1/11. polymerase chain reaction based human leucocyte antigen genotyping for the investigation of suspected gastrointestinal biopsy contamination.BACKGROUND: Mislabelling or contamination of surgical specimens may lead to diagnostic inaccuracy, particularly within gastrointestinal pathology when multiple small mucosal biopsy specimens are commonly taken, and where a tiny fragment of foreign tissue may be indistinguishable from true biopsy material using histological assessment alone. AIMS: To assess the utility of polymerase chain reaction (PCR) based human leucocyte antigen (HLA) genotyping techniques for the investigation of potentially mislabelled or contaminated gastrointestinal biopsy specimens. patients: Ten cases (28 samples) in which mislabelling or contamination was suspected, comprising four upper gastrointestinal tract biopsies and six colonoscopic biopsy series. methods: Direct and nested PCR-sequence specific primer (SSP) based HLA class II genotyping was performed on dna extracted from formalin fixed and paraffin wax embedded tissue (23 samples) or peripheral blood leucocytes (five samples). RESULTS: A full HLA-DRB1 genotype was determined in all 28 samples. In seven cases the HLA-DRB1 genotype of the putative contaminant was different to that of the corresponding reference tissue, confirming different individual origins for the contaminant and reference material. In one case the contaminant tissue was shown to possess the same HLA-DRB1 alleles as a second patient (probable source). In the remaining three cases the same HLA-DRB1 alleles were detected within the potential contaminant and reference tissues. CONCLUSIONS: PCR based HLA class II genotyping is a valuable tool for investigating potential contamination or mislabelling within gastrointestinal biopsy specimens and this report has confirmed contamination in seven of ten cases studied.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/11. Basidiobolus ranarum as an etiologic agent of gastrointestinal zygomycosis.Basidiobolus ranarum is a known cause of subcutaneous zygomycosis. Recently, its etiologic role in gastrointestinal infections has been increasingly recognized. While the clinical presentation of the subcutaneous disease is quite characteristic and the disease is easy to diagnose, gastrointestinal basidiobolomycosis poses diagnostic difficulties; its clinical presentation is nonspecific, there are no identifiable risk factors, and all age groups are susceptible. The case of gastrointestinal basidiobolomycosis described in the present report occurred in a 41-year-old Indian male who had a history of repair of a left inguinal hernia 2 years earlier and who is native to the southern part of india, where the subcutaneous form of the disease is indigenous. diagnosis is based on the isolation of B. ranarum from cultures of urine and demonstration of broad, sparsely septate hyphal elements in histopathologic sections of the colon, with characteristic eosinophilic infiltration and the Splendore-Hoeppli phenomenon. The titers of both immunoglobulin g (IgG) and IgM antibodies to locally produced antigen of the fungus were elevated. The patient failed to respond to 8 weeks of amphotericin b therapy, and the isolate was later found to be resistant to amphotericin b, itraconazole, fluconazole, and flucytosine but susceptible to ketoconazole and miconazole. One other noteworthy feature of the fungus was that the patient's serum showed raised levels of Th2-type cytokines (interleukins 4 and 10) and tumor necrosis factor alpha. The present report underscores the need to consider gastrointestinal basidiobolomycosis in the differential diagnosis of inflammatory bowel diseases and suggests that, perhaps, more time should be invested in developing standardized serologic reagents that can be used as part of a less invasive means of diagnosis of the disease.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
3/11. carcinoembryonic antigen: clinical and historical aspects.To further define and determine the usefulness of CEA, 1100 CEA determinations have been made over the past two years at The ohio State University hospitals on patients with a variety of malignant and nonmalignant conditions. Correlation of CEA titers with history and clinical course has yielded interesting results not only in cancers of entodermally derived tissues, for which CEA has become an established adjunct in management, but also in certain other neoplasms and inflammatory states. The current total of 225 preoperative CEA determinations in colorectal carcinomas shows an 81% incidence of elevation, with postoperative titers remaining elevated in patients having only palliative surgery but falling to the negative zone after curative procedures. An excellent correlation exists between CEA levels and grade of tumor (more poorly differentiated tumors showing lower titers). Left-side colon lesions show significantly higher titers than right-side lesions. CEA values have been shown to be elevated in 90% of pancreatic carcinomas studied, in 60% of metastatic breast cancers, and in 35% of other tumors (ovary, head and neck, bladder, kidney, and prostate cancers). CEA levels in 35 ulcerative colitis patients show elevation during exacerbations (51%). During remissions titers fall toward normal, although in 31% still remaining greater than 2.5 ng/ml. In the six colectomies performed, CEA levels all fell into the negative zone postoperatively. Forty percent of adenomatous polyps showed elevated CEA titers (range 2.5-10.0) that dropped following polypectomy to the negative zone. Preoperative and postoperative CEA determinations are important in assessing the effectiveness of surgery. Serial CEA determinations are important in the follow-up period and in evaluation of the other modes of therapy (e.g., chemotherapy). These determinations of tumor antigenicity give the physician added prognostic insight into the behavior of the tumor growth. Rectal examination with guaiac determinations, sigmoidoscopy, cytology, barium enema, and a good clinical evaluation remain the primary tools for detecting colorectal disease. However, in the high-risk patient suspicious of developing cancer, CEA determinations as well as colonoscopy are now being used increasingly and provide additional highly valuable tools in the physician's armamentarium.