Endothelial nitric oxide synthase (eNOS) is not upregulated in gastric mucosa of Helicobacter pylori (H. pylori)-positive patients with type 2 diabetes mellitus.

AIM: To evaluate the expression of eNOS and CD34 in gastric mucosa of Helicobacter pylori (H. pylori) positive diabetic patients, in correlation with glycaemic control and diabetic autonomic neuropathy (DAN). METHODS: We prospectively studied 49 diabetic type 2 patients (29 women, mean age 65.32+/-8.56 years) and 30 control subjects (15 women, mean age 58.47+/-12.40) that underwent endoscopy. Biopsies from the body and antrum were evaluated for H. pylori-gastritis, eNOS and angiogenic marker CD34 expression. Statistical analysis in correlation with mean glycosylated haemoglobin (HbA1c) of the last 3 years, and DAN was performed. RESULTS: The two groups were matched for age (p=0.144), sex (p=0.335), H. pylori-infection (p=0.617) and degree of gastritis (p=0.78). eNOS and CD34 attenuated expression correlated with diabetes mellitus (DM) in the corpus (p=0.009 and 0.02, respectively). eNOS and CD34 expression was upregulated in H. pylori-positive controls but not in H. pylori-positive diabetic patients (p=0.010 and 0.007 for the corpus and p=0.036 and 0.047 for the antrum, respectively). eNOS expression correlated with good glycaemic control (GGC) in the gastric corpus (p<0.001) and antrum (p=0.0037) and with absence of DAN (p=0.009 and 0.036, respectively for the corpus and antrum). CONCLUSION: Chronic glycaemic control affects eNOS expression and angiogenesis in the gastric mucosa of patients with type 2 DM. eNOS expression is not upregulated in H. pylori-positive diabetic patients.

Spontaneous abdominal wall endometriosis: a case report.

Endometriosis is the presence of endometrial glands and stroma outside the uterus. Spontaneous abdominal wall endometriosis (AWE) is any ectopic endometrium found superficial to the peritoneum without the presence of any previous scar. Rarely, endometriosis represents a disease of specific interest to the general surgeon, on account of its extrapelvic localisations. We describe a case with spontaneous AWE presenting as a painful mass with cyclic symptoms. A 28-year-old woman presented to the day-surgery division of our department, suffering from a painful mass in the left lower abdominal quadrant. A mobile mass of 5 x 4 cm was identified. The initial diagnosis was lipoma and excision was planned. During the operation two masses were spotted, very close to one another, and were excised within healthy limits. Pathology revealed endometrial glands surrounded by a disintegrating mantle of endometrial stroma and fibrous scar tissue in which there was a scattering of leucocytes. The woman had no scars. She was discharged from hospital after 2 hours. Two years after the excision she is free of disease and no recurrence has been observed. Spontaneous AWE is rare, accounting for 20% of all AWEs. The triad ; mass, pain and cyclic symptomatology helps in the diagnosis, but unfortunately it is not present in all cases. Spontaneous endometriomas are usually diagnosed by pathology and the treatment of choice is surgical excision.

Solid cerebral echinococcosis mimicking a primary brain tumor.

Solitary brain affection is rare in echinococcosis. We report the case of a 35-year-old woman presenting with symptomatic grand-mal epilepsy due to a right frontal, partially cystic space-occupying lesion. Pre-operative computed tomography and magnetic resonance imaging (MRI) suggested a cystic astrocytoma. However, histological examination yielded the diagnosis of a 'chitinoma', a rare subtype of solid cerebral hydatid disease (echinococcosis). It mimicked a primary brain tumor and, therefore, posed a diagnostic problem. We present the--to our knowledge--first MRI scans in a case of a histologically proven chitinoma.

Regression of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue triptorelin: a prospective study.

Endometrial hyperplasia is thought to be caused by the prolonged, unopposed oestrogenic stimulation of the endometrium. The regression of hyperplastic back to normal endometrium is the main purpose of any conservative treatment in order to prevent development of adenocarcinoma. The aim of this study was to evaluate the regression of hyperplastic to normal endometrium in patients with various forms of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue (GnRHa) triptorelin for 6 months. Fifty-six patients with endometrial hyperplasia were enrolled in this trial; 39 patients (group I) presented simple hyperplasia, 14 (group II) complex hyperplasia and three (group III) atypical complex hyperplasia. All patients were treated with triptorelin for 6 months. Bleeding control during treatment was excellent. A post-treatment curettage for estimation of endometrial histology was performed on 54 out of 56 patients 100.1 +/- 44.7 days after the last triptorelin dose, following the restoration of pituitary function. Regression of hyperplastic to normal endometrium was observed in 32 (86.5%) out of 37 patients in group I and in 12 (85.7%) out of 14 in group II. Persistence of simple hyperplasia was found in five (14.5%) out of 37 patients in group I. Persistence of complex hyperplasia was found in 1 (7.1%) out of 14 patients and progression to atypical complex hyperplasia in another one (7.1%) woman in group II. In some of these cases, the presence of risk factors such as obesity, diabetes mellitus and ovulatory disturbances may contribute to the disease persistence despite therapy. On the other hand, in group III, none of the three patients had normal post-treatment endometrial histology. It seems, therefore, that in cases of endometrial hyperplasia without atypia, the administration of the GnRHa triptorelin is associated with high regression rates to normal endometrium. Conversely, the presence of atypia seems to be a poor prognostic factor. Treatment tolerance and bleeding control during therapy is excellent.

