Evaluation with doppler sonography of mesenteric blood flow in celiac disease

OBJECTIVE. The aim of this study was to investigate with Doppler sonography the variations of resistance in the superior mesenteric artery, both at fasting and in the postprandial state, in patients with celiac disease. SUBJECTS AND METHODS. Twenty-five patients with celiac disease (20 women, five men; mean age, 30 ± 7 years) and 10 healthy volunteers (seven women, three men; mean age, 28 ± 6 years) were examined with Doppler sonography. Nineteen patients were untreated (no dietary restrictions) and six patients were treated with a gluten-free diet at the time of the examination. Imaging was performed at both fasting and 15 min after an 1890- kJ meal. We introduced a parameter called 'resistive difference,' defined as the mathematic difference between the resistive index measured at fasting (highest value) and that measured at 15 min after the meal (lowest value) as a way to express the postprandial resistive change in the superior mesenteric artery. RESULTS. Untreated patients with flat mucosa showed a resistive difference of 0.03 ± 0.05, followed by untreated patients with mucosal subatrophy (0.05 ± 0.04), treated patients (0.09 ± 0.02), and healthy volunteers (0.12 ± 0.04). A statistically significant difference was noticed between the resistive difference of healthy volunteers and both those of the untreated patients with subatrophy (p = .016) and of the patients with complete atrophy (p = .011), as well as between the resistive difference of the treated patients and both those of the untreated patients with subatrophy (p = .021) and of the patients with complete atrophy (p = .020). CONCLUSION. We believe that Doppler measurement of resistive difference in the superior mesenteric artery can be an effective way to express severity of celiac disease and to document its regression after diet therapy

Celiac disease diagnosis in misdiagnosed children.

Antiendomysial antibodies (EMA) are today considered the most sensitive and specific serological marker of celiac disease (CD). The aim of the present study was to assess the occurrence of EMA of Ige isotype in EMA IgA negative children with clinical suspicion of malabsorption and their relationship with CD. Serum EMA IgG1 determination was performed on 30 EMA IgA negative children with clinical suspicion of CD. Total serum IgA levels were further investigated. Sixty children with gastroenterological diseases other than CD were used as control disease patients and 63 healthy children were evaluated as the control group. Eighteen out of 30 children in the study showed EMA IgG1 positivity in sera and a villous height/crypt depth ratio <3:1 as index of intestinal atrophy. It is noticeable that a selective IgA deficiency was present in only 9 of 18 EMA IgG1 positive children. In addition, clinical symptoms, EMA IgG1, and mucosal atrophy disappeared after 8-10 ma on a gluten-free diet. Neither EMA IgA nor EMA IgG1 were detected in the children in the control groups. The other 12 children in study group showed no histologic abnormalities and were EMA IgG1 negative. In this study, we reveal a group of EMA IgG1 CD children without IgA deficiency. The diagnosis was based on the presence of gluten-dependent typical serological and histologic features of CD. Our data suggest that EMA IgG1 determination could be a new tool in the diagnostic workup of CD, useful in avoiding possible misdiagnosis

Postmortem diagnosis of sepsis: a preliminary immunohistochemical study with an anti-procalcitonin antibody

Post mortem diagnosis of sepsis, especially in the forensic field, is a problem that presents several difficulties. The pathological findings in sepsis are often nonspecific, as they are often compatible with other different clinical pictures. The sensitivity of procalcitonin for the diagnosis of sepsis is estimated approximately in 77% while its specificity is about 79 %. Those characteristics suggested us that procalcitonin could be a possible immunohistochemical marker in the pathological diagnosis of sepsis. We selected 10 cases by the presence of clinical data that could sustain and underlie a certain diagnosis of sepsis. The positive control has been a thyroid gland without pathological alterations. The negative control has been on 5 subjects dead from non-infective causes. In all the samples we found the reaction with the anti-procalcitonin antibody to be positive in blood vessels. In every case we analyzed a definite positivity inside the cytoplasm of the myocardial cells, in brain cells (astrocytes and microglial), in the myelomonocyte line and inside the pneumocytes. In addition inside the cardiomyocytes it has also highlighted a nuclear positivity. In the liver tissue we found a clear positivity in hepatocytes, in the ductal epithelium and in the portal-biliary space. In the kidney tissue samples we found the antibody in glomeruli and in renal tubules. In conclusion we believe that immunohistochemical study with an anti - antibody procalcitonin can be a valuable aid for the postmortem diagnosis of sepsis. The small number of cases that we studied represent a limitation for our research

Forty-eight hours of biopsy culture improve the sensitivity of the in vitro gliadin challenge in the diagnosis of celiac disease

[No abstract available