The Experts below are selected from a list of 21 Experts worldwide ranked by ideXlab platform
Frederick Ogunji - One of the best experts on this subject based on the ideXlab platform.
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A New Method of Quantitative Fecal Fat Microscopy and Its Correlation With Chemically Measured Fecal Fat Output
American journal of clinical pathology, 2000Co-Authors: Kenneth D. Fine, Frederick OgunjiAbstract:Fecal fat microscopy using the Sudan Stain has suffered from a relative lack of specificity, and results are “qualitative.” Therefore, we developed a quantitative fecal fat microscopic method with hopes of improving diagnostic accuracy. One hundred eighty patients with chronic diarrhea collected stools for 1 to 3 days, and fecal fat output was measured by a standard chemical method, and microscopy was performed by the old qualitative and new quantitative methods. There was a highly statistically significant linear correlation between quantitative fecal fat microscopy and chemically measured fecal fat output. The quantitative microscopic method had a sensitivity of 94% and a specificity of 95%; the traditional method had a sensitivity and specificity of 76% and 99%, respectively. Fecal fat Sudan microscopy performed by a dedicated approach to counting and size measurement of fat globules can yield a quantitative result that correlates well with chemically measured fecal fat output and has a high diagnostic accuracy. Patients with chronic diarrhea should be evaluated for nutrient malabsorption because if present, diagnostic pursuits and disease possibilities are very different from those when malabsorption is absent. For more than 50 years, the “gold standard” for detection of malabsorptive states has been a 72-hour quantitative stool collection measured for its fatty acid content by the titration method of van de Kamer et al. 1 With this test, fecal excretion of greater than 7 g/d of fat is considered abnormal, 1-4 although in the setting of diarrhea, as much as 14 g/d may be excreted by healthy persons. 4 Although quantitating fecal weight and fat can provide vital information for the approach to patients with chronic diarrhea, performing this test is difficult logistically for centers unaccustomed to the procedure and usually abhorred by patients and laboratory technicians. Moreover, for patients with chronic diarrhea, the test is complicated further by bowel movement frequencies that may reach 20 or more per day and/or fecal volumes as high as 2 or 3 L per day, both of which decrease the likelihood that patients will collect all of the fecal effluent they pass. 5,6 This is problematic because daily fecal fat output is a calculated value derived from the measured fat concentration and average daily fecal weight; consequently, its accuracy depends on the completeness of the collection, and missed fecal specimens lead to underestimation of the true amount of fecal fat excretion. For these reasons, physicians evaluating chronic diarrhea often avoid tests for steatorrhea altogether, blindly pursuing possible causes of malabsorption, or resort to the more simple screening method of fecal fat microscopy. Like van de Kamer’s original method of fecal fat quantitation, the method of fecal fat microscopy by Drummey et al 7
Kenneth D. Fine - One of the best experts on this subject based on the ideXlab platform.
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A New Method of Quantitative Fecal Fat Microscopy and Its Correlation With Chemically Measured Fecal Fat Output
American journal of clinical pathology, 2000Co-Authors: Kenneth D. Fine, Frederick OgunjiAbstract:Fecal fat microscopy using the Sudan Stain has suffered from a relative lack of specificity, and results are “qualitative.” Therefore, we developed a quantitative fecal fat microscopic method with hopes of improving diagnostic accuracy. One hundred eighty patients with chronic diarrhea collected stools for 1 to 3 days, and fecal fat output was measured by a standard chemical method, and microscopy was performed by the old qualitative and new quantitative methods. There was a highly statistically significant linear correlation between quantitative fecal fat microscopy and chemically measured fecal fat output. The quantitative microscopic method had a sensitivity of 94% and a specificity of 95%; the traditional method had a sensitivity and specificity of 76% and 99%, respectively. Fecal fat Sudan microscopy performed by a dedicated approach to counting and size measurement of fat globules can yield a quantitative result that correlates well with chemically measured fecal fat output and has a high diagnostic accuracy. Patients with chronic diarrhea should be evaluated for nutrient malabsorption because if present, diagnostic pursuits and disease possibilities are very different from those when malabsorption is absent. For more than 50 years, the “gold standard” for detection of malabsorptive states has been a 72-hour quantitative stool collection measured for its fatty acid content by the titration method of van de Kamer et al. 1 With this test, fecal excretion of greater than 7 g/d of fat is considered abnormal, 1-4 although in the setting of diarrhea, as much as 14 g/d may be excreted by healthy persons. 4 Although quantitating fecal weight and fat can provide vital information for the approach to patients with chronic diarrhea, performing this test is difficult logistically for centers unaccustomed to the procedure and usually abhorred by patients and laboratory technicians. Moreover, for patients with chronic diarrhea, the test is complicated further by bowel movement frequencies that may reach 20 or more per day and/or fecal volumes as high as 2 or 3 L per day, both of which decrease the likelihood that patients will collect all of the fecal effluent they pass. 5,6 This is problematic because daily fecal fat output is a calculated value derived from the measured fat concentration and average daily fecal weight; consequently, its accuracy depends on the completeness of the collection, and missed fecal specimens lead to underestimation of the true amount of fecal fat excretion. For these reasons, physicians evaluating chronic diarrhea often avoid tests for steatorrhea altogether, blindly pursuing possible causes of malabsorption, or resort to the more simple screening method of fecal fat microscopy. Like van de Kamer’s original method of fecal fat quantitation, the method of fecal fat microscopy by Drummey et al 7
Esther J Israel - One of the best experts on this subject based on the ideXlab platform.
