Objectives-Endoscopy with systematic randomized biopsies aims to improve the detection of intestinal metaplasia(IM)and dysplasia in Barrett’s esophagus(BE).Magnifying chromoendoscopy with alcoholic acetic acidmight a...Objectives-Endoscopy with systematic randomized biopsies aims to improve the detection of intestinal metaplasia(IM)and dysplasia in Barrett’s esophagus(BE).Magnifying chromoendoscopy with alcoholic acetic acidmight allow directed biopsies to improve detection of IM and dysplasia.Patients and methods-Twenty-eight patients were studied with magnifying chromoendoscopy(Optical power zoom x 115,alcoholic acetic acid).Endoscopy biopsies were performed on one or several zones of BE chosen randomly,for which the chromoendoscopic pattern was determined according to Guelrud’s classification.Results-Among seventy-two biopsies,the agreement between magnifying chromoendoscopy and histology and the positive predictive value of the association of patterns III and IV for the diagnosis of IM were 72.4%;sensibility and specificity were respectively 95.5%and 42.9%.The diagnostic accuracy was 75%.Among the six biopsies that showed high-grade dysplasia,three were suspected because of two particular patterns:local loss of ridged cerebriform pattern due to the disorganization of the mucosal folds and hypervascularization of the mucosa.Conclusion-Magnifying chromoendoscopy with acetic acid allows targeted biopsies of the IM in BE and may help to detect high-grade dysplasia.展开更多
We report the first known case of both Noonan syndrome and Whipple's disease occurring in the same patient.A 36-year-old female with history of Noonan syndrome developed fatigue,anorexia,arthritis of the knees and...We report the first known case of both Noonan syndrome and Whipple's disease occurring in the same patient.A 36-year-old female with history of Noonan syndrome developed fatigue,anorexia,arthritis of the knees and hands with a diffuse hyperpigmented rash,night sweats,and an unintentional fifteen pound weight loss over 4 mo.Small bowel enteroscopy demonstrated mild edematous yellowish mucosa without friability.Random small bowel biopsies revealed extensive periodic acid-Schiff positive material within the foamy macrophages.She was treated with a 12 mo course of trimethoprim-sulfamethoxazole DS with clinical improvement to baseline status.展开更多
Objective: To report the case of an infertile female patient with cystic fibrosis who was diagnosed with endocervical metaplasia of the endometrium at diagnostic hysteroscopy and successfully treated with an oral estr...Objective: To report the case of an infertile female patient with cystic fibrosis who was diagnosed with endocervical metaplasia of the endometrium at diagnostic hysteroscopy and successfully treated with an oral estroprogestinic formulation. Design: Case report. Setting: University hospital. Patient(s): A 27- year- old infertile female patient with cystic fibrosis. Intervention(s): Hysteroscopy with multiple random biopsies was performed at the time of the first visit and after a 10- month cycle with an oral estroprogestinic formulation. Main Outcome Measure(s): Hysteroscopic evaluation with target biopsy; histological examinations of endometrial specimens. Result(s): Our patient benefited from a 10- month cycle with an oral estroprogestinic formulation. At the control visit we noticed a significant improvement in the hysteroscopic appearance of her endometrium, and the histological examination confirmed the complete reversion of the metaplastic alterations previously observed. Conclusion(s): The present report suggests a novel histological alteration possibly involved in affecting fertility in women with cystic fibrosis. In addition, the positive response to the estroprogestinic treatment observed in our patient poses new questions regarding the relationship between ovarian hormones and cystic fibrosis transmembrane conductance regulator protein regulation, offering interesting perspectives for a hormonal therapy in the treatment of subfertility in women with cystic fibrosis.展开更多
文摘Objectives-Endoscopy with systematic randomized biopsies aims to improve the detection of intestinal metaplasia(IM)and dysplasia in Barrett’s esophagus(BE).Magnifying chromoendoscopy with alcoholic acetic acidmight allow directed biopsies to improve detection of IM and dysplasia.Patients and methods-Twenty-eight patients were studied with magnifying chromoendoscopy(Optical power zoom x 115,alcoholic acetic acid).Endoscopy biopsies were performed on one or several zones of BE chosen randomly,for which the chromoendoscopic pattern was determined according to Guelrud’s classification.Results-Among seventy-two biopsies,the agreement between magnifying chromoendoscopy and histology and the positive predictive value of the association of patterns III and IV for the diagnosis of IM were 72.4%;sensibility and specificity were respectively 95.5%and 42.9%.The diagnostic accuracy was 75%.Among the six biopsies that showed high-grade dysplasia,three were suspected because of two particular patterns:local loss of ridged cerebriform pattern due to the disorganization of the mucosal folds and hypervascularization of the mucosa.Conclusion-Magnifying chromoendoscopy with acetic acid allows targeted biopsies of the IM in BE and may help to detect high-grade dysplasia.
文摘We report the first known case of both Noonan syndrome and Whipple's disease occurring in the same patient.A 36-year-old female with history of Noonan syndrome developed fatigue,anorexia,arthritis of the knees and hands with a diffuse hyperpigmented rash,night sweats,and an unintentional fifteen pound weight loss over 4 mo.Small bowel enteroscopy demonstrated mild edematous yellowish mucosa without friability.Random small bowel biopsies revealed extensive periodic acid-Schiff positive material within the foamy macrophages.She was treated with a 12 mo course of trimethoprim-sulfamethoxazole DS with clinical improvement to baseline status.
文摘Objective: To report the case of an infertile female patient with cystic fibrosis who was diagnosed with endocervical metaplasia of the endometrium at diagnostic hysteroscopy and successfully treated with an oral estroprogestinic formulation. Design: Case report. Setting: University hospital. Patient(s): A 27- year- old infertile female patient with cystic fibrosis. Intervention(s): Hysteroscopy with multiple random biopsies was performed at the time of the first visit and after a 10- month cycle with an oral estroprogestinic formulation. Main Outcome Measure(s): Hysteroscopic evaluation with target biopsy; histological examinations of endometrial specimens. Result(s): Our patient benefited from a 10- month cycle with an oral estroprogestinic formulation. At the control visit we noticed a significant improvement in the hysteroscopic appearance of her endometrium, and the histological examination confirmed the complete reversion of the metaplastic alterations previously observed. Conclusion(s): The present report suggests a novel histological alteration possibly involved in affecting fertility in women with cystic fibrosis. In addition, the positive response to the estroprogestinic treatment observed in our patient poses new questions regarding the relationship between ovarian hormones and cystic fibrosis transmembrane conductance regulator protein regulation, offering interesting perspectives for a hormonal therapy in the treatment of subfertility in women with cystic fibrosis.
