The content of serotonin cells in duodenal biopsies of autistic patients

AbstractIntroductionAutistic spectrum disorders (ASD) don’t have the same etiology. Platelet hyperserotonemia remain the most common neurochemical abnormality in these patients. The main producer and storage of peripheral serotonin are enteric enterochromaffin cells – serotonin cells. Platelet hyperserotonemia may result from disorders in the synthesis and/or release of enteric serotonin. An increased number of people with ASD have gastrointestinal disorders. Some of them have a serotonergic background.AimThe aim was to assess the serotonin cells in the duodenal mucosa of patients with ASD.Material and methodsStudy group: 30 children with ASD, including 73% with duodenitis chronica. Control group (patients without ASD): 45 patients, 56% with duodenitis chronica. Immunohistochemical assessment of the number of serotonin cells was performed.’ResultsChildren with ASD and duodenitis have fewer serotonin cells than autistic children with a normal picture of the duodenum. Children with ASD and chronic duodenitis have fewer serotonin cells than patients from the control group. Patients from the control group, suffering from chronic duodenitis have an increased number of serotonin cells in relation to children without inflammatory lesions in the duodenum.ConclusionsThe serotonergic profiles of the GI tract of autistic patients and their peers without autistic symptoms are different. In the course of chronic duodenitis in patients with ASD the number of serotonin cells falls while in persons without autistic features it increases significantly. Chronic duodenitis contributes to an increase in the number of serotonin cells in persons without autistic features while decreasing it in patients with ASD

Compression Anastomosis Clips Versus a Hand-Sewn Technique for Intestinal Anastomosis in Pigs

Background. Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality. The ideal device to create anastomoses should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time. Objectives. The aim of this experimental study was to evaluate the safety and efficacy of a new compression anastomosis clip (CAC) for jejunojejunostomies and ileocolostomies by comparing CAC anastomoses with hand-sewn (HS) anastomoses in pigs in terms of healing, breaking strength and the time to create anastomoses. Material and Methods. The 11 pigs in the study underwent side-to-side CAC and HS jejunojejunostomies and ileocolostomies, for a total of 88 anastomoses. The pigs were sacrificed on postoperative day 5 (5 pigs) or 7 (6 pigs). Macroscopic, histopathological and breaking-strength examinations were performed. The time to create the anastomoses was recorded. Results. Neither group had anastomotic complications such as leakage or obstruction. Macroscopic examination showed no statistically significant differences between the groups. In the CAC group, the healing process was characterized by a lesser inflammatory reaction (p < 0.05) and very thin scar tissue at the anastomotic line (less collagen deposition and better epithelial regeneration), while the HS group had a much thicker anastomotic line. The breaking strength was significantly greater in the CAC group compared with the HS group (p < 0.05). The anastomosis time was shorter in the CAC group than in the HS group (p < 0.01). Conclusions. Anastomosis using a CAC appears to be safe and less time-consuming than HS; it was also characterized by a good healing process with little inflammatory reaction and a high breaking strength compared with HS anastomosis (Adv Clin Exp Med 2015, 24, 6, 000–000)

Usefulness of Faecal Calprotectin Measurement in Children with Various Types of Inflammatory Bowel Disease

Introduction. The aim of the study was to assess the usefulness of the FC measurement in children with various types of IBD and relation to the disease activity. Patients and Methods. 91 patients (49 boys: 53.85% and 42 girls: 46.15%, mean age: 13.38 years, range 6–18 years) were included in the analysis. Patients were divided into the groups: B1—24 children with CD, B2—16 patients with UC, and a group comprising 31 children with other types of colitis; the control group (K) comprised 20 healthy children. FC was assayed by ELISA method, using Phical test (Calpro). Results. The mean faecal calprotectin concentrations were higher in children with CD and UC as compared to healthy controls, patients with eosinophilic, lymphocytic, and nonspecific colitis. A positive correlation was observed between FC concentrations and the disease activity (the PCDAI scale, the Truelove-Witts Scale, and the endoscopic Rachmilewitz Index). Conclusion. It seems that the FC concentrations can be a useful, safe, and noninvasive test in children suspected for IBD, since FC concentration is higher in children with CD and UC than in patients with other inflammatory diseases

Analysis of adrenocortical tumours morphology as regards their structure and potential malignancy

