Evaluation of short-term low-dose triple therapy for the eradication of Helicobacter pylori by factorial design in a randomized, double-blind, controlled study.

BACKGROUND: Studies demonstrating the efficacy of short-term low-dose triple therapies including omeprazole (O), clarithromycin (C) and a nitroimidazole (tinidazole, T) for Helicobacter pylori eradication have largely been open and uncontrolled, and have not assessed antibiotic sensitivity. Simpler regimens using the component drugs have not been evaluated. AIM: To evaluate the OCT regimen in a randomized, controlled trial, testing for pre- and post-treatment antibiotic resistance and comparing, in a factorial design, the OCT regimen with simpler combinations of its components. METHODS: One hundred and twenty-eight patients (68 males, 60 females, age 22-80 years, mean 53 years) with H. pylori gastritis were randomly assigned to one of the following four treatment groups: (C) clarithromycin 250 mg b.d.; (OC) omeprazole 20 mg o.d. + clarithromycin 250 mg b.d.; (CT) clarithromycin 250 mg b.d. + tinidazole 500 mg b.d.; (OCT) omeprazole 20 mg q.d.s. + clarithromycin 250 mg b.d. + tinidazole 500 mg b.d. The drugs were administered for 1 week. Medical interview, upper gastrointestinal endoscopy (with four antral and four corpus biopsies) and the 13C-urea breath test were carried out for all patients prior to and 4 weeks after treatment. Biopsy specimens were used for the urease test, histology, and culture and sensitivities. RESULTS: All but one patient completed treatment. Side-effects were rare and mild in all groups. The eradication rate was 93.8% in group OCT, 59.4% in group CT, 31.3% in group OC and 6.3% in group C. Pre-treatment metronidazole resistance was 12.8%, clarithromycin 1.1% and, to both antibiotics, 2.1%. In patients with pre-treatment metronidazole resistance, the eradication rate was 75% in group OCT and 33% in group CT. Post-treatment resistance to clarithromycin was induced in 28.5% of the failures in group C, but in none of group OC. Resistance to both antibiotics occurred in 22.2% of the failures in group CT and in none of group OCT. CONCLUSIONS: (i) The high efficacy of the OCT regimen is proved and each of the individual components of the regimen is essential to the result, possibly via a synergistic effect. (ii) Pre-treatment metronidazole resistance is scarcely relevant to the outcome. (iii) Acquired resistance is essentially nil if omeprazole is part of the regimen.

Colitis associated to chemotherapy with 5-fluorouracil.

Antitumoral agents, especially when administered in combination, can induce pseudomembranous colitis, due to their antimitotic and antibacterial properties. Although patients given 5-fluorouracil frequently show nonspecific colitis or diarrhea without colitis, very few cases of proven pseudomembranous colitis have been described during 5-fluorouracil monotherapy. We describe the second case reported in the English literature of a typical pseudomembranous colitis occurring in a patient given 5-fluorouracil as a single antimitotic agent for colonic cancer. Intestinal injury was not preceded by antibiotic therapy. Although both stool and pseudomembrane culture did not yield C. difficile, oral vancomycin was started. This treatment led to a prompt improvement of intestinal symptoms and colitis was resolved in one week.

[The surgical treatment of a rare primary cardiac tumor: hemangioma. A report of 2 cases]. / Trattamento chirurgico di un raro tumore primitivo cardiaco: l'emangioma. Osservazione di due casi.

Primary benign tumors of the heart are particularly rare; cardiac hemangioma is one of the most rare primary benign cardiac tumors. Natural history, symptoms and prognosis of the disease depend on the potential complications due to the location and diffusion of the mass. We report on 2 cases of cardiac hemangioma, diagnosed occasionally in the first patient or due to gastroenteric symptoms in the second patient. The diagnosis was obtained by 2-D-echo and magnetic resonance imaging. In both cases the hemangioma was located on the right ventricle. Both patients underwent tumor resection in hypothermic cardiopulmonary bypass. In one case, a graft to the right coronary artery was associated; in the other case, the right ventricular outflow tract was reconstructed with an infundibular patch. Histology showed mixed hemangioma in one case and cavernous hemangioma in the other. The postoperative course was uneventful. At a follow-up of 8 years and 1 year, respectively, both patients are classified as NYHA 1 and both 2-D-echo and magnetic resonance imaging did not show any residual tumoral mass. This experience demonstrates that, depending on their location, benign neoplastic masses may be radically resected with acceptable operatory risks and excellent long-term results.

Cancer of the appendix in long-standing ulcerative colitis: a case report.

Cancer of the appendix was found in a 69-year-old female patient affected by long-standing ulcerative colitis (UC). On histological examination the cancer was a typical cystadenocarcinoma of the appendix. The appendiceal mucosa not invaded by the neoplastic process was normal. Histological examination of the colorectal mucosa did not show dysplasia or cancer. These findings suggest that appendiceal cancer and UC may be unrelated diseases. A surveillance program for early detection of cancer of the appendix in patients with long-standing UC does not seem mandatory.

