[Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting]. / Estimación de riesgo de cáncer gástrico en pacientes con gastritis crónica asociada a la infección por Helicobacter pylori en un escenario clínico.

BACKGROUND/AIM: Severity of chronic gastritis associated with Helicobacter pylori infection (CGAHpI) could play a role in evaluating the potential risk to develop gastric cancer. Our aim was to estimate the risk for gastric cancer in a clinical setting, according to histopathologic criteria, by applying the gastric cancer risk index (GCRI) METHODS: Histopathologic study of the gastric biopsies (corpus-antrum) from consecutive adult patients that underwent gastroesophageal duodenoscopy was carried out, and the GCRI was applied in patients presenting with CGAHpI. RESULTS: One hundred eleven patients (77% female) with a mean age of 38.6±13.1 years were included. Active Helicobacter pylori infection (aHpi) was diagnosed in 77 cases (69.40%). In 45% of the cases with aHpi, pangastritis (23%) or corpus-predominant gastritis (22%) was diagnosed. Nine cases were diagnosed with intestinal metaplasia (8%), 7 of which (77.70%) were in the aHpi group. Twenty one percent of the patients with aHpi had a GCRI of 2 (18.10%) or 3 (2.50%) points (high risk index), while 79.10% accumulated a GCRI of 0 or 1 points (low risk index). Of the patients with no aHpi, none of them had 3 points (p=0.001). Of the 18 patients that accumulated 2 or 3 points, 6 (33.30%) presented with intestinal metaplasia (all with pangastritis and corpus-predominant gastritis), of which 4 cases (66.60%) had aHpi. CONCLUSIONS: The estimated gastric cancer risk in patients with CGAHpI in the clinical setting studied was relatively low and 5% of the patients had a histopathologic phenotype associated with an elevated risk for developing gastric cancer.

[Ultrastructural features of the synaptic plasticity in peritumoral cerebral oedema in humans]. / Aspectos ultraestructurales de la plasticidad sináptica en el edema cerebral peritumoral en humanos.

AIM: To provide an ultrastructural characterisation of the synaptic plasticity phenomena in peritumoral brain tissue in humans. PATIENTS AND METHODS: Sixteen peritumoral tissue biopsy samples were processed using conventional transmission electron microscope techniques. Clinical data and post-surgical follow-up were reviewed and analysed. RESULTS: In the peritumoral brain tissue there was a predominance of cellular or oncotic cerebral oedema. A large number of synapses were seen to be perforated with both convex and, although less frequently, irregular curvatures. Generally, the presynaptic terminals had an oedematous appearance, with oedematous mitochondria with cristolysis and electron-dense deposits in the mitochondrial matrix. The presynaptic terminals showed numerous synaptic vesicles of different sizes and which were sometimes arranged in small accumulations. Observations also confirmed the presence of endocytosis vesicles, which suggest high neurotransmitter reuptake. Some presynaptic terminals displayed degenerative changes. The postsynaptic terminals were seen to be oedematous and the dendritic spines displayed different shapes and spiny processes that were degenerated to varying degrees. Perisynaptic astrocytic prolongations were seen to be oedematous, with a variable number of glycogen granules. We propose a possible sequence of structural changes in the process of forming perforated synapses in peritumoral brain tissue. CONCLUSIONS: The ultrastructural findings observed in the synapses and their microenvironment can be considered to be significant with respect to the clinical manifestations and the sequelae in the patients who were studied. Moreover, they are linked to functional alterations in injured tissue, degenerative changes and neuronal death.

Aspectos ultraestructurales de la plasticidad sináptica en el edema cerebral peritumoral en humanos / Ultrastructural features of the synaptic plasticity in peritumoral cerebral oedema in humans

