PCR identification of Helicobacter pylori in faeces from gastritis patients.
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DNA, Bacterial↗
Biomedical subjects
D A Lynch
Publications and source records attributed to D A Lynch.
Inflammatory airways disease in ulcerative colitis: CT and high-resolution CT features.
Inflammatory airways disease is an uncommon but recognized complication of ulcerative colitis (UC). The present study was undertaken to determine the computed tomographic (CT) and high-resolution CT appearances of this entity. A retrospective review was performed of the radiographs and CT scans of seven patients (ages 24 to 54 years) with UC who presented with cough and recurrent respiratory infections. Four patients had total colectomies, and one had sigmoid colectomy. Fiberoptic bronchoscopy in six subjects showed diffuse mucosal erythema and edema that was most severe in the proximal airways. Sinus radiographs revealed maxillary sinus mucosal thickening in four patients and ethmoid sinus involvement in two. Chest radiographs showed bronchiectasis in two patients and bronchial wall thickening in three; radiographs were normal in two patients. CT features included bronchiectasis in six patients, peripheral airways involvement in four, and airway stenosis in three.
Adult↗
Effect of eradication of Helicobacter pylori on gastric juice ascorbic acid concentrations.
Ascorbic acid, the reduced form of vitamin C, may protect against gastric cancer and is secreted by the normal stomach. Secretion is impaired in Helicobacter pylori (H pylori) associated chronic gastritis. This study examined if eradication of H pylori improves gastric juice ascorbate values. Fasting gastric juice and plasma samples were collected at endoscopy from patients participating in trials of H pylori eradication for duodenal ulcer disease and intestinal metaplasia before and up to 15 months after attempted eradication. Ascorbic acid and total vitamin C concentrations were determined by high performance liquid chromatography. In 12 patients in whom H pylori was successfully eradicated gastric juice ascorbate and total vitamin C concentrations and the ratio of juice to plasma vitamin C rose after treatment. Analysis after treatment suggested that the rise was greatest in patients with high final plasma vitamin C concentrations, even though these did not change with treatment. By contrast, in 22 patients in whom H pylori eradication was unsuccessful there were no significant changes in juice or plasma concentrations after treatment. It is concluded that successful eradication of H pylori improves secretion of vitamin C into gastric juice. It is speculated that this increases protection against gastric cancer.
Aged↗
Failure of colonoscopic surveillance in ulcerative colitis.
A prospective surveillance programme for patients with longstanding (> = 8 years), extensive (> = splenic flexure) ulcerative colitis was undertaken between 1978 and 1990. It comprised annual colonoscopy with pancolonic biopsy. One hundred and sixty patients were entered into the programme and had 739 colonoscopies (4.6 colonoscopies per patient; 709 patient years follow up). Eight eight per cent of examinations reached the right colon. There was no procedure related death. One Dukes's A cancer was detected. Forty one patients (25%) defaulted. Of these 25 remain well; 13 are unaccounted for, and one died from colonic cancer. One patient had colectomy for medical reasons, and another died of carcinoma of the pancreas. Retrospectively an additional 16 eligible patients were identified who had not been recruited. Of these, 14 remain well, two are unaccounted for. None developed colonic cancer. Four patients refused colonoscopy. All remain well. Over the same period seven other cases of colonic cancer were found in association with ulcerative colitis, two in patients who had erroneously been diagnosed as having only proctitis and were therefore not entered into the programme, but were found at operation to have total colitis, one in a patient with colitis of seven years duration, and four patients who had previously attended the clinic but had been lost to follow up before 1978 and then had represented with new symptoms during the surveillance period. Thus, of the nine colitis related cancers diagnosed in this centre during the study period only one was detected by the surveillance programme. The results of this large study, a a review of published works, cast doubts on the effectiveness of colonoscopic surveillance programmes in detecting colorectal cancer in patients with ulcerative colitis.
Adult↗
Identification of Helicobacter pylori DNA in the mouths and stomachs of patients with gastritis using PCR.
