Abrikossoff's tumor mimicking endometrial tumor--literature review and case report of the first described granular cell tumor in scar tissue after caesarean section.

Abrikossoff's tumor (AT) is a rare, predominantly benign, asymptomatic, solitary, less than three cm-in-size tumor with usually favorable prognosis after surgical excision. Most of the tumors are found in the head and neck location in the third to fifth decade of life. Local wide excision, which is a treatment of choice, is curative in most of the cases.The case of 34-year-old female patient the authors report herein is the first described AT located in scar tissue after caesarean section. Physical and ultrasound examinations revealed a well-circumscribed, two-cm-in-size mass located in the fascia level. With a preoperative suspicion of endometrial tumor, the patient underwent surgery. Tumor was excised with wide tissue margin. Postoperative pathologic analysis revealed the presence of granular cell myoblastoma and was essential giving definitive diagnosis.

Interstitial cells of Cajal - systematic review.

This paper reviews the distribution of interstitial cells of Cajal (ICC) in the human gastro-intestinal (GI) tract, based on ultrastructural and immunohistochemical evidence. The distribution and morphology of ICC at each level of the normal GI tracts is addressed from the perspective of their functional significance. Alterations of ICC reported in as well as in GI stromal tumours are reviewed, with emphasis on the place of ICC in the pathophysiology of disease.

The formation of complexes with albumin increases the stability of the protoporphyrin IX spectra.

Photodynamic therapy is a high-target, low-invasive treatment utilized to manage a variety of malignant diseases and precancerous lesions. Protoporphyrin IX (PpIX) is one of the most important photosensitizers used in photodynamic therapy, carried to the cancer tissue by serum albumin. Its delivery by transport protein is one of the major factors in determining the efficacy of photodynamic therapy. The distribution of the albumin-PpIX complexes to the target tissue enables the accomplishment of an optimal PDT effect. This study aimed to assess in vitro the stability of spectrofluorimetric spectra of albumin-PpIX complexes. The experiment used three chemicals: PpIX, human serum albumin (HSA), and bovine serum albumin (BSA). Spectral data was recorded using a Kontron SFM-25 Instrument AG, at two excitation wavelengths λex=280 nm and 295 nm. A concentration of 1x10-5M of PpIX, in combination with 1.25x10-6M of HSA and 4x10-7M of BSA, have been recorded repetitively for ten days and compared to the initial spectrum. The maximum of PpIX fluorescence changed significantly on the first day following sample preparation. The maximum of PpIX - serum albumin complex was stable 10 and 4 days for HSA and 5 and 2 days for BSA for λex=280 nm and 295 nm, respectively. The formation of a complex between PpIX and serum albumin was seen to extend the stability of the spectrofluorimetric spectrum. However, a less significant effect was observed in the case of BSA, which could most plausibly be attributed to the variations in primary structure between HSA and BSA, leading to discernible variations in spectroscopic measurements.

The effects of baclofen on the feeding behaviour and body weight of vagally stimulated rats.

UNLABELLED: It is hypothesised that the GABA(B) receptor agonist baclofen increases or has no effect on food intake, and electrical stimulation of vagal nerves decreases food intake. The aim of this study was to evaluate the effects of baclofen in vagally stimulated rats. MATERIAL AND METHODS: Thirty two Wistar rats were divided into five groups: group A scheduled for microchip implantation for vagal stimulation, group B for sham operation, group C for microchip implantation and baclofen medication, group D for baclofen medication only and group E for gastric motility evaluation under influence of baclofen. The following parameters were then evaluated: food intake and body mass, gastric motility, leptin, insulin, and glucose serum levels. RESULTS: In the comparison of groups B and A, daily food intake and body weight gain decreased by 17% (p<0.05) and by 22% (p<0.05), respectively. Baclofen alone (group D) did not significantly change either food intake nor diurnal body weight compared to the controls, but when used in conjunction with the microchip (group C) it did significantly reduce effect of vagal neuromodulation (p<0.05). Furthermore, a significant decrease in leptin and glucose levels was detected in group C: 677 to 165 pg/ml (p<0.05) and 5,93 to 4,88 mmol/l (p<0.05), respectively. The administration of baclofen stimulated significantly gastric motility and elicited irregular motor migrating complex (327+/-200 against control 255+/-52 cmH2O/s). CONCLUSIONS: These results suggest that microchip vagal neuromodulation through increased vagal afferent activity induces an alteration in the feeding behaviour and decreases nocturnal food intake and body weight. These effects were partially attenuated by baclofen. The data suggests that GABA(B) receptors play an important role in the pathomechanism of attenuation of food intake induced by vagal nerve stimulation.

