Enzymatic fingerprinting reveals specific xyloglucan and pectin signatures in the cell wall purified with primary plasmodesmata.

Plasmodesmata (PD) pores connect neighbouring plant cells and enable direct transport across the cell wall. Understanding the molecular composition of these structures is essential to address their formation and later dynamic regulation. Here we provide a biochemical characterisation of the cell wall co-purified with primary PD of Arabidopsis thaliana cell cultures. To achieve this result we combined subcellular fractionation, polysaccharide analyses and enzymatic fingerprinting approaches. Relative to the rest of the cell wall, specific patterns were observed in the PD fraction. Most xyloglucans, although possibly not abundant as a group, were fucosylated. Homogalacturonans displayed short methylated stretches while rhamnogalacturonan I species were remarkably abundant. Full rhamnogalacturonan II forms, highly methyl-acetylated, were also present. We additionally showed that these domains, compared to the broad wall, are less affected by wall modifying activities during a time interval of days. Overall, the protocol and the data presented here open new opportunities for the study of wall polysaccharides associated with PD.

Endoultrasonography (EUS) examination of the esophagus in the diagnosis of esophageal duplication: a case report and a review of a literature.

Esophageal duplication cysts are a rare medical entity. In most cases they are located at the level of the distal esophagus. Although our case is not unique, we want to focus on it as a reflection on diagnostic methods. The aim of this article is to show through the report on a case of esophageal duplication treated by us, followed by a review of similar cases in the literature, the utility of EUS in the diagnosis of upper-diaphragmatic and not communicating esophageal duplication. We report a case of a 43 year-old woman. She came to our attention for heartburn and retrosternal sense of space. The patient underwent an endoultrasonography (EUS) examination of the esophagus. The framework put EUS diagnosis of cystic formation of the esophagus (esophageal duplication cysts likely). We demonstrate that only EUS has a correlation with the determination of the pre-operative diagnosis with a statistical significance (p <0.001). In the diagnosis of esophageal not communicating duplication cysts EUS is the most specific diagnostic exam.

Relapse of low-grade gastric MALT lymphoma after Helicobacter pylori eradication: true relapse or persistence? Long-term post-treatment follow-up of a multicenter trial in the north-east of Italy and evaluation of the diagnostic protocol's adequacy.

The effect of eradication of Helicobacter pylori on early stage gastric low-grade MALT lymphoma in 76 patients with follow-up of at least 1 year (12-63 months, mean 28) is reported. No regression was found in five cases after 12-48 months. In one case surgical resection detected the involvement of perigastric lymph nodes overlooked by endoscopic ultrasonography (EUS). Neither progression of the disease nor a high-grade component was documented by repeated gastric mappings, EUS and complete stagings in the other four cases. After histological remission five relapses of low-grade and one relapse of high-grade MALT lymphoma were found 12-48 months after eradication. Subsequent histological remission, without any additional therapy, was found in three relapsed cases. A rapid and persistent histological remission was obtained in 56 patients (73%). A late remission was observed in six cases. Monoclonal remission was found in half of the patients and was frequently delayed. Persistent monoclonality was associated with histological remission in the vast majority of patients. Our data confirm H. pylori eradication as the first choice therapy for early stage gastric low-grade MALT lymphoma and recommend extensive bioptic mapping and endoscopic sonography both in the local staging and in the regression evaluation. The rare cases of late remission encourage us to wait for at least 1 year after eradication of H. pylori. Longer follow-up studies will clarify the meaning of histological relapse/persistence and late remission. The study of non-responder cases could show us a step in lymphomagenesis.

[Serum cholylglycine in the evaluation of impaired hepatic function]. / La colilglicina sierica nella valutazione del danno funzionale epatico.

