Brush cytology in malignant biliary obstruction.

Tissue diagnosis is essential for the management of patients with malignant biliary obstruction. We prospectively studied brush cytology in 30 patients with malignant biliary obstruction. Wire guided brush cytology was obtained from the stricturous segment during endoscopic retrograde cholangio-pancreatography. The study comprised of 30 patients (16 males, 14 females), with a mean age of 55 years (range 30-75 years). The obstruction was caused by carcinoma gallbladder in 16 cases, carcinoma head of the pancreas in 10 cases, and cholangiocarcinoma in 4 cases. Brush cytology was positive for malignancy in 8 cases (26.7%). Another 3 samples (10.3%), 1 from each group of tumors, were suspicious for malignancy. Cytology was positive in 25% of gallbladder cancers, 50% of pancreatic cancers, and 50% of cholangiocarcinomas. Brush cytology was positive in 6 of 18 (33.3%) proximal and 5 of 12 (41.7%) distal strictures. Brush cytology yielded a sensitivity of 36.7% in the diagnosis of malignant biliary strictures. However, a larger study is required to confirm these findings.

Significance of serum endotoxin and antiendotoxin antibody levels in predicting the severity of acute pancreatitis.

PURPOSE: A close association between endotoxemia and acute pancreatitis has been reported, and attempts have been made to predict the severity of pancreatitis by estimating the levels of endotoxin. The present study was designed to correlate endotoxemia with the severity and complications of acute pancreatitis as graded by contrast-enhanced computed tomography and Blamey's criteria. METHODS: We examined 20 patients with acute pancreatitis, using Blamey's criteria to assess the severity of pancreatitis. The endotoxin level was estimated by the Limulus Amoebocyte Lysate method and the antiendotoxin antibody level was assayed by the enzyme-linked immunoassay technique measuring combined levels of IgG and IgM. RESULTS: Severe pancreatitis was confirmed in 9 of the 20 patients, 17 (85%) of whom were found to have endotoxemia. There was no correlation between the presence and level of endotoxemia and the severity of pancreatitis; however, antiendotoxin antibody titers were significantly lower in patients with severe disease ( P < 0.05), those who suffered of major complications ( P < 0.01), and those who died of the disease ( P < 0.01). CONCLUSION: The findings of this study demonstrated that the presence of endotoxemia accompanied by a fall in antiendotoxin antibody titer predicts poor outcome in patients with acute pancreatitis.

Ruptured staphylococcal splenic abscess resulting in peritonitis: report of a case.

A 50-year-old man presented with features of peritonitis of 2 days duration. The signs were more marked in the left upper abdomen. Investigations followed by a laparotomy showed a ruptured splenic abscess, the cause of which was not apparent. We herein present the case report of this unusual cause of peritonitis along with a relevant review of the literature.