Malignant eccrine spiradenoma: a case report with pulmonary metastasis

Malignant eccrine spiradenoma is an extremely rare sweat gland tumor. It may develop de novo or arise in pre-existing benign eccrine spiradenoma. However, most tumors are presented in the latter mode. The case of a 50-year-old man with malignant transformation from previously existing benign eccrine spiradenoma over his right lateral thigh is reported. Evidence for this diagnosis includes two distinct morphological components. One is the well demarcated, small round to oval benign eccrine spiradenoma and the other is the malignant element with sarcomatoid differentiation. Some foci of transition between the benign eccrine spiradenoma and the sarcomatoid part are evident and represents that the latter may arise from the former. Whether different morphological patterns influence the patients' outcome is still doubtful. However, the malignant eccrine spiradenoma is thought to have the capacity of metastasis and lethal potentiality.

Clinical effects of intra-arterial infusion chemotherapy with cisplatin, mitomycin C, leucovorin and 5-flourouracil for unresectable advanced hepatocellular carcinoma

BACKGROUND

Intra-arterial infusion chemotherapy (IAIC) can potentially improve survival in some patients with hepatocellular carcinoma (HCC), but the ideal regimen is not yet established. We prospectively evaluated the effects of short-course continuous infusion with the combination of cisplatin, mitomycin C, 5-fluorouracil (5-FU) and leucovorin for unresectable advanced HCC and analyzed their prognostic factors.

METHODS

Patients with unresectable advanced HCC and not suitable for other therapy were enrolled. Cannulation via the left subclavian artery with the tip of catheter at the proper hepatic artery was done before initialization of IAIC routinely. The regimen consisted of the daily administration of cisplatin (10 mg/m2), mitomycin C (2 mg/m2), leucovorin (15 mg/m2), and daily infusion of 5-FU (100 mg/m2) for 5 days. Only the patients that had received at least 2 courses of IAIC were evaluated.

RESULTS

Two-hundred and 11 courses of IAIC were performed, and each patient received at least 2 cycles of chemotherapy. The overall response rate was 28.3%. We observed a complete response in 5 patients (9.4%), a partial response in 10 patients (18.9%), a minimal response in 5 patients (9.4%), no change in 11 patients (20.8%) and a progressive disease in 22 patients (41.5%). The patients with response to treatment survived longer than the patients without response (24.6 +/- 14.2 months vs 8.7 +/- 5.3 months, p < 0.001). In univariate and multivariate analysis, absence of main vessel thrombosis and alpha-fetoprotein (AFP) reduction percentage > 50% following treatment showed significance in our study. All side effects subsided after conservative treatment.

CONCLUSIONS

Continuous IAIC with cisplatin, mitomycin-C, leucovorin, and 5-FU is effective for patients with severe advanced HCC. Absence of main vessel thrombosis, and AFP reduction percentage > 50% following treatment were good predictors of treatment response in our study. All side effects were mild and tolerable.

The interleukin-1 RN polymorphism and Helicobacter pylori infection in the development of duodenal ulcer

BACKGROUND

The host genetic factors that determine the clinical outcomes for Helicobacter pylori-infected individuals remain unclear.

AIMS

To elucidate the relations among interleukin-1 locus polymorphisms, and H. pylori infection in the development of duodenal ulcers.

MATERIALS AND METHODS

In a case-control study involving 168 control subjects and 147 patients with duodenal ulcer, biallelic polymorphisms of two interleukin-1 loci, IL-1B(-511) and IL-1B(+3954), as well as the penta-allelic variable number of tandem repeats of interleukin-1 receptor antagonist IL-1RN, were genotyped, and the H. pylori states of controls and patients were examined.

RESULTS

Helicobacter pylori infection, male gender and the carriage of IL-1RN*2 independently increased the risk of duodenal ulcer with odds ratios of 6.4 (95% confidence interval, 3.7-11.0), 1.9 (95% confidence interval, 1.1-3.4) and 2.7 (95% confidence interval, 1.1-6.8), respectively. Statistical analysis revealed an interaction between IL-1RN*2 and H. pylori infection with the duodenal ulcer risk conferred by the H. pylori infection substantially increased (odds ratios, 22.6; 95% confidence interval, 5.9-86.5) by the carriage of IL-1RN*2. In addition, a synergistic interaction between IL-1RN*2 and blood group O existed. The combined risk of H. pylori infection, the carriage of IL-1RN*2 and blood group O for duodenal ulcer was 27.5 (95% confidence interval, 3.1-243.6).