Loss of interstitial cells of Cajal after pulsating electromagnetic field (PEMF) in gastrointestinal tract of the rats.

Exposure to the magnetic field has remarkably increased lately due to fast urbanization and widely available magnetic field in diagnosis and treatment. However, biological effects of the magnetic field are not well recognized. The myoelectric activity recorded from the gastrointestinal and urinary systems is generated by specialized electrically active cells called interstitial cells of Cajal (ICCs). Thus it seems rational that ICC have significant vulnerability to physical factors like an electromagnetic field. The aim of this study was to evaluate the influence of pulsating electromagnetic field (PEMF) (frequency 10 kHz, 30ms, 300 muT burst, with frequency 1Hz) on ICCs density in the rat gastrointestinal tract. Rats were divided into two groups (n=32). The first group was exposed to PEMF continuously for 1, 2, 3, and 4 weeks (n = 16), and the second group (n=16) served as a control. Tissue samples of the rat stomach, duodenum and proximal colon were fixed and paraffin embedded. The tangential sections of 5 microm thickness were stained immunohistochemically with anti-c-Kit (sc-168) antibody and visualized finally by DAB as chromogen (brown end product). C-Kit positive branched ICC-like cells were detected under the light microscope, distinguished from the c-kit-negative non-branched smooth muscle cells and from the c-kit positive but non-branched mast cells and quantitatively analyzed by MultiScan computer program. Apoptosis detection was performed with rabbit anti-Bax polyclonal antibody (Calbiochem, Germany) and LSAB 2 visualization system. The surface of c-Kit immunopositive cells decreased after exposure to PEMF in each part of the gastrointestinal tract. Reduced density of ICCs was related to exposure time. The most sensitive to PEMF were ICCs in the fundus of the stomach and in the duodenum, less sensitive were ICCs in the colon and pacemaker areas of the stomach. No marked changes in ICC density in the pyloric part of the stomach were observed. We demonstrate that the PEMF induced apoptosis dependent decrease in ICC expression.

Combined risk assessment of physical activity and dietary habits on the development of colorectal cancer. A hospital-based case-control study in Poland.

The purpose of the study was to assess the importance of physical activity performed both in occupational settings and in leisure time on the risk of colorectal cancer, considering the possible confounding effects of dietary habits. The hospital-based case-control study was carried out in Poland. In total, 180 incident cases of colorectal cancer were recruited. An equal number of controls, individually matched by gender and age, were chosen from patients with no history of cancer. A food frequency questionnaire combined with quantity of foods eaten was used to assess the usual dietary pattern for 148 food items. The average physical load of the interviewed patients before the occurrence of disease was ascertained by self-assessment. The degree to which patients' recreational time was sedentary was measured by the number of hours spent watching TV. The adjusted risk of colorectal cancer was reduced by half in those active in leisure time (OR 0.45, 95% CI 0.24-0.84). The effect of occupational physical activity was of about the same order of magnitude in terms of risk reduction (OR 0.61, 95% CI 0.29-1.29) and both activities combined acted as independent protective factors. The protective effect of healthy nutrition appeared to be independent from that attributed to physical effort.

Effects of vagal neuromodulation and vagotomy on control of food intake and body weight in rats.

Food induced neurohumoral signals are conduced to data processing brain centers mainly as vagal afferent discharge resulting in food intake regulation. The aim of this study was to evaluate effects of vagal nerve neuromodulation in control of food intake with fed-pattern microchip (MC) pacing. Experiments were performed on 60 rats divided on 5 groups: I group 0,05Hz left vagal pacing, II - pacing of both vagal nerves with MC 0,05Hz, III- left vagal MC 0,1Hz pacing, IV - pacing of both vagal nerves with MC 0,1 Hz was performed. In group V left vagal pacing was combined with right side abdominal vagotomy. Body weight and total food intake decreased by 12% and 14% (I), 26% and 30%(II), 8% and 21%(III), 14% and 30%(IV), 38% and 41%(IV), respectively (p<0.05). Effects of both vagal nerves stimulation on final body weight and food intake was significantly more effective than only single nerve MC pacing however most effective was stimulation with 0,1Hz combined with right vagotomy. We conclude that vagal stimulation reduce food intake and body weight by increasing vagal afferent signals. Our results suggest that information in vagal afferents can be modulated resulting in changes of feeding behaviour and body weight.

