Eosinophilic oesophagitis in children: responders and non-responders to swallowed fluticasone

2013 ◽  
Vol 66 (5) ◽  
pp. 399-402 ◽  
Author(s):  
Renzo Boldorini ◽  
Francesca Mercalli ◽  
Giuseppina Oderda
Keyword(s):  
Fluticasone Propionate ◽  
High Power ◽  
Elimination Diet ◽  
Response To Treatment ◽  
Eosinophilic Oesophagitis ◽  
High Power Field ◽  
Severe Inflammation ◽  
Oesophageal Mucosa ◽  
Large Numbers ◽  
Histological Data

Eosinophilic Oesophagitis (EO) is characterised by large numbers of eosinophils in oesophageal mucosa in response to food or inhaled antigens. Treatment with elimination diet or corticosteroids lead to improvement in some children, but their efficacy is not optimal.Aimof this study is to identify clinical, endoscopic and/or histological features associated with response to treatment with swallowed fluticasone propionate.Patients and methodsIn the last 12 years 34 children (M/F 25/9) with EO were treated with fluticasone propionate spray 250 μg/puff by inhaler without spacer, three puffs three times a day for 6 weeks, and returned for a follow-up endoscopy. At histology 25 of them were found to be responders to therapy (73.5%) and 9 were non-responders. Anthropometric characteristics, symptoms at presentation, endoscopic and histological data at baseline between responders and non-responders were compared.ResultsAge, sex, height, duration and type of main symptom at presentation, type of allergy and number of allergens, peripheral eosinophil counts an serum IgE were similar in responders and non-responders. At baseline histology findings responders had a more severe inflammation: median peak eosinophils/high power field was higher (76 vs 44 in non responders p=0.04), eosinophilic microabscesses were present in a significantly higher number of responders (p=0.04) and peak mast cells/ high power field was significantly higher (p=0.001).ConclusionsClinical characteristics of children with EO at baseline were similar in responders and non-responders, but a more severe inflammation in oesophageal mucosa was associated with a higher response rate to fluticasone treatment.

Mast Cells in Hemangiomas and Vascular Malformations

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 48-51
Author(s):  
Julie Glowacki ◽  
John B. Mulliken
Keyword(s):  
Mast Cells ◽  
High Power ◽  
Vascular Malformations ◽  
Normal Skin ◽  
High Power Field ◽  
Proliferative Phase ◽  
Large Numbers ◽  
Endothelial Proliferation ◽  
Vascular Birthmarks

Common pediatric vascular birthmarks, classified as hemangiomas or malformations, were analyzed for the presence of mast cells. Hemangiomas in the proliferative phase contained large numbers of mast cells (27 ± 15 cells/high-power field [HPF]) in comparison with hemangiomas in the involuting phase (2.6 ± 2.9), vascular malformations (1.7 ± 3.2), and normal skin (5.0 ± 1.0). Inasmuch as hemangiomas are characterized by endothelial proliferation and increased numbers of mast cells, these data raise the possibility that mast cells may have an important role in the formation and/or maintenance of these lesions.

scholarly journals Treatment-resistant eosinophilic oesophagitis successfully managed with tofacitinib

2019 ◽  
Vol 12 (12) ◽  
pp. e232558 ◽  
Author(s):  
Lybil Briscia Mendoza Alvarez ◽  
Xiuli Liu ◽  
Sarah Glover
Keyword(s):  
High Power ◽  
Immunosuppressive Agent ◽  
Treatment Resistant ◽  
Eosinophilic Oesophagitis ◽  
High Power Field ◽  
Systemic Steroids ◽  
Immune Modulators ◽  
Endoscopic Findings

We present a case of a 34-year-old man with long-term diagnosis of eosinophilic oesophagitis (EoE) who did not achieve control of disease after multiple therapies including topical and systemic steroids, immune modulators and biologics. Initial endoscopic findings showed signs of active eosinophilic oesophagitis and biopsies were significant for up to 100 eosinophils per high power field during his various treatments. There was a significant improvement in the appearance of the oesophagus as well as the least number of eosinophils found in oesophagus biopsies after 3 months of treatment with tofacitinib. There are no cases of EoE treated with tofacitinib. Tofacitinib should be considered for the treatment of eosinophilic oesophagitis given its evolving role as an immunosuppressive agent.

scholarly journals Long-term follow-up of a patient with eosinophilic oesophagitis

2020 ◽  
Vol 18 (5) ◽  
pp. 75-80 ◽  
Author(s):  
A.V. Morkovina ◽  
◽  
N.D. Kulikova ◽  
T.L. Lapina ◽  
E.Yu. Yuryeva ◽  
...  
Keyword(s):  
Proton Pump ◽  
Elimination Diet ◽  
Topical Steroids ◽  
Eosinophilic Oesophagitis ◽  
Oesophageal Stricture ◽  
Oesophageal Mucosa ◽  
Long Term Follow Up ◽  
Histological Remission ◽  
Endoscopic Picture