The biliary serum salts cholylglycine and sulfolithocholylglycine were assessed in 88 chronic liver disease patients subjected to laparoscopy and biopsy. The assay was conducted before and after meals in order to assess the diagnostic value of the test together with the common liver function parameters. The greatest diagnostic sensitivity was provided by gamma glutamyl transpeptidase and bromosulfophtalein K1 clearance. In particular fasting glycocholic acid was as predictively reliable as BSF-K1. Cholylglycine levels also correlated with the prognosis of the liver disease.

[Pediatric digestive endoscopy: personal experience]. / Endoscopia digestiva pediatrica: esperienza personale.

Fiberendoscopy has become a diagnostic and therapeutic procedure of the outmost importance also in pediatric gastroenterology. 100 gastrointestinal fiberoscopies have been carried out on 81 patients ranging in age from 1 month to 14 years during a three-year period (November 79 - October 82), using general anesthesia for 9 patients. The 70 upper GI endoscopies, almost always performed with the Olympus GIF P2 instrument, showed acute or chronic, limited or diffuse inflammatory changes in most cases; post-bulbar areas were successfully visualized in 46 patients. The 30 colonoscopies were carried out with the standard adult equipment in most part of cases; in 50% of cases the inspection was extended to the caecum. Inflammatory diseases have been frequently revealed, but more frequently no remarkable changes were found. Indications for "operative" endoscopy were dilatation of an esophageal achalasia and removal of four gastrointestinal bleeding polyps. All procedures gave satisfactory results, and no morbidity occurred to patients.

Sonographic patent umbilical vein: lack of specificity for portal hypertension.

The sonographically patent umbilical vein is commonly considered a sign of portal hypertension and is held to be specific by some authors. We found sonographically patent umbilical veins in 11 patients with hepatic cirrhosis and esophageal varices, and in three subjects without liver disease and without esophageal varices. All subjects were submitted to Doppler flowmetry, which, with the investigation of the direction of venous flow, proved to be a simple discriminatory test.

Jejunal endoscopic polypectomy in the Peutz-Jeghers syndrome.

The authors describe a transendoscopic wire snare excision of three jejunal polyps in a patient with Peutz-Jeghers syndrome. Two years previously the patient had undergone surgical jejunal segmental resection for invagination caused by several polyps, one of which revealed carcinoma in situ. The procedure was well tolerated, and the subsequent course was uneventful. Endoscopic follow-up of the proximal jejunal polyps in this syndrome is stressed.

Psychological distress in duodenal ulcer and acute gastroduodenitis. A controlled study.

The aim of the study was to assess psychological distress in duodenal ulcer (DU) and acute gastroduodenitis (AGD). Sixty-one consecutive, unselective patients (DU = 25; AGD = 36) were compared with their respective controls matched for age, sex, level of formal education, and social class. Psychological distress was assessed using the Kellner-Sheffield Symptom Rating Test. In order to reduce to the minimum the possible effects of the duration of the symptoms and awareness of the diagnosis, the study was carried out before diagnosis on subjects whose symptoms were of recent onset. The DU and AGD patients had higher mean scores than the controls for neuroticism and anxiety; moreover the mean scores for depression and somatization of the AGD patients were also higher than those of the controls. On the basis of these data, the authors discuss the possibility that gastroduodenitis might be an independent entity or part of the spectrum of acid peptic (ulcer) disease.

Peptic ulcer bleeding: comparison of two hemostatic procedures.