CONCLUSIONS

This work is the first to verify IL-1RN*2 as an independent factor that governs the development of duodenal ulcers. Our data indicate that H. pylori infection and IL-1RN*2 synergistically determine susceptibility to duodenal ulcer. The blood group phenotype is possibly a crucial determinant for the outcome of the impact of an interleukin-1 locus polymorphism on H. pylori-infected individuals.

Primary appendiceal lymphoma presenting as perforated acute appendicitis

Acute perforated appendicitis is a very rare initial presentation of appendiceal lymphoma. A case of primary lymphoma of the appendix in a 42-year-old female is reported here. The symptom was pain in the right lower quadrant of the abdomen. Surgical intervention was performed under clinical diagnosis of acute appendicitis. Grossly, the resected appendix was gangrenous and perforated. Light microscopy revealed transmural infiltration by diffuse large B-cell lymphoma with angioinvasion and tumor necrosis, resulting in perforated acute suppurative appendicitis. To the best of our knowledge, only 4 cases of well-documented primary diffuse large B-cell lymphoma of appendix have been reported in the world literature.

Retroperitoneal enteric duplication cyst

Enteric duplication cysts (EDCs) can occur in any portion of the alimentary tract, but are most commonly associated with the small bowel and esophagus. Retroperitoneal location is really unusual. This 19-year-old female was in excellent health, but a week's abdominal pain made her search for a doctor's help. After the detailed examination, surgical intervention was performed under the impression of cystic tumor of the retroperitoneum. A retroperitoneal cystic tumor, 13.0 x 8.0 x 3.5 cm in size, without any communication with the alimentary tract was noted during the operation. Finally, EDC was diagnosed after the pathologic examination of this resected cystic lesion. To our knowledge, there have been only 6 reported cases of EDC of the retroperitoneum in the English literature. This report concerns the seventh case of retroperitoneal EDC, in an adolescent, with different clinical presentation and histopathologic findings from the previous ones.

Comparison of cetraxate-based and pantoprazole-based triple therapies in the treatment of Helicobacter pylori infection

BACKGROUND

Recent studies suggest that cetraxate possesses anti-Helicobacter pylori (H. pylori) activity. We therefore conducted this pilot study to investigate the efficacy of a cetraxate-based triple therapy and to compare the regimen with proton pump inhibitor-based triple therapy.

METHODS

From April 2001 to January 2002, a total of 58 H. pylori-infected patients were randomly assigned to 1 of 2 regimens for 1 week: cetraxate plus clarithromycin and amoxicillin (CCA group) or pantoprazole plus clarithromycin and amoxicillin (PCA group). Follow-up endoscopy was performed at 8 weeks after the end of treatment to assess the treatment response.

RESULTS

Intention-to-treat analysis showed that the eradication rates of the CCA group (n = 27) and PCA group (n = 31) were 70.4% and 93.5%, respectively. The CCA group had a significantly lower eradication rate than the PCA group (p = 0.03). Per-protocol analysis also showed similar results (69.2% vs. 96.7%, p = 0.01). However, the frequency of adverse events in the CCA group was lower than that of the PCA group (3.7% vs. 25.8%, p = 0.03). Univariate analysis showed that the eradication rate was significantly related to proton pump inhibitor therapy (93.5% vs. 70.4%, p = 0.03 ) and smoking habit (66.7 % vs. 88.4%, p = 0.05), but multivariate analysis disclosed that proton pump inhibitor therapy was the only independent factor predicting treatment success (p < 0.05).

CONCLUSIONS

Cetraxate-based triple therapy is less effective than pantoprazole-based triple therapy in the treatment of H. pylori infection. However, the former has a lower frequency of adverse effects than the latter.

