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Biomedical subjects

H J Freeman

Publications and source records attributed to H J Freeman.

100 records · Page 6Linked to original sources
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Functional asplenia and microscopic (collagenous) colitis.

A 54-year-old female presented with a pulmonary infection that resolved completely with antibiotic treatment. Peripheral blood films showed features characteristic of splenic hypofunction, and radiolabelling studies confirmed an absence of splenic reticulo-endothelial cell activity, which is typical of functional asplenia. The patient had a remote history of watery diarrhea but no clinical and laboratory features of malabsorption. Extensive upper and lower gastrointestinal tract biopsy studies revealed histopathological features of collagenous colitis without gastric or small intestinal inflammatory changes or epithelial lymphocytosis. Hyposplenism has been associated with different gastrointestinal disorders, particularly celiac disease. This is the first report of functional asplenia and microscopic collagenous colitis.

Ampicillin↗
PubMedDate not supplied

Hepatobiliary tract and pancreatic disorders in celiac disease.

A number of hepatobiliary tract and pancreatic disorders have been documented in patients with celiac disease. Some disorders have shared immunological or genetic factors, including chronic hepatitis, primary biliary cirrhosis and sclerosing cholangitis. Other hepatic or pancreatic pathological changes in celiac disease have been documented with severe malnutrition and malabsorption, including hepatic steatosis and pancreatic insufficiency, sometimes with pancreatic calcification. Finally, celiac disease may be associated with other very rare hepatic complications, such as hepatic T cell lymphoma.

Biliary Tract Diseases↗
PubMedDate not supplied

Perinuclear antineutrophil cytoplasmic antibodies in collagenous or lymphocytic colitis with or without celiac disease.

Microscopic forms of colitis, including lymphocytic and collagenous colitis, have been observed in both those with and without celiac disease. Although perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) occur in most patients with ulcerative colitis, investigations in microscopic, particularly lymphocytic, colitis are still needed. In this study atypical p-ANCA was evaluated in 55 patients, including 27 with celiac disease alone, 13 with celiac disease and concomitant lymphocytic colitis, and 15 with microscopic forms of colitis, including lymphocytic and collagenous colitis. Nine patients (16.3%) had atypical p-ANCA, including six with celiac disease and three with a microscopic form of colitis alone. Although five of the six positive celiac disease patients had lymphocytic colitis, all three celiac disease patients with associated primary sclerosing cholangitis--a separate risk factor for a positive assay result--were serologically positive for atypical p-ANCA. These results indicate for the first time that this serological marker may occur in histologically defined celiac disease with or without concomitant lymphocytic colitis. Furthermore, these results suggest that the pathogenesis of ulcerative colitis differs from that of lymphocytic colitis and further emphasizes the heterogeneous nature of these newly recognized types of colonic inflammatory mucosal disorders.

Adolescent↗
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Atypical perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn's disease.

Atypical perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) occur in most patients with ulcerative colitis but only in a minority of those with Crohn's disease. In a recent study from the United States, this serological marker was reported to be present in 100% of Crohn's disease patients with a clinical phenotype of' left-sided ulcerative colitis' but was not present in patients with 'isolated' small bowel disease. In a previously reported survey from the author's hospital, the p-ANCA status of 247 consecutive patients with Crohn's disease was evaluated, and, of these, 33 Crohn's disease patients were seropositive, including 18 (13.0%) with combined small and large bowel disease, 11 (19.6%) with 'isolated' colorecral disease, and four (4.6%) with 'isolated' small bowel but no detectable colorectal disease. To further evaluate and verify the significance of atypical p-ANCA in these 33 patients, clinical, radiological, endoscopic and histological features were examined. This study confirms that an 'ulcerative colitis-like' clinical phenotype may be seen in most, but not all, serologically positive Crohn's disease patients. Moreover, 'isolated' small bowel disease in the absence of colorectal disease occurs. Detection of atypical p-ANCA in Crohn's disease with different clinical and pathological features provides serological evidence that Crohn's disease is a very heterogeneous disorder.

