Distinct B-cell clonal bands in Helicobacter pylori gastritis with lymphoid hyperplasia.

Helicobacter pylori (Hp)-associated gastritis is a risk factor for gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Clonal B-cell populations are present in both reactive and neoplastic MALT tissue, thus limiting their usefulness in the evaluation of gastric lymphoid infiltrates in endoscopic biopsy specimens. The aim of this study was to identify the presence of clonal B-cell populations in Hp-gastritis with MALT and to assess their usefulness in distinguishing reactive from malignant infiltrates. Routinely fixed paraffin-embedded blocks from 20 patients with Hp-gastritis with lymphoid hyperplasia were analysed for B-cell clonality by a semi-nested polymerase chain reaction (PCR) using FRIII/LJH and FRIII/VLJH primers for amplification of the VDJ region of the immunoglobulin heavy chain gene. The histopathological findings were evaluated according to a previously published scoring system. Immunohistochemistry was performed by the labelled streptavidin-biotin technique using the following primary antibodies: CD45, CD45RO, CD3, CD20, and cytokeratin. The histopathological findings were diagnostic of Hp-chronic active gastritis (grade 2, n=17; grade 3, n=3). Scattered intraepithelial B-cells were present in all cases and non-destructive lymphoepithelial lesions in one grade 3 case. Amplifiable DNA was obtained from all samples. Clonal bands were observed in ten (7/17 grade 2 and 3/3 grade 3 lesions) and polyclonal smears in ten cases (all grade 2). The clonal bands were often (n=6) associated with a background polyclonal smear and were not reproducible from deeper sections (n=10) or another paraffin block (n=1), while the clonal bands in control low-grade MALT lymphomas were not associated with a background smear and were reproducible from deeper sections. None of the patients has developed lymphoma to date (follow-up 21-44 months). In conclusion, B-cell clonal bands are common in H. pylori-gastritis with lymphoid hyperplasia. The irreproducibility of these bands is a useful feature in favouring a reactive process.

Pancreatic cancer and fibrinogen storage disease.

BACKGROUND: Ductal adenocarcinoma is the most common type of pancreatic carcinoma while squamous, carcinosarcoma, sarcoma, giant cell carcinoma, and clear cell types are all rare. Hepatocellular fibrinogen storage disease is also an uncommon disorder which may be associated with hepatocellular carcinoma. Two cases of pancreatic carcinoma were encountered in a family with fibrinogen storage disease, further raising the possibility of a predilection to malignancy in this unusual disorder. The tumour in one case was of the rare clear cell type. These two cases are the basis for this report. METHODS: Sections were cut from retrieved paraffin embedded tissue and stained for routine histology. Immunohistochemistry using the avidin-biotin technique was applied for the expression of the markers p53 (D07), carcinoembryonic antigen (CEA), c-erbB-2, epithelial membrane antigen (EMA), and alpha-fetoprotein (AFP). RESULTS: Both cases were adenocarcinoma of pancreatic ductal origin. The tumour in one case showed features of a clear cell carcinoma. The tumour cells expressed p53, CEA, and EMA immunoreactivity and were negative for c-erbB-2 and AFP. CONCLUSIONS: Hepatocellular fibrinogen storage disease is rare and has been described in association with chronic hepatitis, cirrhosis, and rarely with hepatocellular carcinoma. This represents the first report of its association with carcinoma outside of the liver.

Inflammatory bowel disease impact and patient characteristics.

A major purpose of this survey was to describe the impact of inflammatory bowel disease on the daily life of 150 nonhospitalized adults. A complementary purpose was to examine patient characteristics and their relationship to perceived impact. Self-report questionnaires and interviews were used to collect the data. Most patients reported a low to moderate impact of the disease on daily life. Greatest impact was reported in the areas of elimination, worry, recreation and leisure activities, sleep and rest. Among patient characteristics that correlated positively with the impact variable were age, under 35 years, female gender, depressed mood, and affective-oriented coping style. The findings suggest that nurses and other health professionals may enhance patient adaptation and life satisfaction by focusing efforts on patient characteristics that are amenable to change and on areas of life where the disease impact is experienced most intensively.

Coping patterns and related characteristics in patients with IBD.

This article describes a study designed to examine the coping behaviors, personality, and mood characteristics of 150 nonhospitalized adults with inflammatory bowel disease (IBD). Self-report questionnaires and interviews were used to collect the data. Coping responses were measured with the Jalowiec Coping Scale. The Eysenck Personality Questionnaire (EPQ) and Beck Depression Inventory (BDI) were used to ascertain other characteristics. Data were analyzed using analysis of variance (ANOVA), Pearson's correlation coefficient (r), and descriptive statistics. IBD patients scored significantly higher on using problem-oriented coping patterns than on using affective-oriented methods. The results suggest that coping patterns in IBD patients are remarkably effective in contributing to lifestyle satisfaction. It can be inferred that adaptive efforts of IBD patients can be enhanced if health professionals consider coping patterns in the assessment process and if they actively support a sense of control in these patients.

Current medical management of peptic ulcer disease.

Peptic ulceration occurs when the digestive action of gastric secretions overcomes gastroduodenal mucosal defences. The therapeutic strategy used to correct this imbalance uses drugs that either reduce gastric secretion or increase mucosal resistance. Traditional therapies of dietary manipulation and antacid administration no longer play major roles in peptic ulcer therapy. Uncomplicated peptic ulcers respond quite well to drug treatment, although recurrences are common and may require long-term maintenance therapy. Drug-induced gastric ulcers have represented a challenging problem, for which effective therapy is now available.

Lymphocytic interstitial pneumonia and abdominal lymphoma complicating celiac sprue.

