La cupruria estimulada en el diagnóstico de la enfermedad de Wilson / Stimulated urinary copper excretion in the diagnosis of Wilson's disease

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[Endoscopic mucosal resection of Abrikosoff's tumor of the esophagus]. / Mucosectomía endoscópica de un tumor de Abrikosoff esofágico.

Abrikosoff's tumor (AT), or granular cell tumor (GCT), is relatively rare in the gastrointestinal tract, where the most common site is the esophagus. This tumor is usually found incidentally when an upper gastrointestinal endoscopy is carried out for another reason. Endoscopically, GCT appears as a small, yellow and submucosal lesion covered by normal mucosa. Endoscopic ultrasonography shows a homogeneous hypoechoic lesion with well defined margins. The definitive diagnosis is histological. The origin of GCT is neurogenic and the tumor is composed of eosinophilic granular cytoplasm and PAS-positive cells, which show the S-100 protein on immunohistochemistry. Although GCT is usually clinically and histologically benign, some malignant cases have been reported. Consensus is lacking on the treatment and follow-up of this tumor. Currently, endoscopic mucosal resection is a safe and effective technique to treat submucosal esophageal lesions, allowing subsequent histologic analysis. We present three patients with esophageal CGT, who were definitively treated with endoscopic mucosal resection.

Mucosectomía endoscópica de un tumor de Abrikosoff esofágico / Endoscopic mucosal resection of Abrikosoff´s tumor of the esophagus

El tumor de Abrikosoff (TA), o tumor de células granulares(TCG), se localiza raramente en el tracto gastrointestinal.Cuando asienta en el tubo digestivo, habitualmente apareceen el esófago. El diagnóstico suele establecerse de forma accidentalal realizar una endoscopia digestiva alta por otrosmotivos. Endoscópicamente, es una lesión submucosa de pequeñotamaño, de coloración amarillenta y generalmenterecubierta por mucosa normal. El TA es homogéneo, hipoecogénicoy con bordes bien definidos en el examen ecoendoscópico.El diagnóstico definitivo es histológico. El TCG es deorigen neurogénico y está formado por células eosinófilasgranulares PAS-positivas, que en la inmunohistoquímicamanifiestan la proteína S-100. El TA es normalmente un tumorbenigno, aunque se han descrito casos de malignidad.No hay acuerdo sobre cómo debe ser el tratamiento y el seguimientode este tumor. En la actualidad la mucosectomíaendoscópica es una técnica eficaz y segura que se puede aplicara lesiones submucosas esofágicas, lo que permite el análisishistológico posterior de toda la lesión. Presentamos 3casos de pacientes diagnosticados de TCG esofágico que fuerontratados mediante mucosectomía endoscópica como tratamientodefinitivo

Abrikosoff’s tumor (AT), or granular cell tumor (GCT), isrelatively rare in the gastrointestinal tract, where the mostcommon site is the esophagus. This tumor is usually foundincidentally when an upper gastrointestinal endoscopy is carriedout for another reason. Endoscopically, GCT appearsas a small, yellow and submucosal lesion covered by normalmucosa. Endoscopic ultrasonography shows a homogeneoushypoechoic lesion with well defined margins.The definitive diagnosis is histological. The origin of GCT isneurogenic and the tumor is composed of eosinophilic granularcytoplasm and PAS-positive cells, which show the S-100 protein on immunohistochemistry. Although GCT isusually clinically and histologically benign, some malignantcases have been reported. Consensus is lacking on the treatmentand follow-up of this tumor. Currently, endoscopicmucosal resection is a safe and effective technique to treatsubmucosal esophageal lesions, allowing subsequent histologicanalysis. We present three patients with esophagealCGT, who were definitively treated with endoscopic mucosal resection (AU)

Usefulness of penicillamine-stimulated urinary copper excretion in the diagnosis of adult Wilson's disease.