OBJECTIVE: Bleeding is a serious complication of peptic ulcer. Endoscopic injection therapy is accepted as a homeostatic endoscopic treatment in acute nonvariceal of upper GI hemorrhages, particularly in bleeding peptic ulcers. The risk of rebleeding is predicted by the endoscopic appearance of ulcer features classified according to Forrest's criteria. METHODS: Two hundred twenty-three patients were selected from 1,003 emergency upper endoscopies for GI bleeding. According to Forrest's criteria, 99 well-matched patients with ulcers F1 and F2 were considered at risk of rebleeding; 54 patients (group A) received local ulcer injection of epinephrine solution 1:10,000, whereas (group B) patients were treated with local epinephrine injection and then with endoscopic Hemoclips. (1) We considered the control of bleeding, the number of rebleeding episodes, the need for emergency surgery, and mortality. RESULTS: Bleeding ulcers stopped completely in 83.3% group A patients, and in 95.6% group B patients (p = not significant). In a subset of F1b patients the rebleeding rate was 31 % for group A and 0% for group B (p < 0.05). There was no mortality as a result of the procedure. There was a trend toward reducing surgery in favor of the combined therapy (0% vs 7.4%). No differences were found in transfusion requirements or mean hospitalization days. CONCLUSIONS: We conclude that endoscopic injection of l:10,000 epinephrine solution alone and epinephrine solution plus application of Hemoclips are equivalent therapies in treating bleeding and rebleeding from peptic ulcers. There was no difference between therapies in terms of need for surgery or mortality. Possibly combination therapy is more effective in treating ulcers that are actively oozing.

Prevalence of aortic valve stenosis in patients affected by gastrointestinal angiodysplasia.

OBJECTIVES: Angiodysplasia is considered to be an important cause of gastrointestinal bleeding in the elderly. An association between idiopathic gastrointestinal bleeding and aortic valve stenosis has been reported in up to 25% of the patients. The association between angiodysplasia mainly of the right colon and aortic valve stenosis has been suggested, but is not proven. The aim of this study was to examine the prevalence of aortic valve stenosis in patients with gastrointestinal angiodysplasia. METHODS: We studied retrospectively 83 patients submitted to gastrointestinal endoscopy and found affected by angiodysplasia. Of them 24 (16M and 8F) had died from causes unrelated to cardiovascular diseases. The 59 patients still alive (27M and 32F) underwent a complete clinical, electrocardiographic and echocardiographic (M-mode, B-mode, pulsed and continuous-wave Doppler) evaluation. RESULTS: Fifteen patients (25%) had a normal examination, both clinical and echocardiographic. Eleven (19%) had minor cardiac abnormalities but had no murmurs. Although no murmurs were present in 15 patients (25%), some echocardiographic abnormalities such as aortic leaflet sclerosis, mitral annular calcification, their association, or trivial mitral regurgitation detectable only at PW-Doppler were found. In 18 patients (31%) both systolic murmurs and valvular abnormalities, as revealed by echocardiographic examination, were detected: 10 had a regurgitant and 8 an ejectional murmur; of these only 1 (1.6%) had a true severe calcified aortic valve stenosis at echo-Doppler examination. CONCLUSIONS: The low prevalence of aortic valve stenosis in patients with gastrointestinal angiodysplasia (1/59 or 1.6%) in this retrospective study argues against the association of gastrointestinal angiodysplasia and aortic valve stenosis.

Is it possible to recognize portal hypertension with continuous-wave Doppler ultrasonography?

Continuous-wave (CW) Doppler ultrasonography is a well-known technique in the assessment of peripheral and central circulation. The purpose of this study was to find out whether the technique can be used to demonstrate portal hypertension (PH) from liver disease through the evaluation of flow reversal in the veins of the round ligament. One hundred eight patients (50 controls and 58 with PH) underwent abdominal sonography, endoscopic examination, and CW Doppler flowmetry of the umbilical region. In 53 of 58 patients with PH, hepatofugal venous flow was found in the round ligament; this sign was absent in all of the controls. There was remarkable agreement between the results of CW Doppler examination and those of endoscopy and abdominal sonography: its sensitivity was about 91%, and we encountered no false positives. The Doppler ultrasound method is specific for diagnosing PH, simple to perform, and repeatable.

Survival after endoscopic sclerotherapy for esophageal varices in cirrhotics.

