Preliminary Evaluation of the Potential Prognostic Value of Serum Levels of Immunoglobulins (IgA, IgM, IgG, IgE) in Patients with Gastric Cancer

Sixty patients with advanced gastric carcinoma who refused to receive cytotoxic chemotherapy were examined for serum immunoglobulin levels (IgG, IgM, IgA, IgE). Three samples were obtained every two months thereafter. The group of patients who had above-normal values of one or more of the examined immunoglobulins had a longer survival than the other (p<0.024). Immunoglobulin values were independent of the Helicobacter pylori antibody titer and of acute phase reactants. It is concluded that survival potentially correlates with serum immunoglobulin levels. Further studies including larger numbers of patients and correlating serum immunoglobulin levels with specific clinical parameters are needed to establish the prognostic role of serum immunoglobulins in patients with gastric carcinoma.

The incidence of HPV infection in anal cancer patients in Greece

BACKGROUND AND AIM OF THE STUDY

Although anal cancer represents a relatively uncommon malignancy, its incidence over the last five decades, has been reported as increased for both sexes, worldwide. Human papillomavirus (HPV) infection has been shown to be a major cause for its development. The aim of the present study is to report on clinical, epidemiological and virological data of squamous anal cancer in Greek patients.

PATIENTS AND METHOD

Between January 2002 and December 2010, 11 Greek patients (6 females) who were diagnosed as suffering from squamous cell anal or perianal cancer, were treated in our Hospital. Formalin fixed paraffin embedded tissue samples, obtained at the time of the anal biopsy or surgery, were analyzed by PCR in order to identify the presence as well as the type of HPV infection.

RESULTS

Overall, the presence of HPV DNA was detected in 6 out of the 11 patients (54.5%). The "high risk" HPV DNA was detected in 3 of them (2 women and 1 man), while the "low risk" HPV DNA was detected in the remaining three (2 women and 1 man).

CONCLUSION

The incidence of HPV infection in squamous cell anal cancer Greek patients, is lower than other Western countries, probably reflecting differences in sexual habits in the Greek population.

CEA and CA-19.9 serum tumor markers as prognostic factors in patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma: a retrospective analysis

Most pancreatic adenocarcinoma patients present with locally advanced or metastatic disease at diagnosis. in this retrospective study the authors evaluated the prognostic significance of the CEA and CA-19.9 serum tumor markers in advanced (unresectable) pancreatic cancer in correlation to other prognostic factors (demographic data, clinical parameters, treatment modality) and survival time using univariate and multivariate methods, in 215 patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma. median survival was 29.0 weeks, with 21.9% of patients surviving 36 weeks. Among 24 potential prognostic variables, 19 were associated with shorter survival. Multivariate analysis indicated that ten factors had a significant independent effect on survival: chemotherapy, surgery, tumor localization, elevated C-reactive protein, elevated CeA, CA 19-9 (>30 x nl), jaundice at diagnosis, weight loss >10%, distant metastases, and Karnofsky performance status. Patients who had only palliative therapy had a hazard ratio of 8.94 versus those who underwent palliative surgery and chemotherapy. Although certain clinical, biochemical and biological factors remain important predictors of survival in patients with advanced pancreatic cancer, CA-19.9 serum tumor marker levels retain independent prognostic value for poor survival.

Does Helicobacter pylori identification in the mucosa of the gallbladder correlate with cholesterol gallstone formation?

OBJECTIVE

Helicobacter pylori (H pylori) represents a potential initiator of cholesterol crystallization and it has been proposed that it is related to gallstone formation. In this study, any possible association between the H pylori identification in the mucosa of gallbladder and cholesterol gallstone formation was evaluated

METHODS

Gallbladders containing pure or mixed cholesterol gallstones (cholelithiasis group, n = 89) and gallbladders without gallstones (control group, n = 42) were submitted to standard histopathological examination for H pylori detection, as well as to nested polymerase chain reaction amplification for H pylori DNA detection.

RESULTS

Helicobacter pylori was identified in the gallbladder's epithelium in four patients with cholelithiasis and in two patients in the control group by histology. In all the cases which were found to be H pylori positive by histological examination, H pylori DNA were also detected. No correlation between gallstone formation and H pylori detection in the biliary epithelium was found. A higher incidence of acute inflammation in the cholelithiasis (22.5% vs 9.5%, p = not significant [ns]) and in the H pylori positive groups (33% vs 17.6%, p = ns) were histologically detected. A higher incidence (10% vs 0%), p = ns) of H pylori in gallbladders with gallstones and acute inflammation, compared to gallbladders with acute inflammation but without gallstones, was noticed

CONCLUSION

Helicobacter pylori is detectable in low frequency in the mucosa of the gallbladder and it does not seem to act as a lithogenic component for cholesterol gallstone formation. Its higher incidence in gallbladders with gallstones and acute inflammation, suggests a possible accessory role in a subset of patients with cholelithiasis.

