Association of erosive esophagitis with Helicobacter pylori eradication: a role of salivary bicarbonate and glycoprotein secretion

In some populations, Helicobacter pylori eradication is associated with development of erosive esophagitis. The aim of this study was to evaluate the contribution of salivary bicarbonate and glycoprotein secretion to the pathogenesis of erosive esophagitis developing after H. pylori eradication. Gastroscopy and saliva collection were performed at recruitment and 12 months after completion of eradication therapy. Eighty-eight patients with duodenal ulcer were recruited to the study. Erosive esophagitis was found in 13 patients (grade A, 8 patients; grade B, 4 patients; grade C, 1 patient). Among the 74 subjects who completed the study, erosive esophagitis was detected in 21 patients (grade A, 15 patients; grade B, 6 patients); they all were successfully eradicated. Bicarbonate and glycoprotein secretion was not found to differ significantly between the subjects with and without erosive esophagitis both before and 1 year after H. pylori eradication. However, it was lower in H. pylori-infected (baseline) than in H. pylori-noninfected erosive esophagitis subjects (1 year after successful eradication) (bicarbonate 2.34 [1.29-3.40)]vs. 3.64 [2.70-4.58]micromol/min and glycoprotein 0.23 [0.15-0.31]vs. 0.35 [0.28-0.43] mg/min, P= 0.04 and P= 0.04, respectively). We conclude that changes in salivary bicarbonate and glycoprotein secretion related to H. pylori eradication do not promote the development of erosive esophagitis in duodenal ulcer patients.

Smoking habit and gastritis histology

PURPOSE

Long-term cigarette smoking may increase the risk of digestive tract pathologies, however, what is the influence smoking habit on gastric mucosa histology is still poorly elicited. The aim of the study was to compare histological evaluation of gastritis in smoker and non-smoker groups.

MATERIAL AND METHODS

A total of 236 patients of various H. pylori status (109 infected, 127 non-infected), clinical diagnosis (107 duodenal ulcer disease, 129 dyspepsia), and smoking habit (92 smokers, 144 non-smokers) were included. Subjects were classified as smokers if they smoked 5 or more cigarettes per day for at least 3 years. A histological examination of endoscopically obtained samples was performed by two experienced pathomorphologists blinded to the diagnoses and smoking habit. Microscopic slices of the gastric mucosa were stained with hematoxylin-eosin and Giemsa. Apart from histological diagnosis, H. pylori status was additionally confirmed by an urease test (CLO-test) at least in one of two gastric locations (antrum or corpus).

RESULTS

In the H. pylori infected population, H. pylori density, neutrophils, and mononuclear cells infiltration in the gastric corpus mucosa were lower in smokers than non-smokers, while in the antrum the differences were not significant. In the non-infected population, no significant differences in neutrophils and mononuclear cells infiltration between smokers and non-smokers were found.

CONCLUSIONS

Since the significant differences in studied parameters of chronic gastritis between smokers and non-smokers were found in the corpus mucosa of H. pylori infected subjects, smoking should be taken into account when a histological evaluation of the gastric mucosa in the H. pylori infected population is performed.

Mucosal gastrin cells and serum gastrin levels in children with Helicobacter pylori infection

PURPOSE

Impaired control of gastric juice secretion is observed in chronic gastritis due to Helicobacter pylori (H. pylori) infection. G cells are stimulated by such cytokines as tumor necrosis factor (TNF-alpha), interferon gamma (IFN-gamma) and interleukin-8 (IL-8). The number of D cells producing somatostatin decreases simultaneously. An increase in gastrin levels could also depend on alkalization in G cell environment caused by bacterial urease. The aim of the study was to evaluate G cell counts in the antrum and gastrin levels in the serum of children with H. pylori infection and after bacterium eradication.

MATERIAL AND METHODS

The study was performed in 106 patients. Children were divided into 3 groups with regard to the presence and course of H. pylori infection. Fifty nine children (55.7%) had chronic gastritis in the course of H. pylori infection with a positive titre of antibodies in IgG class against H. pylori; 29 children (27.3%) with past H. pylori infection, without bacterium colonization and gastritis but with a positive titre of antibodies in IgG class against H. pylori; 18 children (17%) with functional disorders of the gastrointestinal tract but without H. pylori infection.

RESULTS

The quantitative analysis of gastrin cells in the antral mucosa of children performed by immunohistochemical method showed the highest gastrin cell count in group I with H. pylori infection (112.1 +/- 58.9 cell/mm2) and in group II with past H. pylori infection (105.3 +/- 73.1 cell/mm2). The serum gastrin level (92.9 +/- 41.6 microU/ml) was the highest in children with H. pylori infection. In controls, it was 70.0 +/- 15.3 microU/ml and could be compared to the results of children with past H. pylori infection.

CONCLUSIONS

1. The H. pylori infection plays a significant role in the stimulation of G cells increase and gastrin release in the blood serum in children. 2. The eradication of H. pylori infection is probably a main factor in gastric secretion down-regulation during gastritis in children.

Peptic ulcers and oral health status

PURPOSE

Helicobacter pylori infection plays a crucial role in pathogenesis of peptic ulcers; however, among infected individuals only a small percentage will develop peptic ulcers at any time during their life. This low virulence suggests that many additional factors beside H. pylori are implicated in pathogenesis of the disease. The aim of the study was to determine whether there is a relationship between the prevalence of peptic ulcers and oral health status.

MATERIAL AND METHODS

The evaluation of dental status was performed in H. pylori infected population. The study involved 93 peptic ulcer patients (77 duodenal ulcer, 16 gastric ulcer) with ulcer niche not related to non-steroidal anti-inflammatory drugs (NSAIDs) consumption and 93 gender and age matched dyspeptic controls. H. pylori infection was determined in endoscopically taken slices from gastric mucosa with two methods (CLO-test and histology).