Loss of E-cadherin expression correlates with poor differentiation and invasion into adjacent organs in gastric adenocarcinomas

Perturbation in E-cadherin expression leads to loss of cellular adhesion with possible consequence of cellular transformation and tumor progression. The aims of this study were to determine E-cadherin expression in each subtype of gastric cancer classified by different classification systems, and to investigate the role of E-cadherin in cell differentiation, cancer invasion and metastasis. Expression of E-cadherin was analyzed in 84 patients with gastric adenocarcinoma by immunohistochemistry and correlated with clinicopahotlogical parameters. Our results showed loss of E-cadherin expression in 0% (0/3), 20.0% (9/45), 48% (15/31), 100% (3/3) and 100% (2/2) of papillary, tubular, poorly differentiated, signet-ring cell, and mucinous adenocarcinoma by Japanese histological classification. The reduction of E-cadherin expression was inversely correlated with the grade of differentiation. According to the histological classification of Lauren and Ming, the frequency of lost E-cadherin expression was higher in diffuse type (65%) and infiltrative type (64%) gastric cancer than in intestinal type (20%, P<0.001) and expanding type cancer (22%, P<0.001), respectively. The loss of E-cadherin expression was significantly associated with tumor invasion (P<0.05). Furthermore, there was a borderline association between the loss of E-cadherin expression and poor survival (P=0.109). These data demonstrated a striking correlation between E-cadherin expression and the differentiation of gastric carcinoma. The loss of E-cadherin expression may contribute to gastric cancer invasion to adjacent organs.

Endoscopic banding ligation can effectively resect hyperplastic polyps of the stomach

AIM: Bleeding and perforation are major and serious complications associated with endoscopic polypectomy. To develop a safe and effective method to resect hyperplastic polyps of the stomach, we employed rubber bands to strangulate hyperplastic polyps and to determine the possibility of inducing avascular necrosis in these lesions.

METHODS: Forty-seven patients with 72 hyperplastic polyps were treated with endoscopic banding ligation (EBL). At 14 days after endoscopic ligation, follow-up endoscopies were performed to assess the outcomes of the strangulated polyps.

RESULTS: After being strangulated by the rubber bands, all of the polyps immediately became congested (100%), and then developed cyanotic changes (100%) approximately 4 minutes later. On follow-up endoscopy 2 weeks later, all the polyps except one had dropped off. The only one residual polyp shrank with a rubber band in its base, and it also dropped off spontaneously during subsequent follow-up. No complications occurred during or following the ligation procedures.

CONCLUSION: Gastric polyps develop avascular necrosis following ligation by rubber bands. Employing suction equipment, EBL can easily capture sessile polyps. It is an easy, safe and effective method to eradicate hyperplastic polyps of the stomach.

Unusual presentation of posterior mediastinal chordoma in a 2-year-old boy

Chordoma is a rare and slow-growing malignant neoplasm that arises from the embryonic notochord. It is rare to see a thoracic chordoma presenting as a posterior mediastinal mass with pleural seeding in a child. The authors report a chordoma of the thoracic spine with posterior mediastinal extension and pleural seeding in a 2-year-old boy who presented with asymmetric bilateral hand temperature and lower limb paralysis. The clinical course progressed rapidly, resulting in death.

Glomus tumor of the trachea

Glomus tumor of the trachea is extremely rare. There were approximately 15 reported cases before. Herein, we report another case of glomus tumor of the trachea in a 50-year-old woman presenting with cough and dyspnea for 8 years. She suffered from hemoptysis for 1 day before this admission. Bronchoscopy and CT scan showed a polypoid tumor protruding into the tracheal lumen and with extraluminal extension. The tumor was located at 9 cm below the vocal cord and 1.5 cm above the carina. It measured 2.5 x 2.5 x 2.0 cm and arose from the posterior wall of the trachea. Microscopically, the tumor consisted of a sheet of uniform cells surrounding the vascular spaces. Only few scattered tumor cells showed weak positive staining for muscle actin (HHF-35) by immunohistochemical stain. Ultrastructural study confirmed the presence of small amount of myofibrillar bundles with focal densities in some of the tumor cells. Other cells exhibited only rare or very sparse myofilaments. Characteristic feature of fine pinocytotic vesicles along the plasma membrance of the tumor cells was also noted.

Compartment theory in Helicobacter pylori-associated gastric carcinogenesis

BACKGROUND

The compartment theory has not been well investigated in gastric carcinogenesis. This study was aimed at examining the compartment alterations through the Helicobacter pylori (H. pylori)-related chronic gastritis-intestinal metaplasia-carcinoma sequence, and investigating the long-term effect of bacterial eradication on the compartment changes.

