Cyclooxygenase-2 expression in polyps from a patient with juvenile polyposis syndrome with mutant BMPR1A.

OBJECTIVES: Cyclooxygenase-2 (COX-2) expression is increased in colorectal cancers and has been reported to be upregulated in Peutz-Jeghers polyps. To determine whether germline and somatic loss of BMPR1A in polyps from a patient with juvenile polyposis syndrome have altered COX-2 expression, we characterized a patient with juvenile polyposis syndrome for BMPR1A germline mutations and examined the polyps for BMPR1A expression and COX-2 expression. PATIENTS AND METHODS: DNA analysis for BMPR1A was performed on a patient with juvenile polyposis syndrome. Multiple polypectomies were performed, and several polyps showed adenomatous change. Genomic DNA was extracted from polyp material for loss of heterozygosity (LOH) analyses with microsatellite markers. Immunohistochemistry was performed on sections using antibodies for BMPR1A and COX-2. RESULTS: The kindred possessed a germline BMPR1A missense mutation. In polyp domains containing cystic and adenomatous epithelium, no LOH was observed using markers near the BMPR1A locus. Immunostaining indicated decreased expression of phospho-SMAD1 (pSMAD1), functionally downstream of the mutant BMPR1A receptor in the cystic epithelium, with further reduction in adenomatous portions within the polyp. COX-2 protein, normally not expressed in the colon, was present and increased in polyp epithelium. CONCLUSIONS: Decreased expression of pSMAD1 in the cystic epithelium with further reduction in the adenomatous area, and increase in COX-2 expression within polyps from the BMPR1A heterozygote, suggest a potential mechanism for adenomatous pathogenesis in these hamartomatous polyps. This may imply that COX-2 inhibitors could be a means for chemoprevention in this syndrome.

Pyogenic and amebic liver abscesses.

Pyogenic and amebic liver abscesses are the two most common hepatic abscesses. Amebic abscesses are more common in areas where Entamoeba histolytica is endemic, whereas pyogenic abscesses are more common in developed countries. Pyogenic abscess severity is dependent on the bacterial source and the underlying condition of the patient. Amebic liver abscess is more prevalent in individuals with suppressed cell-mediated immunity, men, and younger people. The right lobe of the liver is the most likely site of infection in both types of hepatic abscess. Patients usually present with a combination of fever, right-upper-quadrant abdominal pain, and hepatomegaly. Jaundice is more common in the pyogenic abscess. The diagnosis is often delayed and is usually made through a combination of radiologic imaging and microbiologic, serologic, and percutaneous techniques. Treatment involves antibiotics along with percutaneous drainage or surgery.

An observer-blinded, prospective, randomized comparison of forceps for endoscopic esophageal biopsy.

BACKGROUND: The designs of 2 new biopsy forceps attempt to address the difficulty of obtaining esophageal biopsy specimens. The angled design is a modified version of currently used straight forceps. The lateral cup forceps has a straight shaft with a bullet-shaped cuffing head for a tangential approach. METHODS: Seventy-five patients were enrolled in a prospective study in which 3 different forceps were compared in random order: a reusable straight-shaft spiked forceps, a reusable angled-shaft spiked forceps, and a disposable lateral cup forceps. Two biopsy specimens were obtained with each device per patient. Two pathologists, blinded as to forceps used, graded the tissue samples for size, histologic depth, shear artifact, crush artifact, and adequacy for diagnosis. Data were compared by using multivariate analysis of variance and Scheffé's method. RESULTS: Analysis of variance showed overall differences in specimen size, histologic depth score, and diagnostic adequacy (p < 0.001). There was no significant difference for crush (p = 0.459) or shear artifacts (p = 0.243). Pair-wise comparisons demonstrated that tissue samples obtained with the straight forceps were larger (p = 0.020) and deeper (p = 0.040) than the angled forceps. These 2 designs were similar in terms of diagnostic adequacy. Biopsy specimens obtained with the straight forceps were larger (p < 0.001) and deeper (p < 0.001) than those obtained with the lateral cup forceps. Both the straight and angled forceps were superior to the lateral cup forceps in terms of diagnostic adequacy (p = 0.020, p = 0.008, respectively). CONCLUSIONS: The reusable straight-shaft spiked forceps provides larger and deeper esophageal biopsy specimens than either the angled or lateral cup forceps. The angled forceps provides specimens of similar adequacy for diagnosis compared with the straight forceps. The lateral cup forceps should not be used in the esophagus.