Biomedical subjects
Publications and source records attributed to H P Spichtin.
We present two cases initially diagnosed as Crohn's disease which were treated with immunosuppressive drugs. In both patients the development of an amoebic liver abscess led to the correct diagnosis of amoebic dysentery. The pitfalls of the diagnosis of amoebic colitis and the possible influence of immunosuppression in the development of extraintestinal amoebiasis are discussed.
The expression of calretinin, a calcium-binding protein, has been studied in a series of 82 human colorectal adenocarcinomas. In 22.5% of the cases, part of the tumor cells were calretinin-positive, whereas the cells of the normal and paratumoral mucosa were always negative. Two types of cells from the tumoral mass reacted positively and selectively with calretinin-antisera: the tumor cells and giant fibroblasts. The neurons of enteric ganglia and reactive mesothelial cells also reacted positively to the same antibody. The results obtained by immunochemistry have been confirmed by Western blot analysis and in situ hybridization for calretinin mRNA. There is a correlation between the expression of calretinin and the degree of differentiation of the tumor. Well-differentiated tumors express calretinin in only 5% of the cases, whereas this percentage is 20% for moderately differentiated tumors and 66.6% for poorly differentiated or undifferentiated tumors. We conclude that calretinin is expressed by most undifferentiated colorectal adenocarcinomas, but only by a limited number of cells in well-differentiated tumors. The degree of its expression coincides also with additional signs of malignancy, such as an increase in the number of metastases in the regional lymph nodes and in other organs.
Bowen's disease of the anal region is a rare, slow-growing, intraepidermal squamous-cell carcinoma (carcinoma in situ). If surgical excision is incomplete, there is a risk of subsequent development of malignancy and metastasis. Between 1980 and 1995 we treated 11 patients (8 female, 3 male) with anal Bowen's disease. The mean age was 55 (34-75) years. The main reason for excision was: pain (4), itching (3), bleeding (3) and a disturbing lump (3). The intraoperative findings were in all cases a lesion at the anocutaneous line: perianal or intra-anal tumor (6), erosion (2) or ulceration (2) as well as lichenoid lesion (4) or hyperpigmentation (3). The procedure was excision of the lesion in 10 cases. Only in one case was a biopsy taken. 3 patients had to be operated on a second time for reasons of radicality. 5 years after primary diagnosis, one patient developed a recurrent invasive squamous-cell carcinoma and had to undergo perineo-abdominal rectum amputation with postoperative radiotherapy (2 years after operation). Only one patient underwent a biopsy, which produced the diagnosis of invasive squamous-cell carcinoma. He underwent combined chemo-radiotherapy. The symptoms of anal Bowen's disease are unspecific and the clinical findings are uncharacteristic. The recommended therapy is complete surgical excision. With complete excision no recurrences do occur.
In 10 patients presenting with acute recurrent dysphagia, seen over a 4-year period, idiopathic, eosinophilic esophagitis (IEE) was diagnosed. The diagnosis was confirmed histologically. Dysphagia of other causes or other diseases causing eosinophilic infiltration was ruled out. Endoscopy showed discrete white structures in the esophagus which were partly finely reticular or plaque-like in 9 of the 10 patients. Of these one had a web and another a mucosal ring. Peripheral eosinophilia and elevated IgE-levels were found in 70% of the cases. To date IEE has been thought to be a rare disorder. Emerging evidence suggests its prevalence has been underestimated. It may also be the most frequent form of eosinophilic gastroenteropathy. The flat, only endoscopically visible form may be more common than the proliferative type. With knowledge of the typical history and of the distinct endoscopic pattern, and with adequate diagnostic workup, the disease will be found more often in the future. Prompt diagnosis also avoids further diagnostic procedures and permits rapid remission through treatment with steroids and antihistamines.
The results of surgical resection in early gastric cancer were analyzed retrospectively. These operations were performed between 1982 and 1991 on 52 consecutive patients (29 women, 23 men; average age 64 [35-85] years). The tumours were resected by total gastrectomy in 11, by subtotal gastrectomy in 31, and by Billroth I resection in 10, followed by limited lymphadenectomy of the perigastric group of lymph-nodes (D1 dissection). There was one operative death (1.9%). The tumor was confined to the mucosa in 36 patients (69%), while submucosal infiltration was present in 16 (31%) and metastases to the regional lymph-nodes in seven (13%). Follow-up examination took place in all patients, after an average period of observation of 6.1 years. For the total group the 5-year survival rate, including operative mortality, was 83.7%. It correlated with the depth of penetration of the tumour and nodal involvement. 5-year survival rate for mucosal tumour was 90%, with submucosal infiltration 66.7% (P < 0.03), without lymph-node metastasis 86.4%, with it 68.6% (P < 0.05). The extent of resection and the tumour classification (according to Laurén--intestinal or diffuse) did not influence survival.--Early gastric cancer, contrary to that in the advanced stages, has a very good prognosis. But it is significantly altered by the depth of penetration of the tumour and nodal metastasis.