PATIENTS AND METHODS

Gastric biopsy specimens were obtained from subjects with H. pylori-negative normal mucosa (N = 12), H. pylori-positive non-metaplastic gastritis (N = 42), H. pylori-positive intestinal metaplasia (N = 21) and intestinal-type adenocarcinoma (N = 20). The specimens were immnostained for monocloncal antibodies against the proliferating cell nuclear antigen (PCNA) for proliferating analysis. Additionally, 50 patients with H. pylori-positive gastritis were enrolled to investigate the long-term effect of bacterial eradication on the compartment changes of gastric epithelium.

RESULTS

The mean PCNA labeling indices (L.I.) of non-metaplastic gastritis, intestinal metaplasia and adenocarcinoma were significantly higher than that of normal mucosa (31.1, 49.2 and 40.7 vs. 21.4; p < 0.01, 0.001 and 0.001, respectively). The proliferating zone was principally located in the lower compartment of normal mucosa. In patients with intestinal metaplasia, there was a full expansion (phase 1 change) of proliferating zone to the middle compartment of gastric pits (ratio of L.I. between middle and lower compartment = 1.00). The proliferating cells were evenly distributed in adenocarcinoma (complete loss of compartmentalization). Eradiation of H. pylori led to a reversion of compartment changes of gastric epithelium in patients with chronic gastritis.

CONCLUSION

H. pylori-related gastric carcinogenesis is a multistep process involving progressive alterations of proliferating activity as well as loss of compartmentalization. Eradication of H. pylori reverses the changes in growth kinetics of gastric epithelium.

Experimental testing of spray dryer for control of incineration emissions

The research investigated the absorption/adsorption efficiency of sulfur dioxide (SO2), heavy metals, and polycyclic aromatic hydrocarbons (PAHs) with different Ca-based sorbents in a spray dryer during incineration process. For further improving the adsorption capacity of Ca-based sorbents, different spraying pressure and additives were carried out in this study. Experimental results showed that CaO could be used as an alternative sorbent in the spray dryer at an optimal initial particle size distribution of spraying droplet. In the spray dryer, Ca-based sorbents provided a lot of sites for heavy metals and PAHs condensing and calcium and alkalinity to react with metals to form merged species. As a result, heavy metals and PAHs could be removed from the flue gas simultaneously by condensation and adsorption. The additions of additives NaHCO3, SiO2, and KMnO4 were also found to be effective in improving the removal efficiency of these air pollutants.

Endoscopic 13C-urea breath test for the diagnosis of Helicobacter pylori infection

BACKGROUND

Endoscopic 13C-urea breath test may avoid contamination of oral urease and rapidly discriminate Helicobacter pylori-positive and Helicobacter pylori-negative patients.

AIMS

To compare the accuracy of endoscopic 13C-urea breath test with conventional invasive methods in diagnosis of Helicobacter pylori infection.

PATIENTS

One hundred patients who attended for routine upper gastrointestinal endoscopy were included.

METHODS

13C-urea was applied to the stomach through the working channel of endoscope at the end of endoscopic examination. Breath samples were collected before endoscopy and 2, 4, 6, 8, 10 min after consumption of 100 or 50 mg 13C-urea. Helicobacter pylori infection was defined as those with positive culture or positive results of both histology and CLO test.

RESULTS

The accuracy of 100 mg endoscopic 13C-urea breath test was significantly higher than that of culture and CLO test (100% vs. 88% and 92%, p = 0.02 and 0.03, respectively). The accuracy of 50 mg endoscopic 13C-urea breath test was higher than that of histology and CLO test (98% vs. 90% and 96%, respectively), although the differences were not statistically significant.

CONCLUSIONS

Endoscopic 13C-urea breath test has a higher accuracy compared with biopsy-based modalities. It may be a good choice to diagnose Helicobacter pylori infection if endoscopy is indicated for a dyspeptic patient.