OBJECTIVE: Diagnosis of Wilson's disease (WD) is reliant on liver biopsy (LB) and measurement of hepatic copper. The aim of this study was to determine the usefulness of penicillamine-stimulated urinary copper excretion (PS-UCE), a non-invasive diagnostic test, for the diagnosis of WD in adults. MATERIAL AND METHODS: In this prospective study of patients with suspected WD, total serum copper, ceruloplasmin, basal 24-h UCE and PS-UCE levels were measured. LB with copper determination was performed in those patients with persistent hypertransaminasemia and low ceruloplasmin or basal UCE > 40 microg/24 h. Diagnosis was established if the ceruloplasmin level was found to be < 20 mg/dl and hepatic copper > 250 microg/g. Results. A total of 115 patients were studied; LB was performed in 43, and WD was diagnosed in 6 (13.9%). Significant differences between WD and non-WD patients were found for basal UCE (WD: median 134.3 microg/24 h versus non-WD: median 19.0 microg/24 h (p < 0.05)) and PS-UCE (WD: median 1284.0 microg/24 h versus non-WD: median 776.0 microg/24 h; p < 0.01). In the ROC (receiver-operated curve) analysis, PS-UCE was the best discriminant between WD and non-WD (area under the curve (AUC) = 0.911, best cut-off point 1057 microg/24 h, 100% sensitivity, 82.3% specificity). CONCLUSIONS: PS-UCE is probably a useful non-invasive test in the diagnosis of WD, improving the selection of patients for diagnostic liver biopsy. Patients with PS-UCE under 1057 microg/24 h only rarely will suffer from WD and are unlikely to benefit from LB.

Thermal degradation of allicin in garlic extracts and its implication on the inhibition of the in-vitro growth of Helicobacter pylori.

Allicin, the main active principle related to Allium sativum chemistry, is considered to be responsible for the bacteriostatic properties of garlic. The work described here has demonstrated the direct implication of the allicin present in solvent-free garlic extracts obtained with ethanol (ethanolic garlic extract, EGE) and acetone (acetonic garlic extract, AGE) in the inhibition of the in-vitro growth of Helicobacter pylori (Hp), the bacterium responsible for serious gastric diseases such as ulcers and even gastric cancer. The evolution of allicin concentration as a function of time and temperature has been the subject of a kinetic study. The reaction order, activation energy, and preexponential factor (in accordance with Arrhenius theory) have been determined for the decomposition process of allicin in these organic media. First-order decomposition, an activation energy of 97.4 kJ/mol, and an Arrhenius preexponential factor of 8.9 x 10(10) s(-1) have been determined for allicin in EGE. For allicin in AGE the kinetic order determined was 1.5, the activation energy 184.5 kJ/mol, and the preexponential factor 3.1 x 10(24) s(-1) (mg/L)(-0.5). The presence or absence of allicin in these garlic products was found to be crucial for the inhibition of the in-vitro growth of Hp, as demonstrated by microbiological analysis for AGE. A relationship has been identified between the effectiveness and durability of the anti-Hp properties shown by AGE and the allicin content of these products. The bacteriostatic properties were active for up to 10 months if the samples were maintained at 6 degrees C.

Allyl-thiosulfinates, the bacteriostatic compounds of garlic against Helicobacter pylori.

Allicin and allyl-methyl plus methyl-allyl thiosulfinate from acetonic garlic extracts (AGE) have been isolated by high-performance liquid chromatography. These compounds have shown inhibition of the in vitro growth of Helicobacter pylori (Hp), the bacterium responsible for serious gastric diseases such as ulcers and even gastric cancer. A chromatographic method was optimized and used to isolate these thiosulfinates. The method developed has allowed the isolation of natural thiosulfinates extracted from garlic by organic solvents and is an easy and cheap methodology that avoids complex synthesis and purification procedures. The capacity and effectiveness of isolated natural thiosulfinates have been tested, and this has enabled the identification of the main compounds responsible for the bacteriostatic activity shown by AGE origin of these kinds of organosulfur compounds along with ethanolic garlic extracts (EGE). Additionally, microbiological analyses have suggested that these compounds show a synergic effect on the inhibition of the in vitro growth of Hp. The results described here facilitate the process of obtaining garlic extracts with optimal bacteriostatic properties. The product is obtained in a way that avoids expensive purification methods and will allow the design of live tests with the aim of investigating the potential for the use of these garlic derivatives in the treatment of patients with Hp infections.

