We tested the hypothesis that liver histology from patients with graft-versus-host disease could be distinguished from other common liver diseases. Liver biopsies from 33 allogeneic marrow transplant recipients with acute and chronic graft-versus-host disease and 37 nontransplant liver disease patients without graft-versus-host disease were recut, restained and coded for blind review. Analysis of individual histologic features showed significantly more cytologic aberration of bile duct epithelium and more cholestasis among biopsies with graft-versus-host disease when compared to biopsies without graft-versus-host disease (p less than or equal to 0.05). The duration of graft-versus-host preceding the biopsy influenced the histologic features. Biopsies before Day 35 showed frequent acidophilic bodies but infrequent bile duct changes. Biopsies from Days 35 to 90 posttransplant had more frequent bile duct exocytosis and disruption, and biopsies from patients with chronic graft-versus-host disease (beyond Day 90) showed more frequent portal fibrosis and bile duct dropout. Pattern assessment of coded biopsies showed that a histologic diagnosis of graft-versus-host disease had a positive predictive value of 86%, a sensitivity of 66% and a specificity of 91%. False-negative diagnoses occurred most frequently in biopsies obtained less than 4 weeks posttransplant, usually because bile duct abnormalities were not present. False-positive diagnoses of graft-versus-host disease occurred in nongraft-versus-host disease biopsies with periportal inflammation and proliferated bile ducts. However, biopsies of chronic graft-versus-host disease had more frequent dropout and disruption of bile duct epithelium than did biopsies of acute or chronic hepatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗

PubMedDate not supplied

The role of endoscopic injection sclerotherapy in the management of bleeding peristomal varices.

Peristomal varices usually occur in patients with enterostomies who develop portal hypertension, and represent a cause of recurrent or intractable gastrointestinal bleeding. Treatment options for such bleeding include surgical ligation of varices, stoma revision with devascularization, injection sclerotherapy, portacaval shunt, or liver transplantation. We reviewed the records of seven patients with peristomal varices, who were followed for a mean of 17 months after diagnosis. Fourteen episodes of clinically significant peristomal bleeding occurred in six patients. Surgical ligation of varices was ineffective in controlling bleeding in two of three patients, although stoma revision with devascularization was temporarily effective in two other patients. Injection sclerotherapy, used in three patients, effectively controlled acute bleeding without serious complications or need for surgery. Definitive treatment for peristomal bleeding (portacaval shunt or liver transplantation) has prevented any further bleeding in three patients for a mean of 8 months after surgery.

Endoscopy↗

PubMedDate not supplied

Utilization of cholecystectomy-a prospective outcome analysis in 1325 patients.

The advent of laparoscopic techniques has resulted in an increased incidence of cholecystectomy, creating a need to reevaluate utilization. The new outcomes research movement emphasizes patient-derived data as well as traditional clinical outcomes. One of the purposes of this prospective study was to seek possible correlations between a variety of variables, both patient- and physician-derived, to the patient's degree of overall satisfaction with the outcome. From July 1992 to May 1997, five different data collection forms were prospectively implemented-three physician-derived (preoperative, intraoperative, and postoperative) and two patient-derived sets of data. In the postoperative patient instrument, patients were asked to rate their degree of satisfaction with the outcome of their surgery on a scale of 1 to 5, with 5 being "extremely satisfied" and 1 being "not at all satisfied." We then sought differences between those patients rating their satisfaction as 5 vs. those rating their satisfaction as 1 to 3. Age, sex, and the presence of comorbid conditions did not correlate with eventual satisfaction. The following were correlated with a statistically significant better degree of satisfaction: the preoperative presence of known gallstones or a preoperative physician-derived history of typical biliary pain. No preoperative patient-derived data were associated with satisfaction; however, the postoperative presence of abdominal pain predicted dissatisfaction. Not surprisingly, continued problems with abdominal pain strongly correlated with dissatisfaction, but this finding supports the accuracy of our assessment instrument. Furthermore, the more typical and clear-cut the clinical presentation, the greater the patient satisfaction with the outcome of cholecystectomy. Satisfaction and pain relief are strongly associated. In patients with pain preoperatively, measurement of either pain relief or satisfaction may be adequate to assess correct utilization of this operative procedure.

Abdominal Pain↗