IgG4-related disease of the hepatobiliary tract : 2 case reports and review of the literature.

IgG4-related disease is a rare inflammatory disorder that may mimic many infectious, malignant, and autoimmune conditions. The biliary tract is frequently involved, but hepatic lesions are rarely seen. Diagnosis is often delayed due to the absence of specific clinical and radiological signs, and the lack of an accurate diagnostic marker. Differential diagnosis includes cholangiocarcinoma, primary sclerosing cholangitis and intrinsic or metastatic liver disease. Corticosteroids are the cornerstone of therapy but treatment has not been standardized and relapse is common. Based on two cases of IgG4-related hepatobiliary disease, we review the current literature on this pathological entity.

Measuring fluctuating asymmetry in fattening rabbits: a valid indicator of performance and housing quality?

Fluctuating asymmetry (FA) has been advocated as the preferred measure of developmental instability and a reliable indicator of the quality of an animal (performance/fitness) and of its environment during its growing life. Empirical studies, however, are too scant or equivocal to consider this assumption adequately validated, which is partly due to the lack of a robust methodological framework for collecting and analyzing FA data. Therefore, we conducted an experiment in which 306 weaned rabbits were housed either in welfare-friendly pens (n = 6) or barren pens (n = 6). The size of both types of pen was similar (1.91 m2), but the welfare-friendly pens were equipped with suitable enrichment material (gnawing stick, elevated platform, and hiding box) and were stocked with one-half of the number of rabbits compared with the barren pens (17 vs. 34 rabbits per pen). Performance data (BW gain, ADFI, and G:F) were collected every 14 d. After slaughter (d 63 to 72), we measured twice the left- and right-hand side of 11 presumed bilateral traits on intact carcasses and 50 traits on fleshed bones. Using a stringent decision process, an optimal combination of morphological traits for estimating FA in fattening rabbits was determined. This combination consisted of five traits (fleshed bones) that showed no directional asymmetry or antisymmetry and showed a high level of FA relative to the measurement error; also, these traits were not correlated in their signed FA values. Measurements on intact carcasses seemed inappropriate for estimating FA. Using this robust FA measuring protocol, rabbits housed in the welfare-friendly pens were less asymmetric than were rabbits from the barren pens. Except for a greater daily BW gain in the welfare-friendly pens during the first 14 d after weaning, there were no effects of housing conditions on performance traits. The FA was negatively correlated with BW gain in rabbits from the barren pens, whereas in the welfare-friendly pens, there was no correlation. These results support the application of FA as an indicator of animal welfare and performance; however, FA seems to be a more reliable estimator of the underlying developmental instability when living conditions are suboptimal.

Efficacy of SF 68 in the treatment of acute diarrhea. A placebo-controlled trial.

BACKGROUND: The therapeutic value of Bioflorin, a preparation containing Enterococcus SF 68 strain, was evaluated in adult patients with acute diarrhea. METHODS: In a double-blind randomized trial we compared the effect of SF 68 strain in a dose of 150 x 10(6) colony-forming units three times a day for 5 days compared with placebo on the duration of diarrhea in 211 adults. RESULTS: Patients receiving SF 68 had a reduced duration of diarrhea compared with placebo, with a highly statistically significant difference between treatments. The proportion of patients with continuing diarrhea during the 2nd day of treatment was 61% in patients receiving SF 68 and 96% in those receiving placebo (P < 0.01). During the 3rd day diarrhea was still present in 8% of patients given SF 68, compared with 66% of those given placebo (P < 0.01). The mean (+/-SD) duration of diarrhea was 1.69 days (0.6) in patients given SF 68 compared with 2.81 days (0.9) in those given placebo. When pathogens were found in the first stool culture, they could not be detected at post-treatment examination. No adverse reactions were observed. CONCLUSIONS: Oral bacteriotherapy with SF 68 strain shortens the duration and the severity of diarrhea in adults and represents a safe and effective approach to re-establishing a balanced microbial flora in this condition.

The brown bowel syndrome and gastrointestinal adenocarcinoma. Two complications of vitamin E deficiency in celiac sprue and chronic pancreatitis?

The brown bowel syndrome is a rare disorder caused by vitamin E deficiency occurring in malabsorption syndromes. In patients with celiac sprue and chronic pancreatitis, the death rate from malignancy is high. We believe that vitamin E deficiency is responsible for the development of the brown bowel syndrome and may be partially responsible for the high incidence of malignancy in patients with celiac sprue and chronic pancreatitis. We report such a patient, and review the literature.

Splenic abscess: a diagnostic challenge.

Splenic abscess is uncommon and remains a diagnostic challenge. We present two cases. Both patients had predisposing factors that may have led to the splenic abscess. At admission, both patients presented clinical and roentgenographic signs, suggestive but nonspecific for splenic suppuration. Of particular interest was the isolation of Salmonella typhimurium in our first patient. The literature on splenic abscess is reviewed.

Systemic mast cell disease: a review of the literature with special focus on the gastrointestinal manifestations.

Mastocytosis is a chronic disease accompanied by specific infiltration of mast cells into the skin and other tissues. In 90% of cases only the skin is involved. In systemic mastocytosis there is an abnormal proliferation of mast cells in various organs including the gastrointestinal tract and liver. Release of various mediators and infiltrative growth of the mast cells lead to the symptoms of the disease. Therefore, many patients present with abdominal symptoms. The clinical manifestations are reviewed with special focus on the gastrointestinal and hepatic involvement. The prognosis of the disease is variable but most often benign. The treatment is based on H1 and H2-blockers and disodium cromoglycate.

An unusual case of cystic lymphangiomatosis of the spleen.

Isolated lymphangiomatosis of the spleen is rare. When present, it is usually considered to be accompanied by splenomegaly. We describe a case of cystic lymphangiomatosis in a patient with a normal-sized spleen. While ultrasound, angiography and computed tomography are considered to complement each other in reaching a preoperative diagnosis of splenic lymphangiomatosis, in the present case, magnetic resonance imaging proved to be an additional helpful non-invasive diagnostic method.

The straight back syndrome.

Chest wall deformities may produce signs that closely mimic organic heart disease. In this category, the straight back syndrome is well recognized. Although clinical identification of this syndrome is thought sufficient to withdraw from any further investigation, its association with idiopathic mitral valve prolapse--a cardiac lesion with considerable morbidity and mortality--may be underestimated. The literature on straight back syndrome is reviewed and its association with mitral valve prolapse discussed.

A case of concomitant ethanol and strychnine intoxication.

The authors describe a patient presenting with both ethanol intoxication and important strychnine poisoning. The diagnosis and treatment of strychnine poisoning are discussed. The authors emphasize the need of careful urine screening for drugs and toxic products in all ethanol-intoxicated patients.

Detection of muscle necrosis in dermatomyositis by 111In-labelled antimyosin Fab fragments.

This paper presents the findings on two patients with a final diagnosis of dermatomyositis in whom 111In-antimyosin imaging revealed diffuse muscle necrosis of the limbs. The potential application of this scintigraphic procedure for diagnosis and follow-up of patients with dermatomyositis-polymyositis is addressed.