Implications for a role of interleukin-23 in the pathogenesis of chronic gastritis and of peptic ulcer disease

The present study aimed to investigate the role of gastric mucosa for the secretion of interleukin (IL)-23 in chronic gastritis. One hundred and one patients were enrolled; 47 with duodenal ulcer, 33 with gastric ulcer and 31 with chronic gastritis. Biopsies were incubated in the absence/presence of endotoxins. Supernatants were collected and IL-23 and IL-1beta were measured by enzyme-linked immunosorbent assay. Scoring of gastritis was performed according to the updated Sydney score. Patients with duodenal and gastric ulcer and those with chronic gastritis had similar scores of gastritis. IL-23 was higher in supernatants of tissue samples of Helicobacter pylori-positive than of H. pylori-negative patients. No differences were recorded in concentrations of IL-23 and IL-1beta between patients with duodenal ulcer, gastric ulcer and chronic gastritis. Positive correlations were found between IL-23 of patients with both duodenal and gastric ulcer and chronic gastritis and the degree of infiltration of neutrophils and monocytes. Similar correlations were observed between IL-23 and IL-1beta. IL-23 secreted by the gastric mucosa could be implicated in the pathogenesis of chronic gastritis. IL-23 was released in the presence of H. pylori from the inflamed gastric mucosa and followed the kinetics of IL-1beta.

The liver in brucellosis

BACKGROUND & AIMS

Brucellosis involves the liver in varying ways, ranging from benign subclinical increases in serum aminotransferase levels to ominous chronic suppurative disease. Data on histopathology of the liver in brucellosis are scarce and contradictory. We sought to determine the liver histologic patterns present in a series of brucellosis patients and review the existing knowledge about liver involvement in this worldwide, prevalent zoonotic infection.

METHODS

Fourteen patients from 2 referral centers were retrospectively studied. They had brucellosis caused by Brucella melitensis and had undergone liver biopsy at the time of diagnosis.

RESULTS

All patients exhibited granuloma formation in the liver parenchyma and in the majority in portal spaces. Varying degrees of cellular infiltration of parenchymal tissue and portal spaces, giant cells in granulomas, parenchymal necroses, and Kupffer's cell hyperplasia were also noted. No significant epidemiological or clinical correlations with liver involvement were exhibited. Thus, liver involvement was not increased in men vs women, young vs old patients, or complicated vs uncomplicated disease.

CONCLUSIONS

The liver is involved in Brucella melitensis infection contrary to past beliefs. Different histologic patterns can be observed in liver involvement in brucellosis, the most common being granuloma formation. The pathogenetic role of brucellosis in development of liver fibrosis and cirrhosis remains limited and understudied.

c-FLIP expression in colorectal carcinomas: association with Fas/FasL expression and prognostic implications

AIMS

Disruption of apoptotic cell death has been implicated in tumour aggressiveness in colonic carcinogenesis. The Fas-Fas ligand (FasL) system is involved in the execution of apoptosis induced by the immune system. c-FLIP protein constitutes an inhibitor of Fas and other (TRAIL) death receptor-mediated apoptosis. The aim of this study was to investigate the simultaneous expression of Fas, FasL and c-FLIP in relation to standard clinicopathological parameters and patients' outcome in colorectal cancer.

METHODS AND RESULTS

Levels of Fas, FasL and c-FLIP protein expression were quantified immunohistochemically in paraffin-embedded tissues from 90 patients. Immunopositivity was detected for Fas, FasL and c-FLIP in 71%, 35.5% and 68.8% of cases, respectively. Concurrent expression of Fas/FasL was seen in 28 samples (31%), of which 24 (85.7%) also displayed c-FLIP positivity (P = 0.04). c-FLIP overexpression (> 10%) tended to prevail marginally in higher stage tumours (P = 0.09). Additionally, FasL and c-FLIP adversely affected survival on both univariate (P = 0.001 and P = 0.0024, respectively) and multivariate analysis [hazard ratio (HR) 3.491, P = 0.005 and HR 2.960, P = 0.036, respectively].

CONCLUSIONS

The frequent expression and coexpression of Fas, FasL and c-FLIP in colorectal carcinoma implicates c-FLIP as an inhibitor of the Fas-FasL-induced death pathway in these tumours. Moreover, c-FLIP conveys independent prognostic information in the presence of classical prognosticators.

Liver tissue dissection: ultrasonic or RFA energy?

BACKGROUND

Hepatic resection is the only potential curative treatment for a wide variety of conditions. However, liver surgery is technically demanding and closely associated with a number of serious complications. New devices and techniques are currently being applied in practice, which will improve the surgical outcome.

METHODS

This retrospective study compares two methods of liver parenchymal division: ultrasound energy, a modern but already widely used technique, and radio-frequency ablation (RFA), a completely novel method. The parameters investigated include the amount of blood transfused, the necessity of the Pringle maneuver, the length of time required for parenchymal division, and postoperative morbidity and mortality. The patients were divided into two groups. In one group (Group A), 15 patients underwent 17 ultrasound-assisted liver resections, in which ten metastatic tumors, six hepatomas, and one cholangiocarcinoma were resected. In Group B, 21 patients underwent 22 RFA-assisted hepatectomies in which 11 metastatic tumors, ten hepatomas, and two cholangiocarcinomas were removed.

RESULTS

Thirteen patients (87%) in Group A and 11 (52%) in Group B received a transfusion, with an average of 3.5 and 1.6 units of red blood cells, respectively. The Pringle maneuver was necessary in two cases in Group A but was unnecessary in Group B. The mean length of time required for parenchymal dissection was 124 min in Group A and 93.18 min in Group B. One (6.7%) and four (19%) complications were observed in Group A and B, respectively (statistically not significant). Mortality remained zero in both groups.

