[Chronic gastritis in children: evaluation after eleven years]. / Gastritis chronica u dzieci--ocena po 11 latach.

UNLABELLED: Chronic gastritis (CG) was diagnosed in 38 of 130 children with abdominal pain treated between 1980-1982. After eleven years, 20 of the 38 patients with CG were re-examined clinically and gastroscopically. Six gastric biopsies for hitopathological examination and two for CLO tests in each patient were taken. In 13 of 20 additional staining for H. pylori was done in the biopsy specimens take 11 years ago. In 95% (19 of 20) patients, CG and H. pylori infection were found. Thirteen of them (all examined) had already been infected with HP in childhood. Gastritis had progressed or remained unchanged in 90% (17 of 19) patients in the corpus and in 75% (15 of 20) in the antrum. All 6 patients who had duodenal ulcers (DU) in childhood had recurrences of DU. Thirty-one percent (4/13) of patients with persisting CG that had no ulcers previously, now had DU or erosions. All 19 patients with CG and HP infection received triple therapy. In 6 of 7 those regression or disappearance of CG and HP eradication were seen re-examined. CONCLUSIONS: CG which began in childhood progresses or persists until adulthood in all H. pylori - positive patients. We suggest that children with H. pylori-positive CG should receive anti-H. pylori treatment.

Diffuse filiform polyposis of the colon in Crohn's disease. Case report.

A case of giant diffuse filiform polyposis of the entire colon with pathological features of Crohn's disease in a 30-year-old man is presented. The most important aspects and difficulties with differential diagnosis of filiform polyposis are discussed.

p53 protein expression in esophageal squamous cell papillomas: a study of 36 lesions.

BACKGROUND AND METHODS: In the present study 36 esophageal squamous cell papillomas (ESCP), uncommon benign neoplasms of the esophagus, were investigated retrospectively for p53 immunoreactivity by using the monoclonal antibody PAb 1801. Two ESCPs had previously been found to be human papillomavirus (HPV) type-6-positive. RESULTS: Only very occasional epithelial cells were stained in two cases, and in three ESCPs p53 staining was restricted to the basal epithelial cells. Both HPV-positive ESCPs remained p53-negative. CONCLUSION: We speculate that these findings are the result of immunohistochemical detection of the stabilized wild-type p53 protein rather then mutated p53 protein.

Malignant transformation of benign epithelial gastric polyps.

OBJECTIVES: To compare the malignant potential of hyperplastic polyps and adenomas in relation to different histological classifications and to try to follow the natural history of the BEGP-carcinoma sequence. METHODS: During a 13-yr period (1981-1993), 811 BEGP were discovered in 432 patients in consecutive esophagogastroscopic examinations in our department. Adequate endoscopic biopsies or polypectomy specimens were histologically diagnosed as hyperplastic polyp in 751 (92.6%) and adenoma in 60 (7.4%) of the lesions, according to WHO classification. Hyperplastic lesions were further divided into two subgroups: 268 were polypoid foveolar hyperplasia (FH) and 483 were typical hyperplastic polyps (HP), according to Elster's classification. Special attention was paid to focal malignancy at the first examination or malignant transformation of BEGP during follow-up. Ninety-six patients with 220 BEGP were followed for 1-11 yr, with an average of 2 yr and 8 months. RESULTS: According to Elster's classification, there were 10/483 (2.1%) HP and 6/60 (10.0%) adenomas with focal carcinoma. Moreover, in 19/265 patients (7.1%) with HP and in 4/30 patients (13.3%) with adenomas, carcinoma was found elsewhere in the stomach. During our follow-up, 5/131 HP showed different steps of histological transformation: focal intestinal metaplasia in two, focal dysplasia in one, and focal carcinoma in two of them, which is 1.6%, 0.8%, and 1.6%, respectively. In 1/23 adenomas, focal carcinoma developed after 1 yr of observation (4.3%). Separate gastric carcinomas developed outside polyps during follow-up in 2/58 (3.5%) patients with hyperplastic polyps only. None of those with FH had focal carcinoma either at primary biopsy or during long-term observation. All proportions concerning gradual transformation of hyperplastic polyps classified as only one group according to WHO were lower. CONCLUSIONS: In contrast to hitherto existing opinions, our results give support to the idea that gastric HP, like adenomas, are susceptible to malignant transformation. It seems sensible to separate a subgroup of FH from HP, since FH have no malignant potential until they change their histology to HP. The treatment of FH and HP as one group is the main reason why the malignant potential of hyperplastic polyps is still underestimated.

