[Helicobacter pylori detection patterns and related injuries through Sydney Protocol in a population of Antioquia, Colombia]. / Patrones de detección de Helicobacter pylori y lesiones relacionadas mediante protocolo Sydney en una población de Antioquia, Colombia.

OBJECTIVES: We sought to determine whether the endoscopies that met the Sydney protocol in a population of Antioquia had a greater detection of H. pylori and their associated lesions than the endoscopies that only took antrum samples. MATERIALS AND METHODS: We carried out a retrospective, cross-sectional and descriptive study. Adult patients undergoing upper endoscopy were included. Patients were divided into two groups depending on Sydney protocol compliance. The detection frequency was measured for H. pylori and premalignant lesions. RESULTS: 261 participants were included, 88 from which biopsies were taken with the Sydney protocol and 173 with biopsies taken exclusively from the gastric antrum. The main endoscopy indication was dyspepsia (35.6%). The detection of H. pylori, atrophic gastritis and intestinal metaplasia was 36.4%, 19.3% and 20.5% respectively in the Sydney group, and 30.1%, 11.6% and 9.8% in the control group. In the Sydney group, the detection of H. pylori was higher in the antrum and body (26.1%) than in antrum (6.8%) or body (3.4%) separately. The detection of atrophic gastritis and intestinal metaplasia was higher in antrum only (10.2% and 11.4% respectively) than in antrum and body or body separately. CONCLUSIONS: The omission of the Sydney protocol reduces the detection of H. pylori, atrophic gastritis and intestinal metaplasia by 9.4%, 29.4% and 27.7% respectively. The protocol must be implemented systematically in every gastrointestinal endoscopy center.

The Colombian Chemoprevention Trial: 20-Year Follow-Up of a Cohort of Patients With Gastric Precancerous Lesions.

BACKGROUND & AIMS: Helicobacter pylori eradication and endoscopic surveillance of gastric precancerous lesions are strategies to reduce gastric cancer (GC) risk. To our knowledge, this study is the longest prospective cohort of an H pylori eradication trial in a Hispanic population. METHODS: A total of 800 adults with precancerous lesions were randomized to anti-H pylori treatment or placebo. Gastric biopsy samples taken at baseline and 3, 6, 12, 16, and 20 years were assessed by our Correa histopathology score. A generalized linear mixed model with a participant-level random intercept was used to estimate the effect of H pylori status on the score over time. Logistic regression models were used to estimate progression by baseline diagnosis and to estimate GC risk by intestinal metaplasia (IM) subtype and anatomic location. RESULTS: Overall, 356 individuals completed 20 years of follow-up. Anti-H pylori therapy (intention-to-treat) reduced progression of the Correa score (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.38-0.93). H pylori-negative status had a beneficial effect on the score over time (P = .036). Among individuals with IM (including indefinite for dysplasia) at baseline, incidence rates per 100 person-years were 1.09 (95% CI, 0.85-1.33) for low-grade/high-grade dysplasia and 0.14 (95% CI, 0.06-0.22) for GC. Incomplete-type (vs complete-type) IM at baseline presented higher GC risk (OR, 13.4; 95% CI, 1.8-103.8). Individuals with corpus (vs antrum-restricted) IM showed an OR of 2.1 (95% CI, 0.7-6.6) for GC. CONCLUSIONS: In a high-GC-risk Hispanic population, anti-H pylori therapy had a long-term beneficial effect against histologic progression. Incomplete IM is a strong predictor of GC risk.

[Why is it important to detect atrophic gastritis and gastric intestinal metaplasia? What is the proper way to do it?] / ¿Por qué es importante detectar la gastritis atrófica y la metaplasia intestinal gástrica? ¿Cuál es la forma adecuada de hacerlo?

Gastric intestinal metaplasia and atrophic gastritis are a known precancerous condition (PCC) of the stomach, meaning that patients with PCC are at risk for gastric cancer and so, diagnosis and risk categorization for these patients is relevant. The aim of this review is to provide an update regarding the problem, diagnosis, and management of PCCs with an emphasis on the role of appropriate endoscopic detection.

¿Por qué es importante detectar la gastritis atrófica y la metaplasia intestinal gástrica? ¿Cuál es la forma adecuada de hacerlo? / Why is it important to detect atrophic gastritis and gastric intestinal metaplasia? What is the proper way to do it?

RESUMEN La metaplasia intestinal gástrica y la gastritis atrófica son condiciones precancerosas conocidas (CPCs) del estómago, lo que significa que los pacientes con CPCs están en riesgo de desarrollar cáncer gástrico y, por lo tanto, el diagnóstico y la categorización de riesgo para estos pacientes es un tema relevante. El objetivo de esta revisión es proporcionar una actualización sobre el problema, el diagnóstico y el manejo de las CPCs con énfasis en el papel de la detección endoscópica adecuada.

ABSTRACT Gastric intestinal metaplasia and atrophic gastritis are a known precancerous condition (PCC) of the stomach, meaning that patients with PCC are at risk for gastric cancer and so, diagnosis and risk categorization for these patients is relevant. The aim of this review is to provide an update regarding the problem, diagnosis, and management of PCCs with an emphasis on the role of appropriate endoscopic detection.

Assessment of Gastritis and Gastric Cancer Risk in the Chilean Population Using the OLGA System.

