Gastric granulomas and Helicobacter pylori: An incidental relationship.

Aims: Studies investigating the relationship between granulomatous gastritis (GG) and Helicobacter pylori infection have been largely inconclusive. This study was designed to determine whether the analysis of a very large number of patients would provide clearer answers evaluate the association between H. pylori infection and gastric granulomas.

Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study).

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard.

Inverse association of esophageal eosinophilia and Barrett esophagus.

Background: The high frequency of gastroesophageal reflux symptoms reported in patients with eosinophilic esophagitis has suggested that the two disorders may be associated; however, few studies have systematically addressed this issue.

Goals: To determine the frequency of the simultaneous occurrence of esophageal eosinophilia and Barrett esophagus and define the clinical characteristics of patients with both conditions.

Study: From a national pathology database of patients who had esophagogastroduodenoscopy with mucosal biopsies we extracted patients with a diagnosis of Barrett mucosa, eosinophilic esophagitis pattern of injury [(≥15 eosinophils/high-power field (HPF)], or both.

Array-based comparative genomic hybridization identifies CDK4 and FOXM1 alterations as independent predictors of survival in malignant peripheral nerve sheath tumor.

Purpose: Malignant peripheral nerve sheath tumors (MPNST) are highly aggressive sarcomas with variable patient survival and few known prognostically relevant genomic biomarkers. To identify survival-associated genomic biomarkers, we performed high-resolution array-based comparative genomic hybridization (aCGH) on a large set of MPNSTs.

Experimental Design: Candidate gene alterations identified by aCGH in 38 MPNSTs were validated at the DNA, RNA, and protein levels on these same tumors and an independent set of 87 MPNST specimens.

Adherence to biopsy guidelines for Barrett's esophagus surveillance in the community setting in the United States.

Background & Aims: Current surveillance guidelines for Barrett's esophagus (BE) recommend extensive biopsies to minimize sampling error. Biopsy practice patterns for BE surveillance in the community have not been well-described. We used a national community-based pathology database to analyze adherence to guidelines and to determine whether adherence was associated with dysplasia detection.

A case of herpes esophagitis after fluticasone propionate for eosinophilic esophagitis.

Background: A 19-year-old white woman presented with a 6-month history of progressively worsening dysphagia.

Investigations: Esophagogastroduodenoscopy, esophageal biopsies followed by histological evaluation of biopsy samples including immunohistochemical staining for herpes simplex virus.

Diagnosis: Herpes esophagitis with concurrent eosinophilic esophagitis.

Laparoscopic choledochojejunostomy via PTFE-covered stent successfully achieves internal drainage of common bile duct obstruction.

The purpose of this study was to develop a method of laparoscopic biliary bypass utilizing a PTFE-covered biliary stent. An animal model of common bile duct obstruction was developed. Three days before the planned choledochojejunostomy, the common duct in 10 female pigs was ligated using mini-laparoscopy instrumentation (2 mm) to create an obstruction model.

Time course of nicotinamide adenine dinucleotide diaphorase staining after renal radiofrequency ablation influences viability assessment.

Background And Purpose: Nicotinamide adenine dinucleotide (NADH) diaphorase staining has been used to confirm cell viability or death after radiofrequency ablation (RFA) of renal tissue. The time course over which NADH staining status converts from viable to non-viable after a lethal insult has not been defined for renal RFA, but the change may not be immediate. Our objective was to assess porcine renal tissue for viability using NADH diaphorase staining at various times after RFA.

Large-volume laparoscopic partial nephrectomy using the potassium-titanyl-phosphate (KTP) laser in a survival porcine model.

Objectives: Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure primarily because of difficulties with hemostasis. In an attempt to develop a hemostatic cutting instrument for laparoscopic partial nephrectomy, we evaluated the potassium-titanyl-phosphate (KTP) laser for use during large-volume laparoscopic partial nephrectomy in a porcine model.