RESULTS

Both in duodenal and gastric ulcer patients, the number of filled teeth was lower and debris index was higher than in controls, the number of decayed teeth was also higher in gastric ulcer patients. The number of natural teeth, number and type of prosthetic restorations, as well as the periodontal index, did not differ between the ulcer and control groups. Poor oral health in patients with peptic ulcers corresponded with education level, smoking habit, and visits to the dentist.

CONCLUSIONS

Poor oral health is associated with the prevalence of peptic ulcers not related to NSAIDs consumption, but it appears doubtful that it is a significant pathogenetic factor in ulcer disease.

Helicobacter pylori infection and mast cells of the antrum mucosa

The studies aimed at evaluating mast cells in inflammatory infiltration of gastric mucosa in children with H. pylori infection, as well as in those after the infection eradication. Biopsy specimens of gastric mucosa were evaluated, the specimens collected from 59 H. pylori-positive patients (Group I), 29 patients after H. pylori infection (Group II) and 18 H. pylori-negative children (Group III). The specimens were assessed for infection and inflammation and stained with anti-human mast cell tryptase to count mucosal mast cells. The evaluations of histopathological changes in the antrum mucosa of the children were performed, according to Sydney's Classification. In morphometric evaluation, slight differences were found in the numbers of mast cells among Groups: I, II and III of the examined children (the number of mastocytes being: 86.4, 81.4 and 70.2 cells/mm2 of specimen, respectively).

Evaluation of proliferating markers Ki-67, PCNA in gastric cancers

Tumours from 45 patients with advanced gastric cancer were assessed by immunohistochemistry. Tissue sections were fixed in 10% buffered formaldehyde solution, embedded in paraffin and stained immunohistochemically with anti-human Ki-67 and PCNA antibodies. No correlation was found between Ki-67, PCNA protein expression, the age of patients and the localization of tumour. A significant, positive association was observed between the expression of Ki-67, PCNA and tumour differentiation and Lauren's classification. Also a strong correlation was found between lymph node involvement and the expression of Ki-67 protein. These data suggest that the expression of Ki-67, PCNA proteins were closely connected with the high grade of tumour malignancy.

Cytotoxic lymphocytes (CD8+) in the antrum mucosa in children with chronic Helicobacter pylori-related inflammation before and after bacteria eradication

The authors assessed the expression of cytotoxic CD8 lymphocytes in the antrum mucosa of children with chronic Helicobacter pylori-related inflammation, before and after bacteria eradication. Biopsy specimens of gastric mucosa were evaluated in specimens, collected from 59 H. pylori-positive patients (Group I), 29 patients after H. pylori infection (Group II) and 18 H. pylori-negative children (Group III). The obtained specimens were assessed for infection and inflammation and the expression of CD8+ lymphocytes was estimated, using monoclonal antibodies. The number of CD8+ lymphocytes in the mucosa was counted. The results of the study showed an increase in the expression of CD8+ lymphocytes in children with H. pylori infection, in comparison to the values in children after bacteria eradication. The increased expression of CD8+ lymphocytes correlated with the severity degree of antrum gastritis.

Effects of changes at the site of E-cadherin expression as an indicator of colon cancer aggressiveness

The aim of the work was to study the effects of changes in the location of E-cadherin from membrane to cytoplasm and the appearance of metastases and recurrence in patients with colon cancer of pT1 grade. The study group consisted of 34 patients with colon cancer. The material was fixed in 10% buffered, directly following surgery, fixed in fonnaldehyde and embedded in paraffin blocks by a standard method. Immunohistochemical reactions were performed, using monoclonal E-cadherin antibodies (Novocastra, NCL-E-Cad). Statistical analysis did not show any relation between the change in the location of E-cadherin expression, the patients' sex, and the location of changes. Simultaneously, we observed a strong relationship between the presence of exudate in the vessels from cancer cells, the histological grade and the loss of E-cadherin expression in the main tumour mass (p<0.01). We also noted a statistically significant correlation between the presence of lymph node invasion and distant metastases and the E-cadherin cytoplasmic reaction (p=0.0001, p=0.000001, respectively). A borderline significance of p=0.06 was noted in the association between the appearance of recurrence at the postoperative site and the change in location of E-cadherin expression in the main tumour mass from cytoplasm to membrane. On the basis of our results, we can conclude that a change in the location of E-cadherin expression (from membrane cytoplasm) is strongly associated with an increased aggressiveness of CRC, which is related to the appearance of proximal and distant metastases and to recurrence at the postoperative scar.

Gastric acid and salivary bicarbonate. Is there a relationship in duodenal ulcer patients?

PURPOSE

Since saliva protects the oesophageal and oral mucosa against hydrogen ions, the aim of the study was to establish the relationship between the secretion of gastric acid and salivary bicarbonate.

MATERIAL AND METHODS

The study involved 43 Helicobacter pylori positive duodenal ulcer patients receiving: 1. omeprazole alone (O), 2. omeprazole and amoxicillin (OA) or 3. omeprazole, amoxicillin and tinidazole (OAT). In each study group the examination was performed twice, before and at the end of a two-week treatment, both under basal conditions and during a gastric secretory test with pentagastrin. Concentrations of gastric hydrogen ions and salivary bicarbonate were evaluated by the titration method.

RESULTS

In all therapeutic groups analysed separately, the secretion of gastric acid as well as salivary bicarbonate decreased at the end of the treatment, however only in OA and OAT groups the differences in bicarbonate reached statistical significance. As the changes in the concentration and output of both salivary bicarbonate and gastric acid had the same direction, the three therapeutic groups (O, OA, OAT) were subjected to combined analysis. It showed that under basal conditions and during stimulation with a gastric catheter or catheter and pentagastrin, bicarbonate concentration and output were higher before than at the end of the treatment. However, no direct correlation between gastric acid secretion and salivary bicarbonate was found in groups subjected to either separate or combined analysis.