Caracterizar ultraestructuralmente los fenómenos de plasticidad sináptica en el tejido cerebral peritumoralhumano. Pacientes y métodos. Se procesaron 16 biopsias de tejido peritumoral mediante las técnicas convencionales para microscopía electrónica de transmisión. Se revisaron y analizaron los datos clínicos y el seguimiento posquirúrgico. Resultados.En el tejido cerebral peritumoral predominó el edema cerebral del tipo celular u oncótico. Se observaron múltiples sinapsis perforadas con curvaturas convexas y, en menor frecuencia, con curvaturas irregulares. Generalmente, los terminales presinápticospresentaron aspecto edematoso, con mitocondrias edematosas con cristolisis y matriz mitocondrial electrón densa.Los terminales presinápticos mostraron numerosas vesículas sinápticas de diferentes tamaños y ocasionalmente dispuestas en pequeños acúmulos. Se evidenció la presencia de vesículas de endocitosis que sugieren una alta recaptación de neurotransmisores.Algunos terminales presinápticos mostraron cambios degenerativos. Los terminales postsinápticos se observaron edematosos y las espinas dendríticas mostraron diferentes formas y aparatos espinosos degenerados en grado variable. Las prolongacionesastrocitarias perisinápticas se observaron edematosas, con cantidad variable de gránulos de glucógeno. Se propone una posible secuencia de cambios estructurales en el proceso de formación de sinapsis perforadas en el tejido cerebral peritumoral.Conclusiones. Los hallazgos ultraestructurales observados en las sinapsis y su microambiente pueden considerarse relevantes en relación con las manifestaciones clínicas y las secuelas de los pacientes estudiados, y se vinculan con alteracionesfuncionales del tejido lesionado, cambios degenerativos y muerte neuronal

To provide an ultrastructural characterisation of the synaptic plasticity phenomena in peritumoral brain tissuein humans. Patients and methods. Sixteen peritumoral tissue biopsy samples were processed using conventional transmission electron microscope techniques. Clinical data and post-surgical follow-up were reviewed and analysed. Results. In the peritumoralbrain tissue there was a predominance of cellular or oncotic cerebral oedema. A large number of synapses were seen to be perforated with both convex and, although less frequently, irregular curvatures. Generally, the presynaptic terminals had an oedematous appearance, with oedematous mitochondria with cristolysis and electron-dense deposits in the mitochondrialmatrix. The presynaptic terminals showed numerous synaptic vesicles of different sizes and which were sometimes arranged in small accumulations. Observations also confirmed the presence of endocytosis vesicles, which suggest high neurotransmitterreuptake. Some presynaptic terminals displayed degenerative changes. The postsynaptic terminals were seen to be oedematous and the dendritic spines displayed different shapes and spiny processes that were degenerated to varying degrees. Perisynapticastrocytic prolongations were seen to be oedematous, with a variable number of glycogen granules. We propose a possible sequence of structural changes in the process of forming perforated synapses in peritumoral brain tissue. Conclusions. The ultrastructural findings observed in the synapses and their microenvironment can be considered to be significant with respectto the clinical manifestations and the sequelae in the patients who were studied. Moreover, they are linked to functional alterations in injured tissue, degenerative changes and neuronal death

[Idiopathic hypertrophic pachymeningitis: a diagnostic dilemma]. / Paquimeningitis hipertrófica idiopática: un dilema diagnóstico.

INTRODUCTION: Idiopathic hypertrophic pachymeningitis (IHP) is a rare fibrosing inflammatory process of unknown pathogenesis that causes diffuse thickening of the duramater. In spite of the fact that this pathological entity has been linked to specific etiological agents such as syphilis, tuberculosis, mycosis and sarcoidosis, In recent years there has been an increase in the number of patients with IHP of undetermined cause. CASE REPORT: 58 year-old female with a long date history of oppressive headaches, frontally located at first, and later generalized, accompanied by weakness and asthenia; urinary incontinence, dizziness, vomiting, and gait ataxia. Physical examination revealed bilateral cerebellar signs, and optic atrophy. Magnetic resonance displayed a diffuse thickening of the falx cerebrii, and cerebellar tentorium, hypointense in T1 and T2- weighted images, and markedly enhanced following administration of intravenous Gd-DTPA. A biopsy obtained from the falx revealed conspicuous fibrosis, and focal chronic inflammatory mononuclear infiltrate. Complementary exams carried out in order to reveal a specific etiologic agent were negative. CONCLUSION: Due to the variable clinical presentation, and the difficulty to establish the etiology of the pathological process, to make the diagnosis of IHP usually represents a true dilemma. This diagnosis is often made by exclusion.

[Cerebrovascular disease: its relationship with cardiovascular and renal pathology in 134 clinical autopsies]. / Enfermedad cerebrovascular: su relación con cardiovasculopatías y nefropatías en 134 necropsias clínicas.

