Omeprazole and adenocarcinoma in the stomach of rats submitted to duodenogastric reflux. Is there a protective effect?

Abstract Purpose: To investigate the role of omeprazole and nitrites on the gastric mucosa of rats submitted to specific techniques to induce duodenogastric reflux. Methods: One hundred and twenty Wistar rats were divided into three groups: Group I (n=40) -gastrotomy; Group II (n=40) - duodenogastric reflux after gastrojejunoanastomosis latero-lateral (DGR); Group III (n=40) - retrograde duodenogastric reflux through the pylorus (DGR-P). The groups were divided into 4 subgroups of 10 animals, respectively treated for 16 weeks with water, omeprazole 1.6 mg / rat / day, nitrite 600 mg / kg / day and omeprazole plus nitrite simultaneously. Results: The proliferative lesions found were: squamous hyperplasia - 69.1%, adenomatous hyperplasia in the anastomosis - 29.1% and prepyloric adenomatous hyperplasia - 42.5%. Adenocarcinomas were registered in 7 animals (5.8%): one in Group I (omeprazole plus nitrite), two in Group II (omeprazole and nitrite plus omeprazole) and four in Group III (water, nitrite, omeprazole and omeprazole plus nitrite). Conclusions: The occurrence of squamous hyperplasia, adenomatous hyperplasia and adenocarcinoma increased after gastrojejunal anastomoses, which cause duodenogastric reflux. The association of omeprazole did not protect the development of proliferative lesions and cancer induced by duodenogastric reflux in rats.

Malformación adenomatoidea quística y riesgo de tumores malignos pulmonares / Adenomatoid lung malformation and malignant tumors

Cystic adenomatoid malformation is the most frequent congenital pulmonary malformation. The usual treatment is surgical resection. However there is controversy over management in asymptomatic patients. The possible malignization would justify surgery of cystic lesions. Relation with pleuropulmonary blastoma has been described, however it is not clear whether this is a primary tumor or cyst malignization. Cystic adenomatoid malformation also has association with adenocarcinoma and rhabdomyosarcoma. Currently available evidence suggests surgical resection, despite the natural course of congenital lung cystic lesions is uncertain

La malformación adenomatoidea quística (MAQ) es la anomalía del desarrollo pulmonar más frecuente. El tratamiento habitual es la resección quirúrgica, no obstante existe controversia sobre el manejo en pacientes asintomáticos. La posible malignización de las lesiones quísticas es uno de los argumentos que justifican la cirugía en estos pacientes. Se ha descrito relación con blastoma pleuropulmonar, sin embargo no está claro si se trataría de una lesión quística que se maligniza o es una entidad diferente. También hay asociación con adenocarcinoma y rabdomiosarcoma . Actualmente se sugiere la resección quirúrgica como el tratamiento más adecuado, sin embargo la evolución natural de las lesiones quísticas pulmonares congénitas es incierta

Efecto del aceite de Sacha Inchi (Plukenetia volubilis L.) en la carcinogénesis de colon inducida por 1,2–dimetilhidrazina en ratas Holtzman / Effect of Sacha Inchi oil (Plukenetia volubilis L.) on 1,2–dimethylhydrazine-induced colon carcinogenesis in Holtzman rats

Objetivos: Evaluar el efecto protector del aceite de Sacha Inchi (ASI) sobre el desarrollo de cáncer de colon (CC) inducido con 1,2–dimetilhidrazina (DMH) en ratas Holtzman. Materiales y métodos: Estudio experimental con 28 ratas albinas machos de la cepa Holtzman distribuidas al azar en 4 grupos: un grupo control positivo expuesto a DMH (C1), un grupo control negativo expuesto a ASI a 150 μL/kg/día (C2), y dos grupos experimentales expuestos a DMH con ASI a 150 μL/kg/día (E1) y ASI a 300 μL/kg/día (E2). La DMH se aplicó por 8 semanas y con un tiempo total de inducción de 22 semanas. Luego se realizó el análisis patológico mediante la identificación de lesiones tumorales cancerosas en los intestinos. El efecto protector se evaluó en base a las proporciones de ausencia de lesión en los grupos expuestos a DMH. Resultados: Se identificaron lesiones tumorales cancerosas en: dos especímenes del grupo C1, un espécimen del grupo E1 y dos especímenes del grupo E2. No se identificaron lesiones intestinales en el grupo C2. Las proporciones de ausencia de lesión fueron: en el grupo C1 de 75%, en el grupo E1 de 87,5% y en el grupo E2 de 75%. No se encontraron diferencias significativas (p>0,05). Conclusiones: No se evidenció un efecto protector significativo del ASI sobre el desarrollo de CC inducido con DMH en ratas Holtzman, respecto al grupo control.

