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Meyer J, Schrenzel J, Balaphas A, Delaune V, Abbas M, Morel P, Puppa G, Rubbia-Brandt L, Bichard P, Frossard JL, Toso C, Buchs N, Ris F. Mapping of aetiologies and clinical presentation of acute colitis: Results from a prospective cohort study in a tertiary centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Our objective was to describe the aetiologies of acute colitis and to identify patients who require diagnostic endoscopy.
Methods
Patients with symptoms of gastrointestinal infection and colonic inflammation on computed tomography were prospectively included. Those immunosuppressed, with history of colorectal cancer or inflammatory bowel disease (IBD) were excluded. Stools were screened with BD-Max and BioFire FilmArray GI panel. Faecal calprotectin was determined. Patients with negative BD-Max underwent colonoscopy. The study was registered into clinicaltrials.gov (NCT02709213).
Results
One hundred and seventy-nine patients were included. BD-Max was positive in 93 patients (52%) and FilmArray in 108 patients (60.3%). Patients with infectious colitis (n = 103, 57.5%) were positive for Campylobacter spp (n = 57, 55.3%), Escherichia coli spp (n = 8, 7.8%), Clostridium difficile (n = 23, 22.3%), Salmonella spp (n = 9, 8.7%), viruses (n = 7, 6.8%), Shigella spp (n = 6, 5.8%), Entamoeba histolytica (n = 2, 1.9%) and others (n = 4, 3.9%). Eighty-six patients underwent colonoscopy, which was compatible with ischemic colitis in 18 patients (10.1%) and IBD in 4 patients (2.2%). Among patients with negative FilmArray, a faecal calprotectin >625μg/g allowed identifying patients with IBD with an area under ROC curve of 85.1%. Introduction of a diagnostic management algorithm including FilmArray and faecal calprotectin could allow decreasing unnecessary colonoscopies from 82 to 29 (corresponding to a decrease of 64.6%).
Conclusion
Computed tomography-proven colitis was mostly of infectious aetiology. Diagnostic management of patients with acute colitis should include broad molecular testing of the stools and, in patients with a calprotectin concentration >625μg/g, colonoscopy to exclude IBD.
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Affiliation(s)
- J Meyer
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - J Schrenzel
- Infectious diseases, Geneva University Hospital, Geneva, Switzerland
| | - A Balaphas
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - V Delaune
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - M Abbas
- Infectious diseases, Geneva University Hospital, Geneva, Switzerland
| | - P Morel
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - G Puppa
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - L Rubbia-Brandt
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - P Bichard
- Department of Gastroenterology, Geneva University Hospital, Geneva, Switzerland
| | - J -L Frossard
- Department of Gastroenterology, Geneva University Hospital, Geneva, Switzerland
| | - C Toso
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - N Buchs
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - F Ris
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
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Allali D, Puppa G, Chizzolini C. Mesenteric inflammatory veno-occlusive disease of the spleen metasynchronous with two arterial thrombotic events in systemic lupus erythematosus. Lupus 2017; 27:150-153. [PMID: 28355983 DOI: 10.1177/0961203317700980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vasculitides, particularly those affecting small vessels, are known to complicate systemic lupus erythematosus (SLE); however, isolated venulitis of the mesenteric bed has rarely been reported. Here we relate the case of a 46-year-old woman with SLE who presented with acute abdominal pain due to artery thrombosis and extended splenic ischemia requiring splenectomy. The histological examination revealed diffuse venulitis in the absence of arterial vasculitis consistent with the definition of mesenteric inflammatory veno-occlusive disease (MIVOD). Furthermore, arterial wall thickening suggestive of uncomplicated atherosclerosis was observed. Two months later, the patient suffered of severe myocardial infarction (MI) resulting from thrombosis of the anterior interventricular coronary artery with otherwise no signs of coronary disease at coronarography. Extensive work-up to establish the cause of MI was negative, with the exception of marginal, isolated and transient elevation of cardiolipin IgG (14.5 GPL, n.v. 0-5 GPL). This patient's SLE history is dramatically marked by the previously non-described association of MIVOD and two arterial thrombotic events (splenic and coronary) occurring within a two months period, and stresses the need of better understanding and prevention of vascular complications in SLE.
