scholarly journals Endoscopic Aspects of Gastric Syphilis

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Mariana Souza Varella Frazão ◽  
Thiago Guimarães Vilaça ◽  
Fred Olavo Aragão Andrade Carneiro ◽  
Kengo Toma ◽  
Carolina Eliane Reina-Forster ◽  
...  

Introduction. Considered as a rare event, gastric syphilis (GS) is reported as an organic form of involvement. Low incidence of GS emphasizes the importance of histopathological analysis.Objective. We aim to characterize GS endoscopic aspects in an immunocompetent patient.Case Report. A 23-year-old man presented with epigastric pain associated with nausea, anorexia, generalized malaise and 11 kg weight loss that started 1 month prior to his clinical consultation. Physical examination was normal except for mild abdominal tenderness in epigastrium. Endoscopy observed diminished gastric expandability and diffuse mucosal lesions, from cardia to pylorus. Gastric mucosa was thickened, friable, with nodular aspect, and associated with ulcers lesions. Gastric biopsies were performed, and histopathological analysis resulted in dense inflammatory infiltration rich in plasmocytes. Syphilis serologies were positive for VDRL andTreponema pallidumreagents. Immunohistochemical tests were positive forTreponema pallidumand CD138. The patient was treated with penicillin, leading to resolution of his clinical complaints and endoscopic findings.Conclusion. Diagnosis suspicion of GS is important in view of its nonspecific presentation. Patients with gastric symptoms that mimic neoplastic disease should be investigated thoroughly based on the fact that clinical, endoscopic, and histological findings can easily be mistaken for lymphoma or plastic linitis.

2020 ◽  
Vol 29 (3) ◽  
pp. 59-64
Author(s):  
Hanaa M. El Maghraby ◽  
Samar Mohaseb

Background: Metronidazole is one of the antimicrobial drugs that can be used in combination with other drugs for eradication of Helicobacter pylori (H. pylori).Unfortunately, metronidazole resistance in H. plori is an increasing health problem which may be attributed to inactivation of many genes as rdx A gene. Objective: To determine the frequency of rdx A deletion mutation in H. pylori detected in infected patients attending at the Gastroenterology Unit, Zagazig University Hospitals. Methodology: Two gastric biopsies were taken from each enrolled patient by endoscopy. H.pylori detection was done by rapid urease test and polymerase chain reaction (PCR) amplification of 16S rRNA gene. Deletion mutation in rdx A gene was detected by conventional PCR. Results: Out of 134 doubled gastric biopsies obtained from 134 patients, 52.2% were positive for H. pylori. Epigastric pain, vomiting and gastritis were significantly associated with detection of H. pylori infection (p˂ 0.05). Deletion mutation of rdx A gene was detected in 28.6% of H. pylori positive specimens obtained from infected patients. Conclusion: Deletion mutation of rdx A gene is a frequent determinant of rdx A inactivation conferring metronidazole resistance among H. pylori.


2019 ◽  
Vol 47 ◽  
Author(s):  
José Artur Brilhante Bezerra ◽  
Ramon Tadeu Galvão Alves Rodrgues ◽  
Isabelle De Oliveira Lima ◽  
Luanda Pâmela César De Oliveira ◽  
Carlos Eduardo Bezerra De Moura ◽  
...  