CONCLUSIONS

The results of our study provide evidence for the partial involvement of hydrogen ions of gastric origin in the regulation of salivary bicarbonate secretion in duodenal ulcer patients.

Memory cells in the antral mucosa of children with Helicobacter pylori infection

A total of 106 patients, included in the study, were divided into three groups with regard to Helicobacter pylori infection. Endoscopy and histopathological examination of the stomach, based on the Sydney's System, were performed in all the children. CD45RA and CD45RO cells were identified by means of specific antibodies in the inflammatory infiltrate of the antral mucosa. An increased expression of CD45RO and CD45RA lymphocytes was reported, basing on the results of the study.

C-erb-B2 and Bcl-xl protein expression in Barrett's oesophagus in correlation with morphological parameters

The aim of the study was to evaluate the correlation of c-erb-b2 and Bcl-xl expression in biopsy specimens of Barrett's oesophagus from 44 patients with morphological features. The examined group was subdivided into: negative for dysplasia, indefinite for dysplasia, positive for dysplasia-low grade, and adenocarcinoma with high grade dysplasia. Positive c-erb-B2 staining was found in 34.1% and Bcl-xl protein expression was observed in 96.9% of BE. The results showed increased c-erb-B2 and Bcl-xl protein expressions with progressive grades of dysplasia to adenocarcinoma. In conclusion, an evaluation of c-erb-B2 and Bcl-xl expression can be useful for the histopatologic diagnosis of BE and correct interpretation of dysplasia.

B (CD20+) lymphocytes in the antrum mucosa of children with Helicobacter pylori infection

The aim of the study was to estimate the expression of CD20+ lymphocytes in the antrum mucosa in children, infected with Helicobacter pylori and after bacteria eradication. Biopsy specimens of gastric mucosa were the specimens, collected from 59 H. pylori-positive patients (Group I), 29 patients after H. pylori infection (Group II) and 18 H. pylori-negative children (Group III). The collected specimens were assessed for infection and inflammation and the expression of CD20+ lymphocytes was estimated, using mice monoclonal antibodies. The expression of CD20+ lymphocytes in the inflammatory infiltrate of the antrum mucosa correlated with the severity of gastritis, found in children with Helicobacter pylori infection and was the highest in comparison with the group of children after H. pylori eradication.

Macrophages of the antral mucosa in children with Helicobacter pylori infection and after eradication

Our study included 59 children, aged 12.2 +/- 4.6 years, with Helicobacter pylori infection and 29 children, aged 11.0 +/- 4.2 years, with past H. pylori infection after spontaneous eradication with positive IgG antibodies against H. pylori and with functional disorders of the gastrointestinal tract, without H. pylori infection, with normal IgG concentration against H. pylori. All biopsy specimens from each of the study groups were stained by an immunohistochemical method for the evaluation of CD68+ macrophages in the antral mucosa. Histopathological changes in the antral mucosa of children with Helicobacter pylori are characterized by an increased infiltrate of macrophages, dependent on the severity grade of inflammation.

Evaluation of protein products of cell cycle regulating genes in gastric cancer

Formalin fixed, paraffin embedded tissue samples of 45 gastric carcinomas, resected curatively, were used for the study. An immunohistochemical analysis employed monoclonal antibodies: p53 (No N1581, DAKO) and p27KIP1 (NCL-p27KIP1, Novocastra). Positive nuclear protein expression was assessed at the 30% level. We found no correlations between the expression of either protein and Lauren's classification, the age of patients and tumour localization. Borderline significance of p=0.07 was noted in the association of p53 expression and histological differentiation. However, a decrease of p27 expression and an overexpression of p53 correlated with the presence of lymph node metastases (p<0.01). Simultaneously, the expression of p27 protein in main mass of tumour correlated with the lack of p53 expression in the main mass and lymph node metastases.

Peripheral blood lymphocyte population in children infected with Helicobacter pylori

PURPOSE

Helicobacter pylori infection in children is associated with a chronic inflammatory process of gastric and duodenal mucosa, which may have a various clinical course ranging from asymptomatic and chronic inflammatory condition to gastric ulceration. The immune system may contribute especially to chronic gastric mucosa inflammation. The aim of our study was to assess the levels of peripheral blood T (CD3+, CD4+, CD8+) and B lymphocyte subpopulation (CD19+) in children with Helicobacter pylori infection and to evaluate their relation to degree of antrum mucosa inflammation.

MATERIAL AND METHODS

The study was performed in 32 children aged 7-18 years, hospitalized due to dyspeptic symptoms. The endoscopic examination of upper gastrointestinal tract was performed and gastric and duodenal mucosa was estimated in all patients. The endoscopic and histological evaluation of gastric mucosa was performed according to the Sydney System [4]. The urease test (CLO-test-H. pylori) was made to estimate the severity of the infection.

RESULTS

Moderate antrum mucosa inflammation was found in 41.2% of the examined. The highest percentage of children (58.8%) presented marked inflammation. No mild inflammation was found in children examined.

CONCLUSIONS

No correlation was found between lymphocyte levels and the degree of the inflammatory changes in antrum mucosa. The evaluation of peripheral blood lymphocytes performed in children with Helicobacter pylori infection suggests that T lymphocytes may play a predominant role in this infection.

Comparative evaluation of gastric mucosa morphological changes in children and adults with positive IgG antibodies to Helicobacter pylori

PURPOSE

Helicobacter pylori colonization of gastric epithelium causes a local and systemic, cellular and humoral immune response. Despite this immune response involvement in the infection, its elimination from the organism does not take place and the process usually becomes chronic. The purpose of the study was to establish the prevalence of gastric mucosa inflammation in children and adults with serum positive anti-Helicobacter pylori antibodies IgG.