AIMS: To determine the prevalence of Helicobacter pylori colonisation in the mouths of patients with H pylori gastritis. METHODS: A nested polymerase chain reaction test for the 16S ribosomal RNA gene of H pylori was used on saliva, dental plaque, gastric juice and gastric biopsy specimens from patients attending a dyspepsia clinic. RESULTS: Thirteen patients had histologically confirmed Helicobacter associated gastritis. Twelve of these had positive gastric aspirates by PCR. Five had at least one positive oral specimen. Eight patients with normal gastric biopsy specimens had no PCR positive oral specimens or gastric aspirates. All, however, had PCR positive gastric biopsy specimens. In an attempt to determine the origin of these positive results in normal patients, it was shown that biopsy forceps could contaminate specimens with DNA from previous patients. CONCLUSION: The demonstration of the organism in the mouths of a substantial proportion of dyspeptic patients has major implications for the spread of H pylori and identifies a potential source for reinfection following eradication of the organism from the stomach.
Base Sequence↗
Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects.
A study was undertaken to define the computed tomographic (CT) appearance of the lungs in subjects with uncomplicated asthma and to compare the prevalence of bronchial dilatation at CT in asthmatic and healthy subjects. Clinical features, pulmonary physiologic findings, chest radiographs, and high-resolution CT scans of 48 asthmatic subjects were reviewed. Forty-one (85%) of the 48 asthmatic subjects were undergoing bronchodilator therapy, 28 (58%) were undergoing steroid therapy, and 21 (44%) were cigarette smokers. Twenty-seven healthy control subjects underwent limited high-resolution CT. At selected CT levels, any bronchus with an internal diameter greater than that of the accompanying pulmonary artery was considered dilated. In the asthmatic subjects, 153 (36%) of 429 bronchi evaluated met criteria for bronchial dilatation compared with 37 (26%) of 142 bronchi in the control group (P < .05). Because bronchial dilatation demonstrated at CT did not correlate with clinical data, the authors conclude a bronchus larger in diameter than the adjacent vessel is not sufficient evidence to diagnose cylindric bronchiectasis.
Adult↗
Correlation between high resolution computed tomography and tissue morphometry of the lung in bleomycin-induced pulmonary fibrosis in the rabbit.
It is generally considered that the hazy increased density and consolidation seen on high resolution lung CT (HRCT) scans in patients with diffuse interstitial lung disease reflect tissue inflammation, whereas a predominance of linear structures corresponds to tissue fibrosis. The purpose of this study was to determine whether abnormalities observed by HRCT in the lungs of bleomycin-treated rabbits correlated with specific pathologic abnormalities seen on morphometric analysis of lung tissue. Bleomycin was instilled into the lungs of intubated rabbits and followed by inhalation of 100% oxygen. In different animals on Days 14, 28, or 56 after bleomycin, 1 or 1.5 mm HRCT scans were obtained at 8-mm intervals. Subsequently, the right lungs were processed for histology, and the left lungs were processed for determination of hydroxyproline content. Using a morphometric technique, the volume density of normal lung parenchyma, hazy increased density, consolidation, nodules, and central or peripheral lines was determined on each HRCT scan. After the rabbits were killed, the volume density of normal lung parenchyma, intra-alveolar cells, intra-alveolar amorphous material, and thickened interstitium (cellular or acellular) was also determined morphometrically in multiple lung tissue sections in each rabbit. There was a correlation between the volume densities of consolidation on HRCT scans and intra-alveolar cells and amorphous material on tissue morphometry (r = 0.90, p = 0.0001) over the 56-day period after bleomycin/oxygen administration. There was no correlation between the volume density of hazy increased lung density (HRCT) and the volume density of these same or any other individual or combined parameters (tissue morphometry) over the 56 days.(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗
Pulmonary capillaritis. The association with progressive irreversible airflow limitation and hyperinflation.
We report two patients with systemic necrotizing vasculitis (microscopic polyarteritis) and associated recurrent pulmonary capillaritis, in whom progressive irreversible airway dysfunction began approximately 10 yr after disease onset. Their course was characterized by repeated episodes of diffuse alveolar hemorrhage, glomerulonephritis, palpable purpura, and splinter hemorrhages. The lung revealed intraalveolar hemorrhage, neutrophilic infiltration and cellular fragmentation, fibrinoid necrosis of the alveolar interstitium, and parenchymal hemosiderin deposits. No medium-sized vessel involvement, granulomatous inflammation, or bronchiolar obliteration were seen. Renal biopsies revealed focal segmental necrotizing glomerulonephritis, and a cutaneous biopsy in one case showed a leukocytoclastic vasculitis. Immunofluorescent studies of lung and kidney showed minimal or no immunoreactivity. The clinical course and serologic tests did not support another systemic vasculitis, connective tissue disease, or antiglomerular basement membrane antibody disease. The acute episodes responded to antiinflammatory and immunosuppressive therapy. Symptoms, serial pulmonary function tests, and chest imaging documented the development of a progressive irreversible obstructive airway disease. No other predisposing factors were identified. These cases demonstrate the unexpected appearance of an irreversible obstructive airway disease with lung parenchymal hyperinflation after systemic necrotizing vasculitis associated with recurrent pulmonary capillaritis and diffuse alveolar hemorrhage.