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Affiliation(s)
- D Allali
- 1 Immunology and Allergy, Department of Internal Medicine Specialties, University Hospital and School of Medicine, Geneva, Switzerland
| | - G Puppa
- 2 Department of Pathology, University Hospital and School of Medicine, Geneva, Switzerland
| | - C Chizzolini
- 1 Immunology and Allergy, Department of Internal Medicine Specialties, University Hospital and School of Medicine, Geneva, Switzerland
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Koessler T, Bichard P, Puppa G, Lepilliez V, Roth A, Cacheux W. [Early oesophageal cancer: epidemiology diagnosis and management]. Rev Med Suisse 2015; 11:1130-1135. [PMID: 26152088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Europe, oesophageal cancers are diagnosed at an early stage in less than 10% of the cases. They are superficial tumours whose invasion is limited to the mucosae and the submucosa. Synchronous node invasion is the most important prognosis factor. Oesophagectomy is the benchmark treatment. Nowadays, endoscopic resection is a validated curative therapeutic alternative. Accurate endoscopic evaluation using chemical or virtual colouring as well as an echoendoscopy, followed by an expert pathological review, must be conducted beforehand. It can be realised for good prognosis tumours after evaluation of the synchronous node invasion or its risk. After completion, regular endoscopic follow-ups are compulsory to detect local relapse.
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Abstract
Colorectal cancer is one of the most commonly diagnosed human malignancies and is a major cause of death worldwide. A high-quality macroscopic examination and histopathology report enables correct tumour staging, affects patient prognosis, and provides indications for further therapy. Although venous invasion is a stage-independent indicator of poor prognosis that identifies high-risk patients for visceral metastases, it is not a stage-influencing factor. Accordingly the use of special stains to facilitate the detection of venous invasion is not universally recommended and therefore not widely used in routine histopathological analysis. In this report based on a case presentation, the different approaches and techniques for detecting venous invasion are presented and discussed.
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Affiliation(s)
- G Puppa
- Division of Pathology, G Fracastoro City Hospital, Verona, Italy.
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Puppa G, Colombari R, Pelosi G, Ueno H. Pericolonic tumour deposits in colorectal cancer patients: the challenge is on-going. Histopathology 2008; 52:767-8; author reply 768-9. [PMID: 18393974 DOI: 10.1111/j.1365-2559.2008.03011.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Puppa G, Maisonneuve P, Sonzogni A, Masullo M, Chiappa A, Valerio M, Zampino MG, Franceschetti I, Capelli P, Chilosi M, Menestrina F, Viale G, Pelosi G. Independent prognostic value of fascin immunoreactivity in stage III-IV colonic adenocarcinoma. Br J Cancer 2007; 96:1118-26. [PMID: 17375048 PMCID: PMC2360113 DOI: 10.1038/sj.bjc.6603690] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Fascin, an actin-bundling protein involved in cell motility, has been shown to be upregulated in several types of carcinomas. In this study, we investigated the expression of fascin in 228 advanced colonic adenocarcinoma patients with a long follow-up. Fascin expression was compared with several clinicopathologic parameters and survival. Overall, fascin immunoreactivity was detected in 162 (71%) tumours with a prevalence for right-sided tumours (P<0.001). Fascin correlated significantly with sex, tumour grade and stage, mucinous differentiation, number of metastatic lymph nodes, extranodal tumour extension, and the occurrence of distant metastases. Patients with fascin-expressing tumours experienced a shorter disease-free and overall survival in comparison with those with negative tumours, and fascin immunoreactivity emerged as an independent prognostic factor in the multivariate analysis. Moreover, patients with the same tumour stages could be stratified in different risk categories for relapse and progression according to fascin expression. Our findings suggest that fascin is a useful prognostic marker for colonic adenocarcinomas.
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Affiliation(s)
- G Puppa
- Division of Pathology, CRO-National Cancer Institute, Aviano, Italy
| | - P Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
| | - A Sonzogni
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
| | - M Masullo
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
| | - A Chiappa
- Division of General Surgery, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
| | - M Valerio
- Division of General Surgery, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
| | - M G Zampino
- Division of Medical Oncology, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
| | - I Franceschetti
- Institute of Pathology, University of Verona, Istituti Biologici, Strada Le Grazie 8-3714, Verona 37134, Italy
| | - P Capelli
- Institute of Pathology, University of Verona, Istituti Biologici, Strada Le Grazie 8-3714, Verona 37134, Italy
| | - M Chilosi
- Institute of Pathology, University of Verona, Istituti Biologici, Strada Le Grazie 8-3714, Verona 37134, Italy
| | - F Menestrina
- Institute of Pathology, University of Verona, Istituti Biologici, Strada Le Grazie 8-3714, Verona 37134, Italy
| | - G Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
- University of Milan School of Medicine, Milan, Italy
| | - G Pelosi
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via G. Ripamonti, Milano 435 I-20141, Italy
- University of Milan School of Medicine, Milan, Italy
- Divisione di Anatomia Patologica e Medicina di Laboratorio, Istituto Europeo di Oncologia, Via G. Ripamonti, 435, I-20141 Milano, Italy. E-mail:
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