Gastric cancer (GC) is the first cancer-related cause of death in Chile; however, no plan for GC early detection has been implemented in this country. The OLGA system characterizes gastritis from stages 0 to IV according to the risk of developing GC based on H. pylori infection, atrophy, metaplasia and GC. In this study, the performance of the OLGA system was evaluated in 485 Chilean patients receiving routine endoscopy to improve the detection of early GC or preneoplastic lesions. The results showed that OLGA scores, atrophy, metaplasia and GC increased significantly with age (p < 0.001). Conversely, H. pylori infection was higher in younger groups (p < 0.05). All gastric lesions were more frequent in men than women. The majority of patients with atrophy also had metaplasia (99%, p < 0.0001). Patients with H. pylori infection had more gastric atrophy and metaplasia than those without infection (p < 0.05). Of the 485 patients, 21 (4.3%) had GC, being 2.3 times more frequent among men than women and about 2/3 (14) were in OLGA stage ≥2. In addition, 19 (90%) GC patients had atrophy and 18 (85%) had metaplasia (p < 0.001). In conclusion, the OLGA system facilitated the evaluation of GC precursor lesions particularly in patients with an OLGA score > 2 between 45 and 56 years old, because this group showed atrophy and intestinal metaplasia more frequently. Therefore, biennial endoscopic surveillance of patients with an OLGA >2 can be an important health policy in Chile for diagnosing GC in its early stages and reducing mortality over the next two decades.

La alta prevalencia de lesiones premalignas gástricas y el bajo rendimiento diagnóstico de la visión endoscópica son argumentos a favor de la toma sistemática de biopsias gástricas por Protocolo Sydney / The high prevalence of gastric premalignant lesions and the low diagnostic performance of endoscopic vision advocate towards a systematic gastric biopsy sampling using Sydney Protocol

Background: Atrophic gastritis (AG) and intestinal metaplasia (IM) are stages that appear in the process of gastric carcinogenesis. Their presence requires programmed endoscopic vigilance. Objectives: To determine the frequency of AG and IM in gastric biopsies (GB) taken according to Sydney Protocol and to correlate them with endoscopic findings. Methods: Retrospective descriptive analysis of 233 upper gastrointestinal endoscopies with GB per Sydney Protocol. OLGA (Operative Link for Gastritis Assessment) and OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment) scores were calculated based on the GB description. Endoscopic findings were analyzed for atypical findings and compared to the GB report. Statistic analysis for Kappa and ANOVA was performed via Stata 12. Results: Mean age of patients was 58 ± 12 years. 69% were women. The frequency of AG and IM was 44% and 33% in the antrum, 31% and 20% in the angular incisure and 14% and 9% in the body, respectively. AG and IM were more frequent in the antrum (p < 0.05). AG and IM were more severe in the angular incisure and body (p < 0.05). We were unable to calculate OLGA and OLGIM in 6% and 9% of cases, respectively, due to absence of severity description in GB. 53% were OLGA 0, 42% OLGA I-II and 5% OLGA III-IV. 70% were OLGIM 0, 25% OLGIM I-II and 5% OLGIM III-IV. Agreement between endoscopic and histological findings was best for IM in the antrum (75.5%, Kappa 0.4). Sensitivity and specificity of endoscopic findings were 39% and 70% for AG, and 30% and 85% for IM, respectively. Conclusion: AG and IM are frequent findings in our patients. Due to the low endoscopic sensitivity for AG and IM, we suggest a systematic GB sampling using Sydney Protocol in patients over 40 years old.

Introducción: La gastritis crónica atrófica (GCA) y la metaplasia intestinal (MI) son etapas en el proceso de carcinogénesis gástrica, su presencia requiere control endoscópico programado. Objetivos: Determinar la frecuencia de GCA y MI en biopsias gástricas (BG) por protocolo de Sydney y relacionarlas con el hallazgo endoscópico. Métodos: Estudio descriptivo mediante revisión de 233 endoscopias digestivas altas con BG por Protocolo Sydney. Se graduó puntaje OLGA (Operative Link for Gastritis Assessment) y OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment) según la descripción de la BG. Se definió el hallazgo endoscópico según su informe y se comparó con BG como patrón de referencia. Estadística: Stata 12 para Kappa y ANOVA. Resultados: Edad promedio 58 ± 12 años, 69% mujeres. La frecuencia de GCA y MI en antro fue de 44 y 33%, en ángulo 31 y 20% y en cuerpo 14 y 9%, respectivamente. Hubo mayor frecuencia de GCA y MI en antro (p < 0,05). La graduación de GCA y MI fue mayor en ángulo y cuerpo (p < 0,05). No se obtuvo OLGA en 6% y OLGIM en 9% por ausencia de graduación. La frecuencia de OLGA 0 fue de 53%, OLGA I-II 42%, OLGA III-IV 5%, OLGIM O 70%, OLGIM I-II 25% y OLGIM III-IV 5%. La mejor correlación se observó entre la MI antral endoscópica con la histológica (75,5%, Kappa 0,4). La sensibilidad y especificidad endoscópica fue de 39 y 70% para GCA y 30 y 85% para MI. Conclusión: GCA y MI son hallazgos frecuentes en nuestros pacientes. Por la baja sensibilidad endoscópica en la identificación de GCA y MI sugerimos la toma sistemática de BG por protocolo de Sydney en pacientes mayores de 40 años.

