Histological spectrum of lymphoid follicles and aggregates in Helicobacter pylori gastritis.

Seventy three patients of non ulcer dyspepsia underwent upper gastrointestinal endoscopy with biopsy from antrum and body of stomach. The tissue was stained with hematoxylin eosin and warthin starry stain. The severity of gastritis was correlated with the presence of Helicobacter pylori and lymphoid follicles and aggregates. The incidence of chronic atrophic gastritis and Helicobacter pylori were found to be 97% and 64.1% respectively. Lymphoid follicles and aggregates were seen in 32.9% of chronic atrophic gastritis. Severity of gastritis with activity correlates with Helicobacter pylori colonisation and the presence of lymphoid follicles and aggregates. We have found that there is no difference between presence of lymphoid follicles and aggregates in Helicobacter pylori positive and negative gastritis. The development of lymphoid follicles probably represents an immune response to the colonisation of gastric mucosa by Helicobacter pylori.

Role of Helicobacter pylori in gastric carcinoma.

BACKGROUND. Helicobacter pylori infection has recently been incriminated in the pathogenesis of gastric carcinoma and chronic atrophic gastritis and intestinal metaplasia are considered to be precursors of this condition. Although the incidence of Helicobacter pylori infection in India is high that of gastric carcinoma is low. We, therefore, decided to examine the association between Helicobacter pylori, intestinal metaplasia and gastric carcinoma in a prospective study. METHODS. Fifty patients with carcinoma of the stomach and 50 with non-ulcer dyspepsia underwent upper gastro-intestinal endoscopy and had biopsies from the antrum, body and carcinomatous tissue. In 12 cases of gastric carcinoma, tissue was obtained from resected specimens at operation. The types of gastritis, intestinal metaplasia and presence of Helicobacter pylori were assessed by staining with haematoxylin and eosin, periodic acid-Schiff reagent with alcian blue and Warthin-Starry stains. RESULTS. The incidence of chronic atrophic gastritis, intestinal metaplasia and Helicobacter pylori were 82%, 36% and 38% in patients with carcinoma and 86%, 4% and 68% in those with non-ulcer dyspepsia. Helicobacter pylori positivity was significantly higher (p < 0.05) and intestinal metaplasia significantly lower (p < 0.001) in patients with non-ulcer dyspepsia than in those with carcinoma. Of the 50 cases with carcinoma, 28 were of the intestinal and 22 of the diffuse type. The incidence of chronic atrophic gastritis, intestinal metaplasia and Helicobacter pylori in the intestinal type of carcinoma was 71%, 46% and 39% while in the diffuse type it was 32%, 23% and 36%. The incidence of Helicobacter pylori infection did not differ significantly in the two types of carcinoma. CONCLUSIONS. We have found that although Helicobacter pylori infection and chronic atrophic gastritis are common in Indians, the incidence of intestinal metaplasia is low. Helicobacter pylori infection was equally common in both the intestinal and diffuse type of gastric carcinomas. Our findings, therefore, cast doubt on the role of Helicobacter pylori infection in gastric carcinogenesis.

Fibrosing necrotic nodule of the liver.

A fibrosing necrotic nodule of the liver is described in a 35 year old man suffering from malaria. This non-tumorous lesion is considered to be an entity of diverse pathogenesis.

Tuberculous abscess of the liver associated with HIV infection.

Tuberculosis is an AIDS-defining illness in HIV-seropositive patients. Though disseminated tuberculosis is common in HIV-seropositive patients, hepatic involvement in the form of abscess formation is rare. We report such a patient.

Helicobacter pylori in normal gastric mucosa.

Since the discovery of Helicobacter pylori (H. pylori) in 1983 several studies have established relationship of H. pylori with gastritis, duodenal ulcer disease and gastric carcinoma. H. pylori infection is widely prevalent and exposure occurs at younger age in our country. Several Western studies have shown prevalence of H. pylori in normal gastric mucosa to range from 0-25%. As similar information is not available from our country we estimated the prevalence of H. pylori in histologically normal gastric mucosa. Of the 50 asymptomatic volunteers studied, 33 showed histological evidence of gastritis and 28 of these were H. pylori. We conclude that histological gastritis is very common in young asymptomatic Indians and H. pylori infection is noticed in almost 25% subjects with histologically normal gastric mucosa.

Cytohistomorphology of prostatic lesions--by FNAC & scrape methods.

A pilot study of transrectal fine needle aspiration biopsy was conducted in 44 patients, above the age of 50 years, who presented with features of obstructive uropathy during a one year period between August 1990 and April 1991. Histopathological study was carried out in 23 out of 44 patients, who underwent total prostatectomy or transurethral resection following the aspiration biopsy procedure. In 21 patients FNAB by the transrectal route could not be obtained because of technical difficulties; therefore intraoperative scrape cytology was studied prior to histopathology, of the fresh prostatic specimen. A good cytohistopathological correlation was obtained by both methods; an accuracy of 95.6% and 95.2% with FNAC and scrape respectively. A wide range of benign and malignant lesions were studied.

Effect of inhaled terbutaline on platelet activity in bronchial asthma.

Thirty five young subjects with long standing bronchial asthma were studied for the effects of terbutaline misthaler (500 micrograms) during acute asthma. Bronchodilators were omitted for a day before the test. Ten matched controls were also studied. In all subjects, basal IgE level (ELISA), pulmonary parameters (FVC, FEV, PEFR, FEF 25-75 and FEF 75-85) and platelet activity, (platelet clumping/150 WBC on smear, platelet adhesiveness, blood recalcification time and kaolin clotting time for platelet factor3) were compared. During acute asthma, the subjects displayed IgE levels > or = 500 IU/ml (n = 33), activation of clotting (n = 30) and eosinophilia > or = 450/cmm (n = 28). These changes were not seen in normal controls. Terbutaline resulted in a reversal of airway obstruction, mainly of small airways, while the platelet hyperactivity and blood hypercoagulability were rectified (P < 0.001). It is concluded that platelet activity increases in acute asthma and is corrected by inhaled terbutaline concomittant with the relief of bronchospasm.

