CD138 immunohistochemistry identifies more plasma cells compared with hematoxylin and eosin staining in autoimmune hepatitis. An observational study.

INTRODUCTION: Autoimmune hepatitis (AIH) is associated with periportal infiltration by plasma cells. Plasma cell detection is routinely performed through hematoxylin and eosin (H&E) staining. The present study aimed to assess the utility of CD138, an immunohistochemical plasma cell marker, in the evaluation of AIH. MATERIALS AND METHODS: A retrospective study was conducted, in which cases consistent with AIH, within the time frame of 2001 and 2011, were collected. Routine H&E-stained sections were used for evaluation. CD138 immunohistochemistry (IHC) was performed to detect plasma cells. RESULTS: Sixty biopsies were included. In the H&E group, the median and interquartile range (IQR) was 6 (4-9) plasma cells/high power field (HPF) and was 10 (IQR 6-20) plasma cells/HPF in the CD138 group (p < 0.001). There was a significant correlation between the number of plasma cells determined by H&E and CD138 (p = 0.31, p = 0.01). No significant correlation was found between the number of plasma cells determined by CD138 and IgG level (p = 0.21, p = 0.09) or stage of fibrosis (p = 0.12, p = 0.35), or between IgG level and stage of fibrosis (p = 0.17, p = 0.17). No significant correlation was found between the treatment response and the number of plasma cells determined by H&E (p = 0.11, p = 0.38), CD138 (p = 0.07, p = 0.55), or stage of fibrosis (p = 0.16, p = 0.20). CD138 expression was different between the treatment response groups (p = 0.04). CONCLUSION: CD138 increased the detection of plasma cells in liver biopsies of patients with AIH, when compared with routine H&E staining. However, there was no correlation between the number of plasma cells determined by CD138 and serum IgG levels, stage of fibrosis, or response to treatment.

Reduced sexual motivation of diabetic female rats: Restoration with insulin.

The aim of this study was to evaluate female rat sexual motivation in a model of diabetes mellitus type 1. Severe hyperglycemia was induced in ovariectomized Wistar rats by injecting streptozotocin [STZ, 100 mg/kg, i.p.]. Ten days later, females received estradiol benzoate (10 µg/rat, s.c.) plus progesterone (3 mg/rat, s.c.). A group of STZ-treated animals was administered with insulin (2-4 U) every 12 h for 10 days, which normalized glucose levels. In the partner preference (PP) and sexual incentive motivation (SIM) tests, control females spent more time close to a sexually experienced male (SE) than with a castrated male (CM). STZ-treated females stayed the same amount of time with both stimuli, that is, they lost their sexual preference. We also evaluated the sense of smell using two behavioral tests, one related to sexual odors (SO) and another one to food odors (FO). In the SO test, control females spent more time sniffing the sawdust coming from cages that contained SE males; hyperglycemic females remained the same amount of time sniffing the sawdust of both stimuli: SE and CM. In the FO test, no differences were found between control and STZ-treated groups. Insulin treatment reverted the changes observed in hyperglycemic females in the PP, SIM and SO tests. These data suggest that severe hyperglycemia decreases sexual motivation and that insulin recovers such diminution.

Factors related to gastric neuroendocrine tumors. / Factores relacionados a tumores neuroendocrinos gástricos.

INTRODUCTION AND AIMS: An association between long-term use of proton pump inhibitors and the development of gastric neuroendocrine tumors has been reported, but it is still a subject of debate. The aims of the present study were to determine the presence of this association in a Mexican population and to identify the risk factors for developing gastric neuroendocrine tumors. MATERIALS AND METHODS: A case-control study was conducted, in which the cases were patients with a histopathologic diagnosis of gastric neuroendocrine tumor and the controls were patients evaluated through upper endoscopy. The controls were paired by age, sex, and endoscopic examination indication. Proton pump inhibitor use was considered prolonged when consumption was longer than 5 years. RESULTS: Thirty-three patients with gastric neuroendocrine tumor and 66 controls were included in the study. Eighteen (54.5%) patients in the case group were women, as were 39 (59%) of the patients in the control group. The median age of the patients in the case group was 55 years (minimum-maximum range: 24-82) and it was 54 years (minimum-maximum range:18-85) in the control group. A greater number of patients in the gastric neuroendocrine tumor group presented with gastric atrophy (p<0.0001) and autoimmune atrophic gastritis (p=0.0002), compared with the control group. No association between gastric neuroendocrine tumor and prolonged proton pump inhibitor use, sex, smoking, gastroesophageal reflux disease, Helicobacter pylori infection, diabetes mellitus, or autoimmune diseases was found in the univariate analysis. CONCLUSIONS: The results of our study showed no association between proton pump inhibitor use for more than 5 years and the development of gastric neuroendocrine tumor. The presence of gastric atrophy and autoimmune atrophic gastritis was associated with gastric neuroendocrine tumor development.

Barrett's esophagus: Ten years of experience at a tertiary care hospital center in Mexico. / Esófago de Barrett: experiencia de 10 años en un centro de tercer nivel en México.