CONCLUSIONS

RFA energy provides a novel reliable and safe alternative that can be used exclusively or as a supplement to the older techniques. Both resection time and amount of blood transfusion were reduced in the RFA group.

H3 Propranolol serum levels following lidocaine administration in rats with CCL4 — induced liver damage

Liver disease alters the pharmacokinetic and pharmacodynamic properties of hepatically eliminated drugs. The main factors influenced are plasma albumin levels, enzyme balance (induction & inhibition) and drug binding to tissue proteins. The influence of lidocaine on serum, heart and liver propranolol levels in Wistar rats after liver injury induced by carbon tetrachloride CCl4 0.4 ml/kg x 2/wkl, was investigated. 40 male Wistar rats were divided into four groups (I, II, III, IV; n=10), Group I animals received only propranolol (labelled + cold substance) 40 mg/kg/12 h p.o., group II propranolol plus lidocaine in a single dose of 4mg/kg s.c., group III was treated with CCl4 for 6 weeks and received propranolol x2 at the same dosage as group I, while group VI was treated with CCl4 and the same drug dosage as group II. The simultaneous administration of H3-propranolol and lidocaine increased propranolol levels in the serum and tissues. The liver in damaged animals showed an increase of propranolol level under lidocaine co-administration, probably due to CCl4 induced liver enzyme activity, resulting in a rapid propranolol metabolism or to competition between both drug protein binding sites. The increased propranolol levels in the heart after lidocaine administration were probably due to attributed to its high affinity for heart tissue. Consequently, as regards the therapeutic approach for patients with liver disease receiving propranolol their propranolol dosage should be reduced when lidocaine is co-administered.

Severe gastrointestinal involvement in systemic sclerosis

Gastrointestinal tract (GIT) is the most common organ system involved in systemic sclerosis (SSc). GIT involvement is mainly attributed to GIT dismobility and wide mouth diverticular. GIT involvement in SSc can be also severely debilitating and even life threatening. To our knowledge, the presence of gastrointestinal bleeding due to the presence of multiple peptic ulcers in scleroderma patients is not well described. In this case report, we describe a scleroderma patient with recurrent gastrointestinal bleeding due to multiple peptic ulcers, in which vagotomy, pyloroplasty, and cholocystectomy were performed and subcutaneous somatostatin was administered to discontinue the recurrent bleeding and stabilize her clinical condition.

Effects of hormone replacement therapy on the main fatty acids of serum and phospholipids of postmenopausal women

BACKGROUND

The anti-atherosclerotic effects of hormone replacement therapy (HRT) in postmenopausal women are partly mediated by improvement of the lipid and lipoprotein profiles. The present study aimed to investigate the effects of HRT on the main fatty acids of serum and phospholipids in postmenopausal women.

PATIENTS AND METHODS

Serum samples of two groups of postmenopausal women, receiving either single oestrogen or in combination with progestogens, were analysed before and after a 6- month treatment period.

RESULTS

Of the main serum fatty acids, there was a significant reduction in palmitic (p < 0.05) and arachidonic acids (p < 0.001), followed by an increase in oleic (p < 0.05) and linoleic acids (p < 0.05) in postmenopausal women receiving HRT compared to single oestrogen. The main fatty acids in phospholipids showed a similar pattern in those women.

CONCLUSION

The above results demonstrate the beneficial effects of HRT in reducing the risk of cardiovascular disease through modification of the fatty acid profiles of postmenopausal women.

Effects of hemodialysis on serum lipids and phospholipids of end-stage renal failure patients

Patients with chronic renal failure undergoing periodic maintenance hemodialysis frequently present dyslipoproteinaemia which has been linked to the sharply increased risk of cardiovascular disease in these subjects. Reported defects on lipoprotein-related enzyme activities suggest a possible influence of hemodialysis not just to plasma lipid and lipoprotein levels but also to the composition of cell membranes. In this study, it was investigated whether the reported lipid abnormalities are accompanied by changes in serum phospholipids levels. Blood samples were obtained from 140 patients undergoing maintenance hemodialysis treatment and 122 normolipidemic healthy controls and analyzed for total serum phospholipids and their individual subclasses, as well as for total cholesterol and triglycerides, HDL-cholesterol and its subclasses. A significant decrease was observed in serum HDL cholesterol levels (p < 0.001) and its subclasses, HDL2-cholesterol (p < 0.01) and HDL3-cholesterol (p < 0.01) in patients when compared with healthy controls. A critical increase in the serum triglyceride content (p < 0.001) of patients was also observed. In addition, the serum levels of sphingomyelin (p < 0.01) and diphosphatidylglycerol (p < 0.001) were increased in the patient group, while the levels of phosphatidylcholine (p < 0.01) and phosphatidylinositol (p < 0.01) were significantly decreased in the patient group compared to healthy controls. In conclusion, this work clearly demonstrates that hemodialysis treatment contributes significantly to the dyslipidemic profile of end-stage renal failure patients by altering serum lipoprotein and phospholipids concentrations.

Computer-aided tumor detection in endoscopic video using color wavelet features

We present an approach to the detection of tumors in colonoscopic video. It is based on a new color feature extraction scheme to represent the different regions in the frame sequence. This scheme is built on the wavelet decomposition. The features named as color wavelet covariance (CWC) are based on the covariances of second-order textural measures and an optimum subset of them is proposed after the application of a selection algorithm. The proposed approach is supported by a linear discriminant analysis (LDA) procedure for the characterization of the image regions along the video frames. The whole methodology has been applied on real data sets of color colonoscopic videos. The performance in the detection of abnormal colonic regions corresponding to adenomatous polyps has been estimated high, reaching 97% specificity and 90% sensitivity.