Background: Multiple cartilaginous exostosis (MCE) is a rare neoplastic disease in dogs that is characterized by the presence of osteochondromas in multiple bones. MCE is a disorder of development during growth and maturation, the real etiology of which has yet to be elucidated, but is believed to have a genetic basis. Usually affected animals have a history of a palpable mass on the bone surface, causing anatomical deformities and compression of adjacent structures. Since MCE is a rare neoplastic disease in dogs it may be difficult to recognize in the clinic. The aim of this study was to report a case of MCE in a pediatric dog.Case: A female 4-month-old Rottweiler dog with a history of bone neoformation on the left hind limb, anorexia, weight loss, and difficulty walking received clinical care. The disease had its initial onset 2 months prior. At physical examination, the animal showed paresis of the hind limbs and a bony tumor on the lateral part of the left tibia. A complete blood cell count and serum biochemical profile were obtained. The only abnormality diagnosed was hyperproteinemia due to hyperglobulinemia. Other diagnostic tests were not authorized and the animal was euthanized. At the necropsy, an intrathoracic neoformation was observed from the sixth to the eighth rib on the right antimer. Some tumors were also observed on the fourth lumbar vertebra and between the first and the second sacral vertebra, and a left tibial tumor, which had been observed at physical examination. The sagittal section of the spine revealed the presence of extradural compression of the spinal cord due to vertebral proliferations with compression of the nerve roots. All of the proliferations had macroscopic similarities, being firm, sessile, irregular, and with complete adherence to deep planes. Tumor samples were submitted to histopathological analysis and the tissue morphology was compatible with osteochondroma. Based on the clinical, necroscopical, and histopathological findings, a diagnosis of MCE was established.Discussion: In MCE, animals less than one year of age are the most frequently affected, as was observed in the case reported. Clinical signs in MCE usually result from poor bone and cartilaginous anatomical formations and from compression of adjacent tissue structures. In the described patient, the proliferations located in the vertebrae and tibia and the consequent compression of nerve roots and nerves caused the neurological deficits. Unlike in canines, the etiology of MCE in humans is already well established and it is classified as an autosomal dominant genetic disorder. The diagnosis is usually obtained through the association of clinical examination with radiographic and histopathological findings. However, in the animal studied, since it was not possible to perform radiographs, confirmation was obtained only after performing histopathological examination of the neoformations, which is considered the standard for the diagnosis of MCE. Although it corresponds to a benign neoplastic process affecting dogs during their growth stage, it may significantly decrease the animal’s quality of life. In this situation, the prognosis of MCE is considered to be reserved to bad, and animals are often referred for euthanasia, as occurred in the animal under discussion, due to the progression of neurological dysfunction. Early recognition of MCE in routine pet hospital practice is of fundamental importance in order to properly institute treatment and monitoring.


2021 ◽  
pp. jclinpath-2020-207378
Author(s):  
Arnaud Uguen

To diagnose Helicobacter pylori (HP) infection and its related mucosal injuries requires the histopathological analysis of gastric biopsies. The move from glass slides interpretation towards digital pathology implies technical choices to maintain the performances of histopathological diagnosis. The intra-rater agreement in assessing gastritis diagnostic criteria between glass slides, low resolution and high resolution digital slides in the subject of the present study. One hundred gastric biopsies were re-assessed by a single digestive pathologist on glass slides and digitalised slides at low resolution (ie, x20 magnification and single focus without z-stack) and high resolution (ie, x40 magnification with seven focus levels and z-stack) about the criteria of the updated Sydney system and the detection of HP. Inter-analyses agreement were very good (Kappa values>0.81) for every criteria but slightly inferior (ie, Kappa values<0.9) comparing glass slides interpretations with low resolution digital slides-based ones. Indeed, some HP infections were misdiagnosed using x20 magnification histochemical stained digitalised slides (p<0.05). At the opposite, anti-HP immunohistochemistry slides and/or x40 magnification digitalisation permitted to maintain almost perfect concordance in diagnosis (Kappa value>0.9). As mentioned in current guidelines, a high resolution x40 magnification digitalisation must be favoured in order to avoid some misdetection of microorganisms as HP.


Case reports ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. 28-35
Author(s):  
Juan Felipe Rivillas-Reyes ◽  
Juan Leonel Castro-Avendaño ◽  
Héctor Fabián Martínez-Muñoz

Introduction: The Zollinger-Ellison syndrome (ZES) is a pathology caused by a neuroendocrine tumor, usually located in the pancreas or the duodenum, which is characterized by elevated levels of gastrin, resulting in an excessive production of gastric acid.Case presentation: A 42-year-old female patient with a history of longstanding peptic ulcer disease, who consulted due to persistent epigastric pain, melena and signs of peritoneal irritation.  Perforated peptic ulcer was suspected, requiring emergency surgical intervention. Subsequently, a tumor lesion in the head of the pancreas was documented and managed with Whipple procedure. The pathology results reported a tumor suggestive of neuroendocrine neoplasm.Discussion: The Zollinger-Ellison syndrome occurs in 0.1 to 3 people per 1 000 000 inhabitants worldwide and is predominant in women between 20 and 50 years of age. It usually appears as a refractory acid-peptic disease or as a complication of gastric acid hypersecretion. Medical therapy is the standard management, being proton pump inhibitors (PPI) the most effective option. Surgery is recommended for sporadic ZES.Conclusions: ZES has a low incidence rate. It is rarely considered in the differential diagnosis of chronic epigastric pain and high clinical suspicion is required to achieve adequate management. This article is highly relevant as it presents a confirmed clinical case of ZES in Colombia, highlighting the importance of producing local scientific literature to improve the diagnosis and treatment of this pathology.