Gastric metaplasia and Helicobacter pylori infection in intestinal tuberculosis.

BACKGROUND: Gastric metaplasia occurs in intestinal epithelium of patients with Helicobacter pylori infection as well as intestinal tuberculosis, but the relationship between the three is not clear. SETTING: Teaching hospital. METHODS: Staining of intestinal sections from patients with ileocecal tuberculosis for H pylori and for metaplasia. RESULTS: Twenty seven of 92 (29.3%) patients demonstrated gastric metaplasia (superficial epithelial and pyloric gland metaplasia) in resected specimens of ileum. Gastric metaplasia was of antral type in all 27 patients. Helicobacter pylori was present in 3 of 27 (11%) patients with gastric metaplasia and was absent in all 65 patients without metaplasia. CONCLUSION: Gastric metaplasia (both superficial epithelial and pyloric gland) occurs in one-third of patients with ileocecal tuberculosis and such mucosa is poorly colonized by H pylori.

Heterotopic gastric mucosa and Helicobacter pylori infection in Meckel's diverticulum in Indian subjects.

Two of twenty nine (6.8%) patients who had undergone resection of Meckel's diverticulum demonstrated heterotopic gastric mucosa. In both these patients gastric mucosa was of antral type. Remaining 27 of 29 (93.2%) patients with Meckel's diverticulum had intestinal mucosa. 9 of 29 (31%) patients with Meckel's resected were symptomatic (8 bleeding, 1 perforation) and all 9 were negative for heterotopic gastric mucosa. Helicobacter pylori (H. pylori) was absent in both patients with intestinal mucosa. Antral biopsy from 13 partial gastrectomy specimens (surgery done for carcinoma stomach) were used as methodological controls and 7 of 13 (54%) showed H. pylori colonization. We conclude that (i) incidence of gastric mucosa is 6.8% in Meckel's diverticulum in our population, (ii) presence of heterotopic gastric mucosa is unlikely to be associated with complications of Meckel's diverticulum and (iii) heterotopic mucosa in Meckel's diverticulum is not commonly colonized by H. pylori.

Epidemiology of Helicobacter pylori: the Indian scenario.

OBJECTIVE: To compare the age-related prevalence of Helicobacter pylori in populations from developing and developed nations to determine the possible mode of transmission. METHODS: Endoscopic gastric biopsies (for biopsy urease test and histology) were obtained in 526 patients with dyspepsia and in 82 control subjects to determine H pylori prevalence. RESULTS: H pylori prevalence in patients with dyspepsia and in control subjects was 65% and 46% respectively. Age-related prevalence in these two groups in the age groups 10-19 years, 20-29 years, 30-39 years, 40-49 years and > or = 50 years was 52%, 70%, 69%, 60% and 59%, and 44%, 55% 58%, 36% and 33% respectively. CONCLUSION: Exposure to H pylori occurs early in India and is widespread, even in control subjects. The high prevalence of the organism in young Indian control subjects and the comparable prevalence of antibodies to H pylori and hepatitis A virus infection in different age groups both in developed and developing nations may suggest a feco-oral mode of transmission.

Multiple chylous cysts of abdomen causing intestinal obstruction.

A case of multiple chylous cysts of the abdomen in a 35 years old female is presented here. The patient presented with signs and symptoms of acute intestinal obstruction. Exploratory laparotomy revealed few intestinal adhesions along with multiple small cysts containing blood stained gelatinous material in the abdominal cavity, some of which were excised alongwith lymph nodes. The abdomen was closed after a saline peritoneal lavage. Chylous nature of the cysts was confirmed on histopathology. The post-operative course was asymptomatic.

Primary malignant hemangioendothelioma of jejunum.

Primary malignant hemangioendothelioma is a rare tumor. We report a patient with a malignant jejunal hemangioendothelioma which had metastasized to the regional lymph nodes and the liver.

Mono and dual therapy for Helicobacter pylori associated gastritis.

Sixty patients with Helicobacter Pylori positive non ulcer dyspepsia were randomly allocated to one of the following treatment groups: Group I--norfloxacin 400 mg bid for 10 days, Group II--amoxycillin 500 mg bid plus tinidazole 500 mg bid for 15 days, Group III--colloidal bismuth subcitrate (CBS) 240 mg bid for 4 weeks. H pylori elimination was achieved in 14%, 81%, and 62% in Groups I, II and III respectively. Eradication of H pylori was not observed in Groups I and II, but was achieved in 25% of patients in Group III. Antral gastritis improved in 69% in Group II and 50% in Group III. We conclude that norfloxacin is not effective in H pylori infection. A combination of amoxycillin and tinidazole is highly effective in H pylori elimination with improvement in associated gastritis, but H pylori eradication is not observed with this therapy. CBS is also effective in H pylori elimination though H pylori eradication is achieved in only 25%.

Primary malignant melanoma of esophagus.

Primary esophageal melanoma is a rare tumor. A 35 year old male with primary malignant melanoma of the esophagus is reported. He presented with dysphagia and weight loss. At autopsy a fusiform polypoidal growth was seen in the middle third of the esophagus. Microscopic sections showed a malignant melanoma in an in situ as well as invasive form.