Right ventricular cardiomyopathy in identical and nonidentical young twins.

We describe the first sets of identical and nonidentical twins with right ventricular cardiomyopathy (RVC). Pair A: A 12-year-old boy was referred because of palpitation and syncope. Clinical and instrument examinations revealed an enlarged and depressed right ventricle (end-diastolic volume = 110 ml/m2; ejection fraction = 44%), spontaneous ventricular tachycardia, and fatty-fibrous infiltrates in the biopsy specimens. His asymptomatic, monozygotic twin showed localized involvement of the right ventricle with isolated, ventricular extrasystoles. Pair B: These 18-year-old nonidentical twin boys showed diffuse right ventricular involvement (end-diastolic volume = 110 ml/m2 and 114 ml/m2; ejection fraction = 30% and 24%, respectively), induction of sustained and nonsustained ventricular tachycardia, respectively, and fibrosis on endomyocardial biopsy. One of the boys died suddenly at rest after documented ventricular fibrillation. These cases support the hypothesis of a genetic etiology with a minor role for genotype and point to the important influence of environmental factors in determining the clinical features of the disease.

Malignant sarcomatoid mesothelioma of the pleura: a histological and immunohistological study of a case.

The authors describe the case of a 70 year-old asymptomatic female, who showed nodular pleural growths at an occasional chest roentgenogram. Histological examinations and laboratory findings excluded the possibility of an inflammatory granulomatous process, but they did not allow differentiation between malignant sarcomatoid pleural mesothelioma and malignant fibrous histiocytoma. Only at immunohistochemistry was the differential diagnosis made. In fact, the co-expression of vimentin and cytokeratins by neoplastic cells, along with their negativity for macrophage markers strongly supported the hypothesis that the neoplastic growth originated from subpleural mesenchymal stem cells.

Acute idiopathic interstitial giant cell myocarditis. A histological and immunohistological study of a case.

The Authors report on a case of acute idiopathic giant cell myocarditis, which occurred in a young man without previous history of immunodeficiency or tumours, and displayed a rapidly fatal clinical course. Autoptic examination showed diffuse damage to the myocardium, with myocytolysis, granuloma formation and abundant giant cell reaction. No significant changes were observed in the other organs and systems . Immunohistochemistry revealed that the giant cells strongly reacted with the antibody KP1--raised to the macrophage-associated antigen CD68--whereas they did not stain with the monoclonal against the muscle-specific marker desmin. In the light of their findings and previous reports in the literature, the Authors discuss the possible origin of giant cells, along with the pathogenesis of the condition.

Human immunodeficiency virus type 1 antigen detection in endomyocardial biopsy: an immunomorphological study.

A virological and immunomorphological study has been performed on endomyocardial biopsy from an AIDS patient. Some data suggest the possible involvement of HIV in the pathogenesis of the cardiomyopathy.

[Idiopathic restrictive cardiomyopathy: clinical, hemodynamic, histologic and prognostic profile]. / Cardiomiopatia restrittiva idiopatica: profilo clinico, emodinamico, istologico e prognostico.

Idiopathic restrictive cardiomyopathy is a rare myocardial disease characterized by restrictive physiology without a specific histologic basis. To assess its clinical, hemodynamic, morphologic and prognostic details we retrospectively evaluated all the patients hospitalized in our Institute from 1974 to 1988. Nine patients, aged 42 +/- 16 years, M/F ratio = 0.29, who represent 64% of all the restrictive myocardial diseases biopsied were identified. Severe cardiac heart failure (3-4 NYHA) and arrhythmias (ventricular and supraventricular) were extremely common. The electrocardiogram showed several non specific signs: low voltage of QRS in peripheral leads (4/7), pseudo-infarctional aspects (3/7), mono or biventricular hypertrophy (3/7) disturbance of ventricular conduction (3/7), aspecific abnormalities of ventricular repolarization (3/7). All patients showed a prolonged QTc. M-mode and 2-dimensional echocardiography demonstrated in 6 cases biatrial enlargement, normal or slightly enlarged ventricles, normal or moderately depressed fractional shortening; biventricular concentric hypertrophy was detected in 3 cases, asymmetrical septal hypertrophy in 1. Five patients showed pericardial effusion. Cardiac catheterization disclosed an increase of left and right ventricular end-diastolic pressures (8/8) with a dip-plateau pattern and/or characteristic W waveform in the atrial pressure tracing (9/9). Passive pulmonary hypertension was detected in 6/9 cases. The cardiac index was decreased in 4/8 cases. Left ventricular angiography showed mitral regurgitation in 5/8 patients, tricuspidal in 5/8. Ejection fraction was decreased in 3/8 cases. Endomyocardial biopsy showed interstitial fibrosis (8/9), cellular hypertrophy and/or nuclear alterations (7/9), slight endocardial thickening (2/9). At a mean follow-up of 22 +/- 15 months 3 patients died and 2 underwent heart transplantation. In conclusion idiopathic restrictive cardiomyopathy is one of the most frequent forms of restrictive myocardial diseases in our geographic area. Severe congestive heart failure and arrhythmias are extremely common. The disease can be suspected by clinical, electrocardiographic and echocardiographic features, but the final diagnosis requires cardiac catheterization and endomyocardial biopsy. Prognosis is severe and heart transplantation must be considered in the cases with severe heart failure.