We report the development of lymphocytic interstitial pneumonia followed later by abdominal lymphoma in a 62-year-old woman with celiac sprue. She presented with dyspnea, cough, weight loss, and bibasilar pulmonary infiltrates. Lung biopsy demonstrated lymphocytic interstitial pneumonia and corticosteroid therapy resulted in clinical and radiological improvement. She remained well for just over a year until abdominal pain developed and investigation revealed an abdominal lymphoma. Chemotherapy effectively controlled the lymphoma while the lymphocytic interstitial pneumonia was satisfactorily managed by corticosteroid therapy. Although lymphoma is a well-recognized complication of celiac sprue, it is not associated with lymphocytic interstitial pneumonia, despite a number of other reports describing the occurrence of pulmonary disease in this disorder.

Serum protein content of rat small-intestinal mucus.

This investigation was performed to determine whether serum proteins which might contribute to mucosal protection are present in rat small intestinal mucus. Rats were fed an elemental diet, their small intestines removed, perfused, everted, and the surface mucus gently collected. Mucus was centrifuged to express its aqueous component (sol), whose serum protein content was analyzed by immunodiffusion in agarose gel. Immunoglobulins G and A were present in intestinal mucus sol; however, M and E could not be demonstrated. Serum albumin was present in mucus sol, but could be detected only following luminal perfusion with protease inhibitors. Although the role of serum albumin in intestinal mucus function is not clear, the presence of immunoglobulins G and A may contribute to the protective role played by mucus in the small intestine.

Entry of [3H]water and [1,2-14C]polyethylene glycol 4000 into normal and cystic fibrosis salivary mucus.

This investigation was performed to compare the entry of [3H]water and [14C]PEG into samples of salivary mucus from patients with CF and normal subjects. A solution containing both radioisotopes was added to samples of salivary mucus and mixed, and entry of each into mucus was determined by their dilution in the supernatant at 1, 2, 4, and 24 hr. [3H]water rapidly entered and equilibrated with the water content of both normal and CF mucus. [14C]PEG entered mucus more slowly than [3H]water and by 24 hr had entered at a ratio of only 0.794 +/- 0.108 and 0.766 +/- 0.039 of the water space accessible to [3H]water in normal and CF mucus, respectively. The mechanisms responsible for the partial exclusion of the large polyethylene glycol molecule were not explored but may reflect steric restriction of access to a portion of mucus water. Thus water entry and solute exclusion, both determinants of permeability, were unaltered in CF mucus, which fact provides evidence against the presence of a generalized defect of mucus permeability in this disease. The techniques developed for this study may be adaptable to the study of the permeability properties of mucus from other sources and other gels.

Coagulation factor therapy for hemophilia: relation to hepatitis B and to liver function.

Therapy with concentrated coagulation factors has greatly improved the management of hemophilia, but the consequence of repeated infusion of these blood products are unknown. Hepatic dysfunction is frequent in patients with hemophilia, and the use of these products may be responsible. The relation between liver function and both the frequency and type of therapy with coagulation factors was studied in a group of patients with hemophilia. Of the 36 patients studied, 75% were found to have antibody to hepatitis B surface antigen in their serum and 44% had high levels of serum glutamic oxaloacetic transaminase (SGOT). The infusion of concentrated coagulation factor more than once per year was significantly associated with the presence of antibody to hepatitis B surface antigen and with a high SGOT level. The patients treated with concentrates prepared from blood obtained from large donor pools were significantly more likely to have antibody to hepatitis B surface antigen in their serum but no more likely to have a high H-SGOT level than the patients treated exclusively with cryoprecipitate, plasma or whole blood. These findings suggest that in patients with hemophilia the frequency of coagulation factor treatment may be a more important determinant of hepatic dysfunction than the type of treatment.

Squamous cell papilloma of esophagus.

Squamous cell papilloma of the esophagus is rare. Seven well-documented cases have been reported in the English literature. Three further cases are presented, in one of which symptoms were related to the tumour. Although there is no proof that this lesion is premalignant, coincident cancer must be excluded. In each of the authors' cases, endoscopic removal of the tumour was possible. The etiology of esophageal squamous cell papilloma has not been established.

Portal hypertension complicating myelofibrosis: reversal following splenectomy.

Portal hypertension occurs in approximately 10% of patients with myelofibrosis. Increased portal blood flow secondary to splenomegaly has been proposed to explain its development. In a 60-year-old woman with proven myelofibrosis of 10 years' duration and gross splenomegaly, portal hypertension developed with esophageal varices and ascites. There was no demonstrable obstruction to portal blood flow. Following splenectomy the ascites and esophageal varices disappeared. Despite the presence of splenic myeloid metaplasia, splenectomy did not impair the patient's hematologic status. Portal hypertension complicating myelofibrosis has a poor prognosis, so careful attention should be given to its detection. Splenectomy may be preferable to portal-systemic shunting in the management of this complication.

Chronic idiopathic intestinal pseudo-obstruction with malabsorption, a scleroderma-like disorder.

A case of intestinal pseudo-obstruction in a 76-year-old man who presented with a six-year history of intermittent vomiting and abdominal pain and a 1(1/2)-year history of diarrhea is described. Investigation demonstrated aperistalsis of the lower esophagus and an unresponsive atonic small intestine. Marked malabsorption was present and appeared due to intestinal bacterial overgrowth consequent to the hypomotility. Autonomic nervous system testing failed to reveal any definite abnormality. Although this disorder is markedly similar to scleroderma involving the gastrointestinal tract, there was only minimal fibrosis of the bowel musculature evident at autopsy and the neural components appeared to be intact. These findings suggest that the basic disorder may be one of smooth muscle dysfunction. Other known causes of pseudo-obstruction could not be demonstrated.