Immunohistochemical Differentiation between Western and East Asian Types of CagA-Positive Helicobacter pylori in Gastric Biopsy Samples.

Background: Cag A-positive Helicobacter pylori isolated from human gastric mucosa is categorized as a Western or East Asian allele-type based on whether the cagA gene encodes an EPIYA-C or EPIYA-D motif. We aimed to differentiate between the 2 types of H. pylori by immunohistochemistry (IHC) using formalin-fixed paraffin-embedded (FFPE) gastric biopsy samples. Materials and Methods: We developed 2 monoclonal antibodies (mAbs) that detect either the EPIYA-C or EPIYA-D motif of the H. pylori CagA protein by IHC using FFPE tissues. FFPE tissue sections from 30 Japanese and 39 Brazilian gastric biopsy samples with H. pylori infection confirmed by Giemsa staining (moderate/severe in the Sydney classification system) were examined by IHC with the novel mAbs followed by polymerase chain reaction (PCR) for EPIYA-C or EPIYA-D using DNA extracted from adjacent tissue sections. Results: Differentiation among Western and East Asian types and CagA-negative H. pylori was successful in most (97%) samples by IHC with the novel mAbs and commercially available mAbs that react with a species-specific lipopolysaccharide or a common CagA motif of H. pylori. The detection status of EPIYA-C/D motifs by IHC with the novel mAbs was consistent with the PCR results in 61 (88%) of 69 samples: EPIYA-C(+)/D(-) in zero Japanese and 26 Brazilian samples, EPIYA-C(-)/D(+) in 26 Japanese and 1 Brazilian sample, and EPIYA-C(-)/D(-) in 1 Japanese and 7 Brazilian samples. The detection sensitivity and specificity of IHC with each novel mAb compared with the PCR results were, respectively, 84% and 97% for EPIYA-C, and 97% and 95% for EPIYA-D. Conclusions: The novel mAbs specific to each EPIYA-C or EPIYA-D motif differentiated between Western and East Asian types of CagA-positive H. pylori by IHC using FFPE tissues. Applying these novel mAbs to large numbers of archived pathology samples will contribute to elucidating the association of these allele types with gastric cancer.

Pre-malignant signs of gastric MALT lymphoma

Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma, which mostly involves the stomach. The clinical suspicion and diagnosis are often challenging because of the lack of specific symptoms and conventional endoscopic findings. Three magnifying endoscopic signs of the gastric mucosa have been described as highly specific to the diagnosis of MALT lymphoma, such as (i) tree-like appearance of the microvessels; (ii) non-structural area; and (iii) ballooning crypt pattern. We report the case of a middle-aged woman in which these signs appeared chronologically over a period of 2 years, showing the association of the sequence of the endoscopic findings and the final histological diagnosis of gastric MALT lymphoma.

Pre-malignant signs of gastric MALT lymphoma.

Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma, which mostly involves the stomach. The clinical suspicion and diagnosis are often challenging because of the lack of specific symptoms and conventional endoscopic findings. Three magnifying endoscopic signs of the gastric mucosa have been described as highly specific to the diagnosis of MALT lymphoma, such as (i) tree-like appearance of the microvessels; (ii) non-structural area; and (iii) ballooning crypt pattern. We report the case of a middle-aged woman in which these signs appeared chronologically over a period of 2 years, showing the association of the sequence of the endoscopic findings and the final histological diagnosis of gastric MALT lymphoma.

Primary aortoesophageal fistula: a rare cause of acute upper gastrointestinal bleeding.

Acute upper gastrointestinal bleeding is a potentially life-threatening emergency, especially in the elderly. This condition accounts for approximately 1% of all emergency room admissions. Among the causes of such bleeding is aortoesophageal fistula, a dreaded but apparently rare condition, first recognized in 1818. The great majority of cases are of primary aortoesophageal fistula, caused by atheromatous aortic aneurysms or, less frequently, by penetrating aortic ulcer. The clinical presentation of aortoesophageal fistula is typically characterized by the so-called Chiari's triad, consisting of thoracic pain followed by herald bleeding, a variable, short symptom-free interval, and fatal exsanguinating hemorrhage. The prognosis is poor, the in-hospital mortality rate being 60%. Conservative treatment does not prolong survival, and the in-hospital mortality rate is 40% for patients submitted to conventional surgical treatment. Here, we report the case of a 93-year-old woman who presented to the emergency room with a history of hematemesis. The patient was first submitted to upper gastrointestinal endoscopy, the findings of which were suggestive of aortoesophageal fistula. The diagnosis was confirmed by multidetector computed tomography of the chest. Surgery was indicated. However, on the way to the operating room, the patient presented with massive bleeding and went into cardiac arrest, which resulted in her death.

Avaliaçäo da integraçäo de retalho muscular na reconstruçäo esofágica após esofagectomia cervical parcial: estudo experimental em cäes / Evaluation of the integration muscle flap in esophageal reconstruction after partial cervical esophagectomy: experimental study in dogs

Objetivou-se desenvolver com metodologia experimental, um modelo cirúrgico preocupado com a complexidade da técnica, aplicabilidade e tempo de duraçäao, utilizando retalho do músculo esternocefálico para reconstruçäo parcial do esôfago cervical, estudando ainda a integraçäo do retalho através da cicatrizaçäo e circulaçäo. Utilizamos 30 cäes machos com peso médio de 14,37Kg. Após a observaçäo pós-operatória, os aniamis foram divididos aleatoriamente em dois grupos de quinze cäes para avaliaçäo da circulaçäo e cicatrizaçäo da reparaçäo esofágica. A grande maioria dos cäes (80 por cento) ganhou peso, näo apresentando dificuldade de deglutiçäo, episódios de regurgitaçäo, e endoscopicamente nenhum dos animais demonstrou presença de fístulas e estenoses. A injeçäo com neoprene látex permitiu verificar pequenos ramos arteriais provenientes do retalho muscular e que supriam a regiäo da reconstruçäo. Os achados histológicos demonstraram quadro de atividade inflamatória crônica, em fase remissiva, na maioria dos cäes analisados, caracterizando portanto integraçäo do retalho com o órgäo.

Tratamento endoscópico de ectasia vascular do cólon na vigência de sangramento com injeçäo de soluçäo de adrenalina 1:10.000 e eletrocoagulaçäo monopolar: uma abordagem alternativa: relato de caso / Endoscopic treatment of colon vascular ectasia during bleeding with injection of epinephrine solution at 1:10,000 and monopolar electrocoagulation: an alternative approach: case report

A hemorragia digestiva é responsável por 2 por cento das internaçöes hospitalares de adultos. As ectasias vasculares estäo entre as causas mais freqüentes de enterorragia. Em cerca de 80 por cento dos casos de ectasias vasculares hemorrágicas há a parada do sangramento espontaneamente, mas com freqüência ocorre a recidiva. Muitos tratamentos säo propostos tais como infusäo de substâncias vasoconstrictoras através de cateterizaçäo superseletiva por arteriografia. O uso da fotocoagulaçäo com laser, heater proable, eletrocoagulaçäo bipolar, uso de pinça tipo hot biopsy, tem sido propostos através de utilizaçäo da via colonoscópica, mas alguns com efeito fugaz e outros com elevado custo e resultado pouco efetivo. Os autores apresentam um caso de ectasia vascular do cólon na vigência de sangramento tratada com injeçäo de adrenalina 1:10.000 seguida pela eletrocauterizaçäo monopolar através de colonoscopia. Trata-se de um novo método, alternativo, seguro e eficaz na abordagem dos doentes portadores de ectasia vascular do cólon na vigência de sangramento