Wstęp: Następstwem rozpoznania raka kory nadnercza (ACC, adrenocortical carcinoma) jest włączenie leczenia farmakologicznego, długotrwałe monitorowanie chorego oraz ewentualna decyzja o reoperacji. Celem pracy jest analiza morfologii pierwotnych guzów kory nadnerczy pod względem ich złośliwości na podstawie punktowej skali zaproponowanej przez Weissa. Materiał i metody: Poddano analizie 110 guzów kory nadnerczy u 107 chorych (M - 27,1%, K - 72,9%; w wieku 32-77 lat, średnia 55,2 &#177; 9,7). Zespół Conna rozpoznano u 16 chorych (14,9%), zespół Cushinga - u 12 (11,2%), a wirylizację - u 3 (2,8%). U 76 chorych (71,0%) w badaniach biochemicznych nie wykazano nadczynności hormonalnej guza. Wyniki: W rutynowym badaniu histopatologicznym u 6 chorych (5,4%) rozpoznano ACC, u 92 (83,6%) - gruczolaka kory nadnercza (ACA, adrenocortical adenoma), a u 12 (10,9%) - rozrost kory nadnercza. Atypię jądrową III lub IV stopnia stwierdzono w 8 guzach (7,3%), odsetek mitoz powyżej 5/50 HPF (high power field) - w 6 (5,4%), atypowe mitozy - w 5 (4,5%), odsetek komórek o jasnej cytoplazmie poniżej 25% - w 10 (9,1%), rozlany charakter zmiany - w 8 (7,3%), ogniska martwicy - w 16 (14,5%), naciekanie żył - w 4 (3,6%), naciekanie zatok - w 7 (6,3%), naciekanie torebki - w 5 (4,5%). W guzach ACC stwierdzono 4-9 opisywanych cech złośliwości, zaś w ACA - 0-3 cechy. W analizie statystycznej wykazano znamienną korelację między liczbą punktów w skali Weissa a największą wielkością guza w badaniach obrazowych (p < 0,05). Wnioski: Struktura i układ komórek w obrębie łagodnych guzów kory nadnerczy są heterogenne. Analiza morfologii guzów kory nadnercza w skali Weissa może stanowić podstawę do rozpoznania ich złośliwości.Introduction: A consequence of diagnosis of adrenocortical carcinoma (ACC) is introduction of pharmacological therapy, precise monitoring of the patients and in some cases re-operation. The aim of the study is to analyse morphology of adrenocortical tumours as regards their malignancy by use of criteria proposed by Weiss. Material and methods: 110 adrenocortical tumours in 107 patients were analysed (M 27.1%, F 72.9%; age 32 to 77 years, mean 55.2 &plusmn; 9.7). Conn syndrome was diagnosed in 16 patients (14.9%), Cushing syndrome in 12 (11.2%), and virilisation in 3 (2.8%). In 76 patients (71.0%) biochemical tests did not reveal hormonal hyperactivity of the tumour. Results: In routine histopatological examination ACC was diagnosed in 6 tumours (5.4%), adrenocortical adenoma (ACA) in 92 (83.6%) and adrenocortical hyperplasia in 12 (10.9%). Nuclear grade III or IV was observed in 8 tumours (7.3%), mitotic rate > 5/50 high power fields in 6 (5.4%), atypical mitoses in 5 (4.5%), clear cells constituting < 25% of the tumour in 10 (9.1%), diffuse architecture in 8 (7.3%), necrosis in 16 (14.5%), veins infiltration in 4 (3.6%), sinusoids infiltration in 7 (6.3%), and tumour capsule infiltration in 5 (4.5%). Among ACC tumours 4-9 features of malignancy were present, among ACA - 0-3 features. Statistical analysis revealed correlation between number of criteria proposed by Weiss and maximal tumour size (p < 0.05). Conclusion: The structure and cell arrangement in adrenocortical adenoma are heterogeneous. Application of criteria proposed by Weiss in histopathological examination of adrenocortical tumours can be useful in differentiating adrenocortical adenoma from carcinoma

The atypical form of granulomatous lobular mastitis – diagnostic dilemmas: a case report

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that may cause diagnostic difficulties during clinical tests and radiological examinations in terms of differentiation from contagious diseases, such as tuberculosis (TB) and fungal infections, as well as cancer. This report presents the case of a 23-year-old woman with granulomatous mastitis, along with a discussion of the diagnostic dilemmas based on a clinical test, mammography, ultrasonography and histopathological examination. IGM produces varied and non-specific manifestations on mammography and ultra­sonography. Therefore, histopathological examination is necessary to make an unambiguous diagnosis. The possibility of this condition must always be borne in mind to minimise the risk of an erroneous cancer diagnosis. There are no standard procedures in force for the treatment of IGM.Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that may cause diagnostic difficulties during clinical tests and radiological examinations in terms of differentiation from contagious diseases, such as tuberculosis (TB) and fungal infections, as well as cancer. This report presents the case of a 23-year-old woman with granulomatous mastitis, along with a discussion of the diagnostic dilemmas based on a clinical test, mammography, ultrasonography and histopathological examination. IGM produces varied and non-specific manifestations on mammography and ultrasonography. Therefore, histopathological examination is necessary to make an unambiguous diagnosis. The possibility of this condition must always be borne in mind to minimise the risk of an erroneous cancer diagnosis. There are no standard procedures in force for the treatment of IGM

