An analysis of histopathological features of Crohn’s disease in surgical specimens

Background The diagnosis of Crohn’s disease is challenging. This study aimed to compare the histological features of Crohn’s disease and non-Crohn’s disease (i.e., other intestinal inflammatory diseases) in surgical specimens to identify histologic features for differential diagnosis. Methods We evaluated patients who were diagnosed with Crohn’s disease (n = 171) and non-Crohn’s disease (n = 215) between 2010 and 2015 and underwent surgical bowel resection. The frequency of histological features in surgical resection specimens were compared between these two patient groups. Results Transmural inflammation, subserosal lymphoid aggregates, fissures or sinus-like structures, granulomas or granuloma-like nodules, abnormalities of the enteric nervous system, and mucosa structure alterations (i.e., muscularis mucosae thickening or mucosal atrophy with pseudopyloric gland metaplasia) were more frequent in Crohn’s disease than non-Crohn’s disease (p < 0.001 for all). A set of 3 of the above pathological features had a specificity of 93.5% for Crohn’s disease. Some of the above histologic features were further grouped as chronic inflammatory change that includes granulomas or granuloma-like nodules, lymphoid aggregates in the muscularis propria or subserosa, fissures or sinus-like structures, and architectural abnormality (i.e., the presence of abnormal enteric nervous system and/or mucosa structure alterations). A combination of transmural inflammation, chronic inflammatory change, and architectural abnormality had a sensitivity of 92.4% and a specificity of 97.7% for Crohn’s disease. Conclusions A combination of transmural inflammation, chronic inflammatory change, and architectural abnormality in surgical bowel resection specimens is diagnostic for Crohn’s disease.

A Pharmacological Approach to the Cause of Asthma

About four years ago I began the investigation of an obscure pharmacological problem which, though interesting enough from a theoretical standpoint, offered no hope that any result of general importance might emerge from it. In the course of the work a number of new observations have been made which, taken together, suggest that adrenaline in circulation in the body has a function in relation to the sympathetic system not hitherto assigned to it. The results indicate that the efficiency of the sympathetic nerve (that is to say the size of the response elicited by a given impulse passing down a sympathetic nerve) depends upon the amount of adrenaline in circulation in the blood. The pathological application of this arises from the consideration that in some persons the amount of adrenaline in circulation may be below normal; some evidence derived from asthmatic patients is in support of this, and there is some evidence that the amount of adrenaline in the blood of different cats differs. If the amount of adrenaline in different persons does indeed vary, it follows that those persons in whom the amount of circulating adrenaline is abnormally low will possess a relatively inefficient sympathetic system; they will be predisposed to asthma. Should any chronic inflammatory change develop, leading either to a direct or to a reflex diminution of the bronchiolar air way, these patients will be unable to dilate their bronchioles and will suffer an asthmatic attack. The conception of the predisposing cause of asthma as being a deficient secretion of adrenaline which enfeebles the sympathetic nerves suggests fresh methods of treatment for the alleviation of the disease, by the addition to the diet of the precursors of adrenaline.

THE HUMAN SPLEEN AS AN HÆMATOPLASTIC ORGAN, AS EXEMPLIFIED IN A CASE OF SPLENOMEGALY WITH SCLEROSIS OF THE BONE-MARROW

1. The nodules found in the spleen are islands of active hæmatoplastic tissue. 2. The bone-marrow, at least in the case which has been described, has been the primary focus of disease; some toxin has probably produced a chronic inflammatory change. 3. The bone-marrow, owing to its enormous sclerosis, has lost its hæmopoëtic powers totally or to a marked degree and the spleen has reverted to its fœtal power to form blood.