Adult↗
Gaucher's disease. An unusual cause of intrathoracic extramedullary hematopoiesis.
A thoracic paravertebral mass in an asymptomatic woman with type 1 Gaucher's disease proved to be due to extramedullary hematopoiesis. This is, to our knowledge, the first case of intrathoracic extramedullary hematopoiesis reported with Gaucher's disease.
Aged↗
Imaging of small airways diseases.
The idiopathic (BOOP) and secondary forms of proliferative bronchiolitis have similar radiographic appearances. Both are characterized radiographically by patchy airspace disease, which often is peripheral. The radiographic presentation of BOOP may have prognostic significance. In primary or secondary constrictive bronchiolitis, the chest radiograph often is nonspecific, but the CT appearance of patchy, lobular areas of hyperlucency, with or without bronchiectasis, may be diagnostic. Respiratory bronchiolitis usually can be distinguished from IPF on the chest radiograph, and the diagnosis may be suggested on HRCT by the presence of hazy increase in lung density or fine centrilobular nodules.
Arthritis, Rheumatoid↗
Evaluation of four commercial automatic endoscope washing machines.
Four commercially available endoscope washing machines (Pyser System 83, Wolf Fiberscope Disinfector, Olympus EW20, Keymed Auto-Disinfector) were evaluated. In most cases the machines were expensive, immobile and noisy, and could only wash one endoscope per cycle. Daily use involved repetitive chores and contact with glutaraldehyde. Disinfection procedures were flawed; no machine auto-disinfected adequately. In conclusion, these machines are unsatisfactory and represent a potential source of serious infection.
Disinfection↗
Imaging of pulmonary histiocytosis X.
Pulmonary histiocytosis X is an uncommon but important cause of pulmonary fibrosis and honeycombing in young adults. This article reviews the pathologic, clinical, radiographic, and high-resolution computed tomographic (HRCT) features of pulmonary histiocytosis X, focusing on differential diagnosis and disease progression. The main pathologic feature of pulmonary histiocytosis X is peribronchiolar inflammation, leading to fibrosis and cyst formation. Although the diagnosis of pulmonary histiocytosis X may be suspected on the basis of chest radiographic findings, the HRCT findings of predominantly upper lobe nodules and cysts are virtually pathognomonic of this disorder. As pulmonary histiocytosis X progresses, the nodules decrease in number, leaving multiple thin-walled cysts. HRCT can be useful in visually estimating the proportion of lung involved and is also valuable in distinguishing histiocytosis from other disorders that produce nodules or cysts. Chest HRCT helps confirm the pattern seen at radiography and is valuable in establishing the correct diagnosis.
Diagnosis, Differential↗
Thymoma with hypogammaglobulinemia (Good's syndrome): an unusual cause of bronchiectasis.
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Agammaglobulinemia↗
Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study.