Polymorphisms in HLA-DQ genes, together with age, sex, and Helicobacter pylori infection, as potential biomarkers for the early diagnosis of gastric cancer.

BACKGROUND: Polymorphisms in inflammation-related genes are factors associated with the development of gastroduodenal diseases in Helicobacter pylori-infected individuals. MATERIALS AND METHODS: We aimed to analyze polymorphisms in HLA-DQ, together with other host and H. pylori variables as risk factors for precancerous and cancerous gastric lesions. 1052 individuals were studied, including nonatrophic gastritis (NAG), intestinal metaplasia (IM), gastric cancer (GC) or duodenal ulcer (DU) patients, and healthy volunteers. RESULTS: Patients with alleles DQA*01:01 (OR 0.78), *01:02 (OR 0.29), *01:03 (OR 0.31), and DQB*02:01/02 (OR 0.40) showed a reduced risk for GC. A multivariate logistic regression analyses showed that patients with homozygote genotypes DQA1*03:01 (OR 7.27) and DQA1*04:01 (OR 8.99) and DQB1*05:01:01 (OR 12.04) were at significantly increased risk for GC. Multivariate analyses also demonstrated that age (OR>10.0) and gender (OR>2.0) were variables that influenced significantly the risk for GC, while H. pylori infection (OR>2.5) increased the risk for IM. CONCLUSIONS: We identified HLA-DQ alleles associated with IM and GC, and confirm that age, sex, and H. pylori infection are variables that also influence the risk for disease. The use of multiple markers, HLA-DQ alleles, age, sex, and H. pylori infection may be useful biomarkers for the early diagnosis of patients with IM and GC.

Metaplasia óssea no gliossarcoma: um achado histológico pouco usual. Relato de caso / Osseous metaplasia in gliosarcoma: an unusual histologic finding. Case report

Gliosarcoma (GS) is a malignant neoplasm of the central nervous system that has coexisting glial and mesenchymal components. GSs are rarely related to osseous metaplasia. The authors report a case of GS in a male patient presenting apathy and catatonia. Computed tomography/magnetic resonance imaging showed an expansive process affecting the left frontal lobe. At microscopy, a malignant glioma constituted by highly atypical glial cells intermingled with spindle-shaped cells was identified. The lesion showed areas of necrosis with pseudopalisading formation, focus of osseous metaplasia, and positive immunoexpression of S100, CD99 and vimentin in both elements. Only the sarcomatous component exhibited negative immunoexpression of glial fibrillary acidic protein (GFAP). The diagnosis of GS was then established...

Gliossarcoma (GS) é uma neoplasia maligna do sistema nervoso central que apresenta coexistência de componentes glial e mesenquimal. Raramente, os GS estão associados à metaplasia óssea. Os autores descrevem um caso de GS em paciente masculino apresentando apatia e catatonia. A tomografia computadorizada e a ressonância magnética mostraram um processo expansivo comprometendo o lobo frontal esquerdo. À microscopia, foi identificado um glioma maligno constituído por células gliais extremamente atípicas entremeadas com células fusiformes. A lesão mostrava áreas de necrose com formação de pseudopaliçada, focos de metaplasia óssea e expressão imuno-histoquímica positiva para S100, CD99 e vimentina em ambos os componentes. Somente o componente sarcomatoso exibiu imunoexpressão negativa para proteína glial fibrilar ácida (GFAP). O diagnóstico de GS foi, então, estabelecido...

Biomarkers for screening of lung cancer and pre-neoplastic lesions in a high risk Chilean population.

BACKGROUND: The mortality of lung cancer (LC), increases each year in the world, in spite of any advances, in development of new drugs to advance stages of LC. The high incidence of LC has been associated with smoking habit, genetic diversity and environmental pollution. Antofagasta region has been reported to have the highest LC mortality rate in Chile and its inhabitants were exposed to arsenic in their drinking water in concentrations as high as 870 µg/L. Non-invasive techniques such as biomarkers (Automatic Quantitative Cytometry: AQC and DR70) and Auto Fluorescence Bronchoscopy (AFB) might be potentially useful as a supplementary diagnostic approach and early detection. Early detection is one of the most important factors to intervene and prevent cancer progression in LC. This is a work of an ongoing prospective bimodality cancer surveillance study in high risk LC volunteers. Enrolment was done in subjects from Antofagasta and Metropolitan regions. In addition, we enrolled subjects who were suspected of having lung cancer. AQC, DR70 and AFB were used as tools in the detection of pre-neoplastic (PNL) and neoplastic lesions (NL). RESULTS: Half of the samples, classified as suspicious by AFB, were confirmed as metaplasia or dysplasia by histopathology. For LC, DR70 showed a higher sensitivity (95.8%) and specificity (91.9%) than AQC. However, for PNL AQC showed a higher sensitivity (91.9%) than DR70 (27.3%), although both with low PPV values. As a pre screener, both biomarkers might be employed as complementary tools to detect LC, especially as serially combined tests, with a sensitivity of 60% and a PPV of 65.2%. Additionally, the use of parallel combined tests might support the detection of PNL (sensitivity 91.2%; PPV 49.1%). CONCLUSION: This work adds information on cellular and molecular biomarkers to complement imaging techniques for early detection of LC in Latin America that might contribute to formulate policies concerning screening of LC. Supported by INNOVA-CORFO, Chile.