A young man with complaints of dysphagia and heartburn had the diagnosis of eosinophilic oesophagitis verified at the age of 21 based on a typical endoscopic picture (transverse rings, oesophageal stricture) and histological examination (significant eosinophilic infiltration of the oesophageal mucosa). According to his medical history, at the age of 7 the patient was diagnosed with bronchial asthma, atopic dermatitis, food allergy, the manifestation of eosinophilic oesophagitis also occurred in childhood, and at the age of 14 an oesophageal stricture was found. Initial treatment with fluticasone and proton pump inhibitors resulted in achievement of clinical, endoscopic and histological remission. The article presents the dynamic course of eosinophilic oesophagitis over a 4-year period; the patient’s refusal of medication or withdrawal of fluticasone, quitting of the elimination diet was followed by clinical or histological worsening. Marked histological changes in the oesophageal mucosa might have not been accompanied by complaints of dysphagia neither a typical endoscopic picture could be observed. Maintenance therapy with topical steroids should be administered for a long period, and histological remission is an important criterion of its effectiveness. Key words: eosinophilic oesophagitis, fluticasone, topical steroids, proton pump inhibitor, remission

scholarly journals Is There Pathological Uniformity between the Periphery and Center of a Gastrointestinal Stromal Tumor?

2021 ◽  
Vol 10 (4) ◽  
pp. 687
Author(s):  
Seong Ji Choi ◽  
Kwan Hong Lee ◽  
Chan Kyoo Yoo ◽  
Jai Hoon Yoon ◽  
Ki Seok Jang ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Mitotic Index ◽  
High Power ◽  
Malignant Potential ◽  
Mitotic Count ◽  
Pathological Diagnosis ◽  
High Power Field ◽  
Gastric Gists ◽  
Significant Difference ◽  
The Mean

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and have some malignant potential. Mitotic count is important for predicting the malignant potential of GISTs. Proper treatment of GISTs requires accurate pathological diagnosis. In general, endoscopic ultrasound-guided fine-needle aspiration and deep biopsy are used for pathological diagnosis of GIST before making decisions about surgery. This study sought to evaluate the pathological uniformity of gastric GISTs for mitotic index of the center and periphery of the GIST. Methods: We retrospectively reviewed the data of 37 gastric GIST patients who underwent wedge resection at Hanyang University Hospital. We used Armed Forces Institute of Pathology criteria to classify gastric GISTs. To determine the pathological uniformity of gastric GISTs, we compared GIST risk stratification between the center and periphery of GISTs. Results: The mean size of GISTs was 3.56 ± 2.10 cm. Three lesions were located in the antrum, 11 in the fundus, 9 in the cardia, and 14 in the body. The mean age of patients was 58.65 ± 9.44 years; 18 patients were male and 19 were female. Thirty-five patients (94.6%) showed the same level of risk stratification between the center and periphery of gastric GISTs, while two patients (5.4%) presented different levels of risk between the two sites. No significant difference in mitotic count was observed between the two sites (kappa value = 0.863; p = 0.001). Conclusions: Mitotic index category (either more than five mitoses per high-power field or five or fewer mitoses per high-power field) of GISTs showed good concurrence between the center and periphery.

Automated image analysis of nuclear atypia in high-power field histopathological image

2015 ◽  
Vol 258 (3) ◽  
pp. 233-240 ◽  
Author(s):  
CHENG LU ◽  
MENGYAO JI ◽  
ZHEN MA ◽  
MRINAL MANDAL
Keyword(s):  
Image Analysis ◽  
High Power ◽  
Automated Image Analysis ◽  
High Power Field ◽  
Nuclear Atypia ◽  
Histopathological Image

Mitotic counts in one high power field in breast core biopsies is equivalent to counts in 10 high power fields

Pathology ◽  
2021 ◽  
Author(s):  
Whayoung Lee ◽  
Timothy Law ◽  
Yunxia Lu ◽  
Thomas K. Lee ◽  
Julio A. Ibarra
Keyword(s):  
High Power ◽  
High Power Field

Febrile Infants at Low Risk for Serious Bacterial Infection—An Appraisal of the Rochester Criteria and Implications for Management

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Julie A. Jaskiewicz ◽  
Carol A. McCarthy ◽  
Amy C. Richardson ◽  
Kathleen C. White ◽  
Donna J. Fisher ◽  
...  
Keyword(s):  
Confidence Interval ◽  
High Power ◽  
Microscopic Examination ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Low Risk ◽  
High Power Field ◽  
Urine Sediment ◽  
Predictive Values ◽  
Risk Criteria

Objective. Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria. Methods. Febrile infants (rectal T ≥ 38°C) ≤60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 109 cells/L (5000-15 000/mm3), band form count≤ 1.5 x 109 cells/L (≤1500/mm3), ≤10 WBC per high power field on microscopic examination of spun urine sediment, and ≤5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated. Results. Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia. The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia. Conclusions. These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.