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/11. Early cytomegalovirus (CMV) gastrointestinal disease that developed 19 days after bone marrow transplantation, with a high-level of CMV antigenemia, of up to 1120 cells/slide.We report a 19-year-old male with acute myeloid leukemia who developed an early cytomegalovirus gastrointestinal disease with a high level of cytomegalovirus antigenemia after bone marrow transplantation. He underwent bone marrow transplantation from HLA-matched related donor. He developed acute graft-versus-host disease on day 15, and he immediately went on prednisolone. The graft-versus-host disease disappeared immediately, but he developed a severe epigastralgia on day 23. Although absolute neutrophil count was 0.5 x 10(9)/l, the pp65 cytomegalovirus antigenemia increased up to 1120 cells/slide. The endoscope examination was performed on day 29 and it showed erosive gastritis, and microscopical examination revealed nuclear inclusion bodies and positive cells of cytomegalovirus antigen. ganciclovir treatment was started, and it continued until negative cytomegalovirus antigenemia was confirmed. He consequently discharged to outpatient without late phase CMV diseases or recurrence of AML. We assessed that the patient had two risk factors. First, he was the cytomegalovirus seropositive patient and received bone marrow from seronegative donor. Second, he was treated with prednisolone for acute graft-versus-host disease. The ganciclovir treatment turned out to be successful, but the cytomegalovirus disease developed too early to start the antigenemia guided preemptive treatment. The high-risk patients could develop the early cytomegalovirus disease even though under the status of myelosuppression after bone marrow transplantation.- - - - - - - - - - ranking = 1.8keywords = antigen (Clic here for more details about this article) |
5/11. Chronic urticaria and blastocystis hominis infection: a case report.We report a case of a 45 year old woman which fulfilled the criteria of chronic urticaria (remitting and relapsing bouts of erythematous and pruriginuos lesions without angioedema, lasted four months). Cutaneous manifestations were not related to a specific inducing factor, had no benefit from antihystamine and steroid drugs and were associated sometimes with mild gastroentric disorders. Patient was submitted to extensive clinical, laboratory and intrumental investigations which permit to exclude many conditions: allergy to inhalants, food, insects and drug adverse reactions, autoimmune urticaria, autoimmune diseases, neoplastic and infectious diseases. Finally coprocolture disclosed the presence of blastocystis hominis in stool samples thus permitting to associate urticaria to parasitic infection. Both cutaneous manifestations and mild abdomen disturbs disappeared after appropriate treatment. Despite the high diffusion the aetiopathogenesis of chronic urticaria remains often undefined. A large number of parasites have been correlated with urticaria but few data exist as regards blastocystis hominis infection; then our findings may add evidence to the role of this parasite in inducing chronic urticaria. Considering that blastocystis hominis is a modest pathogen for humans, the mechanism is probably the typical one of cutaneous allergic hypersensitivity; antigen parasites induce the activation of specific clones of Th2 lymphocytes, the release of related cytokines and the consequent IgE production.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
6/11. Reactive nodular fibrous pseudotumors of the gastrointestinal tract: report of 8 cases.Eight cases of reactive nodular fibrous pseudotumor of the gastrointestinal tract are presented. The patients included 6 males and 2 females between the ages of 1 and 68 years (mean age 41.5 years). Three tumors involved the small intestine, and 5 of the investigated lesions were located in the large bowel. Of these, 2 originated in the sigmoid colon, 1 in the cecum, 1 in the appendix, and 1 in the large bowel not otherwise specified. The tumors' size varied from 3 to 10 cm in the greatest diameter (mean 6.2 cm). Histologically they were composed of stellate or spindle shaped cells resembling fibroblasts arranged haphazardly or in intersecting fascicles, embedded in a collagen-rich stroma, with sparse intralesional mononuclear cells frequently arranged in lymphoid aggregates. Immunohistochemically, the lesions were positive for vimentin (7/7), smooth muscle actin (8/8), muscle-specific actin (5/7), cytokeratins AE1/AE3 (6/7), and CAM 5.2 (1/7), and antigen CD68 (1/7). No case (0/8) reacted positively with antibody to CD117 (c-kit). Genetically no substitutions, deletions, or insertions occurred in exon 11 in all analyzed samples. Likewise, no deletions or insertions in part of exon 9 were observed. Ultrastructurally the tumor cells revealed features typical of myofibroblasts. According to the morphologic, immunohistochemical, and ultrastructural features mentioned above, especially to the positivity of low-molecular-weight cytokeratins, we propose this lesion to be related to a proliferation of multipotential subserosal cells rather than ordinary myofibroblasts or fibroblasts.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