Biomarkers for screening of lung cancer and pre-neoplastic lesions in a high risk Chilean population

BACKGROUND: The mortality of lung cancer (LC), increases each year in the world, in spite of any advances, in development of new drugs to advance stages of LC. The high incidence of LC has been associated with smoking habit, genetic diversity and environmental pollution. Antofagasta region has been reported to have the highest LC mortality rate in Chile and its inhabitants were exposed to arsenic in their drinking water in concentrations as high as 870 µg/L. Non-invasive techniques such as biomarkers (Automatic Quantitative Cytometry: AQC and DR70) and Auto Fluorescence Bronchoscopy (AFB) might be potentially useful as a supplementary diagnostic approach and early detection. Early detection is one of the most important factors to intervene and prevent cancer progression in LC. This is a work of an ongoing prospective bimodality cancer surveillance study in high risk LC volunteers. Enrolment was done in subjects from Antofagasta and Metropolitan regions. In addition, we enrolled subjects who were suspected of having lung cancer. AQC, DR70 and AFB were used as tools in the detection of pre-neoplastic (PNL) and neoplastic lesions (NL). RESULTS: Half of the samples, classified as suspicious by AFB, were confirmed as metaplasia or dysplasia by histopathology. For LC, DR70 showed a higher sensitivity (95.8%) and specificity (91.9%) than AQC. However, for PNL AQC showed a higher sensitivity (91.9%) than DR70 (27.3%), although both with low PPV values. As a pre screener, both biomarkers might be employed as complementary tools to detect LC, especially as serially combined tests, with a sensitivity of 60% and a PPV of 65.2%. Additionally, the use of parallel combined tests might support the detection of PNL (sensitivity 91.2%; PPV 49.1%). CONCLUSION: This work adds information on cellular and molecular biomarkers to complement imaging techniques for early detection of LC in Latin America that might contribute to formulate policies concerning screening of LC. Supported by INNOVA-CORFO, Chile.

Metaplasia intestinal en esófago: diagnóstico con magnificación endoscópica y “flexible spectral imaging colour enhancement” (FICE) corroborado por histología / Intestinal metaplasia in esophagus: diagnosis With magnifying endoscopy and flexible Spectral imaging colour enhancement (fice) Corroborated by histology

La endoscopia estándar no identifica esófago de Barrett. Esta limitación disminuye con magnificación endoscópica, coloración vital y/o virtual que permite observar los patrones de mucosa sugestivos de metaplasia intestinal. Identificar metaplasia intestinal con magnificación endoscópica y cromoscopia virtual realizada con "Flexible Spectral Imaging Colour Enhancement" (FICE) corroborándola con histología. Pacientes: Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400. Consecutivamente se practicó endoscopia con: a) alta resolución, b) FICE, c) alta resolución, d) magnificación, e) FICE y f) alta resolución. Cada patrón encontrado se grabó, se fotografió y se guardó en JPEG en programa Power Point. Los patólogos evaluaron la biopsia del patrón observado sin tener datos del paciente. Se incluyeron 30 pacientes: 11 hombres y 19 mujeres con rango de edad 20-83 años y promedio 51,73 años. Solo con magnificación sola o con cromoscopia virtual se observaron los patrones de mucosa. En el tipo 3 se diagnosticó esófago de Barrett en 33,33% y en ninguno de los otros. Conclusión: La magnificación endoscópica y cromoscopia virtual con FICE identifica metaplasia intestinal y diagnostica esófago de Barrett

Standard endoscopy does not identify Barrett's esophagus or mucosa patterns suggestive of intestinal metaplasia. Endoscopic magnification, vital and or virtual chromoscopy reduces this limitation. Aim: Identify intestinal metaplasia with endoscopic magnification and Flexible Spectral Imaging Colour Enhancement (FICE) corroborating it with histology. Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was consecutively performed with: a) high resolution, b) FICE, c) high resolution, d) magnification, e) FICE, f) high resolution. Each found pattern was recorded, was photographed and was saved in JPEG in program Power Point. Biopsy was obtained of the predominant pattern and the pathologist assessed without patient information. Results: 30 patients were included, 11 men and 19 women with 20-83 years and 51.73 years average age range. Patterns of mucosa were observed only with magnification and virtual chromoscopy, Barrett's esophagus was diagnosed in 33.33% of type 3 and none in type 1 and 2. The endoscopic magnification and virtual chromoscopy with FICE identifies intestinal metaplasia and let diagnose Barrett's esophagus.

Unión escamo columnar y metaplasia intestinal en esófago: magnificación y FICE / Scomo columnar junction and intestinal metaplasia in esophagus: diagnosis with magnyfication and FICE