[Stomach carcinoid associated with chronic atrophic corpus gastritis in pernicious anemia]. / Magencarcinoid assoziiert mit chronisch atrophischer Corpusgastritis bei perniziöser Anämie.

A 41-year-old woman with a chronic atrophic gastritis after endoscopic investigation diagnosed a carcinoid at the corpus of the stomach. There were more lesions in the mucosa of the stomach in the form of dysplasias. The labor investigation indicated an hypergastrinaemia. We performed a resection of the basis of the carcinoid. It has shown to be histologically tumor-free as the rest of the stomach. A gastrectomy was not necessary. After resection the patient was under therapy with vitamin B-12. The level of gastrin in blood was normal under this treatment. Two years later the patient remained symptom-free. Regular endoscopic investigations show a stagnation of the growth of the dysplastic lesions of the mucosa of the stomach.

Changes of hepatitis B core antigen (HBcAg) in liver biopsies of patients with chronic active hepatitis B treated with interferon.

Data have shown that hepatitis B core antigen (HBcAg) is detected in both the hepatocyte nucleus and cytoplasm. Its expression is associated with chronic hepatitis and active viral replication. The intrahepatic distribution of HBcAg was studied in liver biopsies of 14 patients with chronic active hepatitis B (CAH-B) (5 were hepatitis B e antigen [HBeAg]+/anti-HBe--, 9 were HBeAg--/anti-HBe+) by an immunohistochemical method (PAP) before and after 6-month treatment with interferon (IFN), and our findings were analyzed according to the response of patients to treatment. Our findings showed that, at the end of treatment, nuclear HBcAg was decreased or absent in 4 of 5 and cytoplasmic HBcAg in 2 of 4 HBeAg+/anti-HBe--patients, irrespective of the response to treatment. Loss of cytoplasmic expression was related to the outcome of treatment in 5 of 9 HBeAg--/anti-HBe+ patients. Four patients expressed no HBcAg before or at the end of treatment. These findings possibly reflect a different pattern of viral core antigen expression as a result of IFN therapy in the two groups of patients.

Effects of famotidine on gastric mucus of the rat.

The influence of famotidine on the production of gastric mucus was studied at experimental level. We measured the quantity of the intracellular mucus, the surface adherent mucus gel thickness, and the biosynthesis of prostaglandin E2 (PGE2) by the rat gastric mucosa, in pretreated animals. Both the intracellular mucus accumulation and the adherent mucus gel thickness revealed a highly statistically significant increase (P less than 0.0002). PGE2 assay showed that famotidine also led to a statistically significant increase (P = 0.02) of PGE2 in treated versus control animals. These findings raise the question of whether despite its common antisecretory pathway of action this H2-receptor antagonist could play a role in the protection of gastric mucosa. Further research is necessary to determine this.

Formalin-induced experimental sclerosing cholangitis in the rat.

The few reported cases of sclerosing cholangitis following removal of an echinococcus cyst are thought to be a consequence of the chemical action of formalin used for sterilization of the residual cavity. The aim of this study was to assess this hypothesis. We injected 0.15ml of 2% buffered formalin solution into the central hepatic lobe of five rats, after a midline laparotomy. At 6, 12, 18 and 24 weeks after formalin injection all rats were reoperated upon and a sample of hepatic parenchyma from both the central and the left hepatic lobe was obtained for microscopic evaluation. Our findings, dilatation of portal tracts and bile canaliculi, thickening of the pericanalicular cytoplasm, portal and periportal inflammatory cell infiltration and fibrosis and enlargement of the perisinusoidal space of Disse, suggest that 2% formalin solution leads to the development of essential phenomena of cholestasis and sclerosing cholangitis in the rat, so thus it should be avoided in liver hydatid disease surgery.

Common bile-duct mucosa in choledochoduodenostomy patients--histological and histochemical study.

We describe the histological and histochemical changes of the common bile-duct mucosa in specimens obtained by means of peroral cholangioscopy, 1-12 years after choledochoduodenal anastomosis. Our findings--hyperplasia of the superficial epithelium, metaplastic goblet cells containing predominantly acid sialomucins, and pyloric-like gland formation containing neutral mucins--express a morphological and functional differentiation of the common bile-duct mucosa that probably facilitates its survival in a different environment. We consider that these adaptive changes may explain the uneventful long-term postoperative period of choledochoduodenostomized patients.