Evaluation of noninvasive versus invasive techniques for the diagnosis of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori is one of the most common bacterial strains causing chronic infections, affecting over one half of the world's population. There is increasing interest in noninvasive methods for diagnosing H. pylori infection. The aim of the study was to evaluate 3 different noninvasive methods of diagnosis: the stool antigen test (HpSA), the serum antibody test, and the stool-polymerase chain reaction (PCR) test as against invasive methods based on histopathologic diagnosis. MATERIALS AND METHODS: Gastric biopsies were obtained during endoscopy. Sections were stained with hematoxylin and eosin and Giemsa stain. Serum samples were tested for H. pylori antibody using an enzyme-linked immnunosorbent assay kit for the semiquantitative determination of IgG antibodies; stool samples were tested for H. pylori antigen using polyclonal enzyme-linked immnunosorbent assay kits. DNA samples from stool specimens were extracted, followed by PCR for the detection of H. pylori UreA. RESULTS: The results revealed that 18/19 (94.7%) patients were positive for H. pylori infection as detected by Giemsa stain, and 84.2% were positive on the basis of hematoxylin and eosin stain, with a sensitivity and specificity of 88.9% and 100%, respectively. Diagnosis by noninvasive methods, including the serum antibody test, revealed a sensitivity and positive predictive value of 88.9% and 94.2%, respectively, whereas the stool antigen test recorded a sensitivity and positive predictive value of 72.2% and 92.9%, respectively. The stool-PCR test recorded a sensitivity of 72.2% and specificity of 100%. CONCLUSIONS: Among the noninvasive methods for diagnosis of H. pylori infection, the 3 methods used in this study recorded promising results, including good sensitivity, which was the highest in the serum antibody test, whereas the stool-PCR test recorded excellent specificity.

Epidemiology and management of breast carcinoma in Egyptian males: experience of a single Cancer Institute.

OBJECTIVE: To assess the epidemiological and clinico-pathological features, surgical and reconstructive techniques, adjuvant treatments and clinical outcome of breast carcinoma in males (BCM) at the Egyptian National Cancer Institute (NCI). PATIENTS AND METHODS: Thirty-two males with breast carcinoma presented to NCI between January 2000 and December 2002. They were evaluated by complete history, physical examination, laboratory and radiological investigations. RESULTS: Median age was 59 years. Left sided and retroareolar breast lumps were the commonest presentations. Grade II tumors positive for hormone receptors were very common. Stages I, II, III and IV of the disease were encountered in 6.2%, 34.4%, 34.4% and 25.0% of patients, respectively. Curative surgery was done in 22 patients; they received adjuvant hormonal therapy, chemotherapy and radiotherapy in 22, 16 and 10 patients, respectively. Eight metastatic patients were treated with palliative measures. Surgery was done in 25 patients; the most common procedure was modified radical mastectomy (40.6%). Primary closure was feasible in 17 patients (68%), local flaps were needed in 4 cases (16%), while myocutaneous flap was done in 3 cases (12%). The commonest complication was the development of seroma (9 cases). The overall survival (OS) at 5 years was 65.4%. The disease free survival (DFS) at 5 years was 53.9%. Stage and curative surgery significantly affected OS, while type of surgery was the only variable significantly affecting DFS. CONCLUSION: Male breast carcinoma occurs at older ages than females, usually in advanced stage. This necessitates directing attention of males and awareness on the prevalence and risk factors for this disease.

Evaluation of the Value of Combined Urine Cytology and Cystoscopy for Follow-up of Superficial Transitional Cell Carcinoma of the Urinary Bladder.

OBJECTIVE: Cystoscopic biopsy is the most accurate technique used to assess the efficacy of treatment and to detect recurrence of superficial TCC of urinary bladder. Implementation of voided urine cytology to detect tumor cells in urine samples may represent an additional tool. The aims of this study are: (1) To estimate the reliability of combined cystoscopy and urine cytology examination in the follow-up of cases of superficial urinary bladder carcinoma, which might help to restrict cystoscopic biopsies for these cases with its morbidity and cost, (2) To discuss the diagnostic pitfalls of cytologic examination in these cases. PATIENTS AND METHODS: This is a prospective study, on 93 patients with superficial TCC of urinary bladder who were initially treated by complete TUR with or without adjuvant intravesical therapy with Bacillus Calmette - Guerin (BCG) (120mg÷instillation) every week for 6 weeks. Cystoscopic findings, urine cytology and histologic results of cystoscopic biopsies were assessed. RESULTS: By histologic examination, 41 (44%) cases were recurrent TCC and 52 (56%) were reported as negative for recurrence. By cystoscopic examination there were 36 positive cases, 4 of them were false positive. Out of the 57 negative cases for recurrence cystoscopically, 9 were histologically positive and were considered as false negative results. By cytology, 28 cases were positive, 3 were false positive, and 65 were negative for recurrence, 16 of them were false negative. Most of false negative cases were low grade TCC. Sensitivity of cytology and cystoscopy in the detection of recurrence was 61% and 78% respectively. When the two examinations were combined, sensitivity was 100%, and specificity was 92.3%. CONCLUSION: For follow-up of superficial bladder carcinoma, the combination of negative cystoscopic findings and negative urine cytology may replace routine biopsies with their morbidity and cost. KEY WORDS: Superficial bladder carcinoma - Cytology and Cystoscopy - Follow-up.