Helicobacter pylori (H pylori) infection in Greece: the changing prevalence during a ten-year period and its antigenic profile

BACKGROUND

To evaluate changes in H pylori infection prevalence in Greece during a ten-year period, and to examine its antigenic profile.

METHODS

Three groups of patients were studied. Group O-87: Banked serum samples of 200 consecutive adult outpatients, from the Hepato-Gastroenterology clinic of a teaching hospital at Athens, collected in 1987. Group O-97: Serum samples of 201 similarly selected outpatients from the same Unit, collected in 1997. Group BD-97: Serum samples of 120 consecutive blood donors from the same hospital, collected in 1997. H pylori IgG antibody seroprevalence was studied by a quantitative ELISA. Antigenic profile was studied by western-blot IgG assay, in 62 IgG positive patients of O-97 and BD-97. Results were analyzed by conventional statistics and multivariate regression analysis.

RESULTS

The H pylori seroprevalence increased with age in the three tested groups. In O-97, seroprevalence did not differ from that, in BD-97. On the contrary, there was a significant decrease in seropositivity between O-87 and O-97 (59.5% vs 49.2%, p = 0.039). Multiple regression analysis showed that age over 35 years (OR:3.45, 95% CI:1.59-7.49, p = 0.002) and year of patients' selection - that is 1987 or 1997 - (OR:1.73, 95% CI:1.14-2.65 for 1987, p = 0.010), were independent risk factors of H pylori infection. The seroprevalence of CagA+ and VacA+ strains was 77.4% and 58.5%, respectively, and type I(CagA+/VacA+) strains were significantly more common than type II(CagA-/VacA-) strains (59.7% vs 22.6%, p < 0.001).

CONCLUSIONS

During a ten-year period, we found a significant decrease of H pylori infection in Greece and our data support the birth cohort phenomenon as an explanation for the age-dependent increase of H pylori infection. The prevalence of CagA and/or VacA positive strains is relatively high, in a country with low incidence of gastric cancer.

Rapid urease test is less sensitive than histology in diagnosing Helicobacter pylori infection in patients with non-variceal upper gastrointestinal bleeding

BACKGROUND AND AIMS

The validity of the rapid urease (CLO) test to diagnose Helicobacter pylori infection in patients with bleeding ulcers has been questioned. The aim of this paper is to evaluate the validity of the CLO test in comparison with histology in diagnosing H. pylori infection in patients with acute upper gastrointestinal bleeding (UGB), irrespective of non-steroidal anti-inflammatory drug (NSAID) use.

METHODS

Upper gastrointestinal endoscopy was performed within 24 h of admission for all patients with UGB admitted to the Department of Pathophysiology, Medical School, Athens, for a period of 12 months. Patients with variceal bleeding, previous gastric operation, recent treatment with proton pump inhibitors (< 2 months) and those with a history of H. pylori eradication therapy were excluded from the study. At least four biopsies (two from the antrum and two from the body) were obtained for the CLO test and histology (modified Giemsa).

RESULTS

Seventy-two consecutive patients (aged 18-90 years, 51 men, 21 women) were included. Forty-six patients (64%) used NSAID. Thirty-two patients (44%) were found to be positive for H. pylori infection by the CLO test, while 44 patients (61%) were found to be positive on histology (P<0.045, 95% CI, 0.004-0.331). The sensitivity and specificity of the CLO test were 68 and 93% respectively; positive and negative predictive values were 94 and 65%, respectively. The age of the patient and visible blood in the stomach did not influence results of either the CLO or histology.

CONCLUSIONS

The CLO test, performed within 24 h of hospital admission in patients with UGB, irrespective of NSAID use, is unreliable for the detection of H. pylori infection. The age of the patient and the presence of blood in the stomach do not seem to influence these results.

Expression of HLA-DR, costimulatory molecules B7-1, B7-2, intercellular adhesion molecule-1 (ICAM-1) and Fas ligand (FasL) on gastric epithelial cells in Helicobacter pylori gastritis; influence of H. pylori eradication

There is evidence that Helicobacter pylori infection up-regulates the expression of HLA class II molecules by gastric epithelial cells (GEC). In this study we evaluated whether GEC are capable of expression of costimulatory molecules in H. pylori gastritis. The expression of FasL by GEC, before and after eradication of H. pylori, was also studied. Thirty patients (23 men) aged 27-81 years (53.67 +/- 13.99 years (mean +/- s.d.)) with dyspepsia were studied. Upper gastrointestinal endoscopy was performed and six biopsies were obtained (antrum, n = 3; corpus, n = 3) for Campylobacter-Like Organisms (CLO) test and histology; 23 (16 men) were H. pylori+ and seven (all men) were H. pylori- by both methods and served as controls. Helicobacter pylori eradication therapy was given to H. pylori+ patients and all patients were re-endoscoped after 116 +/- 9 days. Formalin-fixed paraffin-embedded tissue sections were stained by the ABC immunoalkaline phosphatase method. In H. pylori gastritis HLA-DR was expressed and correlated with disease activity (P < 0.01). No HLA-DR was observed in controls. In H. pylori-eradicated patients significant decrease of HLA-DR was found (antrum, P < 0. 001). ICAM-1 was expressed by GEC in 80% of H. pylori+ patients; ICAM-1 expression did not correlate with gastritis parameters and decreased significantly after eradication (antrum, P < 0.01). B7-1 and B7-2 were expressed on H. pylori+ samples and their expression decreased after eradication, albeit not significantly. Weak epithelial expression of both B7 molecules was observed in all the controls. FasL was steadily expressed by GEC in both H. pylori+ and H. pylori- patients and remained almost unchanged after eradication. These findings suggest that GEC may acquire antigen-presenting cell properties in H. pylori infection through de novo expression of HLA-DR and costimulatory molecules. This seems to be attenuated after eradication and resolution of mucosal inflammation. The same cells exhibit the capacity to control the inflammatory process, probably by inducing apoptotic cell death to Fas-bearing infiltrating lymphocytes.