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hypoproteinemia anemia and failure to thrive in an infant
Gastroenterology, 1991Co-Authors: Julie E Bines, Esther J IsraelAbstract:An w alanine aminotransferase (ALT), 48 U/L (normal range, lo-55 U/L); 5’nucleotidase, 12 U/L (normal range < 11 U/L); and alkaline phosphatase (ALP), 696 U/L (normal range, 34-270 U/L). The total bilirubin level was 72 kmol/L (4.2 mg/dL) with a direct bilirubin level of 34 kmol/L (2.0 g/dL). Total proteins were 39 g/L (3.9 g/dL) (normal range, 60-80 g/L) with an albumin fraction of 16 g/L (1.6 g/dL) (normal range, 31-50 g/L). Prothrombin (PT) and partial thromboplastin times (PTT) were both normal. Chest radiographs showed mild hyperinflation and peribronchial thickening. Percutaneous oxygen saturation was 95% on room air, and an electrocardiogram showed no abnormality. Urine and blood culture test results were negative. An abdominal ultrasound examination showed normal liver parenchyma with no evidence of intrahepatic or extrahepatic obstruction. Serological studies showed rubella and herpes immunoglobulin G (IgG) present in low titer and undetectable cytomegalovirus and toxoplasma antibodies. Hepatitis B surface antibody was positive, although surface antigen was not detected. Hepatitis C serology was negative. Serum cY-antitrypsin level and urinanalysis and urine organic acids showed no abnormality. Sudan Stain of the stool showed abundant neutral and split fats.
Julie E Bines - One of the best experts on this subject based on the ideXlab platform.
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hypoproteinemia anemia and failure to thrive in an infant
Gastroenterology, 1991Co-Authors: Julie E Bines, Esther J IsraelAbstract:An w alanine aminotransferase (ALT), 48 U/L (normal range, lo-55 U/L); 5’nucleotidase, 12 U/L (normal range < 11 U/L); and alkaline phosphatase (ALP), 696 U/L (normal range, 34-270 U/L). The total bilirubin level was 72 kmol/L (4.2 mg/dL) with a direct bilirubin level of 34 kmol/L (2.0 g/dL). Total proteins were 39 g/L (3.9 g/dL) (normal range, 60-80 g/L) with an albumin fraction of 16 g/L (1.6 g/dL) (normal range, 31-50 g/L). Prothrombin (PT) and partial thromboplastin times (PTT) were both normal. Chest radiographs showed mild hyperinflation and peribronchial thickening. Percutaneous oxygen saturation was 95% on room air, and an electrocardiogram showed no abnormality. Urine and blood culture test results were negative. An abdominal ultrasound examination showed normal liver parenchyma with no evidence of intrahepatic or extrahepatic obstruction. Serological studies showed rubella and herpes immunoglobulin G (IgG) present in low titer and undetectable cytomegalovirus and toxoplasma antibodies. Hepatitis B surface antibody was positive, although surface antigen was not detected. Hepatitis C serology was negative. Serum cY-antitrypsin level and urinanalysis and urine organic acids showed no abnormality. Sudan Stain of the stool showed abundant neutral and split fats.
Jürgen Stein - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis of steatorrhea
Zeitschrift Fur Gastroenterologie, 1994Co-Authors: Bernhard Lembcke, Barbara Braden, Jürgen SteinAbstract:Several indirect parameters of steatorrhea and quantitative measures of fecal fat excretion are described and in use as diagnostic tools for the detection and the differential diagnosis of malabsorption syndromes. The knowledge of their rationals, principles and also of technical aspects is an important foundation for both their application and interpretation, and thereby enables a rational diagnostic approach on a pathophysiological base. This synopsis of traditional, present and innovative, emerging methods for the diagnosis of steatorrhea covers the advantages of the respective techniques (fecal weight, fecal aspect, microscopy [Sudan Stain], steatocrit, serum beta-carotinoids, titrimetric [van de Kamer] and gravimetric analysis, 14CO2-breath tests, NMR-spectroscopy, near infrared spectrometric analysis [NIRA], and 13CO2 stable isotope breath tests for fat maldigestion and -absorption), prerequisites for their application, and practical recommendations for specific situations. It may thus serve as a practical guide to the spectrum of 'coprophilic' and 'coprophobic', of 'low budget"- and 'high tech'-methods for assessing steatorrhea.