OBJECTIVE: To establish the relationship between cardiopathy and chronic nephropathy, and cerebral vascular pathology in clinical necropsies performed in adult patients. MATERIAL AND METHODS: The protocols of 861 clinical autopsies done during the lapse 1990-2000 were reviewed, of these, 134 cases with diagnosis of cerebrovascular disease (CVD) were selected. Analyzed features included: neuropathological study of CVD, renal and cardiovascular pathology, and cause of death. RESULTS: CVD represented 15.5% of all autopsies done during the study period. Ischemic CVD constituted 56.7% of the cases, whereas cases of hemorrhagic CVD accounted for 43.3% of the total. Causes included arterial hypertension (33%), atherosclerosis (19%), emboli and vascular malformations (13% each, respectively), coagulopathies (8%), angeiitis (4%), tumors (1%), and unknown origin (11%). Ischemic CVD was caused by atherosclerosis in 34.2% of the cases, lacunar infarcts in 32.8%, of embolic cause in 14.4% of the cases, angeiitis in 1.3%, and of unknown origin in 17.1% of the cases. Hemorrhagic CVD presented as intraparenchymal hematoma in 50% of the cases, as sub-arachnoid hemorrhage in 28%, as disseminated petechial hemorrhages in 19%, and intraventricular in 3% of the cases. Ischemic CVD was associated with hypertensive cardiopathy in 86.5% of the cases, and with nephrosclerosis in 51.3%, whereas hemorrhagic CVD was seen associated with the same pathological entities in 86.2% and 29.3% of the cases, respectively. Cerebral herniation was the cause of death in 2.6% of the patients with ischemic CVD, and in 74.1% of the patients with hemorrhagic CVD. CONCLUSIONS: CVD was associated with a high frequency of intercurrent pathological processes, namely hypertensive cardiopathy, atherosclerosis, nephroscleroisis, and other chronic nephropathies, that eventually interact, and constitute well known predisposing and/or concomitant factors to the cerebrovascular event

[Non neoplastic space occupying lesions mimicking central nervous system tumors]. / Lesiones ocupantes de espacio no neoplasicas que simulan tumores del sistema nervioso central.

OBJECTIVE: To establish the frequency and nature of space occupying lesions of the central nervous system (CNS) that mimic neoplastic growths. PATIENTS AND METHODS: We reviewed the clinical records, imaging and neuropathological studies of patients operated in different hospitals of Maracaibo, Venezuela during the period January 1 1996 July 31 2002. These patients had a pre operative diagnosis of CNS tumor, and their definitive diagnosis was non neoplastic disease. RESULTS: The 33 cases of expansive, non neoplastic growths represented 8% of 408 CNS lesions diagnosed during the study period. Approximately two thirds of the cases (63,36%) consisted of either inflammatory or vascular lesions, whereas the rest of the cases grouped miscellaneous conditions. CONCLUSIONS: Even though it is not frequent that non neoplastic lesions of the CNS mimic expansive growths of neoplastic nature, on occasions the clinical and neuroimaging features of both groups of entities are remarkably similar.

[Clinical and tomographic aspects of hemorrhagic cerebrovascular disease associated with hypertensive crisis in adults under 50 years of age]. / Aspectos clínicos y tomográficos de la enfermedad cerebrovascular hemorrágica asociada con crisis hipertensiva en adultos menores de 50 años.

The purpose of this study was to analyze both the clinical and tomographic aspects of the hemorrhagic cerebrovascular disease (HCd), associated with hypertensive crisis in adults under 50 years of age. Forty six patients, who were not under anticoagulant therapy, were not using illegal drugs, who had not a cerebral tumor disease, and who had neither arteriovenous malformations nor past traumatic episodes, were studied. Seventy eight percent of the patients had preexisted arterial hypertension, 30% of them had at least a previous emergency for a hypertensive crisis. Mortality for intracerebral hematoma (ICH) and for subarachnoid hemorrhage (SAH) was 21% and 23% respectively. In 68% of the cases, ICH was located in the deep structures of the brain. Asymmetric ventricular system, compression or the absence of mesencephalic cisterna were significantly associated (p > 0.01; p > 0.001 respectively) with higher mortality. There was not a significant difference between the deceased and the survivors in relation with their systolic and diastolic arterial pressure on admission to the emergency unit. A significant positive relation was found between the severity of the injury (percentage of patients with an Scale Coma Glasgow < or = 8 points) and the mortality percentage for the type of HCd (r = 0.81 for ICH; p < 0.001, r = 0.98 for SAH; p < 0.001). Age and a low Scale Coma Glasgow score on the admission, represent unfavorable prognostic factors. Due to the different criteria used to evaluate the tomographic characteristics of intracerebral hematomas, comparisons of the present results with other findings can be difficult.

[Lupus anticoagulant in preeclampsia and non-proteinuria gestational hypertension in primiparous women]. / Anticoagulante lúpico en preeclampsia e hipertensión gestacional no proteinúrica en primigestas.