Objectives: To evaluate the preventive effect of Sacha Inchi oil (SIO) on 1,2–dimethylhydrazine (DMH)-induced colon carcinogenesis (CC) in Holtzman rats. Materials and methods: Experimental study with 28 Holtzman male albino rats randomly distributed into 4 groups: a positive control group exposed to DMH (C1), a negative control group exposed to SIO at 150 uL/kg/ day (C2), and two experimental groups exposed to DMH with SIO at 150 uL/kg/day (E1) and SIO at 300 uL/kg/day (E2). The DMH was applied for 8 weeks and the total induction time was 22 weeks. Pathological examination was performed by identifying cancerous tumor lesions in the guts. The preventive effect was evaluated based on proportions of lack of lesion in the groups exposed to DMH. Results: Cancerous tumor lesions were identified in: two specimens of group C1, one specimen of group E1 and two specimens of group E2. No intestinal lesions were identified in group C2. The proportions of lack of lesion were: in group C1 of 75%, in group E1 of 87.5% and group E2 of 75%. No significant differences were found (p>0.05). Conclusions: It was not found a significant protective effect of SIO on DMH-induced CC in Holtzman rats, compared to control group.

¿Por qué no diagnosticamos el cáncer gástrico incipiente? ¿Cómo podemos mejorar? / Why do we fail in the diagnosis of early gastric cancer? How can we improve?

Detection and treatment of gastric cancer (GC) in early stages is the most effective approach for improving prognosis. Patients with early gastric cancer (EGC), defined as a type of cancer affecting only mucosa and submucosa, has a good prognosis in the long-term, and if some criteria are met, endoscopic therapy is curative. Unfortunately EGC diagnosis is rare, except in case of some Asian countries, where more than 50% of tumors are diagnosed in this stage. In Japan, the main technique for early diagnosis is opportunistic screening, i.e. endoscopy performed for different reasons. Some of the factors that affect endoscopic diagnose include: characteristics of the lesion (some cases slight changes in color or in the surface, a location that is difficult to detect, except in retro view); elements associated with the endoscopic technique (lesions hidden underneath gastric contents, non-systematic visualization, not enough time for exploration); and early access to the procedure (long waiting lists, lack of clinic or epidemiology screening criteria, lack of risk-stratification looking for pre-malignant lesions to establish endoscopic follow-up). Know and act upon the mentioned factors is a path that has proven to improve EGC diagnosis and therefore, improve prognosis.

Detectar y tratar el cáncer gástrico (CG) en una etapa inicial constituye la estrategia más efectiva para mejorar el pronóstico de esta patología. Pacientes con CG incipiente (CGI), definido como el que compromete sólo la mucosa y la submucosa, tienen un muy buen pronóstico a largo plazo y si se cumplen algunos criterios, el tratamiento endoscópico es curativo. Desgraciadamente el diagnóstico de CGI es infrecuente en todo el mundo, a excepción de algunos países asiáticos donde más de la mitad de los tumores se diagnostican en esta etapa. En Japón la principal vía por la que se realiza este diagnóstico precoz es mediante el tamizaje oportunista, es decir, la endoscopia que se realiza de manera cotidiana por diferentes motivos. Dentro de los factores que afectan la capacidad diagnóstica de la endoscopia destacan: las características de la lesión (algunos casos con discretos cambios de color o superficie, ubicación habitualmente en áreas de mejor visualización en retrovisión); factores asociados a la técnica endoscópica (contenido gástrico que puede ocultar lesiones, visualización no sistemática, tiempo insuficiente de exploración); y el acceso oportuno a ella (largas listas de espera, falta de criterios de selección clínicos o epidemiológicos, falta de estratificación del riesgo mediante la búsqueda de lesiones premalignas para definir intervalos de seguimiento endoscópico). Conocer y actuar sobre los factores descritos es un camino que ha demostrado su utilidad en mejorar el diagnóstico del CGI y así mejorar su pronóstico.