OBJECTIVE: Hypersensitivity pneumonitis refers to a group of pulmonary disorders caused by inhalation of organic or inorganic particulates by sensitized persons. The diagnosis relies on a constellation of findings: exposure to an offending antigen, characteristic signs and symptoms, abnormal chest findings on physical examination, and abnormalities on pulmonary function tests and radiographic evaluation. In population-based studies, the sensitivity of chest radiography for detection of this disease is relatively low. The aim of this study was to determine the sensitivity of high-resolution CT (HRCT) for detection of hypersensitivity pneumonitis diagnosed in a population of swimming-pool employees. SUBJECTS AND METHODS: Thirty-one symptomatic employees of a recreation center who were referred because of possible hypersensitivity pneumonitis were examined by using chest radiography, HRCT, and fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Hypersensitivity pneumonitis was diagnosed in subjects who had two or more work-related signs or symptoms, abnormal results on transbronchial biopsies, and abnormal lymphocytosis as shown by examination of bronchoalveolar lavage fluid. The chest radiographs and HRCT scans were interpreted by consensus by two observers who were unaware of the clinical diagnosis. RESULTS: Only one of 11 subjects with a diagnosis of hypersensitivity pneumonitis had abnormal findings on a chest radiograph. Five had abnormal HRCT findings. The abnormality in each case consisted of small, poorly defined centrilobular nodules with variable profusion. No subject without the disease had abnormal HRCT findings. Those who had granulomas shown by lung biopsy were more likely to have abnormal HRCT findings than were those who had more subtle histologic abnormalities. CONCLUSION: The sensitivity of HRCT for the detection of hypersensitivity pneumonitis in a population-based study is greater than that of chest radiography. The finding of poorly defined centrilobular nodules on HRCT scans should prompt consideration of this disease.
Adolescent↗
A pattern-oriented approach to chest radiographs in atypical pneumonia syndromes.
The differential diagnosis of the atypical pneumonia syndrome is facilitated by recognition of the chest radiographic pattern. Both infectious and noninfectious entities should be considered: clinical criteria may be used to exclude unlikely diseases and to construct an ordered list of possible causes.
Adult↗
Pediatric pulmonary disease: assessment with high-resolution ultrafast CT.
High-resolution computed tomography (HRCT) is widely used to assess pulmonary parenchymal disease in adults. The authors used ultrafast CT with 3-mm collimation and a 100-msec scan time to obtain HRCT scans in 36 children (mean age, 49.4 months). Clinical diagnoses included normal lungs (n = 6), cystic fibrosis (n = 12), obliterative bronchiolitis (n = 6), idiopathic pulmonary hemosiderosis (n = 2), and other lung diseases (n = 10). The HRCT scans and chest radiographs were reviewed separately in blinded fashion. Pulmonary parenchymal abnormalities were categorized into interstitial, airspace, and airway processes. Nine patients with normal chest radiographs had abnormal HRCT scans. In five other patients, the extent of abnormal lung parenchyma was considerably greater on HRCT scans than on chest radiographs. HRCT scans allowed accurate characterization of the type of lung process in 24 of 30 patients when compared with clinical or biopsy findings. Early HRCT findings in cystic fibrosis included lobular air trapping, bronchial wall thickening, and centrilobular nodules. The use of cine CT with high-resolution techniques is feasible in children too young or too sick to hold their breath. HRCT may enable early detection and characterization of pulmonary disease and depiction of the extent of lung abnormality.
Bronchiolitis Obliterans↗
Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases.
High resolution CT (HRCT) can image the fine structures of the lung parenchyma and the pleura. Analysis of supine and prone HRCT scans in 300 patients with asbestos exposure shows that asbestosis is characterized the following findings; (1) parenchymal bands, (2) increased interlobular septa, (3) increased intralobular core structures, (4) subpleural lines, and (5) dependent opacity. Pleural disease is well displayed on HRCT scans. Correlated studies with whole lung sections confirm the HRCT findings. Masses in asbestosis may be benign or malignant, and CT helps in their differentiation. HRCT correlates well with radiographic and clinical criteria for asbestosis and is more sensitive than either in detecting abnormalities.
Asbestosis↗
Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans.
In 260 asbestos-exposed individuals evaluated by means of computed tomography (CT), 43 unsuspected pulmonary masses were found in 27 individuals. The masses included fissural pleural plaques (n = 10), dense fibrotic bands (n = 3), round atelectasis (n = 11), carcinomas (n = 3), and other presumed benign masses (n = 16). The most helpful features in the diagnosis of rounded atelectasis with CT were (a) contiguity to areas of diffuse pleural thickening, (b) a lentiform or wedge-shaped outline, (c) evidence of volume loss in the adjacent lung, and (d) a characteristic "comet tail" of vessels and bronchi sweeping into the margins of the mass. Less advanced areas of focal atelectasis had fewer classic features. Intrafissural pleural plaques were readily identified with high-resolution CT. In asbestos-related masses, the demonstration of stability over time is necessary. Careful interpretation of CT and high-resolution CT features and close surveillance can obviate the need for biopsy in the majority of instances.
Asbestos↗