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A K Dube

Publications and source records attributed to A K Dube.

4 recordsLinked to original sources
PubMed2006

The occurrence of terminal ileal histological abnormalities in patients with coeliac disease.

INTRODUCTION: Coeliac disease causes histological changes throughout the small bowel, but is often a proximal lesion. We wanted to assess whether terminal ileal histological abnormalities occurred more commonly in patients with coeliac disease and if specific assessment of intraepithelial lymphocytes increases the recognition of undiagnosed coeliac disease. METHODS: Terminal ileal biopsies were prospectively examined over a 3-year period (April 2001-May 2004). Patients were included if they were found to have a synchronous duodenal biopsy that gave a new diagnosis of coeliac disease (n=20). Terminal ileal biopsies taken at colonoscopy during the same period were also examined from four groups of patients: coeliac disease established on a gluten-free diet but with persisting symptoms (n=25), inflammatory bowel disease (n=47), chronic diarrhoea (n=44) and polyp surveillance (n=47). All biopsies were graded according to the Marsh criteria and an intraepithelial lymphocytes count per 100 enterocytes was obtained. RESULTS: There was only one patient from all five groups who had villous atrophy of the terminal ileal. This patient had a new diagnosis of coeliac disease. The mean intraepithelial lymphocytes count in the coeliac disease group was 23.7 intraepithelial lymphocytes/100 enterocytes. This was significantly higher than the control groups: coeliac disease on a gluten-free diet=17.5 (p<0.012), inflammatory bowel disease=12.3 (p<0.0001), diarrhoea=12.6 (p<0.0001) and polyp=13.7 (p<0.0002). Validating terminal ileal villous intraepithelial lymphocytes counts as a test for coeliac disease using an intraepithelial lymphocytes/100 enterocytes of >25 gives a sensitivity of 45% and a specificity of 97.8%. CONCLUSION: Routinely quantifying terminal ileal intraepithelial lymphocytes may be of limited clinical value. However, subjective recognition of raised intraepithelial lymphocytes on a terminal ileal biopsy should alert the clinician to the possibility of coeliac disease.

Adolescent↗
PubMed1998

Audit of the histopathological diagnosis of non-neoplastic colorectal biopsies: achievable standards for the diagnosis of inflammatory bowel disease.

AIM: To assess the performance of a histopathology department in diagnosing inflammatory bowel diseases with comparison of reports from other centres. STUDY POPULATION: 1067 sets of endoscopic biopsies received in the department of histopathology, Royal Hallamshire Hospital, 1990-1995. METHODS: The histopathological diagnosis of non-neoplastic endoscopic colorectal biopsies was audited using data from histopathology reports. The biopsy diagnosis by the initial reporting pathologist and final diagnosis after additional investigations (endoscopy, radiology, microbiology) or surgery were used to derive sensitivity, specificity, and positive predictive values for categories of disease. RESULTS: Diagnosis was validated for 1067 biopsy sets (43% of those initially assessed). For all biopsies (with or without active inflammation) reports highly suggestive or suggestive of Crohn's disease had a sensitivity of 50%; for ulcerative colitis the comparable figure was 62%. Sensitivity was the same for both diagnoses (74%) in those biopsies with active inflammation. Positive predictive values for highly suggestive diagnoses of ulcerative colitis or Crohn's disease were 100%. In all biopsies the specificity of a histopathological diagnosis of normality was 96%. CONCLUSIONS: These results compare favourably with the other published audits and present an achievable level of performance for non-specialist hospitals with non-specialist histopathology services.

Adolescent↗
PubMed1997

Does funeral preference influence clinical necropsy request outcome?

Attitudes towards necropsy have been shown to be more favourable amongst those relatives preferring cremation as a method of disposal compared to those with a preference for burial. In a two-year retrospective study, no significant relationship was found between funeral preferences (burial or cremation) and clinical necropsy request outcome when age, sex and religion were taken into account. Potential religious objections to necropsy were infrequent and cremation was found to have become the most popular method of disposing of the dead during a period when local clinical necropsy rates have continued to decline. Funeral preference is unlikely to have been a significant factor in the decline in clinical necropsy rates.

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