RESUMEN
OBJECTIVES: Juvenile polyps involving the stomach are uncommon. Massive gastric juvenile polyposis is even rarer. METHODS: We describe the clinicopathologic features of nine cases of massive gastric juvenile polyposis. RESULTS: All patients had anemia; four had hypoalbuminemia. The polyps were composed predominantly of dilated crypts lined by columnar epithelium and abundant edematous stroma with mixed inflammatory infiltrates. One patient had a poorly differentiated adenocarcinoma, arising in juvenile polyp-associated intraepithelial neoplasia. A second patient had a well-differentiated intramucosal adenocarcinoma arising in a juvenile polyp with high-grade dysplasia. Three of our cases had polyposis restricted to the stomach. Six (66.6%) had loss of SMAD4 immunoreactivity, making them subject to severe bleeding and hypoproteinemia, as well as developing severe dysplasia or adenocarcinoma. CONCLUSIONS: SMAD4 immunohistochemstry is a helpful ancillary diagnostic test in cases of suspected juvenile polyposis syndrome involving the stomach.
Asunto(s)
Adenocarcinoma/patología , Pólipos Adenomatosos/patología , Poliposis Intestinal/congénito , Síndromes Neoplásicos Hereditarios/patología , Proteína Smad4/metabolismo , Neoplasias Gástricas/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Pólipos Adenomatosos/diagnóstico , Pólipos Adenomatosos/genética , Adulto , Análisis Mutacional de ADN , Epitelio/metabolismo , Epitelio/patología , Femenino , Mucosa Gástrica/metabolismo , Humanos , Inmunohistoquímica , Poliposis Intestinal/diagnóstico , Poliposis Intestinal/genética , Poliposis Intestinal/patología , Masculino , Persona de Mediana Edad , Mutación , Síndromes Neoplásicos Hereditarios/diagnóstico , Síndromes Neoplásicos Hereditarios/genética , Estudios Retrospectivos , Proteína Smad4/genética , Estómago/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/genética , Adulto JovenRESUMEN
Gastric hyperplastic polyps in organ transplant recipients have been recently described; however, the clinical significance of hyperplastic polyps in this setting remains unclear. The aim of this study is to further characterize the clinical presentation and histopathology of gastric hyperplastic polyps in organ transplant recipients as compared to hyperplastic polyps in non-transplant individuals. All gastric hyperplastic polyps diagnosed in our institute from 1999 to 2005 were retrieved. Clinical data including endoscopic findings were reviewed. Twenty cases without history of transplantation were randomly selected for a control population. Hematoxylin and eosin and Genta stains were reviewed. 104 cases of gastric hyperplastic polyps were identified. Sixteen (15%) had a history of solid organ (one liver/kidney, four livers, one lung, one kidney, one kidney/pancreas, three hearts) or bone marrow transplantation (five). The average time after transplantation was 28 months. Signs/symptoms leading to endoscopy were more frequently nausea/vomiting in transplant patients as compared to bleeding/hematemesis/anemia in non-transplant patients. The transplant patients tended to be younger with a reversed M:F ratio, but age was the only demographic factor that was statistically significant. There was no difference in polyp size, location and number. Histologically, no difference was observed in the frequency of active inflammation, Helicobacter pylori infection or intestinal metaplasia. Dysplasia was not present in any of the cases. None of the patients had a history of polyposis syndrome. In conclusion, a significant percentage of gastric hyperplastic polyps (15%) were from organ transplant patients, further suggesting a strong association of gastric hyperplastic polyps with transplantation. The younger age in the transplant group may be explained by the nature of the cohort qualified for transplantation. While no statistically significant differences in histopathologic features were found between transplant and non-transplant groups, analysis was limited by small case numbers. Overall, gastric hyperplastic polyps in the post transplant setting is a common, but under-recognized entity and merits further clinicopathologic analysis.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Trasplante de Órganos/efectos adversos , Pólipos/patología , Gastropatías/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía Gastrointestinal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos/etiología , Complicaciones Posoperatorias , Gastropatías/etiologíaRESUMEN
OBJECTIVE: To determine whether heart rate variability metrics provide an accurate method of monitoring depth of anesthesia, assessing the response to painful stimuli, and assessing neuroautonomic regulation of cardiac activity in children receiving propofol anesthesia for short-duration procedures. DESIGN: Prospective, case series. SETTING: Sixteen-bed pediatric intensive care unit, oncology unit, and endoscopy suite in a tertiary care children's hospital and ophthalmology examination rooms in an associated eye institute. PATIENTS: Thirty-three pediatric patients undergoing propofol anesthesia for short procedures. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Heart rate variability metrics studied included mean, SD, low- and high-frequency power, detrended fluctuation analysis (represented by correlation coefficient, alpha), and approximate entropy. Compared with the initial anesthetized state, we found increased heart rate SD (3.17 +/- 1.31 vs. 7.05 +/- 0.26 bpm, p <.0001), heart rate low-frequency power (3.69 +/- 0.36 vs. 4.48 +/- 0.41 bpm(2)/Hz, p <.0001), heart rate low-/high-frequency ratio (1.47 +/- 0.26 vs. 1.26 +/- 0.24, p =.001), and heart rate alpha (1.12 +/- 0.24 vs. 1.35 +/- 0.21, p <.0001) during painful procedure. Mean heart rate (105.8 +/- 13.4 vs. 101.5 +/- 12.4 bpm, p =.005) and heart rate approximate entropy decreased with painful procedure (0.75 +/- 0.19 vs. 0.53 + 0.16, p <.001), whereas there was no significant change in heart rate high-frequency power (3.04 +/- 0.63 vs. 3.16 +/- 0.71 bpm(2)/Hz, p =.26). CONCLUSIONS: We conclude that power spectral analysis of heart rate variability may be an accurate and clinically useful measure of depth of propofol anesthesia. We speculate that high-frequency heart rate power during propofol anesthesia correlates with depth of anesthesia, whereas low-frequency power allows for assessment of the patient's sympathetic response to pain.