Role of partner's infection in reinfection after Helicobacter pylori eradication.

AIM: To evaluate whether the Helicobacter pylori status of the patient's spouse plays a role in reinfection after eradication success, and to assess the possibility of transmission of H. pylori among partners by using molecular methods. METHODS: We studied prospectively 120 patients in whom H. pylori had been eradicated. Endoscopy with biopsies and a 13C-urea breath test were performed 1 month after completing therapy. The breath test was repeated in all patients at 6 and 12 months. At the 1-year follow-up visit (or before if reinfection occurred), a breath test was also performed on the patient's partner. Samples for the molecular study included gastric biopsies from patients and gastric content obtained by the string test from partners. The heterogeneity of ureC was studied by enzymatic digestion with MseI and HhaI enzymes of a polymerase chain reaction (PCR) product of 1179 bp belonging to the ureC gene, and different band patterns were generated after electrophoresis. RESULTS: Four reinfections were diagnosed at 6 months, and four were diagnosed from 6 to 12 months (incidence 6.8% per patient-year). Seven of eight (87%) of the reinfected patients' spouses were infected, but H. pylori infection of spouses was also frequent (76%) among non-reinfected patients. In the multivariate analysis, age of the patient (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.87 to 0.99, P < 0.05), delta(13)CO(2) value after therapy (OR 2.51, 95% CI 1.14 to 5, P < 0.05), and therapy regimen (OR 6.23, 95% CI 1.25 to 31, P < 0.05) were the only variables that correlated with H. pylori recurrence. However, family variables (H. pylori status of spouse, breath test value of spouse, length of time couple had lived together, number of children living at home, household density) did not correlate with recurrences. Thus, the OR for the H. pylori status of spouse (adjusted by age, delta(13)CO(2) and therapy) was 2.93 (95% CI 0.29 to 29, P > 0.05). H. pylori recurrence occurred in seven of 92 (7.6%) patients when the spouse was infected (95% CI 3.7% to 15%), and in one of 28 (3.6%) patients when the spouse was H. pylori-negative (95% CI 0.6% to 18%) (P > 0.05; however, the power of this comparison was < 20%). Therefore, even if the spouse was infected, 92.4% of patients will remain uninfected 1 year after H. pylori eradication. Three reinfected patients (at 1 year) and their partners (also infected) agreed to have the endoscopy and string test performed, respectively. The molecular study revealed that H. pylori strains involved were different in all cases. CONCLUSION: Recurrence of H. pylori infection seems to be relatively infrequent, even if the patient's spouse is H. pylori-positive. The molecular study demonstrated that the strains in reinfected patients and their partners are different, suggesting that the patient's partner does not act as a reservoir for H. pylori reinfection.

Rapid urease test utility for Helicobacter pylori infection diagnosis in gastric ulcer disease.