Effects of continuous microchip (MC) vagal neuromodulation on gastrointestinal function in rats.

Afferent fibers from gastrointestinal tract outnumber efferents ten times in vagal nerves. Modifying the afferent input makes possible to change discharge of vagal efferents affecting gastrointestinal functions in process known as neuromodulation (NM). Lately it has been used in the treatment of pain and hyperactive neurogenic bladder in urology. MC induced NM may therefore provide a concurrent to pharmacology tool, in treatment of gastrointestinal disorders. The aim of this study was to investigate the effects of long term neuromodulation procedure with use of MC on gastric motility, secretion and weight control in conscious rats. Experiments were performed on 30 Wistar male rats (250-350 g) divided in two groups: sham operated and microsurgically implanted with MC on left vagal nerve below diaphragm. Following stimulation parameters were used: frequency of 0.5-30 Hz, amplitude of 0.55 V, impulse duration of 10 ms in monophasic fashion. In both groups food intake and body weight were measured through the period of 2 weeks after recovery period. Then gastric fistula was implanted in gastric antrum and fasted gastric motility recorded with use of PowerLab system (Australia). Gastric emptying and secretion were also tested with use of phenol red and automatic titration methods. On the daily basis glucose level with standard test and leptin after MC implantation were measured. Recording of vagal activity in fasted rats showed burst of action potentials about 5 +/- 2.5 in period of 5000 sec, each burst with spike frequency up to 35 Hz. Food (5 ml of Intralipid--intragastrically) almost doubled amount of bursts to 12 +/- 5 in period of 5000 sec with increase in frequency at spike up to 50 Hz. MC induced vagal activity showed continuous spike activity similar to fed pattern. MC induced NM decreases daily food intake by 6% (33.6 +/- 4.8 vs control 35.5 +/- 4.8 g, p < 0.01). Body weight gain in rats before MC implantation decreased by 20% within 2 weeks after recovery (34.8 +/- 9.08 vs control 23.56 +/- 4.15 g). Fasting control glucose level also decreased of 5.5% (93.15 +/- 9.3 vs control 98.5 +/- 11.2 mg%, p < 0.05). Frequency of gastric contractions did not change significantly in MC versus control but amplitude of contractions increased of about 66.7% (2.0 +/- 0.8 vs 1.17 +/- 0.52) at the dominant frequency 0.08 Hz range and about 71.5% (1.17 +/- 0.35 vs 0.68 +/- 0.47, p < 0.05) at the frequency 0.12 Hz. in FFT analysis PowerLab (chart v = 4.01). BAO decreased by 29.25% without H+ concentration changes (0.2 +/- 0.14 vs 0.14 +/- 0.12 mmol/30 min, p < 0.05) but MAO did not change in MC rats (0.37 +/- 0.25 vs 0.42 +/- 0.28 mmol/30 min, p 0.05). Gastric emptying of isotonic solution increased by 10% (90.46 +/- 5.34 vs 80.39 +/- 9.95) percent of marker passing to duodenum/5 min, p < 0.0001). Our results suggest that MC induced NM affect brain-gut axis via influencing metabolic and gastric function and decreases body weight.

A clinico-epidemiological study on gastritis in gastric carcinoma and in non-cancerous gastric pathology in Poland.