La endoscopia estándar no identifica Metaplasia Intestinal en Esófago. Su presencia se ha relacionado con el tipo de Unión Escamo Columnar. La endoscopia de alta resolución con magnificación, colorantes vitales y virtuales aumenta su diagnostico. Asociar la presencia de Metaplasia Intestinal con el tipo de Unión Escamo Columnar, utilizando endoscopia de alta resolución, magnificación y Cromoscopia Virtual con FICE corroborándolo con histología. Previo consentimiento verbal se incluyeron prospectivamente a los individuos que tenían indicación electiva de endoscopia digestiva superior. Se utilizó para endoscopia digestiva superior equipo Fujinon Inc. EG 590 ZW, con procesador EPX 4400 que provee efecto FICE con Cromoscopia Virtual Computada. Se utilizó magnificación y FICE. Se clasificó la Unión Escamo Columnar según Wallner en cuatro tipos y se correlacionaron con la presencia de Metaplasia Intestinal. Se grabó en DVD, se congeló durante 3 segundos la imagen deseada y se fotografió cada hallazgo de interés guardado en JPEG en programa Power Point. Se tomó biopsia del patrón sugestivo de Metaplasia Intestinal. Los patólogos evaluaron las láminas sin tener datos del paciente. Se incluyeron 120 pacientes (p): 44 hombres y 76 mujeres con edad de 20-85 años. Se identificaron los tipos de Unión Escamo Columnar y patrones de mucosa descritos en la literatura y se correlacionaron con la histología. La Unión Escamo Columnar tipo GII se encontró en 45,09% y el Patrón Pit T3 se asoció en 87,5% con GIII. Con FICE se evalúa e identifica mejor el tipo de Unión Escamo Columnar y Metaplasia Intestinal con buena correlación histológica

Barrett´s esophagus is an endoscopic diagnosis stablished when Intestinal Metaplasia is found histologically. We described the association of the type of Scamo columnar Junction (SCJ) described by Wallner et al and pit pattern (PP) classification by Toyoda et al suggestive of Intestinal Metaplasia using High Resolution endoscopy with Magnification and FICE. Salmon and red colored Tongues of columnar epithelium oriented to biopsy the esophagus. SCJ type GII was found in 45,09% and T3 PP in 60,86% of GII and 87,6% of GIII. Our results showed that type o SCJ helps and alert of the presence of Intestinal Metaplasia

Utilidad tinción con azul de metileno en la identificación de metaplasia intestinal en antro gástrico / Utility of the stain with bluue of methylene in the identification of antral gastric intestinal metaplasia

Objetivo: Determinar la utilidad de la tinción con azul de metileno en la identificación de áreas de metaplasia intestinal en antro gástrico. Materiales y métodos: Estudio descriptivo, prospectivo, de corte transversal. Evaluando 75 pacientes del servicio de gastroenterología “Dr. Simón Beker” en el Hospital General del Oeste “Dr. José Gregorio Hernández” durante el período mayo - octubre 2008. Resultados: en el grupo A la sospecha endoscópica de metaplasia intestinal se confirmo con histología en el 71,4%. En el grupo B, con tinción y sin sospecha endoscópica, la histología confirmo 9 (40,9%) casos y en el grupo C sin sospecha y sin tinción, se confirmo en 9 (36%) pacientes con un resultado estadísticamente significativo (p=<0,020). La tinción permitió: en 26 (92,8%) pacientes delimitar con mayor exactitud los bordes de las lesiones sospechosas, en 12 (42,8%) pacientes delimitar la extensión de la lesión la cual era mayor a la descrita en la endoscopia convencional, en 16 (57,1%) pacientes permitió destacar un mayor número de lesiones. Conclusión: La tinción con azul de metileno en el antro gástrico es un procedimiento útil, y debería ser utilizado como pesquisa.

Objective: To determine the utility of the stain with blue of methylene in the identification of antral and angular gastric early intestinal metaplasia. Materials and methods: Descriptive, prospective study. Evaluating 75 patients of the service of gastroenterology “Dr. Simón Beker” in the General Hospital of the West “Dr. Jose Gregorio Hernandez” during the period May - October 2008. Results: 75 patients evaluated, in the group A with intestinal metaplasia endoscopic suspicion of metaplasia, was confimed with histology in the 71.4%. In group B, with tinción and without endoscopic suspicion, the histology was confirmed in 40.9%, and in group C without suspicion and without tinción, was confirmed in 36% of the patient with a statistically significant result (p=<0,020). The stain it allowed: in 26 (92.8%) patient delimit with greater exactitude the edges of the suspicious injuries, in 12 (42.8%) patient to delimit the extension of the injury which was greater to the described one in conventional endoscopy, in 16 (57.1%) patient ones allowed to emphasize a greater number of injuries. Conclusion: The stain with blue of methylene is a useful procedure, and would have to be used like investigation.

Metaplasia intestinal en pacientes con reflujo duodenogástrico y ácidos biliares totales elevados / Intestinal metaplasia en patients with duodenogastric reflux and high total bile acids

Existen evidencias que tanto los ácidos biliares como el Helicobacter pylori en la mucosa gástrica son capaces de desencadenar un proceso inflamatorio que según su intensidad y persistencia favorecen la aparición de fallas y mutaciones en la replicación celular que se expresan desde una metaplasia, displasia hasta un cáncer. Se realizó un estudio epidemiológico observacional, descriptivo, prospectivo de corte transversal en el Instituto de Gastroenterología, en pacientes con reflujo duodenogástrico y ácidos biliares totales elevados, con el objetivo de conocer la asociación entre la metaplasia intestinal y la presencia o no de Helicobacter pylori. Al concluir la investigación se observó que la metaplasia estuvo presente en 48,7 por ciento de los 39 pacientes estudiados, que existió una asociación estadísticamente significativa (p<0,05) en la distribución de la bacteria en los pacientes con y sin metaplasia intestinal, que los pacientes con reflujo duodenogástrico, a pesar de tener una lesión histológica, presentaron resultados negativos en cuanto a la presencia de Helicobacter pylori. En las muestras con diagnóstico histológico de gastritis crónica severa y atrófica, el 75 por ciento presentaban Helicobacter pylori. La localización de la metaplasia intestinal fue mayor en la región antral (84,3 por ciento). En los pacientes con reflujo duodenogástrico la presencia de Helicobacter pylori no parece estar asociada a grados intensos de metaplasia, aunque el microorganismo se encuentre en todas las categorías, mientras que cuando no hay, la metaplasia tiende a ser menos severa. En el 100 por ciento de los casos la densidad de la bacteria fue ligera