MATERIAL AND METHODS

The study included 171 patients comprising 109 (63.7%) children and 62 (36.3%) adults with IgG positive titre against Helicobacter pylori, who were qualified to the study basing on epidemiological examinations estimating the prevalence of Helicobacter pylori infection in the population of north-eastern Poland living in the country, town and city. All patients reported dyspeptic symptoms. The evaluation was performed basing on the morphological (endoscopy) and histopathological examinations estimating the changes in gastric mucosa of these patients.

RESULTS

The evaluation of antrum and corpus gastric mucosa proved normal gastric mucosa in 34 children (31.1%) and 10 adults (16.1%) with positive IgG antibodies against Helicobacter pylori. The evaluation of the severity showed the predominance of moderate inflammation within corpus in children (37.6%) and marked inflammation in adults (45.1%).

CONCLUSIONS

The concentration of IgG antibodies against Helicobacter pylori in both groups was highest in patients with marked antrum gastric mucosa inflammation.

Adenosine deaminase activity in the gastric mucosa of duodenal ulcer patients in relation to the severity of chronic gastritis and gastric acid secretion

Earlier reports suggested that adenosine deaminase activity in the gastric corpus mucosa depends upon either gastric acid secretion or severity of chronic gastritis. Knowing that gastric acid secretion corresponds well with histological status of the gastric mucosa, the aim of this study was to determine the enzyme activity in relation to these two factors evaluated simultaneously. The study was conducted on Helicobacter pylori positive duodenal ulcer patients treated for two weeks with either omeprazole alone or omeprazole in combination with amoxycillin and tinidazole. It was found that these two therapeutic regimens decreased adenosine deaminase activity only in the gastric corpus mucosa and a decline was more deeper in patients on omeprazole monotherapy. Moreover, omeprazole monotherapy inhibited completely basal gastric acid secretion and did not change the severity of chronic gastritis, while omeprazole-based eradication therapy decreased both the gastric acid secretion and severity of chronic gastritis. One month after completion of eradication therapy adenosine deaminase activity returned to the pretreatment values but severity of chronic gastritis decreased further. The results of the present study indicate that adenosine deaminase activity in the gastric corpus mucosa depends primarily upon gastric acid secretion but not upon the severity of Helicobacter pylori associated chronic gastritis.

Bone marrow failure and hematological abnormalities in alcoholic liver cirrhosis

Long term alcohol abuse may result in bone marrow damage and hematologic abnormalities. In the study we evaluated bone marrow and peripheral blood changes in patients with alcoholic cirrhosis. Although majority of the patients (91%) presented with hematologic abnormalities such as leukopenia, thrombocytopenia, low hemoglobin level, only mild alterations in bone marrow were observed. The hematopoietic tissue was of high cellularity with features of activation and moderate myelofibrosis.

[Dental status and efficacy of Helicobacter pylori eradication]

Beside stomach Helicobacter pylori can colonize the oral cavity. One may think, therefore, that if H. pylori persists the eradication therapy in the oral cavity, it could infect the stomach again. Since in the oral cavity H. pylori occurs most frequently in a dental plaque gathering on teeth, the aim of the study was to investigate whether the natural teeth status is important for the efficacy of H. pylori eradication. The study was conducted on 45 peptic ulcer patients with natural teeth. They were eradicated with one of two regimens: 1/OAT-omeprazole (2 x 20 mg), amoxicillin (2 x 1000 mg), tinidazole (2 x 500 mg) (14-day course), 2/OAC-omeprazole (2 x 20 mg), amoxicillin (2 x 1000 mg), clarithromycin (2 x 250 mg) (7-day course). Dentistry examination was performed 4-6 weeks after the end of eradication therapy and consisted of determination of the number of teeth, caries index, dental treatment index, plaque index, and periodontal index. It was found that in successfully eradicated patients with OAT regimen, the number of teeth was higher and caries index lower than in those whose eradication therapy was unsuccessful; 24.8 +/- 5.2 vs 15.5 +/- 8.6 (p < 0.01) and 31.4% vs 46.0% (p < 0.01), respectively. The number of teeth and caries index were not associated with the efficacy of H. pylori eradication in OAC treated group. Irrespectively of the eradication regimen used, OAT or OAC, dental treatment index, plaque index, and periodontal index were not associated with the efficacy of H. pylori eradication. It is concluded that the natural teeth status may have influence on the outcome of H. pylori eradication. One should remember about this prescribing drugs for H. pylori eradication.

Omeprazole therapy and salivary flow rate in duodenal ulcer patients

BACKGROUND

Previous reports have shown that in some reflux-oesophagitis patients omeprazole therapy alters salivary secretion. The aim of the study was to examine this effect in duodenal ulcer patients.

MATERIAL AND METHODS

Thirty nine Helicobacter pylori positive subjects of both sexes, predominantly men, were recruited for the study. They were taking for two weeks only omeprazole (n = 17), or omeprazole in combination with either amoxycillin or amoxycillin and tinidazole (n = 22). Salivary secretion was assessed before and at the end of the treatment, both in basal conditions and during a gastric secretory test. Gastric secretion was monitored concurrently with salivary flow rate. Additionally gastritis score and serum gastrin levels were assessed.

RESULTS

Basal salivary secretions remained unchanged in patients on omeprazole monotherapy, but decreased in five of eight saliva collection periods in patients on eradication regimens. During the gastric secretory test, salivary secretions fell in both groups, but only after pentagastrin stimulation (in one collection period in patients on omeprazole, and in three collection periods in patients on eradication therapy). The observed changes in salivary secretion were inversely related to the pre-treatment gastric pH values.