To investigate the risk of gastric cancer development in subjects with atrophic and nonatrophic gastritis, we studied 221 consecutive gastric cancer patients and 7647 non-cancer subjects for whom endoscopic biopsy of the gastric mucosa was available. In gastritis patients, the relative risk (RR) estimates of gastric cancer were as follows: corpus atrophic gastritis RR = 8.7 (95% CI = 5.4-14.1), antral atrophic gastritis RR = 4.5 (2.4-8.1), chronic atrophic pangastritis RR = 7.6 (3.8-15.3), corpus nonatrophic gastritis RR = 1.6 (0.9-2.7), antral non-atrophic gastritis RR = 1.2 (0.7-2.3), and pangastritis RR = 1.3 (0.6-2.8). The latter was of borderline significance (p = 0.07). In peptic ulcer, a significant excess risk was calculated for subjects with either corpus atrophic gastritis (RR = 3.1 [2.5-3.9] or antral atrophic gastritis (RR = 3.5 [2.6-4.8]). For stomach polyps, the risk was significantly increased only in subjects with corpus atrophic gastritis (RR = 2.1 [1.3-3.5]). The risks for both peptic ulcer and polyps, however, were significantly increased in chronic atrophic pangastritis. A substantial excess risk of gastric cancer was found for atrophy in the corpus (RR = 20.9 [9.0-48.9]) and in the antrum (RR = 14.9 [5.3-41.9]). An increased risk of peptic ulcer was also confirmed in subjects with atrophy in the corpus (RR = 3.0 [1.3-6.9]) and in the antrum (RR = 4.9 [2.0-12.1]).

Amyand's hernia: a report of two cases.

In 2000-2001 two patients with acute appendicitis in the right inguinal hernia (Amyand's hernia) and the symptoms of incarcerated hernia were operated on in emergency. One patient with the symptoms of local peritonitis was subjected to hernioplasty and appendectomy. The second underwent midline inferior laparotomy, because of diffuse peritonitis with appendectomy and hernioplasty. Both patients were operated by Shouldice's method. None of the patients developed recurrent disease. The presented cases point to the necessity of considering acute appendicitis in the differential diagnosis of incarcerated right inguinal hernia.

Pancreatic carcinoma-induced changes in gastric myoelectric activity and emptying.

BACKGROUND/AIMS: Twenty patients with histologically confirmed pancreatic carcinoma without any endoscopic evidence of gastroduodenal obstruction were included in the study. The aim was to determine changes in gastric myoelectric activity and liquid/solid gastric emptying induced by pancreatic tumor. METHODOLOGY: According to TNM/UICC classification patients were divided into two groups A (T2) and B (T3) due to extent of tumor invasion (mainly to retroperitoneum space). In all patients electrogastrography, solid and liquid gastric emptying tests were performed. RESULTS: In the majority of patients of groups A and B the most commonly reported complaints included upper abdominal pain (60% vs. 80%) and icterus (80% vs. 60%). Dyspeptic symptoms were observed in 40% patients of group A and 90% in group B. In group electrogastrography recordings showed dysrhythmia patterns, mostly bradygastria, in 50% of group A patients and in 80% of group B. Liquid/solid gastric emptying were delayed in 20/40% of group A patients and 50/80% of group B. Disorders of gastric myoelectric activity and emptying correlated with tumor stage and location across analyzed groups but not with histology and hyperbilirubinemia levels. CONCLUSIONS: It was observed that solid gastric emptying is affected earlier compared to liquid gastric emptying. Delayed gastric emptying may be attributed to gastric dysrhythmia and/or abdominal pain but not mechanical effects of tumor growth that occur during the course of disease.

Early effects of standard and pylorus-preserving pancreatectomy on myoelectric activity and gastric emptying.

BACKGROUND/AIMS: The main concern about pylorus preserving pancreatectomy (PPP) is delayed gastric emptying (GE). Both cancer and surgical procedures cause damage to the enteric nervous system and induce profound changes in gastric motility and emptying. The aim was to evaluate the effects of primary disease and type of surgical procedure used (standard pancreatoduodenectomy, SP vs. PPP) on myoelectric activity (MA), and solid and liquid GE in pancreatectomy patients. METHODOLOGY: Twenty-eight subjects were included, 18 after Whipple (group A) and 10 after a Traverso (group B) procedure. MA was captured by cutaneous electrodes (Synectics) and simultaneously LGE tested with ultrasonography. On separate days, the SGE of a radiolabelled meal was measured. MA and GE studies were done before and within three months after surgery. RESULTS: Before surgery LGE/SGE were delayed in 5/8 patients in group A and 2/2 in group B. Gastric dysrhythmia was observed in 6 patients in group A and 1 in group B. After PPP, the nasogastric tube was removed within 8.4+/-4.9 days and after SP within 4.6+/-4.1 days. GE studies showed accelerated LGE/SLG in 16/12 and delayed in 6/5 patients, respectively, in group A and B. Dysrhythmia was observed in 16 patients in group A and in 4 in group B. There was a strong relationship between SGE delay and dysrhythmia in patients after PPP. CONCLUSIONS: We conclude that papilla of Vater neoplasia damages mechanisms responsible for gastric emptying to a lesser extent than pancreatic cancer. In patients after PPP, post-operative MA disturbances are partially responsible for delayed GE.