Mastocytic Enterocolitis: Increased Mucosal Mast Cells in Chronic Intractable Diarrhea

2006 ◽  
Vol 130 (3) ◽  
pp. 362-367 ◽  
Author(s):  
Shriram Jakate ◽  
Mark Demeo ◽  
Rohan John ◽  
Mary Tobin ◽  
Ali Keshavarzian
Keyword(s):  
Mast Cell ◽  
Mast Cells ◽  
High Power ◽  
Chronic Diarrhea ◽  
Duodenal Biopsy ◽  
Mast Cell Tryptase ◽  
High Power Field ◽  
Intractable Diarrhea ◽  
Biopsy Specimens ◽  
Hematoxylin Eosin

Abstract Context.—In some adult patients with chronic intractable diarrhea, the diagnosis remains elusive even after detailed evaluations, and colonic or duodenal biopsy specimens may appear unremarkable on routine hematoxylin-eosin staining. Objectives.—To assess the concentration of mast cells in colonic or duodenal biopsy specimens by immunohistochemical analysis for mast cell tryptase from patients with chronic intractable diarrhea and to evaluate their response to drugs affecting mast cell function. Design.—Mast cells per high-power field were assessed in biopsy specimens from 47 patients with chronic intractable diarrhea, from 50 control subjects, and from 63 patients with other specific diseases that cause chronic diarrhea (inflammatory bowel disease, celiac disease, collagenous colitis, and lymphocytic colitis). Patients with chronic intractable diarrhea who had more than 20 mast cells per high-power field were administered drugs affecting mast cell mediator function and release. Results.—The mean ± SD concentration of mast cells in the 50 control subjects was 13.3 ± 3.5 cells per high-power field; hence, patients with more than 20 mast cells per high-power field were considered to have increased mast cells. Thirty-three (70%) of 47 patients with chronic intractable diarrhea had increased mast cells, and symptoms were controlled by drug therapy in 22 (67%) of the 33 patients. No patient had systemic or cutaneous mastocytosis. No increase in mast cells was seen in patients with other common causes of chronic diarrhea. Conclusions.—In chronic intractable diarrhea, colonic or duodenal biopsy specimens may appear unremarkable on routine hematoxylin-eosin staining, but increased mast cells may be demonstrated by immunohistochemistry for mast cell tryptase, with the novel term mastocytic enterocolitis describing this condition. Similar increases in mast cells are not apparent in control populations or in patients with other specific diseases that cause chronic diarrhea. The cause of the increased mast cells remains to be elucidated.

Abstract 13869: Inflammatory Changes in the Lungs of Rats Exposed to E-cigarettes Without Marijuana, Vitamin E Oil, or Nicotine

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jianru Shi ◽  
Michael T Kleinman ◽  
Rebecca J Arechavala ◽  
Dave Herman ◽  
Irene Hasen ◽  
...  
Keyword(s):  
Vitamin E ◽  
High Power ◽  
Inflammatory Cells ◽  
Lung Parenchyma ◽  
Heating Element ◽  
Chromium Alloy ◽  
Sprague Dawley ◽  
High Power Field ◽  
Quantitative Manner ◽  
Inflammatory Changes

Background: Recently, the clinical entity of EVALI (E-cigarette or vaping product use associated lung injury) was described and has similarities to COVID -19 pneumonia. We determined in a quantitative manner the inflammatory changes in the lungs associated with EVALI in a rodent model that does not include use of marijuana, vitamin E oil, or nicotine, which had been implicated as a cause. Methods: Adult Sprague Dawley rats were exposed to either pure air (n=5) or electronic cigarette (eC) vapor (propylene glycol/vegetable glycerin, tobacco flavoring) using a device with a nickel-chromium alloy (NC) heating element at 70 Watts (n=6) for 2 hours. The e-liquid did not contain nicotine, marijuana, or Vitamin E oil. Rats were euthanized within a few days of exposure and H&E-stained lung sections were assessed. Inflammatory cells were counted from 10 random areas per section at 20х magnification. Results: Alveolar structure appeared normal in the air group (Figure, panel C); the eC group using the NC heating element showed alveolar inflammation (D). The numbers of inflammatory cells per high power field in the lung parenchyma were significantly greater in the rats exposed to eC using NC heating element (67.5 ± 44.5) compared to the air group (6.7 ± 0.3; P < 0.001, Kruskal-Wallis test). The predominant cell type was mononuclear and secondary were neutrophils. Other features included accumulation of fibrin and inflammatory cells in the lumen of the trachea (A); thickened alveolar walls; and red blood cell congestion (D). Inflammation of the nasal passages was also observed (B). Exposure of rats to e cigarettes using a stainless steel heating element did not result in EVALI, and the amount of inflammatory cells was closer to air exposed rats (7.2± 0.4). Conclusion: Vaping using a nichrome heating element at high power leads to respiratory tract pathology and a significant increase in the number of inflammatory cells in the alveoli. EVALI occurred without marijuana, vitamin E oil or nicotine.

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