INTRODUCTION: The prevalence of Barrett's esophagus has been calculated at between 1.3 and 1.6%. There is little information with respect to this in Mexico. AIM: To determine the frequency and characteristics of Barrett's esophagus in patients that underwent endoscopy at a national referral center, within a 10-year time frame. MATERIAL AND METHODS: The databases of the pathology and gastrointestinal endoscopy departments of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" were analyzed, covering the period of January 2002 to December 2012. Patients with a histologic diagnosis of Barrett's esophagus were included. The variables of age, sex, the presence of dysplasia/esophageal adenocarcinoma, Barrett's esophagus length, and follow-up were analyzed. RESULTS: Of 43,639 upper gastrointestinal endoscopies performed, 420 revealed Barrett's esophagus, corresponding to a frequency of 9.6 patients for every 1,000 endoscopies. Of those patients, 66.9% (n=281) were men, mean patient age±SD was 57.2±15.3 years, 223 patients (53%) presented with long-segment Barrett's esophagus, and 197 (47%) with short-segment Barrett's esophagus. Dysplasia was not present in 339 patients (80.7%). Eighty-one (19.3%) patients had some grade of dysplasia or cancer: 48/420 (11.42%) presented with low-grade dysplasia, 20/420 (4.76%) with high-grade dysplasia, and 13/420 (3.1%) were diagnosed with esophageal cancer arising from Barrett's esophagus. Mean follow-up time was 5.6 years. CONCLUSIONS: The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer.

Inflammatory fibroid polyp of the gastrointestinal tract: 10 years of experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. / Pólipo fibroideo inflamatorio del tracto gastrointestinal: 10 años de experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

BACKGROUND: Inflammatory fibroid polyp (lFP) is a rare, benign, and solitary neoplasm predominantly located in the gastric antrum and small bowel. Its clinical symptoms are heterogeneous and essentially depend on the location and size of the tumor. Definitive diagnosis is made through histopathology and this pathology has excellent long-term prognosis. AIM: To identify the cases of IFP seen at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán over a 10-year period. METHODS: A retrospective, cross-sectional, descriptive, and observational study was conducted that included patients with histopathologic diagnosis of IFP within the time frame of January 2001 and December 2011. RESULTS: Six cases were found and 5/6 (83.3%) of them were women. The median age was 41 years (minimum-maximum range of 19-56 years). The most frequent symptoms were weight loss (n=3), fever (n=2), nausea (n=2), and vomiting (n=2). Three patients presented with iron deficiency anemia and 2 cases with intussusception. The IFPs were located at the following sites: esophagus (n=1), stomach (n=2), small bowel (n=2), and colon (n=1). Treatment was surgical in 5/6 (83.3%) of the patients. CONCLUSIONS: IFPs are extremely rare in our population. They usually present with weight loss and iron deficiency anemia and are more frequently located in the stomach and small bowel. This is the largest reported IFP case series in a Mexican population.

Remediation of PAHs in a saline-alkaline soil amended with wastewater sludge and the effect on dynamics of C and N.

Contamination of soil with hydrocarbons occurs frequently and organic material, such as sludge, is often applied to accelerate their dissipation. Little is known, however, how sludge characteristics affect removal of polycyclic aromatic hydrocarbons (PAHs) from alkaline-saline soil. Soil of the former lake Texcoco with pH 9 and electrolytic conductivity 7 dS m(-1) was contaminated with phenanthrene and anthracene and amended with sludge, sterilized sludge, sludge adjusted to maintain pH in contaminated soil or glucose plus an inorganic N and P source while emission of CO2 and concentrations of NH4+, NO3-, NO2-, extractable P, phenanthrene and anthracene were monitored in an aerobic incubation experiment of 112 days. An agricultural soil from Acolman treated in the same way served as control. Contaminating the Texcoco soil increased emission of CO2 significantly, but not in the Acolman soil. After 112 days, the largest concentration of anthracene and phenanthrene was found in the Acolman soil added with glucose and the lowest in the sludge-amended soil. The largest concentration of anthracene in the Texcoco soil was found in soil added with sterile sludge and the lowest in the sludge-amended soil. The largest concentration of phenanthrene in the Texcoco soil was found in the glucose-amended soil and the lowest in the sludge-amended soil. It was found that addition of sludge removed more phenanthrene, but not anthracene from soil compared to the unamended contaminated soil, glucose inhibited dissipation of PAHs while microorganisms in the sludge contributed to their removal, and adjustment of soil pH had no effect. Organic material can be used to accelerate removal of hydrocarbons from soil, but the effect is controlled by soil type, contaminant and organic material characteristics.

Giant sigmoid diverticulum: case report and review of the literature.