The cytotoxic and cancerous action of bile acids on gastric mucosa is a very interesting subject within the gastroduodenal diseases due to they are able to alter the membrane, the cellular metabolism, to give rise to a inflammatory process, to increase the proliferation, the cell apoptosis and the DNA damage, that according to its intensity and persistence, favor the appearance of failures and mutations in cell replication. With the discovery and characterization of Helicobacter pylori it is considered that according to its intensity and the time of persistence in gastric mucosa provokes damages with failures and cellular mutations. In this sense, a prospective and descriptive study was conducted in the Institute of Gastroenterology in patients presenting with duodenogastric and high total bile acids to know the association between the intestinal metaplasia and the presence or not of Helicobacter pylori. Metaplasia was present in the 48.7 percent of the 39 study patients, that there was a statistically significant association (p< 0.05) in Helicobacter pylori distribution in patients with and without intestinal metaplasia; that patients with duodenogastric reflux, despite of a histological lesion also had a greater frequency of negative results as regards the presence of Helicobacter pylori. In samples with histological diagnosis of severe and atrophic chronic gastritis, 75 percent, respectively, had Helicobacter pylori and in consequence, there was a significant association between presence or not of microorganism and the chronic gastritis intensity. Intestinal metaplasia location was higher in antral region (84.3 percent) and also with a higher ratio of microorganism positivity. In patients with duodenogastric reflux, presence of Helicobacter pylori don't seems to be associated with intense degrees of intestinal metaplasia, although the microorganism is present in all categories, but when there is not Helicobacter pylori, intestinal metaplasia to tend to ...

Utilidad de la técnica histoquímica de aldehído fucsina de Gómori- azul alcian para el diagnóstico de metaplasia intestinal completa e incompleta / Utility of the hystochemical Gomori's aldehyde fuchsin-Alcian blue technique for the diagnosis of complete and incomplete intestinal metaplasia

Se hizo un estudio descriptivo para evaluar la utilidad de la técnica histoquímica de aldehído fucsina de Gómori- azul alcian para el diagnóstico de metaplasia intestinal (AFG-AA) y sus variedades completa e incompleta, mediante la revisión de 48 muestras para biopsias, extraídas del estómago de pacientes atendidos en la Consulta de Gastroenterología del Hospital Provincial Docente Dr Joaquín Castillo Duany de Santiago de Cuba durante el trienio 2005 – 2007, a los cuales se realizó gastroscopia, se diagnosticó la presencia de metaplasia intestinal a través de la tinción de hematoxilina y eosina, así como se procedió a su confirmación y clasificación con la mencionada técnica histoquímica. Entre las variables estudiadas figuraron: edad, sexo, presencia de Helicobacter pilory, tipo de metaplasia intestinal y alteraciones morfológicas. Se verificó que 41 de los pacientes presentaban metaplasia intestinal completa (85,4 por ciento), de los cuales 37 padecían gastritis crónica activa (90,2 por ciento).

A descriptive study was carried out to evaluate the utility of the histochemical Gomori's aldehyde fuchsin Alcian-blue technique for the diagnosis of intestinal metaplasia (AFG-AA) and its complete and incomplete variants by reviewing 48 samples for biopsies collected from stomach of patients attended in the Gastroenterology Department of Dr Joaquín Castillo Duany Teaching Provincial Hospital in Santiago de Cuba during 2005-2007, in whom gastroscopy was performed, the presence of intestinal metaplasia was diagnosed with hematoxylin and eosin staining, as well as it was confirmed and classified by means of aforementioned histochemical technique. Among studied variables were age, sex, and presence of Helicobacter pilory, type of intestinal metaplasia and morphological alterations. It was verified that 41 out of the patients had complete intestinal metaplasia (85, 4 per cent), of whom 37 suffered from active chronic gastritis (90,2 per cent).

Early morphological and histochemical alterations in rats subjected to ileocystoplasty / Alterações morfológicas e histoquímicas precoces em ratos submetidos à ileocistoplastia

PURPOSE: To study morphologic and histochemical alterations arising at the ileocystoplasty site. METHODS: Sixteen Wistar female rats were subjected to ileocystoplasty and sacrificed after eight weeks. Material collected was divided into four groups for histological and histochemical studies: Group I (control) - isolated ileum segment removed during ileocystoplasty; Group II - ileoileal anastomosis; Group III - ileovesical anastomosis and Group IV - ileal segment from the neobladder. Histological and histochemical study assessed dysplasia, metaplasia, acute and chronic inflammation, fibrosis, atrophy, hypertrophy, total mucins, sialomucins and sulfomucins. The non-parametric Wilcoxon and Mann-Whitney tests were employed in statistical analysis. RESULTS: None of the groups presented dysplasia. Acute inflammation and atrophy occurred in Groups II, III and IV, not reaching statistical significance. Metaplasia was significant only in Group III (p=0.012). Chronic inflammation, fibrosis and hypertrophy were significant in Groups II, III and IV. There was a significant increase in total mucin content in Group IV (p=0.014) and a reduction in Group III (p=0.016). Increases in sialomucins were observed in samples for Groups III (p=0.003) and IV (p=0.002) along with reduced sulfomucins in samples from Groups III (p=0.013) and IV (p=0.008). CONCLUSION: Ileocystoplasty in female rats caused squamous metaplasia, chronic inflammatory infiltration, fibrosis, hypertrophy, increase in sialomucin content, reduction in sulfomucins, and alterations in total mucin content with statistical significance, as well acute inflammatory infiltration and muscular atrophy with less intensity.(AU)