Enfermedad extramamaria de Paget, revisión bibliográfica y reporte de caso / Extramammary Paget's disease, literature review and case report

La enfermedad de Paget es un adenocarcinoma intraepidérmico poco frecuente que se presenta en el complejo areola-pezón o en su forma extramamaria en áreas como las regiones anogenital, perineal y axilar. La enfermedad de Paget extramamaria es un carcinoma epidérmico de diferenciación apocrina que se origina en la epidermis o secundario a la diseminación epidermotropa de neoplasias adyacentes o a distancia. Caracterizado histológicamente por la presencia de células tumorales típicas, denominadas células de Paget...

Late administration of a specific COX-2 inhibitor does not treat and/or prevent progression of gastric tumors in rats submitted to duodenogastric reflux procedure

PURPOSE:To assess whether late introduction of a specific COX-2 inhibitor (Meloxicam) can treat and/or prevent the progression of tumors in the stomach of rats submitted to duodenogastric reflux. METHODS: Seventy five male Wistar rats, weighing 150 grams, were submitted to the induction of duodenogastric reflux through the pylorus. At 36 weeks of follow-up were established three experimental groups: DGR36 sacrificed immediately, DGR54 and DGR54MLX both sacrificed at 54th week of follow-up . The animals of the latter group were fed with a rat chow premixed with Meloxicam (2.0 mg/ kg feed; 0.3 mg / kg bw / day) and the other two with standard rat chow. The lesions found in the pyloric mucosa and gastrojejunal anastomosis were analyzed macroscopically and histologically. For statistical analysis was adjusted a generalized linear model assuming a binomial distribution with LOGIT link function. RESULTS: No significant differences were found when comparing the incidences of benign tumor lesions (Adenomatous Hyperplasia), p=0.4915, or malignant (Mucinous Adenocarcinoma), p=0.2731, among groups. CONCLUSION: Late introduction of specific COX-2 inhibitor (Meloxicam) did not treat and was not able to prevent the progression of tumoral lesions induced by duodenogastric reflux in the rat stomachs.

Seguimiento de mujeres con anormalidad citológica de cuello uterino, en Colombia / Following-up females having an abnormal Pap smear in Colombia

Objetivo Evaluar el acceso y la oportunidad al diagnóstico y al tratamiento que tienen las pacientes con lesiones cervicales de alto grado o cáncer de acuerdo con el reporte citológico, en Colombia entre junio 2005 a junio del 2006. Metodología Estudio retrospectivo mediante encuestas a una muestra de mujeres con anormalidad citológica residentes de cuatro departamentos de Colombia seleccionados por conveniencia en relación con diferentes tasas de mortalidad. Se realizó análisis descriptivo y se compararon las diferencias entre los departamentos. Resultados El 27 por ciento de las mujeres con lesiones de alto grado o invasoras no tuvieron acceso a alguno de los servicios diagnósticos o terapéuticos por razones de tipo administrativo de los servicios de salud, razones clínicas y culturales de las mujeres. Discusión Un elemento crítico que explica el bajo impacto en la mortalidad por cáncer de cuello uterino en la mayoría de los países de Latino América es la disociación entre actividades de tamización y las de tratamiento.

