Antineutrophil Cytoplasmic Antibodies Testing in a Large Cohort of Unselected Greek Patients

Objective. To retrospectively evaluate ANCA testing in a cohort of unselected Greek in- and outpatients. Methods. In 10803 consecutive serum samples, ANCA were tested by indirect immunofluorescence (IIF) and ELISA. ELISA in inpatients was performed only on IIF positive sera. Results. Low prevalence (6.0%) of IIF positive samples was observed. Among these samples, 63.5% presented perinuclear (p-ANCA), 9.3% cytoplasmic (c-ANCA) and 27.2% atypical (x-ANCA) pattern. 16.1% of p-ANCA were antimyeloperoxidase (anti-MPO) positive, whereas 68.3% of c-ANCA were antiproteinase-3 (anti-PR3) positive. Only 17 IIF negative outpatients' samples were ELISA positive. ANCA-associated vasculitides (AAV), connective tissue disorders and gastrointestinal disorders represented 20.5%, 23.9%, and 21.2% of positive results, respectively. AAV patients exhibited higher rates of MPO/PR3 specificity compared to non-AAV (93.8% versus 8%). Conclusions. This first paper on Greek patients supports that screening for ANCA by IIF and confirming positive results by ELISA minimize laboratory charges without sacrificing diagnostic accuracy

Wound dehiscence: is still a problem in the 21th century: a retrospective study

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate the risk factors of wound dehiscence and determine which of them can be reverted.</p> <p>Methods</p> <p>We retrospectively analyzed 3500 laparotomies. Age over 75 years, diagnosis of cancer, chronic obstructive pulmonary disease, malnutrition, sepsis, obesity, anemia, diabetes, use of steroids, tobacco use and previous administration of chemotherapy or radiotherapy were identified as risk factors</p> <p>Results</p> <p>Fifteen of these patients developed wound dehiscence. Emergency laparotomy was performed in 9 of these patients. Patients who had more than 7 risk factors died.</p> <p>Conclusion</p> <p>It is important for the surgeon to know that wound healing demands oxygen consumption, normoglycemia and absence of toxic or septic factors, which reduces collagen synthesis and oxidative killing mechanisms of neutrophils. Also the type of abdominal closure may plays an important role. The tension free closure is recommended and a continuous closure is preferable. Preoperative assessment so as to identify and remove, if possible, these risk factors is essential, in order to minimize the incidence of wound dehiscence, which has a high death rate.</p

Antineutrophic cytoplasmic antibodies (ANCA) testing in routine daily medical practice: correlation with clinical entities and establishment of an algorithm on ANCA detection

