Over-expression of cyclooxygenase-2 in endoscopic biopsies of ectopic gastric mucosa

Ectopic gastric mucosa (EGM) is considered to be a congenital condition. Rare cases of adenocarcinoma have been described. There are no data justifying regular biopsies or follow-up. Cyclooxygenase-2 (COX-2) is a protein involved in gastrointestinal tumor development by inhibiting apoptosis and regulating angiogenesis. The aim of this prospective study was to evaluate COX-2 expression in EGM and compare it with normal tissue and Barrett's esophagus. We evaluated 1327 patients. Biopsies were taken from the inlet patch for histological evaluation and from the gastric antrum to assess Helicobacter pylori infection. Biopsies taken from normal esophageal, gastric antrum and body mucosa and Barrett's esophagus were retrieved from a tissue bank. EGM biopsies were evaluated with respect to type of epithelium, presence of H. pylori, and inflammation. COX-2 was detected by immunohistochemistry using the avidin-biotin complex. EGM islets were found in 14 patients (1.1 percent). Histological examination revealed fundic type epithelium in 58.3 percent of cases, H. pylori was present in 50 percent and chronic inflammation in 66.7 percent. Expression of COX-2 was negative in normal distal esophagus, normal gastric antrum and normal gastric body specimens (10 each). In contrast, EGM presented over-expression of COX-2 in 41.7 percent of cases and Barrett's esophagus in 90 percent of cases (P = 0.04 and 0.03, respectively). COX-2 immunoexpression in EGM was not related to gender, age, epithelium type, presence of inflammation or intestinal metaplasia, H. pylori infection, or any endoscopic finding. Our results demonstrate up-regulation of COX-2 in EGM, suggesting a possible malignant potential of this so-called harmless mucosa.

"Stents" ureterales: una forma de fijación simplificada / Ureteral stents: A simplified fixation approach

Los"stends" ureterales son más utilizados en los reimplantes ureterales con modelaje, en aquellos con dificultades técnicas, en reoperaciones y eventualmente en pieloplastías. De enero de 1995 a junio de 1998 utilizamos "stents"ureterales en 40 niños. 29 sometido a reimplantes vesicoureterales, 10 a pieloplastías y una ureteroplastía. Las extremidades de los stents en los reimplantes permanecieron en la vejiga y fueron fijados a la cistotomía o a la sonda uretral y en la pieloplastías o en la ureteroplastía fueron fijados a la sonda de nefrostomía. Los stents fueron retirados ambulatoriamente, juntamente con la sonda a la que estaban fijados, 7 a 12 días despues de la operación. No hubo complicaciones, el tiempo medio de internación disminuyó de 6 a 3 días. El procedimiento resultó eficaz, facilitó el trabajo médico, permitió mayor confort y movilidad a los pacientes