Objective Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. Materials and Methods This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. Results It was found that 27 percent of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. Discussion Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

Adenocarcinoma de células glassy de colo de útero em paciente jovem com HPV: relato de caso / Glassy cells adenocarcinoma of the uterine cervix in young patient with HPV: case report

Introdução: o câncer de colo uterino é a segunda neoplasia mais comum em mulheres no mundo e a terceira entre a população feminina brasileira. O HPV desempenha um importante papel no desenvolvimento de neoplasias cervicais, estando presente em 95% dos casos de câncer de colo de útero. O carcinoma de células glassy é um carcinoma adenoescamoso misto pouco diferenciado, raro, de comportamento agressivo e altamente resistente à radioterapia. Atinge tipicamente mulheres jovens, com pico de incidência entre a 3a e a 4a década de vida. Está associado aos tipos 16 e 18 de HPV e sua evolução é aceleradana gravidez. O tempo médio de sobrevida após o diagnóstico é de 10 meses. Relato de caso: mulher, 26 anos, multípara, com história prévia de condiloma acuminado, apresentou lesões genitais que agravaram em sua última gestação, tendo evoluído com massas exofíticas diagnosticadas como carcinoma de células glassy, com curso agressivo e metástases precoces, não responsivo à radioterapia e progressão ao óbito em 16 meses. Conclusão: o carcinoma de células glassy destaca-se pela agressividade e rapidez de seu desenvolvimento, levando ao óbito mulheres jovens, em idade fértil e produtiva. Diante da sua baixa resposta às terapias antineoplásicas, destaca-se a importância de sua prevenção, seu diagnóstico e tratamento precoces, possíveis mediante o usode preservativos, da vacina contra o HPV e do exame colpocitológico regular, com coleta de material endocervical e acompanhamento eficaz.

Introduction: cervical cancer is the second most common cancer in women worldwide and the third among the female population in Brazil. HPV plays an important role in the development of cervical cancer, being present in 95% of cases of cancer of the cervix. Glassy cells carcinoma is a poorly differentiated mixed adenosquamous carcinoma, rare, aggressive and highly resistant to radiotherapy. It typically affects young women, with peak incidence between the third and fourth decades of life. It is associated with types 16 and 18 of HPV and its evolution is acelerated during pregnancy. The average survival time after diagnosis is 10 months.Case Report: woman, 26 years old, multiparous, with a history of condyloma acuminata, genital lesions that had increased in their last pregnancy, having evolved with exophytic masses diagnosed as glassy cell carcinoma, and aggressive course with early metastases not responsive to radiation therapy and progression to death in 16 months. Conclusion: glassy cells carcinoma is distinguished by aggressiveness and speed of its development, leading child-bearing age and productive young women to death. In view of its low response to anticancer therapies, we highlight the importance of its prevention, early diagnosis and treatment, possible through the use of condoms, the vaccine against HPV and cervical cytology at regular collection of endocervical material and effective monitoring.

Fish oil ingestion reduces the number of aberrant crypt foci and adenoma in 1, 2-dimethylhydrazine-induced colon cancer in rats

We determined the effect of fish oil (FO) ingestion on colonic carcinogenesis in rats. Male Wistar rats received 4 subcutaneous injections (40 mg/kg body weight each) of 1,2-dimethylhydrazine (DMH) at 3-day intervals and were fed a diet containing 18 percent by weight FO (N = 10) or soybean oil (SO, N = 10) for 36 weeks. At sacrifice, the colon was removed, aberrant crypt foci were counted and the fatty acid profile was determined. Intestinal tumors were removed and classified as adenoma or carcinoma. Liver and feces were collected and analyzed for fatty acid profile. FO reduced the mean (± SEM) number of aberrant crypt foci compared to SO (113.55 ± 6.97 vs 214.60 ± 18.61; P < 0.05) and the incidence of adenoma (FO: 20 percent vs SO: 100 percent), but carcinoma occurred equally in FO and SO rats (2 animals per group). The polyunsaturated fatty acid (PUFA) profile of the colon was affected by diet (P < 0.05): total ù-3 (FO: 8.18 ± 0.97 vs SO: 1.71 ± 0.54 percent) and total ù-6 (FO: 3.83 ± 0.59 vs SO: 10.43 ± 1.28 percent). The same occurred in the liver (P < 0.05): total ù-3 (FO: 34.41 ± 2.6 vs SO: 6.46 ± 0.59 percent) and total ù-6 (FO: 8.73 ± 1.37 vs SO: 42.12 ± 2.33 percent). The PUFA profile of the feces and liver polyamine levels did not differ between groups (P > 0.05). In conclusion, our findings indicate that chronic FO ingestion protected against the DMH-induced preneoplastic colon lesions and adenoma development, but not against carcinoma in rats.