Methods: Transperitoneal lower pole laparoscopic partial nephrectomy was performed in six pigs.

Expression and function of somatostatin receptors in peripheral nerve sheath tumors.

Although somatostatin receptors have been detected in many normal and neoplastic tissues, little is known of their expression and function in peripheral nerve tumors. In the present study, we examined the expression of all 5 somatostatin receptor subtypes (sst1-5) in 3 normal peripheral nerves, 3 traumatic neuromas, 27 schwannomas, 18 neurofibromas, and 177 malignant peripheral nerve sheath tumors (MPNSTs) by immunohistochemistry as well as by Western blot and reverse transcriptase-polymerase chain reaction investigations in 2 normal peripheral nerves, one neurofibroma, 5 schwannomas, and 5 MPNSTs. Immunoreactive somatostatin receptors were not detectable in normal peripheral nerve and in nonneoplastic Schwann cell proliferations.

T-cell prolymphocytic leukemia presenting as an ear canal mass.

Objective: We discuss the first reported case of a chronic leukemia involving the external auditory canal.

Study Design: Case report and review of the literature (Medline, 1962-2003).

Methods And Results: An adult man in good health came to receive medical attention because of a sensation of aural fullness.

Prevalence of malignancy within cytologically indeterminate thyroid nodules.

Background: The optimal management of cytologically indeterminate thyroid nodules is controversial given the variable malignancy rates reported in this patient population. We examined the prevalence of malignancy within cytologically indeterminate follicular thyroid lesions in an attempt to predict malignancy based on cytologic features.

Methods: Cytopathology reports obtained after fine-needle aspiration biopsy (FNAB) examination of indeterminate follicular thyroid lesions were examined over a 4-year period.

Acute histologic effects of temperature-based radiofrequency ablation on renal tumor pathologic interpretation.

Objectives: To describe the histopathologic changes and evaluate the interpretability of human renal tumor specimens obtained after temperature-based radiofrequency ablation (RFA).

Methods: RFA of 119 solid kidney tumors was performed percutaneously under computed tomography guidance, laparoscopically or during open surgery, using a temperature-based system. Of the 119 tumors, 70 were biopsied (two or more samples) after RFA, 39 immediately before ablation, and 10 were not biopsied.

Innate immunity genes influence the severity of acute appendicitis.

Objective: Using acute appendicitis as a model, we tested the hypothesis that polymorphisms in genes involved in host defense can be associated with the severity of local infection-inflammation in humans.

Summary Background Data: Innate immunity is the body's front-line system for antimicrobial host defense. Local inflammation is a major innate immune mechanism for containing and destroying microbes, but it may also contribute to tissue injury.

Ureteral replacement using small-intestinal submucosa and a collagen inhibitor in a porcine model.

Purpose: Small-intestinal submucosa (SIS) has been successful as an onlay graft in ureteral repair, but tubularized segment interposition of SIS has been unsuccessful. Our objective was to evaluate whether a type I collagen inhibitor, halofuginone, would prevent stricture formation in tubularized SIS interposition.

Materials And Methods: We performed either laparoscopic partial ureteral excision followed by an SIS onlay graft (N = 5) or complete laparoscopic ureteral excision followed by an SIS interposition graft (N = 7) in domestic pigs.

Laparoscopic partial nephrectomy using holmium laser in a porcine model.

Objective: To evaluate the utility of the holmium laser for partial nephrectomy in a porcine model.

Methods: Transperitoneal lower pole laparoscopic partial nephrectomy was performed in 5 farm pigs. All animals underwent a left-sided laparoscopic partial nephrectomy and were kept alive for 2 weeks (survival group).

Interpretive disparity among pathologists in breast sentinel lymph node evaluation.

Background: Immunohistochemical staining on breast sentinel lymph nodes (SLN) is controversial.

