and account for 40% of cases and involvement of small intestine in about 30%. The stomach is rarely the sole or predominant site of CD. To date there are only a few documented case reports of adults with isolated gastric CD and no reports in the pediatric population. Isolated stomach involvement is very unusual presentation accounting for less than 0.07% of all gastrointestinal CD. The diagnosis is difficult to establish in cases of atypical presentation as in isolated gastroduodenal disease. In the absence of any other source of disease and in the presence of nonspecific upper GI endoscopy and histological findings, serological testing can play a vital role in the diagnosis of atypical CD. Recent studies have suggested that perinuclear anti-neutrophil cytoplasmic antibody and anti-Saccharomycescervisia antibody may be used as additional diagnostic tools. The effectiveness of infliximab in isolated gastric CD is limited to only a few case reports of adult patients and the long-term outcome is unknown.

Analysis of deferrals on static telepathology consultation service.

The objective of this study is to analyze the deferrals in static telepathology consultation service. A store and forward approach is used to transmit cases from two remotely located rural centers to Tata Memorial Hospital. A total of 346 tele-surgical pathology cases were accessioned for second opinion and were reported from January 2002 to August 2005. The glass slides and paraffin blocks were reviewed at a later date and the telepathology diagnosis was compared with the final diagnosis rendered on light microscopy. Of all 251 teleconsults referred from one of the referring centers, a telepathology diagnosis was rendered in 205 cases and 46 cases were deferred. The reasons for deferral were as follows: the requirement for ancillary studies (40 cases), clinical details (5 cases) and poor quality sections and images (1 case). In all these deferred cases, a probable diagnosis was rendered by the telepathologist and was compared with the final diagnosis after paraffin block evaluation. In 47% of the cases, the "probable" diagnosis on telepathology matched the final diagnosis.