Malacoplakia of the ovary, fallopian tube and uterus: a case associated with diabetes mellitus

Malacoplakia is a chronic xanthogranulomatous inflammation that most commonly affects the urinary tract and the gastrointestinal system of middle-aged women. It is rarely encountered in a female genital tract, and only a handful of cases of malacoplakia of the ovary have been described. We report an unusual case of malacoplakia extensively involving the ovary, fallopian tube and uterus of a 47-year-old woman with poorly controlled diabetes mellitus. Escherichia coli was cultured from the ovarian lesion. To our knowledge, such an extensive female genital malacoplakia associated with diabetes mellitus has not been reported before. Widespread or atypical site malacoplakia occurring in a patient with systemic disease may result from a diminution of macrophagocytic function, either under the influence of the systemic illness or related to corticosteroid excess. We propose that diabetes mellitus without appropriate medical control may have resulted in impaired leukocyte function which, when combined with E. coli infection, led to the development of extensive malacoplakia in the genital tract of this patient.

One-week quadruple therapy is an effective salvage regimen for Helicobacter pylori infection in patients after failure of standard triple therapy

Standard triple therapy remains an important option for eradicating Helicobacter pylori (Hp) in developing countries because of its relatively low cost. However, salvage therapies after failure of this regimen remain undefined. The authors therefore investigate the efficacy of 1-week quadruple therapy as a second-line treatment of Hp infection after failure of standard triple therapy. Seventy-eight patients who failed Hp eradication using a 2-week bismuth-based triple therapy were enrolled and received a course of 1-week quadruple therapy (lansoprazole, 30 mg twice daily; bismuth subcitrate, 120 mg four times daily; clarithromycin, 500 mg twice daily; and amoxicillin, 1,000 mg twice daily) as a salvage regimen. The Hp status was reassessed 7 weeks after cessation of therapy. Among the 78 patients, Hp eradication was achieved in 65 (83%, 95% confidence interval = 75-91%) by intention-to-treat analysis. Only five (6%) patients had side effects, and all (100%) showed good drug compliance. Multivariate analysis disclosed that coffee drinking was an independent factor for treatment failure (odds ratio = 5.3, 95% confidence interval = 1.2-23.6, p = 0.028). The authors therefore conclude that their 1-week quadruple therapy is an effective salvage regimen for Hp infection after failure of standard triple therapy in the population examined. The benefits of this regimen include the high eradication rate, the short duration of treatment, fewer side effects, and good drug compliance. Coffee consumption possibly is an important factor in failure of the rescue regimen. The mechanisms underlying the association between coffee drinking and eradication failure require further research.

The study of modified calcium hydroxides with surfactants for acid gas removal during incineration

The primary objective of the present work is to use additives to extend the sulfation reaction of the calcium hydroxide (Ca(OH)2) used to control SO2 emission from incineration processes. There are two reasons for adding surfactants (surface-active agent): (1) to provide an appropriate dispersion of the Ca(OH)2', thus preventing particle agglomeration due to humidity; (2) to alter the sulfation reaction environment by adsorbing heterogeneous materials on the surface of the Ca(OH)2 to extend the adsorption equilibrium. A dry scrubber integrated with a fabric filter was employed to study the effect of surfactants on the removal efficiency of acid gas in the flue gas with Ca(OH)2 as the sorbent. The operating parameters evaluated include: (1) the different surfactants (calcium lignosulfonate, sodium lignosulfonate, alkyl naphthalene sodium sulfonate and beta-naphthalene sodium sulfonate condensates) and (2) the composition of acid gas (i.e. sulfur dioxide (SO2), nitrogen oxide (NO) and hydrogen chloride (HCl)). The results show that modified Ca(OH)2 with surfactants could effectively decrease the emission of acid gas during incineration. Different additives had individual absorption efficiencies on different acid gases. On the whole, sodium lignosulfonate and beta-naphthalene sodium sulfonate condensates had better sorption capacity for SO2 and NO, but not for HCl. In addition, when SO2 coexisted with NO and HCl, the concentration of NO and HCl will result in decrease or increase of the removal efficiency of SO2.

Sequential changes of gastric hyperplastic polyps following endoscopic ligation

BACKGROUND

Endoscopic ligation has been extensively applied in the management of esophageal and gastric varices with or without bleeding. The varices are automatically eradicated through the use of ligation. However, whether avascular necrosis will occur in a gastrointestinal polyp when the base is ligated remains unclear. The aims of this pilot study were to investigate the sequential changes of gastric hyperplastic polyps following endoscopic detachable snare ligation and to determine the possibility of induction of avascular necrosis in these lesions following ligation.