Effect of Helicobacter pylori infection, smoking and dietary habits on the occurrence of antrum intestinal metaplasia. Clinico-epidemiological study in Poland.

The purpose of the study was to assess risk factors for intestinal metaplasia arising from H. pylori-related chronic gastritis in a subset of the population referred to endoscopic examinations due to dyspeptic complaints. We aimed specifically to establish whether H. pylori itself may be responsible for the occurrence of intestinal metaplasia and to which extent the metaplasia may be associated with life style factors such as cigarette smoking, alcohol consumption or dietary habits. The study was carried out in a sample of 1290 outpatients referred for the first time to gastroenterologic outpatient clinics in 6 university centers in Poland. The study methods covered standardized health interviews, endoscopy and histology of gastric antral specimens taken at endoscopy. The interviews performed by trained interviewers sought information on tobacco and alcohol intake, diet, socioeconomic status, and other variables. In non-ulcer dyspepsia subjects there was 54.9% H. pylori related gastritis and 25.1% of non-H. pylori-related gastritis. The corresponding rates in the group of ulcer dyspepsia were 67.5% and 20.5%. The increased risk of chronic gastritis in antrum was associated with Helicobacter pylori infection (OR = 2.28; 95% CI:1.93-2.69), and with gastric peptic ulcer (OR = 1.88; 95% CI:1.20-2.94). In the non-ulcer dyspepsia the prevalence of metaplasia was 11.1% and in ulcer dyspepsia 19.7%. The risk of intestinal metaplasia within antrum depended greatly upon the presence of gastric peptic ulcer (OR = 3.85; 95% CI:2.35-6.32) and increased with age (OR = 1.05; 95% CI:1.04-1.07), smoking cigarettes currently or in the past (OR = 1.42; 95% CI:1.10-1.84), higher frequency of drinking vodka (OR = 1.32, 95% CI:1.01-1.75) and antral chronic gastritis (OR = 1.31; 95% CI:1.00-1.70), however, it was inversely related to daily consumption of fresh fruits or vegetables (OR = 0.59; 95% CI:0.38-0.93). The results of the study suggest that there is no sufficient evidence supporting the hypothesis about an association between H. pylori gastritis and intestinal metaplasia, however, the transition of gastritis to metaplasia depends greatly on life style factors such as cigarette smoking or vodka drinking and is impeded by daily consumption of fresh fruits or vegetables.

A topographic analysis of atrophic gastritis and stomach cancer risk. A clinicoepidemiological study in Poland.

The purpose of this cross-sectional study was to assess the relation between intestinal and diffuse stomach cancer at its various locations with topography of atrophic gastritis. The study population consisted of 3435 patients who reported over the period of 1991-1994 for the first time to gastroenterological outpatient clinics of 7 university medical centers in Poland. Among these subjects there were 131 histologically proved consecutive cases of gastric carcinoma. The reference group consisted of 1540 patients among whom endoscopic examination did not reveal peptic ulcers, polyps, deformations of antrum or bulbus duodenum and mucosa erosions. Gastroscopy on gastric cancer patients and the reference group was performed and biopsy specimens were obtained from the tumour and from the antrum and stomach corpus distant from the tumour. Among the gastric cancer cases there was a higher prevalence of atrophic gastritis in the intestinal than in the diffuse type. The highest prevalence of atrophic gastritis irrespective of its degree and stomach area was observed in the tumour-area of intestinal cancer located distally (78.9%), and the lowest in the tumour-free area in diffuse proximal cancer (18.5%). Prevalence of atrophic pangastritis (atrophic gastritis present both in the corpus and antrum) was also highest in intestinal distal cancer (69.2%) and lowest in diffuse proximal cancer (21.7%). The age-adjusted correlation coefficients between gastritis score in the tumour-area and tumour-free area were highly significant. It was shown that only atrophic pangastritis was significantly associated with gastric cancer irrespective of its histology and location (OR = 3.8, 95% CI:2.4-6.0), however, it was much stronger related to the intestinal gastric cancer (OR = 5.9, 95% CI: 3.1-11.0), than to the diffuse carcinoma (OR = 2.2, 95% CI: 1.1-4.3).