2021 ◽  
Vol 8 (7) ◽  
pp. 1275
Author(s):  
Tulsi Prasad

National vaccination program (NIS, IAP) provides vaccination for measles and rubella (MR vaccine) for all children below 15 years of age. After vaccination with live attenuated viruses, the virus replicates on a limited scale. Replication may lead to mild symptoms occurring 5-14 days after MR-vaccination including fever, conjunctivitis and rash but sometimes it leads to florid type of severe rashes which are indistinguishable from a wildtype measles infection. A measles like syndrome may occur following MR vaccination, although it seems to be a rare event and therefore as a pediatrician we must take out time to educate and reassurance the parents about this benign nature and so as to avoid unnecessary problems in future. A 14 year old female child was admitted in our hospital with an impressive (florid) rashes, 7 days after MR vaccination in our vaccination clinic. Diagnostic tests were negative for measles and other infections and was discharged after 7 days of nursing and supportive care. Within 14 days after MR vaccination, a child can present with symptoms very similar to a wildtype measles virus infection. The low incidence of wildtype measles infection after MR vaccination, strongly suggests that these symptoms will likely be a reaction to MR vaccination. To elaborate lots of diagnostic procedures may cause the parents a lot of stress and therefore offering nursing care, supportive care and reassurance to parents may be more appropriate and effective in such cases.


2021 ◽  
Vol 11 ◽  
Author(s):  
Jan-Malte Placke ◽  
Josefine Rawitzer ◽  
Henning Reis ◽  
Jassin Rashidi-Alavijeh ◽  
Elisabeth Livingstone ◽  
...  

BackgroundGastritis induced by checkpoint inhibitors (CPI) is a rare but severe drug-related side effect. The reference standard for confirming CPI-associated gastritis (CPI-assGastritis) is histopathological assessment; however, the histopathological features of CPI-assGastritis are not yet adequately defined.Materials and MethodsGastric biopsies of melanoma patients with histopathologically suspected CPI-assGastritis were compared with gastric biopsies of patients with inflammation free gastric mucosa (IFGM), type A, B, and C gastritis with respect to apoptosis count and predominant histopathological features. Immunohistochemical anti-caspase-3 staining was performed to identify apoptosis. Quantification was performed by manually counting the number of apoptotic events per 10 high-power fields (HPF). Clinical symptoms, treatment, and follow-up data of patients with CPI-assGastritis were examined. The nonparametric Mann–Whitney U test was used for statistical testing.ResultsFive melanoma patients (three women, two men; median age: 45 years) were treated with PD-1-based CPI. The patients reported epigastric pain, weight loss, nausea, and vomiting. Histologically, the patients with CPI-assGastritis showed a partly lymphocytic, partly granulocytic inflammatory infiltrate. Manual counting of apoptotic cells in biopsy tissue slides stained against caspase 3 revealed a median of 6 apoptotic events/10 HPF (95% CI, 2.75-17.30) in the patients with CPI-assGastritis. Results for the comparison cohort (patients n = 21) were a median of 1 apoptotic event/10 HPF (95% CI, 0.5–4.5) for type-A gastritis (six patients), a median of 2 apoptotic events/10 HPF (95% CI, 0–4.5) for type-B gastritis (five patients), and no apoptosis for IFGM and type-C gastritis (five patients). Patients with CPI-assGastritis had a significantly higher apoptosis count than patients with IFGM (p&lt;0.01), type A (p&lt;0.05), B (p&lt;0.05), and C gastritis (p&lt;0.01). None of the CPI-assGastritis biopsies showed evidence of Helicobacter pylori. All CPI-assGastritis patients responded to systemic treatment with corticosteroids.ConclusionCPI-assGastritis manifests with nonspecific symptoms but histologically shows a high number of apoptotic events, which can best be visualized by anti-caspase-3 immunohistochemistry. This histopathological feature may help to histologically differentiate CPI-assGastritis from other forms of gastritis and inform decision-making regarding its optimal management.


Author(s):  
Aishwarya Kapur ◽  
Sudha Prasad ◽  
Sangeeta Gupta

Uterine rupture is an obstetric catastrophe with significant maternal and fetal morbidity and mortality which occurs mainly in the third trimester of pregnancy or during labour, especially in previously scarred uterus. The occurrence of rupture in first and second trimester in women with unscarred uteri is quite rare. We report two cases of rupture uteri managed in our centre at 24 and 26 weeks gestation in women with unscarred uteri. First case was G3P1L1A1, 24 weeks with epigastric pain, stable vitals, epigastric tenderness, USG inconclusive, CT scan showed out pouching of amniotic sac through fundus. Laparotomy done, there was 8-9 cm fundal rupture extending between cornua, uterine repair done. Second case was G3P1L1A1 26 weeks with abdominal pain, stable vitals, corresponding fundal height, head engaged, USG revealed outpouching amniotic sac at the fundus. Laparotomy performed, there was 10 cm rent extending trans-fundal, uterine repair done. Unscarred uterine rupture, especially in early pregnancy is a rare event, posing significant difficulty in diagnosis. Uterine rupture should be first ruled out in all pregnant women presenting with acute abdomen irrespective of gestational age. Search for non-gynaecological causes can delay crucial obstetric intervention that can lead to loss of obstetric function, morbidity and mortality.