OBJECTIVES: Gastroesophageal bleeding from varices is the most life-threatening complication in liver cirrhosis with portal hypertension. Since its first application, endoscopic sclerotherapy seems to be the most widely applicable procedure to stop the bleeding and to prevent recurrences. The aim of this study was to ascertain the role of some factors as predictors of survival in different groups of cirrhotic patients. METHODS: At the time of their first hemorrhage from esophageal varices, 184 patients with portal hypertension from cirrhosis were treated by endoscopic sclerotherapy using a combined intraparavariceal procedure and Polidocanol 1% as sclerosing agent. RESULTS: The follow-up range was 1-106 months (mean, 28.2 months), and 84 patients were still alive (45.7%), 97 had died (52.7%), and three had withdrawn (1.6%) at the end of the period. The major cause of death was bleeding, and 35 patients died in the first 6 wk after sclerotherapy. Using Cox proportional hazard models, Child's grading was the most important prognostic factor of both short-term (first 6 wk) and medium/long-term survival (after the first 6 wk up to 5 years). Complete eradication of varices, too, was associated with both short- and long-term survival, whereas age, sex, etiology of cirrhosis, and the presence of esophageal stenosis as a side effect of sclerotherapy were not. The type of sclerotherapy (elective vs emergent) was associated with survival, but it was not independent from Child's grade, because only patients in Child C treated electively showed a better prognosis than those treated in emergency. CONCLUSIONS: We can conclude that patients with severe liver disease (Class C) have poor prognosis, and complete eradication represents an aim because it seems to be protective against the risk of dying.

Eradication of Helicobacter pylori infection in primary low-grade gastric lymphoma of mucosa-associated lymphoid tissue.

OBJECTIVE: To determine the effect of eradicating Helicobacter pylori infection on the course of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. DESIGN: Prospective cohort study. SETTING: University internal medicine clinics, a referral oncology center in southern Switzerland, and a gastroenterology referral center in northern Italy. PATIENTS: 26 patients with localized primary low-grade gastric MALT lymphoma. INTERVENTION: Treatment for H. pylori infection (bismuth or omeprazole or both, amoxicillin, and metronidazole for 14 days). MAIN OUTCOME MEASURES: Endoscopic biopsy specimens of the gastric mucosa were obtained every 3 to 6 months after treatment for H. pylori infection. RESULTS: Helicobacter pylori was completely eradicated in 25 of 26 patients, but 4 patients needed second-line antibiotic treatment to eradicate the microorganism. Disappearance or almost total regression of the lymphomatous tissue was observed in 15 of the 25 evaluable patients (60%; CI, 39% to 79%); however, disappearance or almost total regression was evident in the first biopsy specimen after treatment for H. pylori infection in only 8 of the 15 patients. CONCLUSIONS: Our study confirms recent anecdotal reports of regression of gastric MALT lymphoma after eradication of H. pylori and indicates that the growth of these extranodal lymphomas may depend on H. pylori.

Antigenic mimicry between Helicobacter pylori and gastric mucosa in the pathogenesis of body atrophic gastritis.

BACKGROUND & AIMS: The majority of patients with Helicobacter pylori infection have autoantibodies cross-reacting with gastric antigens. In this study, the relation between autoantibody status, histopathology of body mucosa, and antigenic profile of H. pylori was investigated. METHODS: One hundred patients were examined for H. pylori infection, body gastritis, and gastric autoantibodies. Balb/c mice were analyzed for serum autoantibodies after immunization with H. pylori from patients with and without atrophic gastritis. RESULTS: Immunoglobulin G autoantibodies were detected in 57 of the 87 infected patients (65.5%) but in none of the 13 patients without infection and gastritis. The autoreaction involved mainly the luminal surface of glandular cells and secretory canaliculi of parietal cells. The autoantibody status correlated with the presence and degree of inflammation and atrophy of the glands. H. pylori from patients with atrophic gastritis showed a higher capacity to induce autoantibodies than H. pylori from patients with a minimal superficial gastritis. Monoclonal antibodies showed differences in the bacterial expression of cross-reacting determinants. CONCLUSIONS: H. pylori-mediated autoimmunity is involved in the pathogenesis of chronic atrophic gastritis. The grade of antigenic mimicry of the infecting H. pylori strain plays a role in the progression of chronic gastritis to atrophy.