AIM: Because the presence or absence of H pyloriinfection has important implications for therapeutic decisions based on histological assessment, the reproducibility of Sydneysystem is important. The study was designed...AIM: Because the presence or absence of H pyloriinfection has important implications for therapeutic decisions based on histological assessment, the reproducibility of Sydneysystem is important. The study was designed to test the reproducibility of features of Helicobacter pylori gastritis, using the updated Sydney classification. METHODS: Gastric biopsies of 40 randomly selected cases of H pylori gastritis were scored semiquantitatively by three pathologists. Variables analysed included chronic inflammation,inflammatory activity, atrophy, intestinal metaplasia, H pylori,surface epithelial damage. k values below 0.5 represented poor, those between 0.5 and 0.75 good and values over 0.75 excellent interobserver agreement. RESULTS: The best interobserver agreement (k=0.62) was present for intestinal metaplasia. The agreement was the poorest for evaluating atrophy (k=0.31). CONCLUSION: Although the results of this study were in accordance with some previous studies, an excellent agreement could not be reached for any features of H pylori gastritis. This low degree of concordance is assumed to be due to the personal evaluation differences in grading the features, the lack of standardized diagnostic criteria, and the ignorance to reach a consensus about the methods to be used in grading the features of H pylori gastritis before initiating the study.展开更多
AIM: Studies on Helicobacter pylori (H pylon) and gastroduodenal diseases have focused mainly on the distal sites of the stomach, but relationship with the gastric cardia is lacking. The aim of this study is to determ...AIM: Studies on Helicobacter pylori (H pylon) and gastroduodenal diseases have focused mainly on the distal sites of the stomach, but relationship with the gastric cardia is lacking. The aim of this study is to determine if the gastric topology and genotypic distribution of Hpyloriwere associated with different upper gastrointestinal pathologies in a multiethnic Asian population. METHODS: Gastric biopsies from the cardia, body/corpus and antrum were endoscoped from a total of 155 patients with dyspepsia and/or reflux symptoms, with informed consent. H pylori isolates obtained were tested for the presence of 26kDa, ureC, cagA, vacA, iceA1, iceA2 and babA2 genes using PCR while DNA fingerprints were generated using random amplification polymorphic DNA (RAPD). RESULTS: Hpyloriwas present in 51/155 (33%) of patients studied. Of these, 16, 15 and 20 were isolated from patients with peptic ulcer diseases, gastroesophageal reflux diseases and non-ulcer dyspepsia, respectively. Of the Hpyloripositive patients, 75% (38/51) had Hpyloriin all three gastric sites. The prevalence of various genes in the H pylori isolates was shown to be similar irrespective of their colonization sites as well as among the same site of different patients. The RAPD profiles of H pylori isolates from different gastric sites were highly similar among intra-patients but varied greatly between different patients. CONCLUSION: Topographic colonization of H pylori and the virulence genes harboured by these isolates have no direct bearing to the clinical state of the patients. In multiethnic Singapore, the stomach of each patient is colonized by a predominant strain of H pylori，irrespective of the clinical diagnosis.展开更多
BACKGROUND Intravascular lymphoma(IVL)is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy.Because of various modes of presentation and its rarity,IVL i...BACKGROUND Intravascular lymphoma(IVL)is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy.Because of various modes of presentation and its rarity,IVL is often diagnosed postmortem.Herein,we report a case of intravascular B-cell lymphoma with hypopituitarism,an extremely rare complication,that was successfully treated with chemotherapy.CASE SUMMARY An 80-year-old Japanese woman presented with a 7-mo history of a tingling sensation in the lower limbs.She also presented with various other symptoms such as pancytopenia,high fever daily,and unconsciousness with hypoglycemia.Although the doctor who previously treated her diagnosed hypoglycemia as being due to hypopituitarism,the cause of the other symptoms remained uncertain despite a 7-mo evaluation period.We performed bone marrow aspiration to evaluate pancytopenia and found that she had hemophagocytic lymphohistiocytosis(HLH).On the basis of a random skin biopsy for assessing the cause of HLH,she was diagnosed with intravascular B-cell lymphoma.HLH and hypopituitarism were considered secondary to IVL.All her clinical findings matched the presentations of IVL.She was immediately treated with chemotherapy and achieved complete response.She was relapse free two years after treatment.CONCLUSION IVL should be included in the differential diagnosis of hypopituitarism,which although life-threatening,is treatable through prompt diagnosis and appropriate chemotherapy.展开更多