METHODS

Eleven patients with eighteen gastric hyperplastic polyps were treated with endoscopic detachable-snare ligation. The polyps were observed for 5 minutes and biopsies were then conducted. At 14 days after endoscopic ligation, follow-up endoscopies were performed to assess the outcome of the strangulated polyps.

RESULTS

After being strangulated by the detachable snares, a majority of the polyps immediately congested (94%), and then developed cyanotic change (89%) approximately 4 minutes later. Pathological examination revealed severe venous congestion in the lamina propria of the strangulated polyps. On follow-up endoscopy 2 weeks later, all the snares had dropped off, and avascular necrosis occurred in sixteen polyps (89%). All of the polyps with avascular necrosis were detected to have developed cyanotic changes in initial endoscopy. No complications occurred during or following the ligation procedure.

CONCLUSIONS

Most gastric hyperplastic polyps develop avascular necrosis following ligation by detachable snare. Cyanotic change is an important predictor of the outcomes of the lesions following endoscopic ligation. The application of this ligation technique in treatment of bleeding or non-bleeding gastrointestinal polyps deserves further investigation.

Nephrogenic adenoma associated with cytomegalovirus infection of the ureter in a renal transplant patient: presentation as ureteral obstruction

Nephrogenic adenoma (NA), a rare benign lesion of the urinary tract, is widely accepted to be a metaplastic reaction due to urothelial injury. It mainly occurs in the urinary bladder and rarely in the ureter. Renal transplant recipients are prone to the development of NA. However in those patients, NA was diagnosed exclusively in the bladder. Herein, we present the--to our knowledge--first case of NA involving a transplanted ureter. A 42-year-old female kidney transplant recipient suffered hematuria, oliguria, and acute renal failure and presented with ureteral obstruction and hydronephrosis of the renal transplant. To our surprise, evidence of cytomegalovirus (CMV) infection of the NA was demonstrated using special immunohistochemical staining. The findings in this case raise the possibility that CMV infection, as an irritant of the ureteral epithelium, may be an etiological factor of NA.

Clinical significance of oral urease in diagnosis of Helicobacter pylori infection by [13C]urea breath test

This study was performed to evaluate the effect of oral flora on [13C]urea breath test in detecting H. pylori infection and find an optimal method and timing for sample collection. Forty-five volunteers were included in this study. The [13C]urea breath test was performed using mouthwash, endoscopic administration, and conventional methods. According to the receiver-operating characteristic curves, the earliest optimal time for discriminating H. pylori-positive and H. pylori-negative patients was at 25 min with the mouthwash method with 78% sensitivity and 82% specificity, at 2 min with the endoscopic administration method with 100% sensitivity and 100% specificity, and at 6 min with the conventional method with 100% sensitivity and 95% specificity. The study shows a significant effect of oral urease on the results of the [13C]urea breath test. The timing of sampling collection can be shortened to 6 min with the conventional method or to 2 min through endoscopic administration.

Follow-up of Helicobacter pylori status by using 13C-urea breath test in nonulcer dyspeptic patients after eradication therapy

BACKGROUND

The role of eradication therapy is still controversial in H. pylori-related nonulcer dyspepsia (NUD). The aim of this study was to follow up the H. pylori status after eradication therapy in patients with NUD by using l3C-urea breath test (UBT).

METHODS

Patients with a clinical and endoscopic diagnosis of NUD were included. H. pylori infection was established by endoscopic biopsies and 13C-UBT. Patients with H. pylori infection then received a quadruple therapy with colloidal bismuth subcitrate, metronidazole, tetracycline and lansoprazole. Two months after completion of therapy, endoscopic biopsies and 13C-UBT were performed again to confirm eradication. A follow-up 13C-UBT was carried out again in one year to detect recurrence of H. pylori infection.