BACKGROUND/AIMS: To establish rapid urease test utility for initial diagnosis of Helicobacter pylori infection in gastric ulcer patients and to determine the best site for sampling for gastric biopsies. METHODOLOGY: Seventy consecutive gastric ulcer patients were prospectively studied. All these patients underwent three biopsies from both antrum and body (two for hematoxylin-eosin staining and one for rapid urease test -Jatrox H. p. Test-). Likewise, IgG ELISA serology and 13C-urea breath test were carried out. Gold standard for H. pylori infection was defined as two or more tests (i.e., histology, serology, breath test) with positive results. RESULTS: Rapid urease test yielded 96.8% sensitivity (95% CI = 89-99%) and 100% (66-100%) specificity when using biopsy specimens from the body, with identical results when biopsy specimens from both antrum and body were considered together. However, when only biopsy specimens from the antrum were used, sensitivity dropped to 72.6% (60-82%) and specificity was 100% (66-100%). As far as concordance between rapid urease test and histology is concerned, we found a "proportion of positive agreement" of 0.78 for the antrum, with 0.46 kappa statistic (P < 0.0001) and 15 McNemar statistic (P < 0.0001). For the gastric body, "proportion of positive agreement" was 0.98, with 0.94 kappa statistic (P < 0.0001) and 1 McNemar statistic (P = 0.3). Larger (P < 0.01) prevalence of both glandular atrophy (17.8%, 11-28%) and intestinal metaplasia (68.5%, 57-78%) was observed in the antrum in comparison with that in the body (4.1%, 1-11%; and 16.4%, 10-26%, respectively). CONCLUSIONS: Biopsy specimens from the body should always be obtained when the rapid urease test is performed to diagnose H. pylori infection in gastric ulcer, since this procedure is less accurate when biopsy specimens from the antrum are used, probably due to larger prevalence of both glandular atrophy and intestinal metaplasia in the latter site. Likewise, it seems that rapid urease test from body biopsies is sufficient to reach a reliable infection diagnosis in gastric ulcer patients as this procedure performed with antrum biopsies fails to improve its overall results.

Consideraciones prácticas para el diagnóstico de la infección por Helicobacter pylori / Practical considerations for the diagnosis of Helicobacter pylori infection

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Efecto de la erradicación de Helicobacter pylori sobre la recurrencia de la úlcera gástrica a lo largo de 12 meses / Effect of Helicobacter pylori eradication on gastric ulcer recurrence. A 12 month follow-up study

Fundamento: Valorar la influencia de la erradicación de Helicobacter pylori sobre la incidencia de recurrencias ulcerosas durante un período de seguimiento de 12 meses en enfermos con úlcera gástrica. Pacientes y métodos: Se estudiaron prospectivamente a 73 enfermos con úlcera gástrica. Durante la endoscopia se tomaron, tanto de antro como de cuerpo, dos biopsias para estudio histológico (hematoxilina-eosina) y una para test rápido de la ureasa. También se realizaron serología y prueba del aliento con urea-13C. Cincuenta y seis pacientes infectados por H. pylori fueron seguidos tras administrar una terapia erradicadora con omeprazol, claritromicina y amoxicilina. Inmediatamente después de completar el tratamiento erradicador, se llevó a cabo una endoscopia de control de la cicatrización. Al mes de finalizar la terapia se realizó una segunda endoscopia con estudio histológico y un test del aliento (se definió la erradicación como la ausencia de H. pylori por ambas técnicas). Finalmente, para estudiar las recurrencias ulcerosas se efectuó de nuevo una endoscopia a los 6 y 12 meses. Resultados: La edad media de los pacientes estudiados fue de 54 ñ 13 años, y el 69 por ciento eran varones. La tasa acumulada de recurrencias ulcerosas a los 12 meses en los grupos con éxito y fracaso erradicador fue, respectivamente, del 2,3 por ciento (IC del 95 por ciento, 0-12 por ciento) y del 70 por ciento (IC del 95 por ciento, 34-93 por ciento) (*2: 23,9; p < 0,0001). La comparación de las curvas de Kaplan-Meier para la recurrencia ulcerosa en función de la erradicación de H. pylori demostró diferencias significativas (prueba de log-rank; *2: 33,8; p < 0,0001). Uno de los pacientes en los que se erradicó el germen presentó recidiva ulcerosa coincidiendo con la toma de ácido acetilsalicílico y sin objetivarse recurrencia de la infección. Conclusiones: La erradicación de H. pylori se asocia con una drástica reducción de la recidiva de la úlcera gástrica, con una tasa de recurrencia acumulada durante 12 meses de sólo el 2,3 por ciento. Esto indica que podría lograrse la curación definitiva de esta enfermedad mediante la erradicación del microorganismo (AU)

Manifestaciones extradigestivas de la infección por helicobacter pylori. ¿Ciencia o ficción? / Extradigestive manifestations of Helicobacter pylori infection. Science or fiction?

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