Objective: To retrospectively evaluate ANCA testing in a cohort of unselected Greek in and outpatients. Methods: In 10803 consecutive sera samples, ANCA were tested by indirect immunofluorescence (IIF) and ELISA. ELISA in inpatients was performed only on IIF positive sera. Results: Low prevalence (6.0%) of IIF positive samples was observed. Among these samples, 63.5% presented perinuclear (p-ANCA), 9.3% cytoplasmic (c-ANCA) and 27.2% atypical (x-ANCA) pattern. 16.1% of p-ANCA were anti-myeloperoxidase (anti-MPO) positive, whereas 68.3% of c-ANCA were anti-proteinase-3 (anti-PR3) positive. Only 17 IIF negative outpatients’ samples were ELISA positive. ANCA associated vasculitides (AAV), connective tissue disorders and gastrointestinal disorders represented 20.5%, 23.9%, and 21.2% of positive results, respectively. AAV patients exhibited higher rates of MPO/PR3 specificity compared to non-AAV (93.8% versus 8%). Conclusions: This first report on Greek patients supports that screening for ANCA by IIF and confirming positive results by ELISA minimizes laboratory charges without sacrificing diagnostic accuracyΕισαγωγή Τα ANCA (antineutrophil cytoplasmic antibodies) είναι αυτοαντισώματα που στρέφονται κυρίως έναντι των αζουρόφιλων κοκκίων των ουδετεροφίλων και των μονοκυττάρων. Η παρουσία τους έχει συσχετισθεί με μικροσκοπική πολυαγγειΐτιδα (MPA), κοκκιωμάτωση Wegener (WG), σύνδρομο Churg Strauss (CSS), αλλά και με άλλες κλινικές οντότητες. Σκοπός Ο προσδιορισμός της συχνότητας των ANCA σε εσωτερικούς και εξωτερικούς ασθενείς, η συσχέτιση της παρουσίας και ειδικότητας των ANCA με αγγειίτιδα και άλλα νοσήματα και η καθιέρωση αλγορίθμου αναζήτησής τους Ασθενείς και μέθοδοι Σε 10803 διαδοχικά δείγματα ορού που προσκομίσθηκαν στο Τμήμα Ανοσολογίας-Ιστοσυμβατότητας αναζητήθηκαν τα ANCA α) με μέθοδο έμμεσου αοσοφθορισμού (IIF )όπου έγινε διάκριση του τύπου φθορισμού σε περιπυρηνικό (p), κυτταροπλασματικό (c) ή άτυπο (x) β) με ELISA για αντισώματα έναντι μυελοΰπεροξειδάσης (MPO) και πρωτεΐνάσης 3 (PR3). Η ELISA στα δείγματα των εσωτερικών ασθενών εφαρμόσθηκε μόνο επί θετικού αποτελέσματος IIF. Αποτελέσματα Η επίπτωση των IIF θετικών δειγμάτων ήταν μικρή (6%). Από αυτά το 63.5% παρουσίασαν περιπυρηνικό, 9.3% κυτταροπλασματικό και 27.2% άτυπο τύπο φθορισμού. Στο 16.1% των p-ANCA βρέθηκαν αντι-MPO, ενώ στο 68.3% των c-ANCA αντι-PR3 θετικά αντισώματα. Μόλις 17 IIF αρνητικά δείγματα βρέθηκαν θετικά στην ELISA. Οι ANCA-συσχετιζόμενες αγγειίτιδες,(AAV) τα νοσήματα του συνδετικού ιστού και οι παθήσεις του γαστρεντερικού αντιπροσώπευαν το 20.5%, 23.9% και 21.2% των ANCA θετικών αποτελεσμάτων, αντίστοιχα. Οι AAV ασθενείς εμφάνισαν πολύ υψηλά ποσοστά ειδικότητας σε MPO/PR3 σε σχέση με τους ασθενείς χωρίς AAV (93.8% έναντι 8% αντίστοιχα). Συμπεράσματα Η επίπτωση των ANCA ήταν χαμηλή στον πληθυσμό των ασθενών που εξετάσθηκε. Η παρουσία c-ANCA/PR3 και p-ANCA/MPO συσχετίζεται ισχυρά με WG και ΜPΑ/CSS, αντίστοιχα. Η εμφάνιση p ή x ANCA, χωρίς ειδικότητα MPO/PR3, σε άλλα νοσήματα, εγείρει την ανάγκη προσδιορισμού και άλλων αντιγονικών ειδικοτήτων των ANCA, στα πλαίσια της διαγνωστικής προσέγγισης των νοσημάτων αυτών. Τέλος, στη διαγνωστική προσέγγιση των MPA, WG, CSS η αναζήτηση των ANCA με IIF και η επιβεβαίωση των θετικών αποτελεσμάτων με την ELISA μειώνει το χρόνο και το κόστος χωρίς να επηρεάζει σημαντικά τη διαγνωστική ακρίβεια της εξέτασης

The prevalence and relevance of adrenal masses in patients with sporadic gastroenteropancreatic neuroendocrine tumours (GEP-NET)

Objective The widespread application of abdominal computerized tomography (CT) imaging has revealed that 0 center dot 984 center dot 0% of individuals harbour adrenal lesions (incidentalomas). There is, however, paucity of information regarding the prevalence of adrenal lesions in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETS). Purpose of this study was to estimate the prevalence of adrenal lesions in patients with GEP-NETS and identify their radiological features and clinical significance. Design The prevalence of adrenal lesions was estimated retrospectively in 438 patients with GEP-NETS who underwent abdominal imaging. Secretory status and changes in size were documented during subsequent follow-up. MEN-1 patients and ectopic ACTH-secreting tumours were excluded. Results Adrenal lesions were detected in 32 (8 center dot 4%) of 383 patients included. The majority (22 patients 69%) were located at the left adrenal gland and the mean size was 23 center dot 6mm. In two patients, one with a well and another with a poorly differentiated tumour, clinicopathological features suggested adrenal metastases. During a mean follow-up period of 69 center dot 5months, no subsequent growth of any adrenal lesion was observed. Endocrine evaluation documented subclinical glucocorticoid hypersecretion in 4 cases (14%). The presence of adrenal lesions did not correlate to distant metastases, however, they were observed more frequently in patients with G3 tumours. Conclusion The prevalence of adrenal lesions in patients with GEP-NETs was found to be higher than the general population and mostly represent benign adrenal adenomas (except patients with G3 tumours). Nevertheless, individualized assessment of imaging characteristics should be still considered

Comparative Evaluation of Three Commercial Identification Systems Using Common and Rare Bloodstream Yeast Isolates▿

The commercial yeast identification systems API ID32C, Auxacolor, and Vitek were evaluated using 251 molecularly identified bloodstream isolates and 2 reference strains, representing a total of 35 species (6 common and 29 rare). Correct identification rates were higher for common species (Auxacolor, 95%; API ID32C, 94%; Vitek, 92%) than for rare species (Auxacolor, 43%; API ID32C, 56%; Vitek, 64%). All systems performed equally among the former, and Vitek performed best among the latter