The purpose of this study was to determine the relationship between the lupus anticoagulant and the proteinuric and non-proteinuric Gestational Hypertension in primigravids without subjacent pathology. Sixty- five patients with a single gestation of twenty or more weeks long were studied. Thirty four patients (Group A) were pregnant women with a normal blood pressure. Hypertensive disease developed during pregnancy (according to Davey and MacGillivray, classification) affected 31 patients (Group B). A test to determine the presence of the lupus anticoagulant was performed on all of them, according to the method of the diluted Russel viper venom. None of the patients developed any other symptomatic subjacent pathology. Fifty-five percent of the Group B patients developed proteinuric gestational hypertension (preeclampsia) and forty-five percent of them non-proteinuric gestational hypertension. The test to determine the lupus anticoagulant was negative in all the patients from both groups. The results suggest that the presence of a lupus anticoagulant is unlikely in the proteinuric and non-proteinuric gestational hypertension in primigravidas without subjacent pathology, therefore it remains as a controversial study issue.

Genitourinary tract gas: imaging evaluation.

Gas-forming infections of the genitourinary tract may manifest as life-threatening conditions, often requiring aggressive medical and surgical management. Accurate interpretation of the radiologic studies is essential for early and accurate diagnosis of gas within the renal parenchyma or collecting system, bladder, uterus, and scrotum. Three distinct entities are associated with renal or perirenal gas: emphysematous pyelonephritis, emphysematous pyelitis, and gas-forming perirenal abscess. Gas in the bladder may occur secondary to emphysematous cystitis or a vesicoenteric fistula and must be differentiated from air introduced by means of instrumentation. Uterine gas usually indicates an underlying infection or a neoplasm. Gas in the scrotum is most commonly due to an infectious process or bowel herniation into the scrotal sac. Before institution of a specific therapeutic regimen, an effort should be made to establish the exact location of gas in the genitourinary tract. Plain radiography, including tomography, and ultrasonography are useful screening modalities. Although in some cases urography, barium enema studies, and other contrast material-enhanced studies enable a diagnosis to be made, in many patients computed tomography is the definitive diagnostic technique.

Derivaciones biliodigestivas en pacientes asistidos en un hospital clínico-quirúrgico / Biliodigestive derivations in patients assisted in a clinical-surgical hospital

Se realizó un estudio de 63 pacientes que estuvieron ingresados en el Servicio de Cirugía del Hospital "Dr. Ambrosio Grillo", La Habana, Cuba, por presentar afecciones de las vías biliares y del páncreas, a los cuales se les realizó, como procedimiento quirúrgico derivaciones bilio-digestivas, desde el primero de enero de 1986 al treinta y uno (31) de diciembre de 1989, siendo la litaisis vesicular y coledociana la más frecuente en el sexo femenino y la neoplasia maligna de cabeza del páncreas, zona o región periampular y de 105 conductos biliares en el hombre. Se utilizó como procedimiento quirúrgico en las afecciones malignas la triple derivación bilio-digestiva, mientras que en las infecciones benignas se utilizaron la coledocoduoderostomia y la esfinterotomía y esfinteroplastía, respectivamente. La gran mayoría de las operaciones fue de tipo electiva 87.79//y el método diagnóstico más utilizado fue la ultrasonografía (USD) con un 97.07//de los casos. Cirugía, vías biliares, páncreas, derivaciones biliodigestivas

Radioimmunodetection of colorectal carcinoma using technetium-99m-labeled Fab' fragments of the IMMU-4 anti-carcinoembryonic antigen monoclonal antibody.

