Effects of cimetidine and pentagastrin on surgical repair of gastric mucosa.

BACKGROUND/AIMS: The aim of this work is to evaluate the repair of mucosal epithelium at the critical time of the beginning of reepithelization of stomach wound. METHODOLOGY: Structural and ultrastructural evaluation of rat gastric mucosa repair was carried out with administration of placebo, cimetidine and pentagastrin in different groups of rats (Rattus norvegicus albinus) during the first 7 post-operative days. Following 48 hours of starvation and anesthesia by ethyl ether inhalation, the animals were submitted to laparotomy exposing the stomach. A fusiform gastric resection measuring 5 mm in length was performed in the fundus stomach wall. The surgical wound was sutured in 2 plans: muscular tunic and visceral serosa. The abdominal wall was also sutured in 2 plans: parietal serosa-abdominal musculature and skin. During 6 consecutive post-operative days, the placebo group rats received 1 ml of distilled water intragastrically; those of the cimetidine group 10 mg/kg of cimetidine; and, animals of the pentagastrin group, 250 micrograms/kg of pentagastrin by intraperitoneal injection. On the 7th post-operative day, rats were killed and fragments of the stomach wall containing transverse section of surgical wound were collected and processed for light microscopy and electron microscopies. RESULTS: At the beginning of gastric mucosal wound reepithelization cimetidine has better effect than that of pentagastrin. CONCLUSIONS: Comparative mucosal morphology showed that cimetidine tends to accelerate the beginning of reepithelization of granulation tissue while pentagastrin delays reepithelization due to alteration of protective mucus and a provoking increase of granulation tissue.

Morphological evaluation of ethylic damage on gastric mucosal repair after surgery.

BACKGROUND/AIMS: The damage caused by either yeasted or distilled alcoholic beverages on repair of gastric mucosa is not totally clear. The aim of this work was to verify morphologically the effect of ethylic damage on the initial repair of gastric surgery. METHODOLOGY: Eighteen albino rats equitably were divided into an experimental group receiving a placebo (EGpl), experimental group receiving fermented ethanol (EGfe) and experimental group receiving distilled ethanol (EGde). All of the rats were submitted to standardized gastric surgery of the fundic wall. During the first 6 post-operative days, 1 ml of distilled water to EGpl, 1 ml of ethanol 11.8% to EGfe and 1 ml of ethanol 43% to EGde were intragastrically administered on a daily basis. All of the animals were killed on the 7th post-operative day and fragments of fundic mucosa at the site of suture were adequately processed and a comparative observation was carried out through light and electron microscopies. RESULTS: Both, low (wine) and high (whisky) concentrations of ethanol in the alcoholic beverage produced mild and severe erosion, respectively, on the gastric superficial lining epithelium. CONCLUSIONS: The severe erosion of the epithelium was counterbalanced by an explosive secretion of gastric mucus caused by the high concentration of ethanol, but reepithelization of surgical repair, either of EGfe or EGde was slower than of EGpl.

[Peutz-Jeghers syndrome and adenocarcinoma. Report of a case]. / Síndrome de Peutz-Jeghers e adenocarcinoma. Relato de caso.

Peutz-Jeghers syndrome is a rare disease, characterized by autosomic inheritance, presenting skin stain and hamartomatous polyps. We report one case of Peutz-Jeghers syndrome and duodenal adenocarcinoma in a young male who presented with liver metastasis and pancreatic invasion. Such association is reported to be presented in 5% of patients with the syndrome. The reasons of such association are unknown, being possible that: 1) there is malignant degeneration of a adenomatous polyp; 2) malignant degeneration of a hamartomatous polyp, or 3) adenomatous portion of a hamartomatous polyp could undergo malignant transformation.

Endoscopic study of the ileal papilla in a normal case and in patients under several pathological conditions.

The ileal protrusion into the lumen of the large intestine was studied in 9 patients (8 adults and 1 girl), 6 females and 3 males, all Brazilians and Caucasians. One of the patients resulted to have no disease, whereas in the others was confirmed the suspected diverticulosis, non specific ulcerative colitis, polyposis, regional ileitis or tuberculosis. In all cases the papillary and bilabial types of the termination of the ileum was documented by endoscopic photography, justifying the change of the expression "Bauhin's ileocecal valve" to that of "eminentia ilealis". Even in cases (one with regional ileitis and the other with tuberculosis) in which the disease altered the eminentia ilealis, it was possible to recognize the ileal papilla. Endoscopy confirmed direct, in vivo observations of ileal papilla, excluding the influence of the surgical procedure (incision and exteriorization in cases of cecostomy) in the morphological aspect of the normal eminentia ilealis.