2019 ◽  
Vol 7 ◽  
pp. 232470961983457 ◽  
Author(s):  
Marian Poley ◽  
Richard Koubek ◽  
Leonard Walsh ◽  
Brian McGillen

Cryptococcal meningitis is an uncommon and severe infection that tends to affect immunocompromised hosts worldwide and in the United States. Annually it is estimated that there are 200 000 cases of cryptococcal meningitis, with the most recent estimate of 3400 cases per year in the United States alone. However, despite the low incidence, 1-year mortality is estimated at 20% to 30% even with long-term consolidation antifungal therapy. A 37-year-old man presented to the emergency department with headaches, dysarthria, hallucinations, and acute worsening of altered mental status, and he was found to have increased intracranial pressure, cerebrospinal fluid leukocytosis, and few encapsulated yeasts consistent with Cryptococcus neoformans meningitis in addition to radiologic evidence consistent with a cryptococcoma of the lungs. This report highlights the occurrence of Cryptococcus neoformans meningitis in a presumed immunocompetent host. The clinician should be aware of sources of minor immunosuppression, as they may contribute to development of Cryptococcus neoformans meningitis. Mortality in this condition remains high due to subacute presentations and delayed diagnosis in non-immunocompromised patients.


2020 ◽  
Vol 31 (4) ◽  
pp. 353-356
Author(s):  
Luiz Gabriel Gonçalves Cherain ◽  
Carollayne Mendonça Rocha ◽  
Marcos Antônio de Oliveira ◽  
Denis Batista Pereira ◽  
Michelli Bárbara Pinto ◽  
...  

Cryptococcosis commonly associated with immunosuppressed individuals is an infection caused by Cryptococcus neoformans/var. gattii. This infection has high mortality worldwide. C. neoformans inhabits the lung, later spreading to the Central Nervous System (CNS) which is the most significant site in the clinical manifestation of the disease. However, the prevalence in the CNS is low in immunocompetent individuals. Case presentation: A 42-year-old woman presented only headache, nausea, vomiting and simple partial epileptic seizure. Neuroimaging showed an expansive hypointense frontal lesion and a neurosurgical treatment was proposed, confirmed by histopathological analysis. Discussion: The exposure to C. neoformans among human populations is almost ubiquitous. The immunological status of the patient, the parasitic load and the virulence of the infectious strain are fundamental for the progression of the pathology. The balance of these factors is decisive for the prognosis. Currently, treatment is limited and consists of long term antifungal therapy. Conclusion: In this case, the necessity of differential diagnosis like brain tumors (e.g.: lymphoma and glioblastoma multiforme), resulting in poor prognosis and late treatment is seen. A neurosurgical approach should be instituted as soon as possible when pharmacological treatment is ineffective.


2012 ◽  
Vol 2 (2) ◽  
pp. 29-32
Author(s):  
Waleed S. Alghamdi

Crohn's disease is usually associated with intestinal disease when it affects the stomach. It is the most common cause of granulomatous gastritis; however, isolated gastric Crohn's disease is an uncommon finding. This is a case report of a 26-year-old woman who presented with intermittent epigastric pain for 2 years and severe weight loss during the course of her illness. Paraclinical investigations ruled out the possibility of malignancy; further investigations revealed a short segment of focal thickening in the gastric antrum. However, small and large bowels were normal on abdominal computed tomography and severe form of hemorrhagic gastritis on upper gastrointestinal endoscopy. Multiple gastric biopsies obtained from the stomach were consistent with the diagnosis of Crohn's disease. Treatment with prednisolone and azathioprine was effective in controlling the patient's symptoms; however, these recurred 3 weeks after she interrupted therapy. Treatment was resumed with the same drugs, and she was symptom-free over the18 months during which she was followed up. This case demonstrates the role of gastric biopsy as an important investigation in establishing the diagnosis of this rare presentation. It also reflects the dramatic response of gastric Crohn's disease to the treatment with prednisolone and azathioprine.


Sign in / Sign up

Export Citation Format

Share Document