Giant colonic diverticulum is a rare entity first described in 1946 by Bonvin and Bonte. It may be congenital or acquired and the average age of presentation is 65. There are less than 150 reported cases in the literature. A large abdominal mass was detected during a routine physical examination in an 82-year-old man. CT scan showed a large air-filled mass, barium enema showed multiple sigmoid diverticula, but no communication with the mass was found. A diagnosis of giant sigmoid diverticulum was made, elective sigmoidectomy and resection of the diverticulum was performed with no complications. The clinical picture may be different, varying from asymptomatic to acute abdomen, intestinal perforation or fistula. It can be diagnosed with abdominal X-ray, CT scan, barium enema or MRI, but colonoscopy is not effective. There are two accepted theories of the pathophysiology of this entity: first, a congenital origin and second, that inflammatory diverticula are caused by a perforation with a ball-valve that allows gas to enter, but not to leave the cyst, thus, enlarging the false diverticulum, and progressively destroying the bowel layers, causing secondary fibrosis. Elective treatment is a segmental resection of the affected colon with the diverticulum and in cases of acute abdomen two-stage bowel resection is preferred.

[Giant aneurysms of the pulmonary artery and peripheral venous thrombosis (Hughes-Stovin syndrome): regression with immunosuppressant therapy]. / Aneurismas gigantes de la arteria pulmonar y trombosis venosa periférica (síndrome de Hughes-Stovin): regresión con tratamiento inmunosupresor.

We report the case of a young Afro-Caribbean patient who complained of dry cough and low-grade fever. A chest film upon admission showed bilateral hilar masses in the lungs, which a CT scan with contrast medium confirmed were giant aneurysms of the pulmonary artery. The most relevant past history was deep venous thrombosis six months before admission. Hughes-Stovin syndrome was diagnosed and treatment was started with prednisolone and azathioprine. A scan 6 months after treatment ended showed the aneurysms had disappeared. Hughes-Stovin syndrome is characterized by pulmonary artery aneurysms and peripheral deep venous thromboses. Severe lung complications can include hemoptysis and thromboses inside the aneurysms. Hughes-Stovin syndrome has been considered a variety of BehCet's disease.

Aneurismas gigantes de la arteria pulmonar y trombosis venosa periférica (síndrome de Hughes-Stovin): regresión con tratamiento inmunosupresor / Giant aneurysms of the pulmonary artery and peripheral venous thrombosis (Hughes-Stovin syndrome): regression with immunosuppressant therapy

Presentamos el caso de un paciente joven de origen afrocaribeño, que consultó por tos seca y febrícula. En la radiografía del tórax de ingreso se observaron masas pulmonares hiliares bilaterales que, al ser evaluadas posteriormente con TC de tórax con contraste, se confirmó que correspondían a aneurismas gigantes de la arteria pulmonar. Su antecedente más importante era una trombosis venosa profunda detectada 6 meses antes de su ingreso. Se estableció el diagnóstico de síndrome de Hughes-Stovin y se inició tratamiento con prednisolona y azatioprina. La TC realizada 6 meses después de tratamiento ininterrumpido demostró la desaparición de los aneurismas. El síndrome de Hughes-Stovin se caracteriza por aneurismas de las arterias pulmonares y trombosis venosa profunda periférica. Puede cursar con complicaciones pulmonares graves, como hemoptisis y trombosis dentro de los aneurismas. Se ha considerado una variedad de la enfermedad de Behçet (AU)

Nodulation of legumes by members of the beta-subclass of Proteobacteria.

Members of the Leguminosae form the largest plant family on Earth, with around 18,000 species. The success of legumes can largely be attributed to their ability to form a nitrogen-fixing symbiosis with specific bacteria known as rhizobia, manifested by the development of nodules on the plant roots in which the bacteria fix atmospheric nitrogen, a major contributor to the global nitrogen cycle. Rhizobia described so far belong exclusively to the alpha-subclass of Proteobacteria, where they are distributed in four distinct phylogenetic branches. Although nitrogen-fixing bacteria exist in other proteobacterial subclasses, for example Herbaspirillum and Azoarcus from the phylogenetically distant beta-subclass, none has been found to harbour the nod genes essential for establishing rhizobial symbiosis. Here we report the identification of proteobacteria from the beta-subclass that nodulate legumes. This finding shows that the ability to establish a symbiosis with legumes is more widespread in bacteria than anticipated to date.

[Gastric carcinoma in patients under 35 years]. / Carcinoma gástrico en pacientes menores de 35 años.

OBJECTIVE: To address the frequency, type of clinical presentation, treatment modalities and survival of gastric carcinoma in young Mexicans. PLACE: Hospital de Especialidades, Centro Medico Nacional Siglo XXI, IMSS, Mexico City. METHODS: A retrospective review of all charts of patients 35 years old or younger, with a diagnosis of gastric carcinoma treated at the department of surgery, from July 1986 to January 1990 was performed. Follow up was conducted at the surgery clinic until death or up to January 1998. RESULTS: Eleven patients under 35 years of age were identified, they represent 13.7% of 80 patients treated during that time period. Women were affected more frequently (1.7:1). Ten patients presented with advanced disease, and only one patient had Stage II. Five gastric resections were performed, one patient had a bypass only, three underwent surgical explorations and two were not operated. Ten had diffuse type lesions and only one intestinal adenocarcinoma. Median survival was 15.3 months and only one patient is alive and well. CONCLUSIONS: In our series, gastric carcinoma is frequent, it is diagnosed in advanced stages, and this is the reason for a very poor prognosis.