Duodenitis: histopathological and endoscopic study: critical analysis of parasitic duodenits and white spot

In the study we examined several types of chronic duodenitis, such as, nonspecific, parasitic and those associated to other pathologies, in order to verify the amin histopathological alterations; to correlate endoscopical alterations on light microscopy; to analyze the "white spot" of the duodenal mucosa in parasitic diseases and other types of duodenitis. In 213 endoscopies with 2130 biopsies, we found chronic duodenitis as a difuse process in 91.5 per cent of the cases. Histopathological and morphological correlations show 78.3 per cent "agreement", 18 per cent "false negative" and 3.7 per cent "false positive". However, normal mucosa occured in 86,3 per cent of "false negative"; erosive duodenal pathology was 10.8 per cent of the total cases being classified into: "autonomous" - 26 per cent, "simultaneous" - 9 per cent, portal hypertension - 13 per cent, giardiasis-9 per cent and strongyloidiasis-39 per cent; complete erosions, located in the duodenal bulb, were suggestive of parasitic diseases

[Carcinosarcoma of the esophagus: diagnostic importance of partial endoscopic polypectomy]. / Carcinossarcoma de esôfago: importância diagnóstica da polipectomia endoscópica parcial.

The clinical and pathological manifestations of a case of carcinosarcoma of the esophagus are reported. Barium swallow and endoscopy revealed a polypoid mass in mid esophagus. The tumor was large, pedunculated, covered by smooth mucosa with some erosions. Histologically the tumor was composed of a mixture of invasion keratinizing cells and intermingled bundle of spindle shaped cells resembling fibrosarcoma. The tumor was removed with surgery and did not show submucosa infiltration. It was not detected any metastasis or local recurrence during the 12 months follow-up period. The diagnosis was made by an endoscopic partial polypectomy. We conclude that partial polypectomy may be of value in preoperative diagnosis of esophageal polypoid mass.

Use of ampicillin plus ranitidine for Helicobacter pylori gastritis.

1. Helicobacter pylori (formerly Campylobacter pylori) is now recognized as an etiological factor in gastritis and duodenal ulcers and probably also gastric ulcers. Eradication of the bacteria is fundamental to avoid ulcer relapse. Although bismuth salts have been shown to be effective for treatment, they are not commercially available in Brazil. 2. We report an attempt to treat patients with Helicobacter pylori-associated gastritis with ampicillin (1000 mg twice daily for one month) and compare the results with the conventional treatment used in Brazil (ranitidine, 300 mg daily for one month) and with a combination of the two drugs. We studied 44 patients with histologically confirmed gastritis and with Helicobacter pylori, who were examined at the beginning and after one month of treatment. 3. Ampicillin associated with ranitidine was better than ampicillin or ranitidine alone for the treatment of gastritis. Although ampicillin may be more efficient in patients with lower acid output we did not find a statistically significant difference between these two groups (ampicillin vs drug combination), perhaps owing to the small number of patients studied. When ampicillin was combined with ranitidine there was 25% normalization of the histological picture of the gastric mucosa. 4. We conclude that ampicillin in combination with ranitidine may be a useful treatment for Helicobacter pylori-associated gastritis.

Use of ampicilin plus ranitidine for Helicobacter pylori gastritis

Helicobacter pylori (formerly Campylobacter pylori) is now recognized as an etiological factor in gastritis and duodenal ulcers and probably also gastric ulcers. Eradication of the bacteria is fundamental to avoid ulcer relapse. Although bismuth salts have been shown to be effective for treatment, they are not commercially available in Brazil. We report an attempt to treat patients with Helicobacter pylori-associated gastritis with ampicilin (1000 mg twice daily for one month) and compare the results with the conventional treatment used in Brazil (ranitidine, 300 mg daily for one month) and with a combination of the two drugs. We studied 44 patients with histologically confirmed gastritis and with Helicobacter pylori, who were examined at the beginning and after one month of treatment. Ampicilin associated with ranitidine was better than ampicilin or ranitidine alone for the treatment of gastritis. Although ampicilin may be more efficient in patients with lower acid output we did not find a statistically significant difference between these two groups (ampicilin vs drug combination), perhaps owing to the small number of patients studied. When ampicilin was with ranitidine there was 25% normalization of the histological picture of the gastric mucosa. We conclude that ampicilin in combination with ranitidine may be a useful treatment for Helicobacter pylori-associated gastritis