[Autonomic nervous system and gastric myoelectric activities in type 1 and type 2 diabetes]. / Aktywnosc autonomicznego ukladu nerwowego a czynnosc mioelektryczna zoladka w cukrzycy typu 1 i 2.

The aim of the study was to compare autonomic function and gastric myoelectric activity in patients with type 1 and 2 of diabetes. We used the skin electrodes for recording gastric myoelectric activity (EGG) and the heart rate variability (HRV). Patients were divided into two groups. The first group: 19 patients with IDDM. The second-16 patients with NIDDM. We made two comparative control groups, matched with age and gender. We conclude, that decrease in gastric myoelectric activity was observed in both groups of patients, mostly in 1 group (IDDM) of patients. There was increase of heart rate and reduction of spectral analysis parameters in both types of diabetic. In patients with type 1 we noticed the increase of sympathetic activity (LF/HF ratio increased). In patients with type 2 there was the non significant decrease in sympathetic activity (LF/HF ratio decreased). On the basis of our observations we confirmed the correlation among autonomic function tested by HRV and changes of stomach electric activity. Decrease in HRV and gastric myoelectric activity could be indicating damage of parasympathetic system in IDDM.

[Gastric motility disturbances in pancreatic cancer patients]. / Zaburzenia czynnosci motorycznej zoladka u pacjentów z rakiem trzustki.

Eighteen patients with confirmed pancreatic carcinoma without endoscopic evidence of mechanical gastroduodenal obstruction were included in the study. Aim was to determine changes in gastric myoelectric activity and liquid emptying (LGE) induced by pancreatic tumor growth. According TNM/UICC classification patients were divided in two groups A (T2) and B (T3) due to extend of expansion. Dyspeptic symptoms were observed in 4 patients of group A and 8 in group B. In group A dysrhythmic patterns of gastric myoelectric activity mostly bradygastria type were observed in 5 of patients and 8 in group B. LGE were delayed in 2 in group A and 5 in group B respectively. Disordered gastric myoelectric activity and emptying correlated with tumor stage and location. Delayed gastric emptying may be attributed to gastric dysrhythmia and abdominal pain that occur during the course of disease due to splamchnic plex infiltration.

[Controlled clinical studies for topographic analysis of atrophic gastritis and stomach cancer]. / Badania kliniczno-kontrolne nad topografia zanikowego zapalenia blony sluzowej i rakiem zoladka.

The purpose of this cross-sectional study was to assess the relation between intestinal and diffuse stomach cancer at its various locations with topography of atrophic gastritis. The study population consisted of 3435 patients who reported over the period of 1991-94 for the first time to gastroenterological outpatient clinics of 7 university medical centers in Poland. Among these subjects there were 131 histologically proved consecutive cases of gastric carcinoma. The reference group consisted of 1540 patients among whom endoscopic examination did not reveal peptic ulcers, polyps, deformations of antrum or bulbus duodenum and mucosa erosions. Among the gastric cancer cases there was a higher prevalence of atrophic gastritis in the intestinal than in the diffuse type. The highest prevalence of atrophic gastritis irrespective of its degree and stomach area was observed in the tumour-area of intestinal cancer located distally (78.9%), and the lowest in the tumour-free area in diffuse proximal cancer (18.5%). Prevalence of atrophic pangastritis (atrophic gastritis present both in the corpus and antrum) was also highest in intestinal distal cancer (69.2%) and lowest in diffuse proximal cancer (21.7%). For other types of cancer the prevalence rates of atrophic pangastritis was 50.0% in intestinal proximal cancer and 37.5% in diffuse distal carcinoma. The age-adjusted correlation coefficients between gastritis score in the tumour-area and tumour-free area were highly significant. It was shown that only atrophic pangastritis was significantly associated with gastric cancer irrespective of its histology and location (OR = 3.8, 95% CI:2.4-6.0), however, it was much stronger related to the intestinal gastric cancer panga (OR = 5.9, 95% CI: 3.1-11.0), than to the diffuse carcinoma (OR = 2.2, 95% CI: 1.1-4.3).