Assessment of the Sydney System in Helicobacter pylori-associated gastritis in children.

OBJECTIVE: The aim of our study was to establish the usefulness of the Sydney System in grading H. pylori-associated chronic gastritis in biopsies from pediatric patients. STUDY DESIGN: Fifteen children (average age: 10.8 years) with histologically-proven gastritis were studied. Classification and grading of gastritis were performed according to the analogue visual scales described in the updated version of the Sydney System. A chart was specially designed to record the morphological grading in this study. Altogether, we studied 79 gastric biopsies. RESULTS: Neutrophilic infiltrates were absent in 27 biopsies, mild in 35, and moderate in 17. This feature was not marked in any of the biopsies. Mononuclear infiltrates were mild in 38 biopsies, moderate in 36, and marked in 5. Density of H. pylori was mild in 39 biopsies, moderate in 27, and marked in 2. In three post-treatment biopsies belonging to the same patient, no H. pylori was observed. Additional 8 biopsies (7 from the body and 1 from the antrum) showed no H. pylori, although organisms were simultaneously present in other stomach sites. Lymphoid follicles were present in 19/79 biopsies. Intestinal metaplasia was not seen on slides stained with hematoxylin-eosin (HE). However, the Alcian blue-PAS stain revealed isolated positive cells in 8 out of 15 patients. None of the gastric biopsies showed mucosal atrophy. CONCLUSION: The results show that the Sydney System is applicable for pediatric patients in case of H. pylori-associated gastritis. However, the number of biopsies recommended in the Sydney System seems excessive for this age group.

[Toxocariasis with liver involvement]. / Toxocariasis con afectación Hepática.

We are reporting 16 cases of toxocariasis found in a two year period. Mean age was 2 years and 9 months. Sex distribution was 1:1. Thirteen (81%) children presented pica, 8 (50%) had pets at home, 10 (62.5%) presented anemia and long standing fever, and all eosinophilic leukocytosis. Fundoscopy was normal in all. Toxocara antibodies (Through ELISA) were increased in all of them. High resolution ultrasonography revealed hypoechoic areas in the liver in 50% of the cases. Therapeutic response was good, the clinical signs and symptoms disappearing at the end of treatment. The eosinophilic leukocytosis, ELISA serum positivity for toxocara and ultrasound findings persisted approximately for a year. Toxocariasis is a common parasitosis in our setting. It must be regarded as the first diagnosis when confronted with eosinophilic leukocytosis and abnormal liver findings by ultrasound.

Evaluación de la utilidad del sistema Sydney en la gastritis asociada a Helicobacter pylori en niños / Assessment of the Sydney system in Helicobacter pylori associated gastritis in children

Objetivo: Establecer la utilidad de la escaa visual del "Sistema Sydney"actualizado (Ssa) para calificar las biopsias con gastritis crónica en la edad pediátrica. Material y métodos: Se analizaron 79 biopsias gástricas de 15 pacientes con gastritis crónica asociada con H. Pylori. Se obtuvieron biopsias de antro y cuerpo de todos los pacientes, y en 13 series de biopsias de 11 pacientes (dos con dos series), se realizaron cinco biopsias siguiendo la propuesta del Ssa: dos del antro a 2-3 cm proximales al piloro (una de la curvatura menor y otro de la curvatura mayor), dos del cuerpo a 8 cm del cardias (una de la curvatura menor y otro de la curvatura mayor), y una de la incisura angularis. La presencia de sulfomucinas se detectó mediante la coloración de azul Alcian-PAS a pH 1,0, preferentemente en las muestras de la incisura angularis. En cada muestra se calificó la densidad de H. pylori, infiltrados de neutrófilos y células mononucleadas, atrofia y metaplasia intestinal como: normal (ausencia), leve moderada o marcada, y se determinó la presencia o no de folículos linfóides. Resultados: Diez pacientes fueron mujeres y cinco, varones; la edad osciló entre 2 y 16 años (promedio: 10.8 años). Los principales síntomas de presentación fueron dolor abdominal recurrente (10 casos), hemorragia gastrointestinal (4 casos), pirosis (2 casos), vómitos y anemia (uno cada uno). Un paciente tenía hipertensión portal. En los 15 pacientes, se efectuaron en total 79 biopsias. La evaluación de esas muestras siguiendo la escala de analogía visual del Ssa mostró las siguientes calificaciones morfológicas: no hubo infiltrados de neutrófilos en 27 biopsias; fueron leves en 35 y moderados en 17. No se halló ninguna biopsia con marcada cantidad de neutrófilos. Los infiltrados mononucleares fueron leves en 38 biopsias, moderados en 36, y abundantes en 5. La densidad de H. pylori fue considerada leve en 39 biopsias, moderada en 27 y marcada en dos. En tres biopsias postratamiento del mismo paciente (caso 8) no se encontró H. pylori. Otras ocho biopsias (7 del cuerpo y una del antro) revelaron ausencia de H. pylori, aunque los gérmenes estuvieron presentes simultáneamente en otros sitios del estómago...

Toxocariasis con afectación hepática / Toxocariasis with liver involvement

We are reporting 16 cases of toxocariasis found in a two year period. Mean age was 2 years and 9 months. Sex distribution was 1:1. Thirteen (81 per cent) children presented pica, 8 (50 per cent) had pets at home, 10 (62.5 per cent presented anemia and long standing fever, and all eosinophilic leukocytosis. Fundoscopy was normal in all. Toxocara antibodies (Through ELISA) were increased in all of them. High resolution ultrasonography revealed hypoechoic areas in the liver in 50 per cent of the cases. Therapeutic response was good, the clinical signs and symptoms disappearing at the end of treatment. The eosinophilic leukocytosis, ELISA serum positivity for toxocara and ultrasound findings persisted approximately for a year. Toxocariasis is a common parasitosis in our setting. It must be regarded as the first diagnosis when confronted with eosinophilic leukocytosis and abnormal liver findings by ultrasound.