Distribution of basement membrane antigens in bladder carcinomas: an additional prognostic parameter. Immunohistochemical study.

A retrospective study of basement membrane (BM) components (laminin and type IV collagen) in urothelial tissues was performed by applying an immunoperoxidase method to 64 formalin-fixed specimens. The distribution of laminin and type IV collagen was investigated in normal and non-cancerous epithelium (11 cases), where the staining of the basement membrane was continuous. In the invasive bladder carcinomas (53 cases), two distinct staining patterns were observed both with type IV collagen and with laminin: preserved or thin and discontinuous (pattern I) and fragmented or absent (pattern II). These patterns were largely related to the type of growth of the bladder neoplasias ("pushing margin" or "finger-like") and to the cellular arrangement. Furthermore, five-year survival exceeded 70% in patients with pattern I, whereas only three of the 18 patients with pattern II survived for five years or more.

Ultrastructural and immunohistochemical contribution to the histogenesis of human cardiac myxoma.

The ultrastructural features of 8 human cardiac myxomas were analyzed and correlated with immunohistochemical data, with the aim to clarify the characteristics of the cell lines involved in the tumor genesis. Immunohistochemical studies were performed to detect the presence and the distribution of intracytoplasmic filaments (vimentin, desmin, actin, myosin) as well as myoglobin and factor VIII-related antigen, albumin, and lysozyme. Eighty percent of myxoma cells were simultaneously positive for vimentin, desmin, and actin, whereas 30% of them stained with antifactor VIII and antivimentin antibodies. The submicroscopic analysis revealed two main cell populations: (1) one composed of stellate-shaped cells with scanty organelles and sparse hyaloplasmic filaments scattered throughout the myxoid stroma and forming a loose network with their projections; (2) another one included cells with more cytoplasmic organelles, intermediate filaments, and myofilaments arranged either singly or in both solid and hollow cord-like structures. Our results support the hypothesis that cardiac myxoma may originate from a reserve multipotent mesenchymal cell able to differentiate more or less completely along two major evolutional lines: myoid and endothelial. The tumor tissue thus seems to be involved in vessel formation, suggesting a growth pattern akin to that manifested in other forms of endocardial pathological reactivity in which reserve mesenchymal cells are engaged.

A rare case of mucous-secreting villous adenoma of the bladder.

A case of mucous-secreting villous adenoma of the urinary bladder associated with cystitis glandularis is reported which led to radical cystectomy because of the extensive bladder involvement. An immunohistochemical study was performed in order to detect ABH tissue antigens. The histogenesis and the possible malignant potential of this neoplasm are discussed.

The use of absorbable suture: morphological findings in a newborn three months after coarctation repair.

The macroscopic and histological findings in a case of surgical repair of aortic coarctation in a newborn, performed using polydioxanone, a monofilament absorbable suture material, are reported. The persistence of suture material three months after surgery, the lack of severe inflammatory changes, calcification and elastic disruption of the arterial wall, confirm previous experimental data. For these characteristics, the use of polydioxanone in the repair of aortic coarctation in newborns is suggested, in order to avoid recoarctation, the most frequent complication of this surgical therapy.

Cystic lesion of the kidney with ultrastructural evidence of mesothelial origin.

A case of cystic renal mesothelioma in a 55 year-old woman is described. The patient had only intense pain in the left lumbar region. The tumor macroscopically appeared as a cystic multilocular mass, 20 cm. in diameter, sharply demarcated from the renal parenchyma. A light and electron microscope study was performed, and strongly supported mesothelial origin. The patient was treated by surgical therapy which was completely resolutive. The differential diagnosis between this tumor and peri and para-renal cystic lesions is discussed.

Atypical juvenile polyposis.

Two cases of atypical juvenile polyposis are described in males of 9 months and 25 years-of-age. The first was associated with congenital megacolon and presented as juvenile polyps with features suggesting mild dysplasia. In the second case six histological lesions are found: I hyperplastic polyps; 2 juvenile polyps; 3 hyperplastic polyps with adenomatous areas; 4 juvenile polyps with areas of dysplastic epithelium; 5 adenomas; and 6 adenocarcinomas. On the basis of the morphological features we propose a pathogenetic sequence of focal mucosal hyperplasia to adenoma and carcinoma through stages of non-neoplastic and non premalignant polyps. Finally, the possibility that hyperplastic epithelium can in some circumstances have a greater dysplastic potential that normal colorectal mucosa is raised.