HIV/AIDS education for nurses in Poland.

Funded by an agreement with the World AIDS Foundation, a team of American and Polish healthcare professional was established to provide expert and timely training on HIV/AIDS course for nurses was conducted in Gdansk, Poland. The course identified significant professionals concerns of Polish nurses, including fear of infection, discomfort with male sexuality, and lack of information about drug users. Precourse and postcourse evaluations demonstrated significant changes in level of comfort during discussions of sensitive topics and improvement in instructional self-confidence.

Human papillomavirus infection in esophageal squamous cell papillomas: a study of 29 lesions.

The etiology and pathogenesis of esophageal squamous cell papillomas (ESCP), rare benign tumors of human esophagus, are still controversial. Chronic mucosal irritation and infection with human papillomaviruses (HPV) are two proposed etiologies. To investigate these hypotheses, we screened 29 ESCPs from 28 patients originating from Slovenia and Poland for HPV infection using in situ hybridization (ISH) and polymerase chain reaction (PCR). No evidence of HPV DNA was found using ISH. By PCR, the presence of HPV DNA was detected in only one lesion using two different HPV L1 consensus primer sets. The restriction fragment analyses of PCR product showed patterns unique to HPV type 6. All other ESCPs were successfully amplified only with internal control human beta-globin primers. Our results show that HPV DNA is not frequently detectable in ESCPs, even when highly sensitive methods like PCR are used and that other pathogenetic mechanisms are more important in the etiology of ESCPs.

Squamous cell papillomas of the esophagus: report of 20 cases and literature review.

A series of 20 patients with 24 squamous cell papillomas of the esophagus are presented. Nonspecific symptoms not directly connected with esophageal disorders were the reason for esophagoscopy. Clinical findings, treatment, and follow-up of the patients in the context of the world literature review of 141 cases reported to date, are discussed.

[Behcet's syndrome with esophageal and intestinal involvement]. / Zespól Behçeta z zajeciem przelyku i jelit.

A case of 22-years old man with Behçet's syndrome is presented. Apart from typical aphtous ulcers in the mouth and on the scrotum the patient had oesophageal ulcerations and inflammatory changes in the ileum. During 8 years follow up the patient had several bleeding episodes from the gastrointestinal tract that required blood transfusions.

A conservative approach to granular cell tumors of the esophagus: four case reports and literature review.

We present here four patients with six granular cell tumors of the esophagus: all are women, 22, 38, 47, and 49 yr old. In three of them, single polyps were encountered. In the fourth, age 38, two lesions were found in 1982, and a new one, a satellite polyp, has appeared after 5 yr of follow-up. All of the patients' conditions were followed up [mean time 65 months (16 months to 10 yr)]. In connection with these case reports, we include an up-to-date review of the world literature on this subject.

[Correctness of diagnosis of celiac disease based on personal data]. / Prawidlowosc rozpoznawania celiakii na podstawie wlasnego materialu.

A way of coeliac disease diagnosis was assessed in 348 children, Only 14% of patients has been examined according to ESPGAN recommendations and in the proper time. Diagnosis has been completed in 123 patients, and coeliac disease has been diagnosed only in 38 of them. The I biopsy has not been performed in 96 children, the II biopsy--in 136 children, gluten-free diet has not been observed in 105 children after the I biopsy. Other causes of diagnostic failures included: prolongation of the consecutive stages and improper histological evaluation, change of biopsies order, erroneous clinical evaluation. Diagnosis according to ESPGAN recommendations is practically very difficult and time consuming. Immunological markers of coeliac disease (IgA EmA, ARA) should lead to simplification and adjustment of those recommendations in Poland.

Carcinoma in hyperplastic polyps of the stomach. An underestimated possibility. Case reports.

The formation of carcinoma in the hyperplastic gastric polyp is extremely rare. This paper presents two cases of carcinomas which developed in hyperplastic polyps of the stomach in a 39-year-old man and an 82-year-old man. The problem of malignant transformation of gastric hyperplastic polyps is stressed and discussed in the light of data in the literature.

Multifocal gastric carcinoma arising from hyperplastic and adenomatous polyps.