OBJETIVO: Estudar alterações morfológicas e histoquímicas nas ileocistoplastias em ratos fêmea. MÉTODOS: 16 ratos fêmea foram submetidos à ileocistoplastia, sacrificadas após oito semanas. O material coletado foi e dividido em quatro grupos para análise morfológica e histoquímica: Grupo I (controle) biópsia intestinal no momento da cirurgia; Grupo II - anastomose íleo-ileal; Grupo III - anastomose íleo-vesical e Grupo IV - segmento intestinal da neobexiga. Os parâmetros avaliados foram: displasia, metaplasia, processo inflamatório agudo e crônico, fibrose, atrofia, hipertrofia, conteúdo total de mucinas, sialomucinas e sulfomucinas. Utilizou-se os testes não-paramétricos de Wilcoxon e Mann-Whitney para estudo estatístico. RESULTADOS: Não houve displasia. Processo inflamatório agudo e atrofia ocorreram nos grupos II, III e IV, sem significância estatística. Metaplasia com significância estatística ocorreu somente no grupo III (p=0.012). Processo inflamatório crônico, fibrose e hipertrofia foram significantes nos grupos II, III e IV. Observou-se aumento significante no conteúdo total de mucinas no grupo IV (p=0.014) e redução no grupo III (p=0.013). Aumento significante de sialomucinas foi observado nos grupos III (p=0.003) e IV (p=0.002) e redução significante das sulfomucinas nos grupos III (p=0.013) e IV (p=0.008). CONCLUSÃO: Nas ileocistoplastias em ratos fêmea observou-se metaplasia escamosa, processo inflamatório crônico, fibrose, hipertrofia, aumento do conteúdo de sialomucinas, redução das sulfomucinas e alterações no conteúdo total de mucinas com significância estatística, bem como atrofia e processo inflamatório agudo em menor intensidade.(AU)

Examen citológico anal: prevalencia y citomorfología de las anormalidades / Anal cytological examination: histological and cellular parameters

Introducción: El estudio citológico anal es usado más frecuentemente como un test de screening para detectar las lesiones intraepiteliales escamosas anales (ASIL en inglés). Este estudio tuvo como objetivo la evaluación del uso y limitaciones del citológico anal en busca de la ASIL. Método: Se realizó un examen citológico anal de un hemiano, raspando con un bisturí y colocando en portaobjetos. Estos se sumergieron por espacio de un minuto en alcohol 96 por ciento y luego se llevaron al laboratorio para tinción y análisis. Fueron recolectadas 200 muestras. Pacientes: 100 pacientes fueron operados del ano desde Julio 2007 hasta Mayo 2008, que se separaron en varios grupos según la patología anal. Resultados: 55 pacientes fueron mujeres. El promedio de edad fue 47 años. La patología más frecuente por la cual los pacientes fueron intervenidos quirúrgicamente fue hemorroides. También hubieron fistulas y fisuras, así como condilomas. Encontramos metaplasia en el 60 por ciento de los pacientes y ninguna displasia severa. Se describieron las morfologías celulares que acompañan a la metaplasia. Conclusiones: En este estudio el examen citológico anal tiene una alta sensibilidad para la detección de metaplasia y displasia en pacientes de la población general operados del ano. Por lo tanto sugerimos que se realice en todos los pacientes que vayan a ser operados del ano o que consulten por patología anal, pues es un estudio sencillo de realizar y poco costoso, demostrando que hay muchos pacientes con cambios en el epitelio anal.

Introduction: The anal cytological study is mostly used as a screening test to detect anal scamous intraepithelial lesions (ASIL), among high risk populations. The objective of this study was to assess the use and limitations of the anal cytological one, as well as, to establish the parameters of histology and cytology. Method: An anal histological examination was performed with a curettage, and the material obtained was placed in a slide. It is submerged in 96 per cent alcohol for one minute and then, it is taken to the laboratory to be tinted. 200 samples were collected from 100 patients. Patients: These 100 patients underwent anal surgery from July 2007 to May 2008. They were organized in several groups in accordance with the anal pathology. Results: 55 of them were women. Average age was 47 years old. The most frequent pathology the patients were operated on was hemorrhoids. There were also, fistulas and fissures, as well as condylomas. Metaplasia was observed in 60 per cent of the patients. The cellular morphologies that come with metaplasia were described. Conclusions: In this study, the anal cytological examination is highly sensitive to metaplasia and displasia detection, in patients who underwent anal surgery. Thus, we recommend this study to all patients who will undergo anal surgery or who enquire about any anal pathology. This is a simple and cheap study, and shows that there are a lot of patients with changes in the anal epithelium.