Chemoprevention by celecoxib in reflux-induced gastric adenocarcinoma in Wistar rats that underwent gastrojejunostomy / Quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo em ratos Wistar submetidos à gastrojejunostomia

PURPOSE: To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS: Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info®, version 3.4.3. RESULTS: Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION: Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.

OBJETIVO: Avaliar a quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo, em ratos Wistar, submetidos a gastrojejunostomia. MÉTODOS: Sessenta ratos machos Wistar, com média de idade de três meses foram operados e distribuídos em 03 grupos: Grupo 1 - Os animais foram submetidos a laparotomia exploradora. Grupo 2 - Os animais foram submetidos a gastrojejunostomia. Grupo 3 - Os animais foram submetidos a gastrojejunostomia e tomaram celecoxib, diariamente. Após um período de 53 semanas, os animais foram sacrificados. As alterações da mucosa do corpo gástrico dos animais do grupo 1 e da anastomose gastrojejunal dos animais dos grupos 2 e 3 foram analisadas no exame histopatológico e imuno-histoquímica e foram comparadas. Todas as análises estatísticas foram realizadas pelo programa Epi Info®, versão 3.4.3. RESULTADOS: No cotejo entre os animais dos grupos 2 e 3 com relação à presença de adenocarcinoma observou-se uma diferença estatística significante (p=0,0023). A análise de associação entre os grupos 2 e 3 com relação à expressão da COX-2, também evidenciou uma diferença estatística significante (p=0,0018). CONCLUSÃO: O celecoxib teve efeito inibidor da carcinogênese gástrica, induzida pelo refluxo em ratos.

Isoflavone-deprived soy peptide suppresses mammary tumorigenesis by inducing apoptosis

During carcinogenesis, NF-kappaB mediates processes associated with deregulation of the normal control of proliferation, angiogenesis, and metastasis. Thus, suppression of NF-kappaB has been linked with chemoprevention of cancer. Accumulating findings reveal that heat shock protein 90 (HSP90) is a molecular chaperone and a component of the IkappaB kinase (IKK) complex that plays a central role in NF-kappaB activation. HSP90 also stabilizes key proteins involved in cell cycle control and apoptosis signaling. We have determined whether the exogenous administration of isoflavone-deprived soy peptide prevents 7,12-dimethylbenz[alpha]anthracene (DMBA)-induced rat mammary tumorigenesis and investigated the mechanism of action. Dietary administration of soy peptide (3.3 g/rat/day) significantly reduced the incidence of ductal carcinomas (50%), the number of tumors per multiple tumor-bearing rats (49%; P < 0.05), and extended the latency period of tumor development (8.07 +/- 0.92 weeks) compared to control diet animals (10.80 +/- 1.30; P < 0.05). Our results have further demonstrated that soy peptide (1) dramatically inhibits the expression of HSP90, thereby suppressing signaling pathway leading to NF-kappaB activation; (2) induces expression of p21, p53, and caspase-3 proteins; and (3) inhibits expression of VEGF. In agreement with our in vivo data, soy peptide treatment inhibited the growth of human breast MCF-7 tumor cells in a dose-dependent manner and induced apoptosis. Taken together, our in vivo and in vitro results suggest chemopreventive and tumor suppressive functions of isoflavone-deprived soy peptide by inducing growth arrest and apoptosis.

Prevention of gastric cancer: a challenging but feasible task / Prevención del cáncer gástrico: una tarea difícil pero factible

Despite its declining incidence gastric cancer still ranks as the second most common malignancy of the digestive tract, accounting for 10% of cancer deaths worldwide. At the time of the diagnosis less than 15% of the patients are in the stage of early cancer, the only stage in which a definite cure of gastric cancer is possible. Therefore the challenges are either early detection or even better prevention of gastric cancer. H. pylori has become recognized as the major risk factor for gastric adenocarcinoma. Epidemiological, biological, histomorphologic, molecular-genetic, epidemiological evidence and more recently few clinical trails have shown that H. pylori eradication has the potential to prevent the development of gastric cancer. Currently, H. pylori eradication is an indication for the prevention of gastric cancer in patients and groups of individuals with strongly increased risk, but further investigations are still required before an implementation of a general and global policy to eradicate H. pylori for the prevention of gastric cancer can be instituted. At present time, the main challenge remains to find out at what point mucosal abnormalities are no longer reversible and gastric cancer development cannot be prevented despite H. pylori eradication.