This paper is a presentation of the unusual case of a 61-yr-old woman operated on for multiple gastric cancers. Two of the cancers were found in the hyperplastic polyps and one in the adenoma. Apart from cancers that arose from these polyps, there were four separate polypoid or flat gastric carcinomas and three other hyperplastic polyps with no signs of malignancy, in this case. The presentation is followed by a detailed discussion focusing on the possible development of carcinoma in gastric hyperplastic polyps in view of the data from the literature.

[Role of coloscopy in diagnosis and treatment of large bowel diseases]. / Miejsce kolonoskopii w diagnostyce i leczeniu chorób jelita grubego.

Coloscopy is the most accurate method of evaluation of the whole large bowel. The main indications for this examination are doubtful radiological changes in the colon and unexplained intestinal symptoms, bleeding in the first place. Coloscopy plays also an important role in the differential diagnosis of colitis and in the oncological follow-up of patients after polypectomy or with long-standing ulcerative colitis. The therapeutic use of coloscopy includes removal of polyps and foreign bodies, control of bleeding, and laser photocoagulation of neoplasmatic lesions. Since 1973 in the Department of Gastroenterology of the Postgraduate Medical Center 2360 diagnostic coloscopies were carried out in 1838 patients. The most frequent diagnoses were polyps (34%) and large bowel cancer (12%). Various forms of colitis were diagnosed in 7% of patients, and all other diseases jointly in 11% of cases. In 36% of patients the large bowel showed no changes, in spite of undoubtful indications for coloscopy. Many of these patients were spared explorative laparotomy. By means of diathermic loop 808 colorectal polyps were removed in 421 patients. Rare complications of this procedure were bleedings (1.5%) and peritoneal irritation symptoms without perforation (0.25%). Adeneomas prevailed among polyps. Seventeen patients with invasive cancer in adenoma were treated successfully only endoscopically.

Small intestine carcinoma in the Peutz-Jeghers syndrome.

A woman with Peutz-Jeghers syndrome is reported in whom malignant transformation was found in a polyp of the small intestine. The patient was operated on for occlusion of the small intestine. A tumour of the jejunum was disclosed and histological examination revealed, besides typical structure of a Peutz-Jeghers polyp, also severe carcinomatous dysplasia with beginning invasion of the submucosa. The modern strategy of management of Peutz-Jeghers polyps is discussed.

Reduced thickness of gastric mucosa and retarded progression of chronic gastritis in patients with renal failure.

Conflicting results are reported in the literature on the structure and function of gastric mucosa in patients with chronic renal failure (CRF). In the present endoscopic study of 68 CRF patients on conservative treatment (regular dialyses or transplantations had not yet been undertaken), we sought to clarify whether CRF leads to hypertrophic or hypotrophic phenomena in gastric mucosa, as interpreted by the presence and grade of gastritis and by the thickness of the gastric mucosa. We found that the mean progression of gastritis in both antrum and body was significantly slower than expected in CFR patients, and that the thickness of both antral and body mucosa was significantly lower in CFR patients than in non-CRF controls. Furthermore, although the thickness of the oxyntic body mucosa in CRF showed a positive correlation to serum gastrin (SeGa) levels and even though 12 of the patients showed high SeGa levels corresponding to those seen in the Zollinger-Ellison synbdrome (300-1500 ng/l), the thickness of the oxyntic body mucosa in CRF patients did not exceed that seen in control subjects with normal SeGa. We conclude that CRF exerts inhibitory effects on the gastric mucosa resulting in retardation in the progression of chronic gastritis and hypotrophy of the gastric mucous membrane.

Short- and long-term results of colonoscopic polypectomy in children.

Eighty-four colorectal polyps of up to 3.3 cm in diameter were removed with the diathermy snare during 48 colonoscopies on 42 children, aged 2 to 18 years (mean, 7.4 years). Most polyps were juvenile and the majority were located in the sigmoid colon (55%) or rectum (37%). No complications related to medication, colonoscopy, or snare polypectomy were observed. The two presenting symptoms, rectal bleeding and anemia, disappeared soon after polypectomy in all but one patient with adenomatous polyposis coli, subsequently operated upon. Follow-up examinations, including total colonoscopy, performed 4 months to 7 years (mean, 25 months) later did not reveal abnormalities in any of the 37 children whose previously removed polyps were juvenile. The authors conclude that endoscopic snare polypectomy is an effective and safe treatment for colorectal polyps in the pediatric age group.