Neural network application in the discrimination of benign from malignant gastric cells

OBJECTIVE

To investigate the potential value of morphometry and neural networks for the discrimination of benign from malignant gastric lesions.

STUDY DESIGN

One thousand cells from 19 cases of cancer, 19 cases of gastritis and 56 cases of ulcer were selected as a training set, and an additional 4,000 cells from the same cases of cancer, gastritis and ulcer were used as a test set. Images of routinely processed gastric smears stained by the Papanicolaou technique were analyzed by a custom-made image analysis system.

RESULTS

Application of the neural network gave correct classification in 96% of benign cells and 89% of malignant cells.

CONCLUSION

The results indicate that the use of neural networks and image morphometry may offer useful information concerning the potential of malignancy in gastric cells.

Ranitidine versus ranitidine plus octreotide in the treatment of acute non-variceal upper gastrointestinal bleeding: a prospective randomised study

AIM

To compare the efficacy of ranitidine with that of ranitidine plus octreotide in the treatment of non-variceal upper gastrointestinal (UGI) bleeding.

DESIGN

Prospective, randomised, open study.

PATIENTS AND METHODS

Upper GI endoscopy was carried out during the first 24 hours in all patients with UGI bleeding who had been admitted within a period of 18 months. Patients with variceal bleeding, and those who had undergone any type of gastric operation, were excluded. Eighty-four patients (58 men and 26 women) aged 21-92 years (mean age: 61.2 +/- 15.0 SD) were included. Patients were randomised to receive ranitidine 50 mg tid intravenously alone (Group A: 44 patients, 29 men), or in combination with octreotide 100 micrograms tid subcutaneously, the second drug given for three days only (Group B: 40 patients, 29 men). The study end-points were discharge without operation, emergency surgical intervention or death. The number of blood units given and the days of hospitalization were also recorded.

RESULTS

Aspirin and non-aspirin NSAID use before bleeding was reported by 16/44 (36%) patients in Group A and by 19/40 (47.5%) patients in Group B (p = 0.38, OR = 0.63, 95% CI = 0.26-1.51). The endoscopically detected pathology and bleeding stigmata did not differ between the groups (p = 0.86, p = 0.64, OR = 0.78, 95% CI = 0.3-1.99, respectively). Mean use of blood units (p = 0.16) and days of hospitalization (p = 0.25) did not differ. Three patients in Group A (6.8%) and three in Group B (7.5%) required surgical intervention (p = 1.0, OR = 1.1, 95% CI = 0.21-5.84).

CONCLUSION

Ranitidine plus subcutaneous octreotide is not superior to ranitidine alone in the management of patients with acute non-variceal UGI bleeding.

The CLO test is unreliable in diagnosing H. pylori infection in post-surgical stomach; is there any role of H. pylori in peptic ulcer recurrence?

AIM

To evaluate the validity of the CLO test in detecting Helicobacter pylori in patients with gastric operation and to investigate the relationship of H. pylori with peptic ulcer recurrence in these patients.

METHODS

In this prospective study, 110 consecutive patients, the majority of whom had undergone gastric operation for benign disease (n = 102), were included. Eighty patients (62 males), aged 38-87 years, had had a gastrectomy (10 Billroth I, 70 Billroth II), and 30 patients (27 males), aged 36-73 years, had had a vagotomy (13 vagotomy plus gastroenterostomy, 17 vagotomy plus pyloroplasty). H. pylori was sought on multiple biopsy specimens, using CLO test and histology (modified Giemsa stain). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the CLO test were estimated using histology as 'gold standard'.

RESULTS

Overall, 21 gastrectomy patients (26%) were H. pylori-positive by CLO and 25 (31 %) were H. pylori-positive by histology. The estimated sensitivity, specificity, PPV and NPV of the CLO test, using histology as 'gold standard', were 68%, 91%, 77% and 86%, respectively. The CLO test was positive in 67% of vagotomy patients (20 of 30), while 50% (15 of 30) were H. pylori-positive by histology. The estimated sensitivity, specificity, PPV and NPV of the CLO test were 87%, 53%, 65% and 80%, respectively. H. pylori prevalence by histology was 50% in patients with vagotomy and 31% in those with gastrectomy (P = 0.0787). Recurrent ulcers were observed in 8/30 patients (27%) after vagotomy and in 10/72 patients (14%) after gastrectomy. Recurrent ulcer was documented in 6/15 H. pylori-positive patients with vagotomy (40%), and in one of 25 H. pylori-positive patients with gastrectomy (4%). This difference was significant (Fisher's exact test, P = 0.007, relative risk 5.091, 95% CI 0.819-31.64).