A pesar de la disminución en su incidencia, aún hoy el cáncer gástrico se presenta como la segunda causa más común de muerte por enfermedad maligna del tubo digestivo, siendo responsable del 10% de las muertes por cáncer a nivel mundial. Al momento del diagnóstico menos del 15% de los pacientes se encuentran en la etapa de cáncer gástrico temprano, el único estadío en el cual es posible su curación. Por lo tanto, el desafío está en la detección temprana o aún mejor, en la prevención del cáncer gástrico. H. pylori ha sido reconocido como el factor de riesgo más importante para el desarrollo del adenocarcinoma de estómago. Evidencia epidemiológica, biológica, histológica, molecular y más recientemente algunos estudios clínicos han demostrado que la erradicación del H. pylori tiene el potencial de prevenir el desarrollo de lesiones premalignas y del cáncer gástrico. Actualmente la erradicación del H. pylori está indicada para la prevención del cáncer gástrico en pacientes y grupos de individuos con alto riesgo, pero futuras investigaciones son aún necesarias antes de que sea establecida una política global para la erradicación del H. pylori en la prevención del cáncer gástrico. Actualmente el mayor desafío radica en encontrar en qué punto los cambios en la mucosa gástrica se tornan irreversibles, siendo el cáncer gástrico no prevenible a pesar de la erradicación del H. pylori.

Quimioprevención en adenocarcinoma de esófago / Chemoprevention in adenocarcinoma of the esophagus

The incidence of the adenocarcinoma of the esophagus (ACE) has dramatically for the last decades in western countries, which has been associated with a parallel increase in the incidence and prevalence of symptoms associated with gastroesophageal reflux diseases (GERD) and Barrett's esophagus (BE). Both conditions are now considered risk factors for ACE. Different pathways, including overexpression of cyclooxygenase (COX) isoenzymes, has been proposed to explain the carcinogenic process leading from normal esophagus to esophagitis, BE and ACE. The survival rate in patients with ACE is very low because of the poor outcomes of surgery and the limited benefits obtained with concomitant chemo-radiotherapy Several strategies based on early detection and surveillance of preneoplastic lessions have failed to have a global and significant impact on the prognosis of the ACE. Recent epidemiological and experimental studies suggest that chemoprevention could be useful in the management of patients with GERD and especially in those with BE. The current therapy with protom pump inhibitors (PPI) is effective to reduce the esophageal acid exposure, to improve reflux symptoms, and to heal inflammatory injuries, but probably is not enough to avoid the dysplastic progression of the metaplastic epithelium. Regular use of COX inhibitors (aspirin and other non steroid antiinflamatory drugs) has been associated with reduction of the risk of ACE and to decrease the incidence of ACE in animal models. In humans, the association of PPI with COX inhibitors could be a cost-effectiveness strategy but direct evidence is lacking. Other potential agents that have shown some chemoprevention potential include troglitazone, free radical scavengers, tamoxifen or prostaglandin receptor blockers, but the available scientific evidence is still poor and not ready to be tested in humans.