CONCLUSION

The influence of omeprazole and omeprazole-based eradication therapies on salivary flow rate is presumably secondary to changes in gastric pH values and is likely to be related to oesophago-salivary reflex generation.

[Mast cells in chronic gastritis of children]

Mast cell involvement in chronic gastritis in children was analyzed. 25 children with normal mucosa (controls), 20 children with chronic gastritis and 28 children with chronic gastritis and infected Helicobacter pylori were included to the study. Bioptic material from antrum and corpus of the stomach were stained with toluidine blue and anti-human mast cell tryptase to evaluate mast cell density. Changes in mast cells number were also estimated in 7 children before and after successful eradication of Helicobacter pylori infection. Mast cell density was significantly greater in children with chronic gastritis with or without Helicobacter pylori infection when compared to the controls. Mast cell degranulation was demonstrated by electron microscopy in children with chronic gastritis and infected Helicobacter pylori. Mast cell through it's numerous mediators may play a key role in chronic gastritis especially when Helicobacter pylori infection is present.

[The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication]

None of the drug regimens used to treat H. pylori infection ensures 100% of efficacy. One may think therefore that among factors modifying H. pylori eradication there are also cigarette smoking and alcohol consumption. The aim of the study was to determine the influence of cigarette smoking and alcohol consumption on efficacy of H. pylori eradication. The study was conducted on 142 H. pylori positive peptic ulcer patients treated with either OAT-omeprazole (2 x 20 mg), amoxycillin (2 x 1000 mg), tinidazole (2 x 500 mg) (69 patients) or OAC-omeprazole (2 x 20 mg), amoxycillin (2 x 1000 mg), clarithromycin (2 x 250 mg) (73 patients). Detailed information on smoking and drinking habits was obtained from a questionnaire fulfilled by all subjects. Patients were defined as smokers if smoked 5 or more cigarettes per day and as drinkers if drank 25 g or more alcohol per week. To enter the study patients had to have confirmed H. pylori infection by two tests (CLO-test and histology). Eradication was considered successful if both tests gave negative results 4-6 weeks after the cessation of treatment. The efficacy of H. pylori eradication was similar in both groups (OAT--69.6%, OAC--78.1%). Patients who smoked cigarettes had lower rate of H. pylori eradication in OAC group (smokers 65.8%, non-smokers 91.4%, p < 0.01), while patients who drank alcohol had higher eradication rate in OAT group (drinkers 85.2%, non-drinkers 59.5%, p < 0.05). When two factors (smoking, drinking) were analyzed together, it was found that in drinkers treated with OAT, smoking did not change the efficacy of H. pylori eradication, while in non-drinkers decreased by two times (75.0% vs 38.9%, p < 0.02). In drinkers treated with OAC, smoking did not change the efficacy of H. pylori eradication (but this was likely related to the limited number of patients), while decreased it in non-drinkers from 90.0% to 65.2% (p < 0.05). When two groups were analyzed together (OAT + OAC), the lowest efficacy of H. pylori eradication exhibited smokers who do not drink (53.7%) followed by smokers who drink (75.8%), non-smokers who do not drink (83.3%) and non-smokers who drink (92.9%); in each case the efficacy of eradication was higher than in smokers who do not drink (p < 0.05, p < 0.01, p < 0.01, respectively). Both cigarette smoking and alcohol consumption can affect the efficacy of H. pylori eradication. Smoking and drinking habits should be taken into account, when the set of drugs for H. pylori eradication is chosen.

[Mast cell of upper gastrointestinal tract mucosa and Helicobacter pylori infection in children]

Using histological, immunohistochemical and electron microscopic examinations of gastric and duodenal mucosa the authors showed the increase in the number of mast cells with ultrastructural changes characteristic of their degranulation in H. pylori infected children. The damage of various intensification in glandular and covering epithelial cells and the inflammatory response were also proved. The results suggest the role of mastocytes in the inflammation of gastric and duodenal mucosa in H. pylori infected children.

[Lymphocytic response of gastric and duodenal mucosa in Helicobacter pylori infection in children]

The authors evaluated morphologically gastric and duodenal mucosa in H. pylori infection in children. Fenotypic evaluation of T lymphocytes carried out in patients showed the increase in number of these cells in gastric antrum and corpus mucosa in comparison with controls according to the level of mucosal inflammation. B lymphocytes in inflamed gastric mucosa were dispersed as lamina propria infiltrates or in clusters (lymph nodules).

Evaluation of selected cytokines and mononuclear cell infiltration in gastric mucosa of children with food allergy

The authors performed simultaneous evaluation of histological changes in gastric and duodenal mucosa, phenotypic evaluation of mononuclear cells infiltration and the levels of selected cytokines of gastric mucosa in children with diagnosed food allergy. It was determined that IL-4, IL-5, IL-10 and TNF-alpha were produced locally within alimentary tract mucosa; they may play pathogenic role in food hypersensitivity in children. Increase in the number of T lymphocytes (CD3+, CD8+) and B lymphocytes (CD20+) as well as mastocytes with positive reaction to Mast Cell Tryptase-Mastocyte antibody was also observed in gastric and duodenal mucosa of these patients.

The gastrointestinal mast cell in health and disease

Mast cells are metachromatic cells found widely throughout the body. In gastrointestinal tract they reside particularly in mucosa having close contact with external environment. Their certain role in health and disease remains unclear. Mast cells seem to be involved in lots of allergenic and non-allergenic inflammatory events taking place throughout the gastrointestinal tract including IgE-dependent hypersensitivity reaction, gastritis with or without Helicobacter pylori infection, Crohn's disease, ulcerative colitis, irritable bowel syndrome. Mast cell involvement in certain inflammatory processes in gastrointestinal tract were reviewed.