7/11. Subhepatic ciliated foregut cyst.Foregut cyst derives from the primitive foregut and occurs in the tracheobronchial tree, mediastinum, liver, pancreas, tongue, and upper digestive tract. We report the first case of a foregut cyst in the subhepatic area. A computed tomographic scan of a 45-year-old man with dull backache showed a discrete subhepatic multiloculated cystic lesion. The cyst lining consisted of ciliated, columnar epithelium, goblet cells, and underlying double layer of smooth muscle. In addition to positivity for cytokeratin and epithelial membrane antigen in the epithelial cells, focal weak positivity for thyroid transcription factor was present, a novel finding further supporting respiratory differentiation. We hypothesized the occurrence of this cyst in this location based on the embryonic communication between the thoracic and abdominal cavities through the pericardio-peritoneal canal, eventually separated by pleuroperitoneal membranes. Abnormal buds off the tracheobronchial tree may get pinched off by these membranes, leading to migration into the abdomen.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
8/11. helicobacter pylori as cause of gastrointestinal disease in children with hemato-oncologic diseases.After documentation of a case of life threatening helicobacter pylori (H. pylori) gastric ulcer in an adolescent girl on treatment for acute lymphoblastic leukaemia, we started to systematically look for gastro-intestinal symptoms due to H. pylori infection in our cancer patients at G. Gaslini Children's Hospital. During a period of 46 months, we observed 13 further cases of severe dyspepsia syndrome or gastro intestinal bleeding associated with presence of H. pylori faecal antigen. All patients recovered with appropriate therapy. H. pylori may represent a cause of severe gastrointestinal complications in children with cancer or following bone marrow transplant.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
9/11. Colon-specific antigen-p (CSAp). I. Initial clinical evaluation as a marker for colorectal cancer.A radiometric immunoassay for detecting colon-specific antigen-p (CSAp) in the blood of patients suspected of having colorectal cancer has been developed and evaluated in 272 subjects of various disease entities. Using 10 units/ml as the cutoff value for normalcy, the results indicate that the highest number of elevated CSAp titers occurred in patients with advanced colorectal cancer (61%). Only one of 12 colonic adenoma patients had an elevated CSAp titer, and this was slightly above the 10 units/ml cutoff. Other nonneoplastic gastrointestinal disorders showed an 18% abnormal CSAp titer frequency, of which more than half bordered the upper limit of normalcy. CSAp elevations were also found in gastric cancer (20%), pancreatic cancer (20%), breast cancer (5%), and normal individuals (3%). CSAp was compared to carcinoembryonic antigen (CEA) in 44 colorectal cancer patients, in 12 patients with colonic adenomas, and in 62 patients with diverse gastrointestinal disorders. Using a CEA cutoff of 5 ng/ml, CSAp could increase the diagnostic accuracy of the CEA plasma test in colorectal cancer patients by 14%. In patients with colonic adenomas, the CSAp titer was normal when the CEA value was elevated in 25% of the cases. However, both were simultaneously elevated in only 3% of the patients with benign gastrointestinal disorders. Since the CSAp test was less frequently elevated (0-7%) in patients with breast, ovarian, lung, or cervical cancer than was found for CEA (39-75% elevated), it seems that the CSAp blood assay detects colorectal cancer more specifically than the more generally distributed CEA. These results suggest that the combined use of blood CEA and CSAp could enhance the discrimination of colorectal cancers from other nonmalignant gastrointestinal diseases, and could also serve to enhance the colorectal cancer-specificity of the CEA assay. Furthermore, serial monitoring of both markers in four advanced colorectal cancer patients indicated that they reflect disease activity, falling after successful treatment and rising again with recurrence and disease progression.- - - - - - - - - - ranking = 1.2keywords = antigen (Clic here for more details about this article) |
10/11. Immunologically confirmed disseminated, asymptomatic encephalitozoon cuniculi infection of the gastrointestinal tract in a patient with AIDS.microsporidia are obligate intracellular protozoan parasites that infect a broad range of vertebrates and invertebrates. They are increasingly recognized as human pathogens, especially in patients infected with human immunodeficiency virus (hiv). Organisms of the genus Encephalitozoon have been implicated as a major cause of disseminated microsporidian infections in persons with AIDS. Until recently, E. hellem was the only Encephalitozoon species confirmed by antigenic or nucleic acid methods to have infected humans. We describe the clinical course and morphological features of a case of disseminated microsporidian infection with encephalitozoon cuniculi in an hiv-infected patient with chronic sinusitis, rhinitis, and keratoconjunctivitis. parasites were found in conjunctival swab, nasal discharge, sputum, urine, stool, and duodenal biopsy specimens, but no pulmonary, renal, or gastrointestinal symptoms were documented. The patient was treated with albendazole (400 mg po b.i.d.), resulting in complete remission of his ocular and nasal symptoms, and microsporidian spores disappeared from all sites. To our knowledge, this case is only the second of E. cuniculi infection in humans that has been confirmed by either antibody- or nucleic acid-based methods, and it is the first in which an Encephalitozoon species has been found in the intestinal tract of a human. microsporidiosis is an important emerging opportunistic infection in hiv-infected patients and, as documented in this report, has an expanding clinicopathologic spectrum.- - - - - - - - - - ranking = 0.2keywords = antigen (Clic here for more details about this article) |
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