As the modern treatment for anal carcinoma is either radiotherapy alone or combined radiochemotherapy, an exact histological staging is impossible. Therefore we have to depend on an accurate preoperative staging method. Endoanal ultrasonography enables imaging of the normal anal canal and its pathologies. In a prospective investigation we were able to confirm the histological proven diagnosis of an anal epidermoid carcinoma in 12 patients with a 10-MHz transducer covered with a sonolucent plastic cone. The depth of infiltration can be determined in relation to the normal layers of the anal canal. Six patients treated with radiotherapy alone or combined radiochemotherapy were followed and the success or failure of the treatment was documented. Endosonography of the anal canal allows an exact staging of a primary anal carcinoma and the follow-up in irradiated carcinomas. Besides digital palpation and proctoscopy with biopsy, endosonography complements the preoperative staging of anal carcinomas.
We observed the rare case of a 50-year-old man with intestinal obstruction due to an inflammatory fibroid polyp (IFP) of the jejunum. Here, we report its clinical and pathological characteristics, and its histologic appearance. Limited small bowel resection led to complete recovery of the patient. In a short review of the literature, possible pathogenetic mechanisms as well as diagnostic and therapeutic means are discussed. Although rare, IFP should be considered in the differential diagnosis of small bowel obstruction.
Endorectal ultrasound is the most reliable method in staging rectal cancer and is superior to computed tomography. In a prospective series of 152 consecutive patients, comparison of preoperative ultrasound staging and postoperative histopathological staging resulted in an overall accuracy of 90.1%. Overstaging was observed in 9.2%, understaging in 0.7%. Peritumoral inflammatory changes, preoperative radiotherapy and localization of the tumor in the lower rectum were the main reasons for overstaging. Understaging was seen in stenotic or only minimal invasive tumors. Accuracy in staging lymph nodes was 78.5%. Inflammatory changes in the nodes were responsible for either overstaging or understaging. Whether diagnosis will be improved with a higher frequency--mainly in lymph nodes--has yet to be proved. With knowledge of the reasons for misinterpretation, endorectal sonography is--mainly in the lower rectum--a valuable aid in evaluation of surgical procedure.
The endoluminal sonography is a new investigation in staging rectal cancer. In a prospective series the value of the endoluminal sonography is compared with clinical staging and computed tomography. The accuracy in clinical staging, computed tomography and endoluminal sonography was 77%, 76% and 87%, respectively. The reasons for under- and overstaging and the interpretation of perirectal lymph nodes are discussed. The endoluminal sonography is an important new method evaluating the operative procedure of cancers in the lower rectum.
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Hepatitis non-A, non-B (HNANB) is due to one or more transmissible agents, probably viruses. Epidemiologically, HNANB is transmitted predominantly by transfusion of blood or plasma derivatives, and percutaneous inoculation, but a non-percutaneous transmission by the fecal-oral route is also established. However, despite 10 years of intense world-wide research, the transmissible agent, or agents, have not been identified and there are no serological assays for either an antigen or an antibody that can be used to detect this infection. The clinical diagnosis of HNANB remains, therefore, a diagnosis of exclusion mainly of hepatitis A and B, Epstein-Barr virus, cytomegalovirus and drug-induced liver disease. In contrast to hepatitis A and B, the clinical and biochemical course of HNANB tends to be less severe and the proportion of asymptomatic and anicteric cases is higher, but fulminant hepatitis and fatalities also occur. Typically, there is a fluctuating waxing and waning pattern of the serum aminotransferase activities in HNANB. HNANB has a relative high tendency to progress to a chronic stage. The exact frequency of HNANB-induced liver cirrhosis and convincing evidence for an association with hepatocellular carcinoma cannot be assessed, although the persistence of the infectious agent in chronic HNANB and the existence of a chronic asymptomatic carrier state have been proved. By light microscopy there is a broad morphologic spectrum of acute and chronic viral hepatitis, but no single pathognomonic lesion exists that allows a reliable distinction to be made of HNANB from hepatitis A and B. Electron microscopy of liver biopsy specimens of chimpanzees, experimentally infected with HNANB agents, permits the visualisation of cytoplasmic changes, which appear to be specific for infection with HNANB viruses. In human liver biopsy specimens from patients with HNANB, identical ultrastructural cytoplasmic changes could not consistently be demonstrated. In contrast, intranuclear aggregates of spherical and tubular particles measuring 20-29 nm, first described in experimental HNANB in chimpanzees, have been repeatedly demonstrated in acute and chronic HNANB in man. These nuclear particles have been considered as compelling evidence of human HNANB infection. The specificity has been challenged, however, by the demonstration of identical particles in other viral and non-viral hepatopathies and in liver biopsies of healthy volunteers. By immune electron microscopy, a multiplicity of virus-like particles are described in association with HNANB.(ABSTRACT TRUNCATED AT 400 WORDS)
A 33-year-old long-distance runner had three episodes of bloody diarrhoea, all occurring after competitive marathon runs. Colonoscopy revealed a small lesion in the caecum histologically compatible with ischaemia of the mucosa. The discussion centres on the pathophysiology of impaired intestinal blood supply during excessive effort and the frequency of gastrointestinal symptoms and occult blood loss due to jogging.