Ultrastructural changes in rat hepatocytes in acute intoxication with 2,4-dichlorophenoxyacetic acid (2,4-D)

The hepatotoxic effect of 2,4-dichlorophenoxyacetic acid (2,4-D) was investigated. Ultrastructural changes were evaluated in transmission electron microscope. The experiment used 60 male Wistar rats divided into two groups: I--control-18 animals and II--42 animals which received chemically pure 2,4-D acid by gastric gavage in a dose of 200 mg/kg b.w. The animals were sacrificed after 12, 24, 48 hours and 4, 10 and 30 days of the experiment. The results obtained indicate that the administration of 2,4-D acid to rats in a dose inducing acute intoxication leads to ultrastructural changes in the liver, which suggest nonspecific reversible adaptative-type damage to parenchymal cells. The changes observed indicate disorders in energetic processes in hepatocytes and are morphological exponents of detoxicative processes there.

Histological diagnosis of gastritis based on Sydney System

The review of literature concerning gastritis, especially the chronic form has been carried out. Based on published data and own authors experience an application of the Sydney System in differential diagnosis of gastritis was presented.

Glycogen content in the gastric mucosa of partially resected stomach; a possible relationship with the development of cancer

Since gastric carcinoma, unlike uninvaded mucosa, has a relatively high glycogen content and the risk of gastric carcinoma is especially high in patients with a partially resected stomach, the aim of this study was to follow glycogen storage in both uninvaded gastric stump mucosa and carcinoma developing in the stump postsurgery performed for benign and malignant conditions. One hundred patients were recruited, including controls with non-operated stomachs (duodenal ulcer or gastric cancer patients). In endoscopically taken biopsies glycogen was determined by the anthrone method. It was found that the glycogen content in the gastric remnants was higher than in non-operated stomachs and increased with the time after surgery. It is possible that the risk of gastric cancer, which increases with the time from surgery, may be related to glycogen storage.

Pathological changes in rats hepatocytes on acute lindane poisoning

Histological, histochemical and ultrastructural examinations of the liver were carried out on rats. The animals were given crystalline lindane intragastrically, in a dose evoking acute intoxication, (1/3 LD50). Then the rats were decapited after 1, 3, 10, 20 and 36 days following pesticide administration. The obtained results indicate, that acute lindane intoxication produces morphological changes in the rat liver, which evidence a disturbance inenergetic processes of hepatocytes and they are reversible and adaptative.

Influence of endotoxin on the level of tumor necrosis factor alfa and blood morphology in rats

The influence of endotoxin E.coli O127 B:8 given intravenously or intraperitoneally on the level of Tumor Necrosis Factor alfa (TNF-alpha), blood cells count and bone marrow morphology in rats was studied. The presented results show that endotoxin (3 mg/kg) given intravenously or intraperitoneally (1 or 3 times) provoked an appearance of TNF-alpha in the systemic circulation 24 hours after its injection. Endotoxin given intravenously evoked greater changes in blood morphology and bone marrow than that applicated intraperitoneally.

Morphological changes in mitochondria and lysosomes of hepatocytes in acute intoxication with 2,4-dichlorophenoxyacetic acid (2,4-D)

The hepatotoxic effect of 2,4-dichlorophenoxyacetic acid (2,4-D) was investigated. Ultrastructural changes were evaluated under a transmission electron microscope. Certain histoenzymatic reactions were examined (to acid phosphatase according to Gomori (AP) and to succinic dehydrogenase (SD) according to Nachlas) in parenchymal cells of the rat liver in acute intoxication induced by this herbicide. The experiment used 60 male Wistar rats divided into two groups: I-control--18 animals and II--42 animals which received chemically pure 2,4-D acid by gastric gavage in a dose of 200 mg/kg b.w. The animals were sacrificed after 12, 24, 48 hours and 4, 10 and 30 days of the experiment. The results indicate that the administration of 2,4-D acid to rats in a dose inducing acute intoxication leads to histoenzymatic and ultrastructural changes in the liver, which suggest nonspecific reversible adaptive-type damage to parenchymal cells. The changes observed indicate disorders in energetic processes in hepatocytes and are morphological exponents of intense detoxicative processes.

Adenosine deaminase activity in patients with the intestinal type of gastric carcinoma

Adenosine deaminase activity was studied in tissue slices taken endoscopically from gastric mucosa of patients with the intestinal type of gastric carcinoma. The enzyme activity was measured in mucosal homogenates by determination of ammonia liberated from substrate during 10-min incubation. It was found that: (1) the enzyme activity of de novo gastric cancer was significantly lower than that of recurrent cancer of the gastric remnant; and (2) the enzyme activity of uninvaded gastric mucosa surrounding the neoplastic lesion of non-operated stomach was significantly lower than of the gastric mucosa of partially resected stomach due to malignancy. Since the enzyme activity in gastric cancer and surrounding uninvaded gastric mucosa correlated well with the advance of neoplastic disease estimated by ultrasonography examination, we speculate that some systemic factors associated with tumor progression might be implicated in the regulation of adenosine deaminase activity.

[Exocrine pancreatic function and gastric mucosa and duodenal mucosa in patients with chronic kidney failure]

Uraemic pancreatopathy is frequently observed in patients with chronic renal failure. The aim of the study was to assess some parameters of exocrine pancreatic function in uraemic patients maintained on intermittent haemodialyses. Elevated serum amylase activity was found in these patients. The most significant finding was the low bicarbonate output in duodenal content after secretin-cerulein stimuli, comparable with that obtained in patients with chronic pancreatitis. It indicates pancreatic exocrine defect in uraemic patients. A fall in protein output and lower amylase activity in duodenal content was also observed in haemodialyzed patients after stimulation. Low basal acid output (BAO) and enhanced maximal (MAO) and peak (PAO) acid outputs were found in uraemic patients after pentagastrin stimulation. Gastritis and duodenitis were frequently diagnosed in endoscopic and histopathological examinations in these patients. In patients with chronic renal failure even without clinical signs of pancreatic, laboratory findings of exocrine pancreatic abnormalities are reported. It may be the cause of uraemic pancreatopathy.