Analysis of morphology of adrenal pheochromocytoma as regards their potential malignancy

Wstęp: Guzy chromochłonne nadnerczy rozpoznawane są najczęściej w trakcie diagnostyki chorych z nadciśnieniem tętniczym oraz u chorych z rakiem rdzeniastym tarczycy i podejrzeniem zespołów MEN II. Celem niniejszej pracy jest analiza morfologii guzów chromochłonnych nadnerczy w oparciu o Pheochromo-cytoma of the Adrenal Gland Scaled Score (PASS) celem określenia ich potencjalnej złośliwości. Materiał i metoda: Analizie poddano 40 guzów. Średni wiek chorych w chwili zabiegu wynosił 45,2 &plusmn;13,4 lat. Guza chromochłonnego rozpoznano przed operacją u 87,5% chorych. U 12,5% chorych kwalifikacja do adrenalektomii została podjęta na podstawie wielkości guza (wymiary od 70 do 102 mm). U 20,0% chorych rozpoznano zespoły MEN II.Wyniki: W rutynowych badaniach histopatologicznych u 39 przedstawionych pacjentów rozpoznano łagodnego guza chromochłonnego. W 1 przypadku rozpoznano jego postać złośliwą na podstawie przerzutów do węzłów chłonnych (ryc. 1.). Sumując punkty PASS &#8805;4 wystąpił w 9 z 40 guzów co stanowiło 22,5%. Spośród 35 chorych, u których od zabiegu upłynęło ponad 12 miesięcy, 2 chorych zmarło: 1 chory ze złośliwym guzem chromochłonnym zmarł 5 miesięcy po operacji i 1 chora z zespołem MEN IIA zmarła z powodu rozsiewu nowotworowego raka rdzeniastego tarczycy. U pozostałych 7 chorych u których PASS &#8805; 4 punkty w okresie od 13-90 miesięcy obserwacji nie stwierdzono wznowy lub przerzutu nowotworu. U 1 spośród chorych z PASS < 4 usunięto chirurgicznie wznowę miejscową 82 miesiące po pierwszej operacji.Wnioski: Analiza guzów chromochłonnych w skali PASS ma charakter jedynie orientacyjny i nie pozwala na jednoznaczne histologiczne rozpoznanie łagodnych i złośliwych guzów chromochłonnych. Jedynym pewnym kryterium złośliwości guza chromochłonnego pozostają przerzuty.Background: Adrenal pheochromocytoma are diagnosed the most often in patients with arterial hypertension or with thyroid medullar cancer and suspicion of MEN II syndromes. The aim of the study is to analyse the morphology of pheochromocytomas on the basis of Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) in order to estimate their potential malignancy. Material and methods: Forty tumours were subjected to analysis. Mean patients age was 45.2 &#177;13.4 years. The diagnosis of pheochromocytoma was establish before surgery in 87.5%. 12.5% of patients were referred to surgery on the basis of tumour diameter (range 70 to 102 mm). In 20.0% of patients MEN II syndromes were diagnosed. Results: In pathological examination benign pheochromo-cytoma was diagnosed in 39 presented patients. In 1 cases malignant form of pheochromocytoma was diagnosed on the basis of lymph nodes metastases. Number of points in PASS was &#8805; 4 in 9 of 40 tumours (22.5%). Among 35 patients operated on more than 12 months ago 2 patients died: 1 patient with malignant pheochromocytoma (PASS = 8 points) and 1 patient with MEN IIA syndrome (due to disseminated thyroid medullar cancer). In remaining 7 observed patients with PASS &#8805; 4 points neither recurrence nor metastases were diagnosed within the period of observation (13-90 months). In 1 out of patients with PAS

Analysis of pathogenetic factors of persistent hypertension in patients with pheochromocytoma who underwent unilateral adrenalectomy