El adenocarcinoma de esófago (ACE) ha aumentado notablemente su incidencia en las últimas décadas, en los países occidentales; lo que se ha asociado a un crecimiento paralelo de la incidencia y prevalencia de los síntomas atribuibles a la Enfermedad por Reflujo Gastroesofágico (ERGE) y a un aumento de los diagnósticos de esófago de Barrett (EB). Ambas situaciones sonconsideradas como factores de riesgo para el desarrollo de ACE. Se han propuesto diferentes vías, incluyendola sobreexpresión de los isoenzimas de la ciclooxigenasa (COX), para explicar el proceso de carcinogénesis quetranscurre entre la mucosa esofágica normal, la esofagitis, el EB y el ACE.La tasa de supervivencia en pacientes con ACE es muy baja, debido a los deficientes resultados del tratamientoquirúrgico, así como a los escasos beneficios aportados por la quimio y radioterapia concomitantes. Diversasestrategias basadas en el diagnóstico precoz y seguimiento de las lesiones preneoplásicas han fracasado enconseguir un impacto global y significativo sobre el pronósticodel ACE. Estudios epidemiológicos y experimentales recientes sugierenque la quimioprevención podría ser útil en el manejo de los pacientes con ERGE, y especialmente en aquellos con EB. La terapia convencional con inhibidoresde la bomba de protones (IBP) es eficaz para reducir la exposición ácida esofágica, mejorar los síntomas por el reflujo y curar las lesiones inflamatorias, pero probablemente no es suficiente para evitar la progresión displásica del epitelio con metaplasia. El uso regular de inhibidores de la COX (aspirina y otros antiinflamatoriosno esteroides) es capaz de bloquear vías decarcinogénesis y disminuir la incidencia de ACE en modelos animales. En humanos, la asociación de IBPcon inhibidores de la COX podría ser una estrategia segura y coste-efectiva, aunque no existen evidencias directasque lo corroboren. En lo que respecta a...

Bypass gástrico por videolaparoscopia para el tratamiento de la obesidad mórbida. Experiencia clínica inicial / Gastric Bypass by videolaparoscopia for the treatment of the morbid obesity. Initial clinical experience

Antecedentes: El único tratamiento eficaz a largo plazo para la obesidad mórbida es el quirúrgico. El bypass gástrico es la técnica más utilizada mundialmente. Objetivos: Evaluar los resultados obtenidos con los primeros 70 bypass gástricos videolaparoscópicos para el tratamiento de la obesidad mórbida. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Retrospectivo. Población: 70 pacientes consecutivos sometidos a bypass gástrico videolaparoscópico. Método: Análisis retrospectivo de base prospectiva de datos. La población fue dividida en dos períodos, representado cada uno una mitad de la experiencia, para su posterior análisis. Medidas de evaluación: Características demográficas, IMC, comorbilidades y evolución de las mismas, descenso ponderal, tiempo operatorio, días de internación, morbilidad, índice de conversión, mortalidad, etc. Resultados: 68% de pacientes correspondieron al sexo femenino con una edad e IMC promedio que fue de 42,6 años y 50,25 Kg/m2 respectivamente. El promedio de comorbilidades fue de 2,7 por paciente. El índice de conversión fue del 8,57% y la morbilidad global del 15,28%. No hubo mortalidad. Diferencias significativas fueron encontradas entre ambos períodos en tiempo operatorio y días de internación. El ERR a 6 y 12 meses fue del 44 y 56%, respectivamente. Conclusiones: La realización de bypass gástrico videolaparoscópico con buenos resultados es factible, siempre que sea realizado por un equipo quirúrgico entrenado, en el contexto de un quipo multidisciplinario.

Is the presence or absence of Helicobacter pylori in gastric mucosa a greater risk?

Helicobacter pylori is a unique organism which is pathogenic for stomach-duodenum (chronic gastritis, duodenal ulcer, gastric ulcer, gastric malignancy, mucosa-associated lymphoid tissue (MALT) lymphoma) and protective for oesophagus (Barrett's oesophagus, oesophageal adenocarcinoma) at the same time in an individual. For prevention of diseases, the necessity of presence of some bacteria throughout the gastrointestinal lumen needs to be emphasized. The concept--only good Helicobacter pylori is a dead Helicobacter pylori, is dangerous and humans should learn to live in harmony with a few bacteria throughout the gastrointestinal tract.

Oesophageal cancer in Bahrain

Data from all 148 cases of oesophageal cancer in Bahrain during 1952-99 were analysed according to patient sex and age and site and histological pattern of tumour, and compared with other Gulf countries. In Bahrain, oesophageal cancer accounted for 2.6% of malignant neoplasms. The female:male ratio was 1.8:1, and the majority of patients were >/=51 years and