Campylobacter pylori in dyspeptic patients

The presence of Campylobacter pylori in gastric mucosa of patients with dyspeptic complaints has been described. The association of the symptoms and endoscopic and histopathologic alterations with the presence of the bacterium still remains unknown. 117 patients were studied with respect to dyspeptic symptoms, endoscopic and histopathologic examinations, microbiological analysis and urease test to detect Campylobacter pylori. Campylobacter pylori was found in 77 per cent of all patients. Of these 36.8 per cent had normal gastric mucosa and 84.7 per cent presented gastritis. There was no association between the symptoms, the endoscopic and histological findings.

Tratamento de pacientes portadores de dispepsia alta ou de úlcera peptica com preparaçöes de Espinheira-santa (Maytenus ilicifolia) / Treatment of Patients of High Dyspepsia or Peptic Ulcers with Maytenus ilicifolia Preparations

Em esquema duplo-cego, vinte e três pacientes diagnosticados como portadoes de dispepsia alta näo-ulcerosa foram alocados para receber, durante 28 dias, duas cápsulas contendo 200 mg cada de liofilizado de abafo de espinheira-santa (treze pacientes) ou cápsulas contendo açucar mascavo como placebo (onze pacientes). Apenas um paciente do grupo espinheira-santa näo terminou o tratamento contra cinco desistências do grupo placebo, sendo a diferença estatisticamente significante. O grupo espinheira-santa também apresentou melhora estatisticamente significante, em relaçäo ao grupo placebo, no que diz respeito a sintomatologia dispéptica global, e, particularmente, nos sintomas de azia e dor. Näo houve queixas de efeitos colaterais produzidos pela espinheira-santa. Vinte pacientes com úlceras pépticas, diagnosticadas endoscopicamente, passaram a receber, em esquema duplo-cego, duas cápsulas diárias com 200 mg de liofilizado de espinheira-santa (dez pacientes) ou cápsulas de palcebo (dez pacientes). Dado o número de desistências (cinco e quatro, respectivamente) e das cicatrizaçöes de úlceras terem ocorrido também no grupo placebo, os resultados näo diferiram estatisticamente

Sulfated glycosaminoglycan composition of human gastric mucosa: effect of aging, chronic superficial gastritis and adenocarcinoma.

The sulfated glycosaminoglycan (SGAG) composition of gastric mucosa from 24 patients with chronic superficial gastritis, 2 patients with adenocarcinoma and 36 normal subjects is reported. The mucosa was obtained by endoscopic biopsy and after histopathological examination the SGAG were extracted and characterized. Three different SGAG were isolated: chondroitin 4,6-sulfate, dermatan sulfate and heparan sulfate. Their relative concentrations for the different groups were submitted to analysis of variance by Scheffe's method. Different SGAG compositions were observed in two gastric regions (antrum and body), in chronic superficial gastritis, in adenocarcinoma and in two age groups (less than 40 years and greater than 40 years). These and other results suggest that these macromolecules might be involved in the processes of cell division and aging.

Successful endoscopic treatment of extensive recurrent papillary stenosis six years after endoscopic papillotomy.

A case of recurrent almost complete papillary stenosis after endoscopic papillotomy is presented. The stenosis was treated successfully, again by renewed endoscopic papillotomy, prior to fistulotomy. The endoscopic findings, the therapeutic procedure and the results are documented.

Differences in sulfated glycosaminoglycans composition of the gastrointestinal mucosa.

Sulfated glycosaminoglycan (SGAG) composition of normal mucosa of esophagus, gastric body, antrum, duodenum, jejunum and rectum is reported. Each region examined may be defined by specific sulfated glycosaminoglycan distributions showing variations in relative proportions and total amount of heparan sulfate, dermatan sulfate and chondroitin 4, 6-sulfate. The results are discussed in the light of a recent proposal regarding the role of these compounds in cell-cell recognition and stimulation of cell division. The methodology made it possible to detect sulfated glycosaminoglycans from small amounts of tissue obtained by endoscopic biopsies.