Methods: Twenty-five SLN cases were reviewed by 10 pathologists (three academic, seven private) including 5 negative by both hematoxylin and eosin (H&E) and immunohistochemistry, 11 micrometastases (<2 mm) negative by H&E but positive by immunohistochemistry, and 8 micrometastases and 1 macrometastasis (>2 mm) positive for both H&E and immunohistochemistry. Answers included "positive," "negative," and "indeterminate" for each slide.

Infection by gram-negative organisms via the biliary route results in greater mortality than portal venous infection.

Cholangitis requires bile duct obstruction and infection. Patients with cholangitis are often more affected than those with infections that reach the liver through the portal vein. We will attempt to study the influences of (i) route of entry and (ii) presence of bile duct obstruction on hepatic infection.

Infrared thermography and thermocouple mapping of radiofrequency renal ablation to assess treatment adequacy and ablation margins.

Objectives: The primary disadvantage of renal tumor RF ablation is the inability to monitor the intraoperative propagation of the RF lesion with real-time imaging. We sought to assess whether adequately lethal temperatures are obtained at the margins of the intended ablation zone using laparoscopic thermography to monitor radiofrequency (RF) lesions in real time, thermocouple measurements, and histopathologic evaluation.

Methods: Renal RF lesions were created under direct laparoscopic vision in the upper (1 cm diameter) and lower (2 cm) poles of the right kidney in 5 female pigs.

Regional and systemic cytokine responses to acute inflammation of the vermiform appendix.

Objective: To measure local (peritoneal fluid) and systemic (plasma) cytokine profiles in patients with infection-inflammation of the vermiform appendix, a relatively mild, localized inflammatory process.

Summary Background Data: The systemic host response to invading microorganisms, often termed the systemic inflammatory response syndrome (SIRS), includes changes in heart rate, respiratory rate, body temperature, and circulating white blood cell numbers. Although these changes can be induced experimentally by administering proinflammatory cytokines, the mediators that appear in the bloodstream during early, localized infection in humans have not been defined.

Laparoscopic partial nephrectomy with a diode laser: porcine results.

Purpose: To develop a safe and effective technique for laparoscopic partial nephrectomy without need for hilar occlusion.

Materials And Methods: Laparoscopic transperitoneal lower-pole partial nephrectomy was performed in five 45- to 50-kg female farm pigs using a 980-nm diode laser. Standard transperitoneal access was obtained, and a four-port approach was used to perform a laparoscopic right partial nephrectomy using a diode laser (23 W) without hilar occlusion.

Laparoscopic interstitial laser coagulation of renal tissue with and without hilar occlusion in the porcine model.

Purpose: To evaluate the safety and efficacy of interstitial laser coagulation (ILC), applied via a laparoscopic approach, with and without hilar occlusion in the porcine model.

Materials And Methods: In nine female farm pigs, bilateral renal mobilization was performed via a transperitoneal laparoscopic approach. Using a 600- micro m bare-tip silicon diode laser fiber inserted 0.

Ureteral replacement using porcine small intestine submucosa in a porcine model.

Objectives: To investigate an alternative technique using an onlay patch of porcine small intestine submucosa (SIS) allograft to bridge a ureteral defect. For ureteral strictures that fail endourologic management, few options are available for minimally invasive repair or reconstruction. Although laparoscopic interposition of a tubularized allograft of porcine SIS has great promise, animal studies have yielded mixed results.

Radiofrequency coagulation of renal parenchyma: comparison of effects of energy generators on treatment efficacy.

Purpose: We compared experimental renal lesions created with temperature-based or impedance-based radiofrequency (RF) generators using normal renal parenchyma in an animal model with protocols recommended by the manufacturer.

Materials And Methods: Bilateral renal mobilization was completed in seven farm pigs in preparation for RF ablation, and the tines of each RF probe were expanded to a 2-cm diameter. Pigs were sacrificed immediately (N = 3) or at 24 hours (N = 4) after treatment.