RESULTS

Eighty-eight of the 148 patients (59.5%) were found to have H. pylori infection by both endoscopic biopsies and 13C-UBT. Anti-H. pylori therapy was given for 55 patients and proved successful in 33 of them two months after the end of therapy. However, recurrence was found one year later in three of these 33 cases, making a recurrence rate of 9.1% (3/33). Three of the 22 cases with unsuccessful eradication were found to have H. pylori eradication at one year by follow-up 13C-UBT. One of the 33 H. pylori-positive patients without anti-H. pylori therapy, who had negative 13C-UBT in one year follow-up, was found taking a high dose and long period of antibiotics.

CONCLUSIONS

The recurrence rate of H. pylori infection in our study was higher than that in the Western population. Delayed eradication of H. pylori may occur after anti-H. pylori therapy. Spontaneous eradication is rare in patients not receiving anti-H. pylori eradication.

Cathepsin E and subtypes of intestinal metaplasia in carcinogenesis of the human stomach

BACKGROUND

Cathepsin E is found mainly over the gastric surface and foveolar epithelial cells, and it also is found in the metaplastic pyloric glands and cancer cells. The exact function of cathepsin E in gastric mucosa remains unclear. The colonic type (type III) of intestinal metaplasia (IM) is strongly associated with intestinal-type gastric carcinoma. IM is considered to be a precancerous lesion. The aim of this study was to find out the role of cathepsin E in IM, dysplasia and cancer of stomach.

METHODS

Sixty nine biopsy specimens with IM and dysplasia and 33 gastrectomy specimens with gastric carcinoma were fixed, sectioned and stained with PAS-alcian blue stain, high iron-diamine alcian blue stain to classify IM and immunohistochemical stain to localize cathepsin E. Those patients with dysplastic gastric lesions received regular endoscopic follow-up.

RESULTS

Fifteen of 69 patients with gastric dysplasia developed cancer in a median 10.5 months follow-up. Severe dysplasia developed carcinoma significantly higher than mild dysplasia (12/20 vs. 1/25, p < 0.001), and type III intestinal metaplasia seemed to have significantly predilection for severe dysplasia and gastric cancer. Cathepsin E was stained in intestinal metaplasia with dysplastic change in 44/69 specimens (63.8%), and carcinoma in 28/48 (58.3%) specimens, there was no significant difference between intestinal type and diffuse type carcinoma in cathepsin E staining. The positive staining for cathepsin E decreased significantly in severe dysplastic gastric mucosa.

CONCLUSIONS

Type III IM is commonly associated with severe dysplasia and cancer; it may be a precancerous lesion. The positive staining of cathepsin E decreased with the severity of gastric dysplasia, representing dedifferentiation of the cells.

Solitary fibrous tumor of the liver

Solitary fibrous tumor of the liver is a rare neoplasm. So far, 21 cases have been described in the English literature. We reported an additional case. Our patient, a 75-year-old man, suffered from abdominal fullness and body weight loss of 6 kg over 6 months, and chills and fever for 2 months. Hypoglycemia was noted at admission. Both abdominal sonography and CT showed a huge mass occupying the right lobe of liver. Liver biopsy showed fibrous tumor. Right lobectomy was performed and the tumor was resected. Pathological examination showed spindle-shaped and fibroblast-like cells within the collagenous stroma. On immunohistochemical stains, these spindle tumor cells showed CD34 positive reactivity. The post-operative course was uneventful and there was no more hypoglycemia. The patient recovered smoothly, regained his body weight, and was alive without evidence of disease recurrence at the last follow-up visit in November, 2000.

Pollutants in incineration flue gas

Previous studies have shown that pollutants from incineration include heavy metals, organic compounds, particulate and acid gas. However, most studies on a single pollutant, it is rare for a study to concentrate on all possible pollutants and the relations between these pollutants under various incineration conditions. The objective of this work was to experimentally study the effect of different operating conditions on the pollutants emitted during incineration and the relations between these pollutants. The operating conditions of the experiments included the temperature of the combustion chamber and the species of organics. The findings indicated that the concentration of hydrogen chloride (HCl) in the presence of polyvinyl chloride (PVC) was higher than that of sodium chloride (NaCl). Regardless of what Cl-containing feedstock was added, the concentration of chromium (Cr) was constant. When organic chloride was added, Cr was the main metallic element which influenced the formation of polycyclic aromatic hydrocarbons (PAHs). On the other hand, when inorganic chloride (NaCl) was added, lead (Pb) was the major element.