CONCLUSION

The CLO test seems to be unreliable in diagnosing H. pylori in post-surgical stomach. The H. pylori prevalence is higher, although not significantly, in vagotomized patients compared with gastrectomized patients, and in this group is closely related to the presence of recurrent ulcer. So, at least in this group of patients, it is strongly recommended to look for and eradicate H. pylori.

Diazepam treatment in rats induces changes in the concentrations of different phospholipid classes in liver and liver mitochondria

Liver phospholipid concentrations were determined in rats after the administration of diazepam (5 mg/Kg/day), for a period of two months. Increased concentrations of total phospholipids (P < 0.05), phosphatidylcholine (P < 0.05) and phosphatidylinositol (P < 0.05) were found in the rats taking diazepam. In contrast, a decreased concentration of phosphatidylserine (P < 0.01) was observed in the same group of animals. In addition, changes in the concentration of rat liver mitochondrial phospholipids after the administration of diazepam during the same period of time were determined. Increased concentrations of total phospholipids (P < 0.01), phosphatidylcholine (P < 0.001) and diphosphatidylglycerol (P < 0.001) were found in the rats treated with diazepam. In contrast, decreased phosphatidylserine (P < 0.001) and phosphatidylinositol (P < 0.01) concentrations were observed in the same group of animals. The considerable changes observed in liver phospholipids and individual classes of liver mitochondrial phospholipids induced by long-term administration of diazepam, possibly suggest a stimulation of liver phospholipid biosynthesis. This effect may be related to enzymatic systems which are involved in phospholipid pathways, and are linked to benzodiazepinergic binding sites.

Clinical significance of plasma HDL subfractions (HDL2, HDL3) in patients with peripheral arterial disease (PAD) in the Greek population

OBJECTIVE

In this study the major high density lipoprotein (HDL) subfractions (HDL2, HDL3) were examined, in angiographically selected patients with peripheral arterial disease (PAD).

RESULTS

Patients with PAD have significantly high triglyceride levels. HDL2 and HDL3 levels were found significantly reduced in patients with PAD. Also, the ratio HDL2-C/HDL3-C was significantly reduced in patients with PAD.

CONCLUSIONS

The aim of the present study is to provide additional support to the hypothesis that the determination of HDL subfractions could be useful to elucidate possible mechanism(s) for a better assessment of the risk profile for PAD.

Combined epirubicin, 5-fluorouracil and folinic acid vs no treatment for patients with advanced pancreatic cancer: a prospective comparative study

The combination of 5-fluorouracil (5-FU) and folinic acid (FA) has demonstrated activity in most gastrointestinal tumors. The addition of epirubicin (EPI) may increase the efficacy of the combination for cancers of the upper gastrointestinal tract, such as advanced pancreatic cancer. We examined two groups of patients, explaining the potential benefits and limitations of therapy, and those patients who agreed to undergo chemotherapy formed Group A and the remaining formed Group B. Therefore, the study was a non-randomized prospective comparison between patients receiving chemotherapy and those offered the best supportive care. Group A consisted of 42 patients; 19 underwent Roux-en-Y operation, and 23 were inoperable. Group B consisted of 48 patients who refused chemotherapy; 18 underwent Roux-en-Y operation, and 30 were considered inoperable. Chemotherapy consisted of FA 200 mg/m2/day, 5-FU 600 mg/m2/day both for 5 days, and EPI 35 mg/m2/day before FA-5-FU administration on days 1 and 2, every 28 days. All patients were evaluable for response and toxicity. Objective tumor responses (partial responses) in Group A were seen in 8 patients (19%) (6 women and 2 men), and 6 (14%) had stable disease. The estimated median survival was 27.6 weeks (mean 27.5) for Group A and 22.5 weeks (mean 24) (p=0.01) for Group B. From the onset of therapy, median duration of response was 16.6 weeks and median time to progression 11.8 weeks in Group A. Toxicity consisted primarily of myelosuppression, nausea and vomiting, diarrhea, alopecia, and mucositis. In Group A 12/42 patients became free from pain for a median duration of 10 months, 14/42 had improved appetite, and 15/42 had improved performance status in comparison to Group B, where no patients had improved performance status or symptoms. We conclude that the combination of EPI+FA+5-FU has moderate activity and increased toxicity in the treatment of advanced pancreatic cancer.

A comparative study of three variations of the learning vector quantizer in the discrimination of benign from malignant gastric cells

A prospective study was undertaken to investigate the potential value of morphometry and artificial neural networks (ANN) for the discrimination of benign and malignant gastric lesions. Two thousand five hundred cells from 23 cases of cancer, 19 cases of gastritis and 58 cases of ulcer were selected as a training set, and an additional 8524 cells from an equal number of cases of cancer, gastritis and ulcer were used as a test set. Images of routine processed gastric smears stained by the Papanicolaou technique were processed by a custom image analysis system. The application of the learning vector quantization (LVQ) classifier enabled correct classification of > 97% of benign cells and > 95% of malignant cells, obtaining an overall accuracy of > 97%. This study presents the capabilities of ANN, and also indicates that ANN and image morphometry may offer useful information on the potential of malignancy in gastric cells.

