Expression of the cyclin-dependent kinase inhibitor p21(WAF1/CIP1) and p53 tumor suppressor in dysplastic progression and adenocarcinoma in Barrett esophagus.

BACKGROUND: Barrett esophagus predisposes individuals to esophageal carcinoma, which develops from intermediate stages of tissue dysplasia primarily in the vicinity of the gastroesophageal junction. Understanding the cellular and molecular events in the progression of Barrett esophagus to adenocarcinoma may contribute to its early diagnosis and treatment. Mutation and overexpression of the tumor suppressor p53 have previously been observed in Barrett high grade dysplasia and adenocarcinoma. The expression of the cyclin-dependent kinase (CdK) inhibitor p21 can be up-regulated by p53, resulting in the down-regulation of cell division at the G(1)/S-phase transition. The current study examined the correlation between the expression of p21 and p53 by quantifying their levels during the progression of dysplasia and adenocarcinoma in Barrett esophageal tissues. METHODS: Barrett esophageal tissue samples that were negative or indefinite for dysplasia, contained dysplasia, and contained adenocarcinoma were examined by immunohistochemistry. Paraffin embedded sections of lining and glandular epithelia were adsorbed with primary murine antibodies against human p21 or p53 followed by horseradish peroxidase secondary antibody. An immunoreactivity score for each primary antibody and section was obtained by multiplying a staining intensity factor by the percent of positively stained cells. RESULTS: Nuclear p21 expression was detectable immunohistochemically in Barrett esophagus that was negative for dysplasia, but it was significantly elevated (P

Prevalence of previous appendectomy among patients needing gastrointestinal endoscopy.

BACKGROUND: The appendix may be an immune modulator of the gut, and its absence may lead to an increase in gastrointestinal illnesses. If this is true, we may expect patients needing endoscopy to have a higher prevalence of previous appendectomy. METHODS: We did a case-control study at the University of Oklahoma Hospital for 13 months. Subjects having endoscopic evaluation at the University of Oklahoma Hospital formed the study group. Patients seen at the general medicine clinic of the University of Oklahoma served as controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy. RESULTS: The endoscopy group had 524 patients; 469 patients were in the control group. There were no differences based on race or history of smoking. There was greater prevalence of previous appendectomy in the endoscopy group (33.46% vs. 20.55%). The prevalence of tonsillectomy was 29.28% in the study group vs. 21.61% among the controls. Multiple regression revealed that history of appendectomy and not tonsillectomy was related to the performance of endoscopy. CONCLUSION: History of appendectomy is associated with greater performance of endoscopy.

Role of appendectomy and tonsillectomy in pathogenesis of ulcerative colitis.

We wished to determine the effect of appendectomy and tonsillectomy on the subsequent risk for development of ulcerative colitis (UC). We conducted a case-control study at the University of Oklahoma Hospital and VA Medical Center gastroenterology clinics, as well as at the offices of private physicians. Subjects being followed for UC formed the study group. Patients being followed at Internal Medicine Associates of the University of Oklahoma clinics formed the controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy. The study group consisted of 193 patients, and there were 394 controls. The prevalence of appendectomy was lower (17.8% vs 5.2%) among patients with UC (P < 0.01). The prevalence of tonsillectomy was similar in the two groups (20.6% vs 18.1%; P = NS). We conclude that appendectomy is associated with a decreased risk for subsequent development of ulcerative colitis.

Is a history of tonsillectomy associated with a decreased risk of Helicobacter pylori infection?

To determine the relation between a history of tonsillectomy and the prevalence of colonization by Helicobacter pylori (HP), we conducted an observational, cohort study at the University of Oklahoma Hospital over a 13-month period. Subjects under-going upper endoscopic evaluation and antral biopsies for HP at the University of Oklahoma Hospital formed the database. The indication of the endoscopy and biopsies was determined by the endoscopist. The antral biopsy specimens were tested for HP using a rapid urease test. We recorded the patient's name, age, gender, race, history of smoking, and history of appendectomy or tonsillectomy. One hundred nine subjects constituted our database. There was no difference in age, gender, or smoking between the HP+ (n = 37) and HP- (n = 72) groups. The ability to pay for healthcare through a third-payor party also was similar. The prevalence of prior tonsillectomy was 30.6% in HP- group versus 5.4% in HP+ group (p < 0.01). In contrast, the prevalence of prior appendectomy was 21.6% in HP+ group versus 23.6% in HP- group (p = not significant). Multiple regression was carried out to account for confounding variables. The model showed that only white race and tonsillectomy were significantly related to the presence of HP colonization. Both appendectomy and health insurance, which were the surrogate markers for access to healthcare and socioeconomic status, were insignificant. We conclude that a history of tonsillectomy is associated with decreased prevalence of HP colonization.