Background/AimsTechniques for endoscopic evaluation of gastrointestinal subepithelial lesions include conventional endoscopy, jumbo biopsy, endoscopic ultrasonogrphy (EUS), EUS-guided fine needle aspiration, and endoscopic submucosal resection. However, these procedures have many limitations, such as low diagnostic yields and high complication rates. We therefore evaluated the diagnostic yield for tissue sampling of incidental subepithelial lesions using the bite-on-bite technique.MethodsOne hundred and forty subepithelial lesions were found in 129 patients during conventional diagnostic esophagogastroduodenoscopy by one examiner from October 2003 to November 2004. Bite-on-bite biopsies with conventional-sized forceps were taken from 36 patients having 37 lesions that did not appear to be hypervascular or to have a thick overlying epithelium. Two to eight bites were performed to obtain submucosal tissue for one lesion.ResultsThe bite-on-bite technique was diagnostic in 14 of the 37 lesions (38%). Blood oozing for more than 30 seconds occurred in five cases, but was easily controlled by epinephrine injection (2 cases) or hemoclip (3 cases). The diagnostic yield tended to be higher in the esophagus than in the stomach and duodenum (54% vs. 28%, p=0.109).ConclusionsThe bite-on-bite technique for subepithelial lesions is an effective and safe method in selected cases. This technique may be useful for incidental subepithelial lesions, especially those of the esophagus, except for ones with a high risk of bleeding or thick overlying epithelium.
Euryhaline teleosts possess excellent adaptability to a wide range of environmental salinities. Although intestinal water absorption is important for seawater (SW) adaptation, little is known about the molecular mechanisms of the water-transporting pathway in the intestine. We have cloned three homologs of the mammalian aquaporins (AQPs) 3, 8 and 10 from the intestine of the SW-acclimated Japanese eel. The deduced amino-acid sequences shared 47-98% homology with other known respective AQP isoforms. Topology prediction of the identified sequences showed six membrane-spanning domains, intracellular N-and C-terminal tails, and two NPA (asparagine-proline-alanine) motifs in the second and fifth connecting loops, all of which are highly conserved among known AQPs. Reverse transcription PCR analysis revealed that AQP3 was expressed in various tissues, whereas the expression of AQP 8 and 10 mRNAs was detected predominantly in the intestine. The expression levels of AQPs 1, 3, 8 and 10 in the anterior and posterior intestines and the rectum were determined by real-time quantitative PCR and compared for FW (freshwater)-and SW-acclimated eels. AQP1 expression levels in the posterior intestine and rectum were significantly higher in the SW-acclimated eel than in the FW-acclimated fish. AQP3 expression in the SW-acclimated eel was only higher in the rectum than that in the FW-acclimated eel. Expression levels of AQPs 8 and 10 in the intestinal segments tended to be higher in the SW-acclimated eel than in the FWacclimated eel. These results showed that intestinal AQP expression is closely related to SW adaptation, suggesting the presence of a water-absorbing mechanism associated with multiple AQP isoforms in the intestinal tract.
An epidemic of trichodinosis associated with severe epidermal hyperplasia occurred in adult largemouth bass (Micropterus salmoides) from the Chowan River drainage, North Carolina (USA) in late winter to early spring 2002. Initial reports by anglers of fish with a "jelly-like slime coat" on the skin prompted an electrofishing survey in which about 10% of sampled largemouth bass had a very thick, bluish-white "mucoid layer" on the body and fins. Moderate to heavy infestations of the ciliate Trichodina were detected in wet mounts of skin from five of five fish having the mucoid layer; these fish also had significant gill infestations. An additional two fish with only mild reddening and four asymptomatic fish (no skin lesions) had mild skin infestations but no gill infestations. Two asymptomatic fish had no skin parasites. Four fish with the mucoid layer were necropsied and had extremely severe epidermal hyperplasia on the body and fins. The hyperplasic epidermis had relatively few mucus cells and typically was about 5-10 times thicker than healthy epidermis. The upper four fifths of the epidermis consisted of finely vacuolated, highly flattened, somewhat disorganized epithelial cells. No other significant clinical or histopathologic abnormalities were detected. No systemic infection by pathogenic bacteria was noted. The environmental cause of the epidemic is uncertain but the lesions suggest that some chronic stressor was involved.
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