Clostridium difficile colitis associated with a 'triple' regimen, containing clarithromycin and metronidazole, to eradicate Helicobacter pylori

We describe a 54-year-old man with Helicobacter pylori (+) duodenal ulcer who developed Clostridium difficile associated colitis, 5 days after commencing a 'triple' regimen consisting of omeprazole 20 mg b.d., metronidazole 500 mg b.d. and clarithromycin 500 mg b.d., to eradicate H. pylori. Despite the fact that oral metronidazole did not prevent the disease, the patient did well after treatment with oral metronidazole plus a yeast preparation (Saccharomyces bulardii). No relapse occurred.

One-week therapy with omeprazole, clarithromycin and metronidazole or ornidazole, followed by 3 weeks' treatment with omeprazole, eradicates Helicobacter pylori equally and heals duodenal ulcer

OBJECTIVE

To estimate and compare the efficacy of 'triple' 1-week regimens--omeprazole, clarithromycin and a nitroimidazole (metronidazole or ornidazole)--followed by omeprazole, for an additional 3 weeks, on Helicobacter pylori eradication and duodenal ulcer (DU) healing, in a country with a high resistance rate of H. pylori to metronidazole.

DESIGN

Open, prospective, two-centre study.

METHODS

Patients older than 18 years with active duodenal ulcer (DU), diagnosed by endoscopy and found to be infected with H. pylori (modified Giemsa stain and CLO test, Delta West, Australia), were included in the study. Three triple-drug regimens, given for 7 days, were used. (1) omeprazole (Om) 20 mg once a day, plus clarithromycin (Cl) 250 mg twice daily, plus ornidazole (Or) 500 mg twice daily (O1COr); (2) Om 20 mg twice daily, plus Cl 250 mg twice daily, plus Or 500 mg twice daily (OCOr); and (3) Om 20 mg twice daily, plus Cl 250 mg twice daily, plus metronidazole (M) 500 mg twice daily (OCM). Two hundred and three consecutive H. pylori-positive patients were included in the study, randomly assigned as follows: 50 patients (group A1: 32 men, 18 women, age 23-77 years) on O1COr; 47 patients (group A2: 29 men, 18 women, age 27-77 years) on OCOr; and 106 (group B: 71 men, 35 women, age 18-83 years) on OCM. Ulcer healing and H. pylori eradication were assessed endoscopically, 8-9 weeks after the start of treatment. H. pylori was considered eradicated if both histology and rapid urease test (six biopsies, antrum-body) were negative.

RESULTS

Eleven patients were lost to follow-up; 192 patients were analysed. Group A1: 48; group A2: 44; group B: 100. 'Per-protocol' analysis: H. pylori eradication, 90-93% (P = 0.901); ulcer healing, 90-98% (P = 0.300). 'Intention to treat' analysis: H. pylori eradication, 85-88% (P = 0.887); ulcer healing, 86-91% (P = 0.657). Compliance was excellent, no serious side effects were observed and no patients withdrew due to side effects.

CONCLUSIONS

No differences were observed in the H. pylori eradication and the healing rate among the groups. It seems that twice daily omeprazole is no better than single daily dosage and that ornidazole is as effective as metronidazole. In addition, in the studied population which is believed to have a high prevalence of metronidazole resistance, all the regimens used were effective.

High eradication rate of Helicobacter pylori using a four-drug regimen in patients previously treated unsuccessfully

The objective of this study was to assess the efficacy of a new regimen in eradicating Helicobacter pylori (Hp) in patients with duodenal ulcer (DU) who were previously treated unsuccessfully with standard triple therapy (tripotassium dicitratobismuthate [TDB] 120 mg QID, metronidazole 500 mg TID, and tetracycline 500 mg QID) or proton-pump inhibitor (PPI) dual therapy (omeprazole 20 mg BID and amoxicillin 500 mg QID). The study included 133 consecutive patients aged 17 to 83 years with endoscopically diagnosed DU (diameter > or = 5 mm) in whom standard triple therapy or PPI dual therapy had failed to eradicate Hp. A rapid urease (CLO) test was performed on four biopsy specimens at study entry and at least 1 month after the end of treatment to confirm Hp colonization and eradication, respectively. Patients were considered to be Hp positive if any CLO test was positive within 2 hours, and Hp was considered to be eradicated if all CLO tests were still negative after 24 hours. In 31 randomly selected patients, Hp eradication was confirmed histologically as well. Patients were given omeprazole 60 mg/d (20 mg in the morning and 40 mg in the evening) plus amoxicillin 500 mg QID for 10 days and subsequently were given metronidazole 500 mg TID for 10 days plus TDB 120 mg QID for 6 weeks. One hundred and twenty-four patients were followed up; five (4%) withdrew because of side effects (protracted diarrhea, stomatitis, skin rashes). Per-protocol analysis showed Hp eradication in 113 of 119 patients (95%) and ulcer healing in 118 of 119 (99%). Intent-to-treat analysis showed an Hp eradication rate of 85% (113 of 133 patients) and an ulcer healing rate of 89% (118 of 133 patients). In per-therapy analysis, the Hp eradication rate was 91% (113 of 124 patients), and the ulcer healing rate was 95% (118 of 124 patients). Side effects were observed in 39 of 119 patients (33%) and were generally mild. The four-drug regimen used in this study, when given to patients previously treated unsuccessfully with standard triple therapy or PPI dual therapy, was highly effective in eradicating Hp and healing DUs and had no major side effects.