A series of 610 consecutive liver biopsies collected from Jan. 1980 to Oct. 1983 in two Swiss gastro-enterological centers was studied by immunohistology for the presence of delta-antigen, HBsAg and HBcAg in frozen sections. This led to the identification of 46 tissue and 45 serum samples of 28 patients, including 5 with follow-up biopsies. All had ongoing hepatitis B (HB) with delta-superinfection, representing 13.3% of all patients with HB. The sera were studied for HBsAg, anti-HBs, anti-HBc and HBe-markers by RIA, for anti-delta by indirect immunofluorescence on delta-positive test sections and for Dane particles by immune electromicroscopy. 18 of the 21 native Swiss patients were i.v. drug users between 20 and 28 years of age (30% of all drug users in this series). The other patients were residents from Mediterranean countries (n = 5), Eastern Europe (n = 1) and Asia (n = 1). Female patients (n = 5) were seen only among i.v. drug users. The most frequent histological type of HB was chronic active (aggressive) hepatitis (CAH) (26 of 46 biopsies or 13 of 28 patients, respectively), followed by acute HB with histological signs of possible transition to chronicity (8 of 46 biopsies or 6 of 28 patients), and acute lobular HB (6 of 46 biopsies or 5 of 28 patients). Chronic persistent HB (CPH) was rare (5 of 46 biopsies, final diagnosis in 3 patients). The delta-infection was found to persist in sequential biopsies when a chronic HB was established, the longest documented period being 72 months.(ABSTRACT TRUNCATED AT 250 WORDS)
2014 biopsies and surgical specimens of 524 patients with suspected aganglionosis of the colon were analyzed using enzyme histochemical techniques for acetylcholinesterase and lactate dehydrogenase. The diagnosis could be confirmed in 70 patients. Hypoganglionosis was found in 6, neuronal dysplasia (or hyperganglionosis) in 2, and a complete lack of intramural neurons and nerve fibers in 1 patient. The disease was found to occur most often during the first year of life (65.7%) and to be more common in males than females (3.3:1). Enzyme histochemistry is useful for the final diagnosis of aganglionosis provided the biopsy contains mucosa and parts of the submucosa of the colon.
The present state of the art in non-A, non-B hepatitis is reviewed. Eight years of world-wide efforts in research have not yielded a definite characterization of agent(s) and markers of this viral infection. Diagnosis is therefore established mainly by exclusion of the hepatitis viruses A and B, Epstein-Barr virus and cytomegalovirus, and drug-induced liver disease. Currently available serological, electron microscopic, immune electron microscopic and clinical information on non-A, non-B hepatitis in chimpanzee and man is briefly reviewed. Some light microscopic features provisionally regarded as suggestive of non-A, non-B hepatitis in man are presented. In daily practice the diagnostic tools in the near future will largely depend upon progress in the elaboration of suitable serological test systems and on further confirmation of microscopic findings, unless an unexpected breakthrough occurs through identification and characterization of the virus(es) in non-A, non-B infection.
Three chimpanzees were inoculated with an infectious factor VIII preparation. Two of the chimpanzees received in addition a human immunoglobulin preparation as used for prophylaxis in humans. All three chimpanzees developed an acute limited non-A, non-B hepatitis as judged from light and electron microscopic markers after an incubation period of two weeks. The use of immunoglobulin did not prevent the infection. A prolonged incubation of 15 weeks, however, was observed in one animal when alanine aminotransferase (ALT) elevation was used as criterion of infection. In the electron microscope, non-A, non-B hepatitis was characterized by tubular structures, spongelike inclusions and attaching curved membranes, in the absence of nuclear viruslike particles. An additional finding were viruslike particles in crystalline arrays which were found in the cytoplasm of sinusoidal-lining endothelial cells and tubuloreticular complexes.
Two chimpanzees (Pan troglodytes) were inoculated and cross-challenged with a fibrinogen and factor VIII preparation, respectively. Successful non-A, non-B (NANB) infection was documented by biphasic elevations of aminotransferases (ALT), concomitant hepatitic reactions and typical electron microscopic alterations, the most consistent being dilatation of the endoplasmic reticulum, as well as tubular and sponge-like cytoplasmic inclusions in the absence of nuclear virus-like particles. An anti-nuclear (anti-DNA) antibody of the IgM class in one of the chimpanzees simulating an antiviral antibody is described.