Real-world multicentre experience of the pathological features of colonic ischaemia and their relationship to symptom duration, disease distribution and clinical outcome

AIM

To determine the pathological features of colonic ischaemia (CI) and their relationship to symptom duration, disease distribution and clinical outcome in a real-world, clinical setting.

METHOD

A retrospective, multicentre chart review was performed in patients diagnosed with CI at Montefiore Medical Center (January 2005 to July 2015), and Yale-New Haven Hospital (January 2005 to June 2010). Patients were included if clinical presentation, colonoscopic findings and colonic pathology were all consistent with CI.

RESULTS

Six hundred and sixteen patients with pathologically proven CI were included. Common pathological findings included inflammation (51.1%), ulceration (38.2%), fibrosis (26.0%) and necrosis (20.4%). Infarction and ghost cells were seen in 1.6% and 0.2% of cases, respectively. There was a significant relationship between symptom duration and hyalinization of the lamina propria (P = 0.05) and cryptitis/crypt abscesses (P = 0.01). Patients with isolated right CI (IRCI) were more likely than patients with isolated left CI (ILCI) to exhibit necrosis (P < 0.01), cryptitis/crypt abscess (P < 0.01) and inflammation (P = 0.03). Patients with poor outcomes were more likely to exhibit necrosis (P < 0.01) and capillary fibrin thrombi (P < 0.01) and less likely to exhibit fibrosis (P < 0.01) and epithelial changes (P < 0.01).

CONCLUSION

CI is accompanied by a broad spectrum of pathological findings. The traditional pathognomonic findings of CI are rare and cannot be relied upon to exclude the diagnosis. Patients with IRCI and/or poor outcomes were more likely to have pathological findings of necrosis than patients who had ILCI and/or nonpoor outcomes.

Transthoracic three-dimensional echocardiographic volumetry of distorted left ventricles using rotational scanning

The purpose of this study was to evaluate the relation of transthoracic three- and two-dimensional echocardiographic left ventricular volumetry to cineventriculographic volumetry. Twenty-five patients with distorted left ventricles were included in the study. To demonstrate the impact of acquiring data by rotational scanning, we performed three- and two-dimensional echocardiography in 36 latex ventricles with data acquisition in different areas of the ultrasound sectors. Interobserver and intraobserver variability were calculated to test for reproducibility. The three-dimensional imaging system consisted of a rotation motor device, a transthoracic 2.5 MHz transducer, a conventional ultrasound unit, and a work-station (TomTec) which provides data acquisition, post-processing, and two- or three-dimensional visualization of digitized data. The transducer moved automatically at 2-degree increments with data acquisition at each tomographic level. The mean investigation time for three-dimensional echocardiography was 21 +/- 6 minutes. In the central near field of the transducer, differences from true volumes in latex ventricles were remarkably smaller for three-dimensional compared with two-dimensional echocardiography (root mean square percent error: three-dimensional echocardiography = 5.3% versus two-dimensional echocardiography = 14.6%). In three-dimensional echocardiography, there was considerable overestimation of volumes in the lateral far field (root mean square percent error = 13.2%) of the ultrasound sector. Differences between two-dimensional echocardiographic human left ventricular volumes and cineventriculography increased with larger volumes. In three-dimensional echocardiography the differences remained constant. Interobserver and intraobserver variability is reduced nearly twofold by three-dimensional echocardiography. Three-dimensional echocardiographic volumetry provides fewer discrepancies to cineventriculography and lesser variability than two-dimensional echocardiography. With the use of rotational scanning, the ventricle has to be positioned in the central near field of the transducer.