BACKGROUND: Radioimmunodetection of cancer using monoclonal antibody fragments offers certain potential advantages over that with whole monoclonal antibodies, including the ability to image early (i.e., to provide images at an early time after injection of the radioantibody) while minimizing the incidence of human anti-mouse antibody response. This paper reports a prospective trial comparing radioimmunodetection with IMMU-4 (a murine anti-CEA monoclonal antibody) 99mTc-labeled Fab' fragments to conventional imaging in 35 colorectal cancer patients. METHODS: All patients were investigated by conventional diagnostic methods (CDM) within 4 weeks of radioimmunodetection. Surgical corroboration of findings was obtained in 26 patients (15 with evidence of disease on CDM [CDM+] and 11 with abnormal serum CEA [CDM-] as the only evidence for recurrence). After 1 mg IMMU-4 99mTc-Fab' was injected (19.3 mCi on average), patients underwent planar/SPECT radioimmunodetection 2-5 hours later and planar radioimmunodetection 18-24 hours later. Three patients underwent a second radioimmunodetection study 16, 20 and 23 months after the first. RESULTS: Radioimmunodetection was superior to CDM, accurately predicting disease distribution in six nonsurgical and ten CDM+ surgical patients, and was complementary to computed tomography in two nonsurgical and two CDM+ surgical patients. Radioimmunodetection would have directed or changed management decisions in 6 of the 15 (40%) CDM+ surgical patients. Radioimmunodetection correctly identified all recurrent tumor in 8 of 11 CDM- surgical patients and was negative in one patient with cirrhosis and no recurrence, representing a potential clinical benefit of 82%. Analyzed on a regional basis, radioimmunodetection was found to be superior to CDM in extrahepatic abdomen and pelvis imaging and was complementary to (although not as accurate as) CDM in the liver. Human anti-mouse antibody did not develop in any of the patients, including three who were injected twice. CONCLUSIONS: IMMU-4 99mTc-Fab' radioimmunodetection shows promise as a clinically useful diagnostic tool in patients with colorectal cancer, detecting disease often missed by conventional imaging. IMMU-4 99mTc-Fab' may prove useful for serial radioimmunodetection studies, because human anti-mouse antibody response does not appear to be a problem with this radioimmunoconjugate. It also has the advantage of permitting same-day imaging.

Indicaciones, técnicas y resultados de la esfinterotomia y de la esfinteroplastia en afectados de vías biliares / Indications, technics and results of the esphiterotomy and esphinteroplastia in billiary tract disorders

Se estudiaron 17 pacientes intervenidos por afecciones de la vía biliar principal (VBP), a los cuales se le realizaron esfinterotomía y esfinteroplastia, señalando la experiencia acumulada en nuestro servicio en estos 3 años. Siendo la litiasis coledociana la causa más frecuente que llevó a realizar el procedimiento. No hubo mortalidad en nuestra casuistica, la complicación no fatal más frecuente fue la sepsis de la herida, por la baja mortalidad y morbilidad operatoria de este procedimiento es que somos partidarios de su utilización sistemática y por eso planteamos que es una técnica no despreciable, si sabemos realizarla

Imaging of intra- and extraabdominal desmoid tumors.

Desmoid tumors are characterized by proliferation of fibroblastic cells that arise from the fascia or aponeurosis of muscle. They are most commonly found in the abdomen of adults, arising from the anterior abdominal wall, mesentery, or retroperitoneum. At sonography, desmoids have variable echogenicity, with smooth, well-defined margins. On contrast-enhanced computed tomographic scans, the tumors are generally high attenuation (relative to muscle) and have either ill- or well-defined margins. At magnetic resonance imaging, desmoids have low signal intensity relative to muscle on T1-weighted images and variable signal intensity on T2-weighted images. There are no specific imaging features to distinguish desmoid tumors from other solid masses. The diagnosis of desmoid tumor should be considered in patients with an abdominal mass, a history of abdominal surgery or injury, or Gardner syndrome.

Comparison of CT and MR imaging in musculoskeletal neoplasms.

Magnetic resonance (MR) and CT of 50 musculoskeletal neoplasms were compared to investigate the relative values of these modalities in the assessment and staging of musculoskeletal neoplasms and to determine how often they are complementary and when they are redundant. The material included 25 benign and 25 malignant neoplasms, of which 33 were skeletal and 17 were of soft tissue origin. Magnetic resonance was superior to CT with respect to all morphologic criteria except for cortical bone destruction, calcification, ossification, and the assessment of lytic and sclerotic changes in flat bones. Magnetic resonance was found to be complementary to CT in 48% of the cases (30% malignant, 18% benign). Use of both MR and CT was considered redundant in 52% of the cases (20% malignant, 32% benign). Magnetic resonance was found to be the modality of choice for all benign and malignant soft-tissue neoplasms. Both modalities are complementary and necessary for complete evaluation of malignant skeletal tumors. Benign skeletal tumors should be considered for evaluation by CT, MR, or both on an individual case basis.

The CT appearance of cystic masses of the liver.

The authors here discuss twelve discrete pathologic entities that they found, in a review of over 500 abdominal CT scans, caused the appearance of a cystic lesion in the liver. The CT characteristics of the various lesions are illustrated, differential points in the patients' histories are noted, and gross and microscopic pathology specimens are correlated with the CT appearances to explain the CT findings. Lesions considered include: simple (bile duct) cyst, adult polycystic kidney disease, Caroli disease, pyogenic abscess, echinococcal cyst, amebic abscess, metastasis, biliary cystadenoma and cystadenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, biloma, and extrapancreatic pseudocyst.