Fotodiagnóstico na cavidade bucal através da espectroscopia de fluorescência nativa: estudo preliminar em humanos / native Fluorescence spectroscopy of oral normal micosa: preliminary study in humans

Componentes moleculares como fibras colágenas e elásticas, flavinas, algumas proteínas e outras estruturas, quando excitadas por luz ultravioleta, mostram fluorescência nativa na região de 450 a 500 nm (azul - verde). Alterações na constituição tecidual podem alterar sua fluorescência nativa. Sítios de metaplasia em lesões leucoplásicas, carcinomas in situ e cáries dentárias são patologias que podem e têm sido diagnosticadas, prematuramente, por fluorescência óptica. Forma de estudo: Clínico preliminar. Objetivos: Estabelecer um padrão de fluorescência nativa da cavidade bucal, visando o diagnóstico de patologias por estudo comparativo diferencial entre espectros de tecido patológico e normal. Materiais e Métodos: Utilizando espectrômetro "plug-in" (PC2000-S, Software OOIBase 32 da Ocean Optics Inc.), computador e fibra óptica, registrou-se a fluorescência nativa da mucosa bucal de 50 indivíduos adultos, saudáveis, de gênero e idade variáveis, selecionados no Ambulatório de Laser da Disciplina de ORL, da FCM Unicamp. Foram obtidos registros de seis sítios distintos e pré-determinados da cavidade bucal, usando fonte de luz ultravioleta, desenvolvida com auxílio da Indústria Komlux. Resultados e Discussão: Os 300 espectros obtidos apresentaram, basicamente, as mesmas bandas e picos de fluorescência. A intensidade apresentou significativa diferença, de acordo com o sítio e o tipo de mucosa, caracterizando, assim, espectros de emissão de fluorescência nativa dos tecidos sadios. Conclusão: Os resultados deste trabalho preliminar sugerem um padrão de normalidade das amostras de acordo com sua fluorescência nativa, possibilitando que a espectroscopia óptica da fluorescência nativa possa ser utilizada como diagnóstico não invasivo e de fácil aplicabilidade.

When components of the human tissue, such as collagen and elastic fibers, flavins and some proteins, are excited by ultraviolet radiation they become strongly autofluorescent and present their native fluorescence in the 450 to 500 nm region (blue-green). When any constitutional tissue alterations occur, pathological or otherwise, the autofluorescence is modified. Hence, this optical phenomenon can be considered a reliable method for early diagnosis. Study Design: Preliminary Clinical study. Purpose: to study tissue alterations by establishing a standard spectrum for the native fluorescence of normal oral mucosal sites and compare them with the spectra of the pathological sites. Material and Methods: The native fluorescence of the oral mucosa in 50 healthy adult individuais who were selected at the Laser Discipline Outpatient department, Faculty of Medical Sciences, UNICAMP, was studied using the "plug in" spectrometer (PC2000-S, Software OOIBase 32 , Ocean Optics Inc.), a computer and the optical fiber. Data related to six distinct predefined sites in the oral cavity were obtained using an ultraviolet light source that was developed with the help of KOMLUX. Results and Discussion: Overall, the 300 spectra obtained presented similar fluorescent bands and peaks. The degree of fluorescence differed significantly according to the type and site of the mucosa. Conclusion: The results of this pilot study suggest that the native fluorescence spectra of the oral mucosa should be standardized since it is easily applicable and can be used in non-invasive diagnoses.

Relato de dois casos de condiloma imaturo: descrição dos achados colposcópicos, cervicográficos, cito-histológicos e moleculares / Report of two cases of immature cervical condyloma: description of colposcopic, cervicographic, cytohistological and molecular findings

Por meio da descrição de dois casos, os autores visam chamar a atenção para a forma de apresentação do condiloma imaturo ou metaplasia papilar imatura atípica (MPIA), assim como para as dificuldades de detecção citológica, classificação histológica e interpretação adequada. As características do condiloma imaturo ao colposcópio e na cervicografia foram relacionadas com seu aspecto histopatológico e com o padrão colposcópico do condiloma acuminado típico cervical. Exames citopatológicos resultaram negativos ou com células escamosas atípicas de significado indeterminado (ASCUS). Em um dos casos foi realizada captura híbrida para papilomavírus humano (HPV), que identificou tipos virais de alto e baixo graus. A partir do estudo dos casos concluiu-se que: a) o condiloma imaturo pode ser identificado por exame colposcópico ou cervicográfico, podendo ser precedido ou acompanhado do diagnóstico citológico de ASCUS ou detecção de HPV por teste molecular; b) a caracterização histopatológica dessas lesões como de baixo grau evita o tratamento cirúrgico desnecessário.

Based on the report of two cases, we aim to highlight the presentation of immature condyloma or atypical papillary immature metaplasia (AIM) as well as the difficulties in its cytological detection, histopathological classification and accurate interpretation of results. The colposcopic and cervicographic characteristics of the immature condyloma were related to its histopathological features and the colposcopic standard of acuminated condyloma. Cytopathological exam results were negative or presented atypical squamous cells of undetermined significance (ASCUS). In one case, a hybrid capture test for human papillomavirus (HPV) was carried out, what identified viral types of high and low grades. The study concluded that: 1) immature condylomas may be identified by means of colposcopic or cervicographic exam, and may be preceded or followed by a cytological diagnosis for ASCUS or HPV detection using molecular test; 2. histopathological characterization of these lesions as low grade avoids unnecessary surgical treatment.