文摘AIM: Because the presence or absence of H pyloriinfection has important implications for therapeutic decisions based on histological assessment, the reproducibility of Sydneysystem is important. The study was designed to test the reproducibility of features of Helicobacter pylori gastritis, using the updated Sydney classification. METHODS: Gastric biopsies of 40 randomly selected cases of H pylori gastritis were scored semiquantitatively by three pathologists. Variables analysed included chronic inflammation,inflammatory activity, atrophy, intestinal metaplasia, H pylori,surface epithelial damage. k values below 0.5 represented poor, those between 0.5 and 0.75 good and values over 0.75 excellent interobserver agreement. RESULTS: The best interobserver agreement (k=0.62) was present for intestinal metaplasia. The agreement was the poorest for evaluating atrophy (k=0.31). CONCLUSION: Although the results of this study were in accordance with some previous studies, an excellent agreement could not be reached for any features of H pylori gastritis. This low degree of concordance is assumed to be due to the personal evaluation differences in grading the features, the lack of standardized diagnostic criteria, and the ignorance to reach a consensus about the methods to be used in grading the features of H pylori gastritis before initiating the study.
基金Supported by NMRC Grant,No.0415/2000,R-182-000-037-213
文摘AIM: Studies on Helicobacter pylori (H pylon) and gastroduodenal diseases have focused mainly on the distal sites of the stomach, but relationship with the gastric cardia is lacking. The aim of this study is to determine if the gastric topology and genotypic distribution of Hpyloriwere associated with different upper gastrointestinal pathologies in a multiethnic Asian population. METHODS: Gastric biopsies from the cardia, body/corpus and antrum were endoscoped from a total of 155 patients with dyspepsia and/or reflux symptoms, with informed consent. H pylori isolates obtained were tested for the presence of 26kDa, ureC, cagA, vacA, iceA1, iceA2 and babA2 genes using PCR while DNA fingerprints were generated using random amplification polymorphic DNA (RAPD). RESULTS: Hpyloriwas present in 51/155 (33%) of patients studied. Of these, 16, 15 and 20 were isolated from patients with peptic ulcer diseases, gastroesophageal reflux diseases and non-ulcer dyspepsia, respectively. Of the Hpyloripositive patients, 75% (38/51) had Hpyloriin all three gastric sites. The prevalence of various genes in the H pylori isolates was shown to be similar irrespective of their colonization sites as well as among the same site of different patients. The RAPD profiles of H pylori isolates from different gastric sites were highly similar among intra-patients but varied greatly between different patients. CONCLUSION: Topographic colonization of H pylori and the virulence genes harboured by these isolates have no direct bearing to the clinical state of the patients. In multiethnic Singapore, the stomach of each patient is colonized by a predominant strain of H pylori，irrespective of the clinical diagnosis.
文摘BACKGROUND Intravascular lymphoma(IVL)is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy.Because of various modes of presentation and its rarity,IVL is often diagnosed postmortem.Herein,we report a case of intravascular B-cell lymphoma with hypopituitarism,an extremely rare complication,that was successfully treated with chemotherapy.CASE SUMMARY An 80-year-old Japanese woman presented with a 7-mo history of a tingling sensation in the lower limbs.She also presented with various other symptoms such as pancytopenia,high fever daily,and unconsciousness with hypoglycemia.Although the doctor who previously treated her diagnosed hypoglycemia as being due to hypopituitarism,the cause of the other symptoms remained uncertain despite a 7-mo evaluation period.We performed bone marrow aspiration to evaluate pancytopenia and found that she had hemophagocytic lymphohistiocytosis(HLH).On the basis of a random skin biopsy for assessing the cause of HLH,she was diagnosed with intravascular B-cell lymphoma.HLH and hypopituitarism were considered secondary to IVL.All her clinical findings matched the presentations of IVL.She was immediately treated with chemotherapy and achieved complete response.She was relapse free two years after treatment.CONCLUSION IVL should be included in the differential diagnosis of hypopituitarism,which although life-threatening,is treatable through prompt diagnosis and appropriate chemotherapy.