Papillary Hürthle cell tumor of thyroid: report of a case with a cytomorphologic approach to diagnosis

BACKGROUND

Hürthle cells are founded often in fine needle aspirates of the thyroid from nonneoplastic and neoplastic lesions. Papillary Hürthle cell tumors of the thyroid are composed of oxyphilic cells with a prominent papillary component. Papillary Hürthle cell carcinoma is a relatively uncommon type of thyroid carcinoma.

CASE

A 42-year-old man had two asymptomatic nodules (2.5 and 3.5 cm) in the left lobe and one (2.5 cm) in the right lobe of the thyroid. Fine needle aspiration biopsy of the tumor in the left lobe showed large cells in monolayers and papillary clusters with moderate to abundant eosinophilic, granular cytoplasm with sharp borders, a granular nuclear enlargement with pleomorphism and single nucleoli. Histologic examination showed capsular invasion and infiltration of vessels.

CONCLUSION

The cytologic appearance of papillary Hürthle cell carcinoma is not specific but can be suspected on fine needle aspiration.

The effect of a herbicide--sodium salt of 2,4-dichlorophenoxyacetic acid on guerin carcinoma

The effect of sodium salt of 2,4-dichlorophenoxyacetic acid, being an active component of herbicide "PIELIK", upon the development of Guerin carcinoma implanted in male Wistar rats, was studied. 192 animals were divided in to 6 equal groups: I-animals which obtained physiological salt solution; II-rats exposed to the herbicide in postlactational period; III-animals with Guerin carcinoma, non exposed to the herbicide; IV- rats exposed to the herbicide in postlactational period+Guerin carcinoma; V-animals exposed to the herbicide from prenatal period to the end of an experiment, without Guerin carcinoma; VI-the same as in V group, but with Guerin carcinoma. The effect of the herbicide on tumor growth dynamism (diameters and mass), degree of tumour malignancy (metastases to lymph nodes), animals survival time and morfological changes in the primary tumour and in metastases was evaluated. Basing of the results obtained, it was stated that this herbicide accelerates the development of Guerin carcinoma and reduces the survival time in the rats exposed to it in the prenatal and postnatal period. However, it does not significantly influence the growth of the carcinoma in the rats exposed only in the postlactational period.

Gastric and pancreatic functions in haemodialyzed patients

The aim of this work was to assess gastric acid secretion in relation to morphological and histological changes in the gastric mucosa as well as prevalence of Helicobacter pylori in chronically haemodialyzed uraemic patients. Exocrine pancreatic functions after secretin-cerulein test were also studied. In haemodialyzed patients low basal gastric acid output was found, whereas peak output after pentagastrin stimulation did not differ significantly when compared to controls. Endoscopy of gastric and duodenal mucosa revealed inflammatory changes in the majority of patients, described histologically as chronic gastritis with duodenitis. Helicobacter pylori antigen was detected in the serum of 45% of uraemic patients. Serum amylase activity was elevated in haemodialyzed patients relative to controls. Although clinically asymptomatic, haemodialyzed patients exhibited various degrees of gastrointestinal mucosal abnormalities and impairment in exocrine pancreatic functions, mainly low stimulated bicarbonate and protein output as well as low electrolyte concentrations in duodenal content.

Adenosine deaminase activity in gastric cancer

Adenosine deaminase activity, the key enzyme of adenosine inactivation, was studied in slices taken endoscopically from gastric cancer and macroscopically unchanged gastric mucosa surrounding the cancer. The activity of the enzyme was measured in mucosa homogenates by determination of ammonia liberated from substrate. It was found that adenosine deaminase activity in neoplastic lesions did not differ significantly from normal mucosa and that the gastric region studied (antrum, corpus) did not have an impact. A significant difference in enzyme activity was noticed between intestinal and diffuse-type gastric carcinoma (according to Lauren's classification); the intestinal type was characterized by lower adenosine deaminase activity than was the diffuse type. Since the activity of adenosine deaminase in gastric cancer did not exhibit significant differences from normal mucosa the diagnostic value of its determination is of less importance.

[Evaluation of agreement between brushing cytology diagnosis and histology evaluation of biopsy from gastric mucosa based on analysis of 362 cases]

Retrospective analysis is presented for the diagnoses basing on brushing cytology and biopsy histology in 362 patients selected from the total number of 8600 cytologic examinations of gastric mucosa performed in this Department in the years 1984-1992. Endoscopy suggested neoplasma in 58 cases, peptic ulcer in 146 and gastritis in 158 cases. In 64 cytologic specimens neoplastic cells were found (17.7%). Histologic evaluation, in addition to brushing cytology, was possible in 316 cases; in 186 on gastroscopy, in 82 in surgical specimens, in 48 on postmortem. In one case only of positive brushing cytology the diagnosis of cancer was confirmed (1.7%). In 16 cases (8.2%) the brushing cytology is stressed, especially in monitoring subjects of high risk.

Widespread myocardial and pulmonary bone marrow embolism following cardiac massage

Widespread fatal massive bone marrow embolism of the coronary and the pulmonary arteries are described in a 71-year-old man with a respiratory disease. Cardiac massage was carried out during the cardiac arrest. In autopsy findings there were no fractures of the ribs or the sternum. The authors suggested that the cardiac massage was the most important predisposing factor for the bone marrow embolism.

[A case of esophageal pemphigus]

A case of oesophageal pemphigus was observed in a man aged 76. Attention is called to the rarity of this disease and resulting diagnostic difficulties.