Wstęp W przypadku nadciśnienia tętniczego wywołanego guzem chromochłonnym metodą z wyboru jest leczenie chirurgiczne. Celem niniejszej pracy jest analiza czynników uczestniczących w patogenezie utrzymujących się podwyższonych wartości ciśnienia tętniczego u chorych poddanych jednostronnej adrenalektomii z powodu guza chromochłonnego. Materiał i metody W analizowanej grupie 25 chorych średnia wartość najwyższego ciśnienia skurczowego (SBP) przed operacją wynosiła 232,6 &plusmn; 38,5 mm Hg, a rozkurczowego (DBP) 133,3 &plusmn; 22,2 mm Hg. U 40% chorych nadciśnienie tętnicze miało charakter stały, u 60% - napadowy. Średni największy wymiar guza w badaniach obrazowych wynosił 58,1 &plusmn; 19,6 mm. Czas obserwacji po adrenalektomii wynosił średnio 48,0 &plusmn; 28,4 miesiąca. Wyniki Spadek wartości najwyższego SBP po operacji był znamienny i wynosił średnio &#8211;85,9 &plusmn; 36,9 mm Hg, a DBP &#8211;44,1 &plusmn; 22,8 mm Hg. Wykazano dodatnią zależność pomiędzy obniżeniem się SBP i DBP po zabiegu i największym wymiarem guza. Przygodna wartość SBP mierzona u chorych po operacji wynosiła średnio 124,6 &plusmn; 18,3 mm Hg, a DBP 79,0 &plusmn; 9,2 mm Hg. U 56% chorych wartości przygodnego ciśnienia tętniczego wynosiły poniżej 140/90 mm Hg, co nie powodowało konieczności przyjmowania leków przeciwnadciśnieniowych. W grupie chorych wymagających farmakoterapii stwierdzono znamiennie dłuższy czas występowania nadciśnienia tętniczego przed adrenalektomią (średnio 76,3 &plusmn; 63,5 miesiąca wobec 30,5 &plusmn; 44,1 miesiąca) oraz starszy wiek w chwili operacji (średnio 46,4 &plusmn; 10,2 roku wobec 38,3 &plusmn; 9,8 roku). Wnioski Adrenalektomia u chorych z nadciśnieniem tętniczym i guzem chromochłonnym nadnercza prowadzi do trwałej poprawy najwyższych wartości SBP i DBP. Dłuższy czas trwania nadciśnienia przed operacją i starszy wiek chorych w chwili zabiegu przyczyniają się do uzyskania gorszych wyników adrenalektomii i konieczności stosowania farmakoterapii w celu utrzymania prawidłowych wartości ciśnienia tętniczego w okresie pooperacyjnym.Background Surgery is a method of choice in the treatment of patients with pheochromocytoma. The aim of the study was to analyse factors which participate in pathogenesis of persistent hypertension in patients who underwent unilateral adrenalectomy due to pheochromocytoma. Material and methods In the analysed group of 25 patients mean value of maximal systolic blood pressure (SBP) before surgery was 232.6 &plusmn; 38.5 mm Hg, and diastolic (DBP) 133.3 &plusmn; 22.2 mm Hg. In 40% of patients arterial hypertension was permanent, and in 60% &#8212; paroxysmal. Mean maximal tumour size in diagnostic imaging was 58.1 &plusmn; 19.6 mm. Mean time of observation after adrenalectomy was 48.0 &plusmn; 28.4 months. Results A significant decrease of maximal SBP and DBP after surgery was achieved (&#8211;85.9 &plusmn; 36.9 and &#8211;44.1 &plusmn; 22.8 mm Hg respectively). A positive correlation between decrease of SBP and DBP after surgery and maximal tumour size was revealed. Accidental value of SBP measured in patients after surgery was 124.6 &plusmn; 18.3 mm Hg, and DBP &#8212; 79.0 &plusmn; 9.2 mm Hg. In 56% of patients accidental blood pressure values were lower than 140/90 mm Hg without any antihipertensive drugs. In patients who required pharmacological therapy significant longer duration of arterial hypertension before adrenalectomy (mean 76.3 &plusmn; 63.5 vs. 30.5 &plusmn; 44.1 months) and older age of patients at the time of surgery (mean 46.4 &plusmn; 10.2 vs. 38.3 &plusmn; 9.8 years) were observed. Conclusions In patients with arterial hypertension due to pheochromocytoma adrenalectomy leads to a permanent improvement of maximal values of systolic and diastolic blood pressure. Longer duration of arterial hypertension before surgery and older age of patients ignificantly contribute to worse results of adrenalectomy and necessity of antihipertensive therapy in order to keep blood pressure values in the normal range

Pierwotne guzy neuroendokrynne piersi, opis czterech przypadków

Breast neuroendocrine tumours are rare, accounting for up to 5% of all breasts tumours and approximately 1% of all neuroendocrine tumours. In most cases, breast neuroendocrine tumours are histologically and moderately well differentiated. Neuroendocrine breast tumours lack characteristic imaging patterns. The histopathological assessment of these tumours is difficult, and in most cases the correct diagnosis is made after proper examination of the postsurgical specimen.Guzy neuroendokrynne piersi są rzadkimi nowotworami, stanowią do 5 % guzów piersi i około 1% wszystkich guzów neuroendokrynnych. Większość zmian jest dobrze i umiarkowanie zróżnicowana, jednak  w badaniach obrazowych trudno wskazać cechy morfologiczne, które byłyby charakterystyczne dla tej grupy nowotworów. Ocena histopatologiczna również jest trudna i najczęściej właściwe rozpoznanie stawiane jest dopiero na podstawie materiału pooperacyjnego.