Adolescent↗
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Clinical, pathological and molecular genetic findings in small intestinal follicle centre cell lymphoma.

A 44-year-old male was evaluated for an iron deficiency anemia. Endoscopic investigation revealed marked serpiginous ulceration of the proximal small intestine due to a B cell lymphoma. Endoscopic small intestinal mucosal biopsies revealed a nodular lymphoid infiltrate, and polymerase chain reaction of biopsy material from the same site demonstrated rearrangement of the bcl-2 gene, the molecular equivalent of the t(14;18) chromosomal translocation. Primary small bowel follicular small cleaved cell lymphoma was diagnosed. Endoscopic tissue biopsies for immunophenotyping, molecular genetic studies or both are a valuable diagnostic aid for precise classification of lymphoid neoplasms in the gastrointestinal tract.

Adult↗
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Atypical perinuclear antineutrophil cytoplasmic antibodies after colectomy in inflammatory bowel disease.

A typical perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) have been detected in most patients with ulcerative colitis and primary sclerosing cholangitis. Persistent atypical p-ANCA have been observed in ulcerative colitis patients with a prior proctocolectomy, especially with pouchitis, suggesting that this serological marker might be predictive of subsequent development of chronic or refractory pouchitis. This study prospectively evaluated this serological marker in 24 consecutive patients with inflammatory bowel disease and prior colectomies (12 with a clinical diagnosis of ulcerative colitis and 12 with a clinical diagnosis of Crohn's disease involving the colon). Of these, 14 were positive, including 11 with extensive ulcerative colitis and three with Crohn's disease. Although two of three ulcerative colitis patients with pouchitis were positive, eight of eight ulcerative colitis patients having a pelvic pouch with no] pouchitis were also positive, as was a patient who elected to have an end-ileostomy (Brooke's ileostomy). Two patients had abnormal liver chemistry tests. Both had end-stage primary sclerosing cholangitis treated with liver transplantation and were positive for this serological marker. Although atypical p-ANCA may be a marker of persistent inflammation in pelvic pouch patients, a positive test result should not be used for prognosis or as a decision-making parameter for pelvic pouch procedures.

Adolescent↗
PubMedDate not supplied

Inflammatory bowel disease with cytoplasmic-staining antineutrophil cytoplasmic antibody and extensive colitis.

A cohort of 18 patients with inflammatory bowel disease who were characterized by the presence of cytoplasmic-staining antineutrophil cytoplasmic antibody (cANCA) and extensive colitis is reported. Almost half were Indo-Canadians, and atypical perinuclear-staining antineutrophil cytoplasmic antibody was also detected in five (28%), similar to the detection rate for Crohn's disease and other less commonly detected forms of colitis, such as lymphocytic or collagenous colitis. Careful pathological review of all endoscopic biopsies and surgically resected colonic tissues did not reveal evidence of vasculitis or so-called 'palisading' granulomas, which is a typical pathological change of Wegener's granulomatosis, an entity that has been traditionally characterized by the detection of cANCA. This report describes 18 patients with extensive colitis and the seromarker cANCA but without clinical features or histological evidence of vasculitis.

Adolescent↗
PubMedDate not supplied

T cell lymphoma of the thyroid gland in celiac disease.

Previous studies have reported the association between celiac disease and T cell lymphoma of the intestine as well as hepatosplenic lymphoma, a specialized peripheral type of T cell lymphoma. In this report, a 66-year-old woman with dermatitis herpetiformis and biopsy-defined celiac disease developed a thyroid mass that proved to be a T cell lymphoma. A T cell lymphoma in the setting of celiac disease appears to be unique. The thyroid gland, due to its shared embryological developmental links with the gastrointestinal tract, is possibly another site of extranodal lymphoma linked to celiac disease.

Aged↗