[Morphological changes of bone marrow in patients with bronchial and gastrointestinal carcinoma and hematological abnormalities in peripheral blood]

The authors carried out the morphological and clinical analysis of 200 cases patients suffering from carcinoma but not treated (104 cases of carcinoma of the bronchus, 30 cases of the stomach, 26 cases of the pancreas, 24 cases of the liver and gallbladder and 16 cases of the large intestine) and have estimated the hematological and bone marrow abnormalities. Most frequently occurring hematological changes in this group were: anaemia (28.5%), thrombocytopenia (22.4%), clinical symptoms of thrombosis (22.0%) and changes of bone marrow: sclerosis (42.5%), neoplastic metastases (30.0%), and atrophy (27.5%). In the examined cases the authors have not found any particular connection between the kind of hematological abnormalities and the kind of morphological changes of the bone marrow. The most common changes in the bone marrow which accompanied hematological abnormalities were neoplastic metastases and atrophy of the marrow especially in cases with anaemia and thrombocytopenia.

[Endocardial fibroelastosis in children to one year of age]

Out of 2398 autopsies of newborns and infants performed between 1976 and 1985, thirty two cases of endocardial fibroelastosis were found, i.e. 10.6% of the congenital heart diseases in this age group. Endocardial fibroelastosis was most frequent (44%) in infants aged between 3 and 6 months. Seventeen cases of the disease were seen in male infants and 15 cases in female infants. Twenty cases of the endocardial fibroelastosis (62.5%) were of isolated character (primary) whereas 12 cases (37.5%) were of the secondary character associated with other heart abnormalities. Nine cases (about 28%) coexisted with congenital abnormalities of joint and bone system and respiratory tract. A morphologic analysis of the endocardial fibroelastosis with particular reference to its etiopathogenesis suggest its congenital origin or (and) an effect of infection on myocardium. It was also suggested that endocardial fibroelastosis may be a symptom of collagenic disease. About 70% of autopsied infants were hospitalized over 3 days what meant that the course of the disease was severe. Endocardial fibroelastosis was diagnosed clinically only in 6 cases (18.75%).

[Multifocal periventricular leukomalacia in children up to 1 year of life]

The authors present an analysis of the multifocal leucoencephalomalacia in children under 1 year of life based on the material obtained from 2.398 autopsies. It was found that 32 autopsied children suffered from this disease (1.33%). Twenty four of these children were premature. The disease was more frequent in the infants (23 cases) than in neonates (9 cases), and in boys (20 cases) than in girls (12 cases). Multifocal leucoenephalomalacia was manifested mainly as spastic infantile paralysis in the majority of the infants (14 cases). Morphological lesions to the brain most frequently embraced white substance adjacent to the cerebral ventricles (foci of leucoencephalomalacia of 1 cm in diameter) and cerebral vessels. Widening of the ventricular system of the brain was seen in 15 cases. Pathological reaction resulted from the brain anoxia and ischemia in perinatal period (20 cases) or septicaemia (12 cases) while predisposing factors included: prematurity, respiratory failure with hyaline membranes in the lungs and congenital abnormalities of the heart.

Morphologic changes of small intestine epithelium in the course of post-alcoholic liver cirrhosis

Morphologic changes of the duodenal mucous membrane were studied in 50 patients (20 with post-alcoholic liver cirrhosis and 30 non-alcoholic with postinflammatory liver cirrhosis). The macroscopic condition of the duodenal mucous membrane was evaluated during endoscopic examination; evaluation of the histopathologic changes in the biopsy specimens of the duodenal mucous membrane was carried out according to the criteria of Whitehead et al. (Digestion, 13 (1975) 129). Endoscopic examinations showed changes of chronic inflammatory process of the duodenal mucous membrane in 60% of the patients in both groups. The microscopic studies did not show essential differences in the intensity of histopathological changes of the duodenal mucous membrane between both groups, i.e, alcohol is not a decisive factor evoking or intensifying pathological changes of the duodenum.

[Coexistence of polycystic kidney and other developmental defects. Analysis of autopsy specimens 1953-1985]

The cases of polycystic disease of kidney selected from 33 years postmortem data were presented. They were classified into 4 types (according to Osathanond, Potter and Heptinstall) and the results correlated with accompanying malformations. It has been established that type I of polycystic disease of kidney was mostly correlated with CNS, skull and spine abnormalities. Type II and III were coexisting with genitourinary and ++gastrointestinal system malformations. No type IV of the disease has been found.

[A case of myxoma of the left cardiac atrium--morphologic analysis]

A case is reported of left atrial myxoma with clinical manifestations suggestive of mitral stenosis. The morphogenesis of the tumour is analysed on the basis of histological examination.

[A rare case of coexistence of pancreatic cystadenoma and adenocarcinoma of the rectum]

A rare coexistence is reported of a benign pancreatic tumour--cystadenoma--with anal adenocarcinoma. A particular attention is called to the histological structure of the tumour and differential diagnosis. Photographic documentation is enclosed.

[Biliary atresia in children]

Congenital biliary tract atresia was found in 0.58% of children dying in the first year of life. Most frequently atresia included the extrahepatic bile ducts, among them the common bile duct. Five cases (35.7%) had atresia associated with other developmental anomalies, which may suggest a genetic determination of the atresia. The most frequent cause of death of the newborns and infants with congenital biliary tract atresia was bronchopneumonia with associated biliary cirrhosis of the liver.

[Analysis of neoplasm metastases to the bone marrow in patients with lung cancer]

The authors analysed bone marrow metastases in lung cancer in 104 deceased patients. Trepano-biopsy was taken from the sternum, hip bone and spine. Bone marrow metastases were found in 33 cases (31.73%). Most often they were seen in small cell lung cancer (16 cases--35.56%). In 12 cases the bone marrow was the only site of lung cancer metastases.