Chronic granulocytic leukemia in a patient with ankylosing spondylitis and ulcerative colitis: an interesting association

Chronic granulocytic leukemia in a 59-year-old man with ankylosing spondylitis and ulcerative colitis is described. Ankylosing spondylitis was confirmed at age 28 years and ulcerative colitis at age 49 years. Etiologic considerations and a brief review of the literature are presented.

Comparative study of artificial neural networks in the discrimination between benign from malignant gastric cells

OBJECTIVE

To compare the accuracy of two different artificial neural networks (ANNs) for the discrimination of benign and malignant gastric lesions using morphometric and textural data on the nucleus.

STUDY DESIGN

Three thousand cells from 30 cancer cases, 26 cases of gastritis and 64 cases of ulcer were selected as a training set, and an additional 10,300 cells from equal cases of cancer, gastritis and ulcer were used as a test set using two different neural net architectures: back propagation (BP) and learning vector quantizer (LVQ). Images of routinely processed gastric smears stained by the Papanicolaou technique were processed by a custom image analysis system.

RESULTS

Application of the BP and three variations of the LVQ established correct classification of more than 97% of the benign cells and more than 95% of the malignant cells, obtaining an overall accuracy of more than 97%.

CONCLUSION

This study not only presents a comparative study of the abilities of ANNs but also indicates that the use of ANNs and image morphometry may offer useful information on the potential of malignancy of gastric cells.

Gastric epithelial polyps: a retrospective endoscopic study of 12974 symptomatic patients

This is a retrospective endoscopic study on the incidence of gastric epithelial polyps (adenomas, hyperplastic, inflammatory) in 12,974 consecutive symptomatic Greek adults submitted to endoscopy during a 4-year period, in two endoscopy units. A total of 258 polyps were found in 157 patients (1.2%), 80 males and 77 females (age: 22-87 years); 67.5% of these patients were older than 60 years. Two hundred and two (202) polyps were totally removed. In 43 patients (27%), more than one polyp was found. Polyps were mainly hyperplastic (75.6%). Adenomas were found in 6.6%, and only in patients older than 50 years. Hyperplastic and inflammatory polyps were equally distributed in males and females. A male predominance was observed in adenomas (2:1). Most of the polyps were in the antrum (43.8%) and were hyperplastic (75.2%). Of 501 previously operated patients (gastrectomy or gastrojejunostomy), 26 (5.2%) had polyps. No adenomas were seen in the anastomosis area. Most of the polyps (61.9%) were smaller than 0.5 cm; 13.3% were greater than 1 cm. No coincidence of polyps with gastric cancer was observed.

Potential of the back propagation neural network in the discrimination of benign from malignant gastric cells

OBJECTIVE

To investigate the potential value of morphometry and the back propagation neural network for the discrimination of benign and malignant gastric lesions.

STUDY DESIGN

The study group consisted of 23 cases of cancer, 19 of gastritis and 58 of ulcer. Images of routinely processed gastric smears stained by the Papanicolaou technique were processed by a custom image analysis system. Analysis of the images gave a data set of 11,024 cells. Two different neural net architectures were used to classify benign from malignant cells based on the extracted morphometric and textural features. The data from 2,500 randomly selected cells were used as a training set, and the data from the remaining 8,524 cells were applied as a test set.

RESULTS

Application of the back propagation neural network permitted the correct classification of 97.6% of benign cells and 95% of malignant cells with overall accuracy 97.3%.

CONCLUSION

These results indicate that neural networks and image morphometry may offer useful information about the potential for malignancy in gastric cells.

Cisapride, metoclopramide, and ranitidine in the treatment of severe nonulcer dyspepsia

Cisapride, a prokinetic drug with a novel mechanism of action, was compared with another prokinetic drug, metoclopramide, and an H2-blocker, ranitidine, in the treatment of nonulcer dyspepsia. In a double-blind study, 60 patients with severe dyspeptic symptoms received cisapride 5 mg TID, metoclopramide 10 mg TID, or ranitidine 150 mg BID for 8 weeks. Symptoms were evaluated during treatment and 4 weeks after the end of therapy. All three drugs effectively controlled the symptoms of chronic functional upper gastrointestinal tract disorders. The prokinetic drugs, particularly cisapride, were significantly better than ranitidine in controlling symptoms, especially reflux symptoms. All three drugs were generally well tolerated; cisapride in particular was associated with fewer adverse effects.

Ranitidine and antacids in the prevention of duodenal ulcer relapse in Greece

The present study was undertaken to compare the efficacy of ranitidine 150 mg/nocte with that of antacids taken "on demand" in the prevention of recurrence of duodenal ulcer (DU). Two groups (A, B) of patients with DU recently healed by ranitidine or antacids were studied. Patients of Group A (110) healed by ranitidine were put on maintenance treatment with ranitide, and patients of Group B (32) healed by antacids were given antacids "on demand" for a period of one year. Endoscopy was performed at the end of the 6th and 12th months, as well as whenever symptoms appeared. Patients were followed up clinically at 2-month intervals. Relapse rates of 11% (group A) and 34% (group B) were found at the end of the 6th month, (p less than 0.005), while the total relapse rates at the end of the 12th month were 19% and 47%, respectively (p less than 0.005). Recurrences were asymptomatic in 62% (Group A) and 27% (Group B) of patients. No significant side effects were observed. It is concluded that ranitidine 150 mg nocte is significantly superior to antacids "on demand" as far as the recurrence of DU is concerned.