Immediate versus staged revascularisation of non-culprit arteries in patients with acute coronary syndrome: a systematic review and meta-analysis.

Although there is robust evidence that revascularisation of non-culprit vessels should be pursued in patients presenting with an acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD), the optimal timing of complete revascularisation remains disputed. In this systematic review and meta-analysis our results suggest that outcomes are comparable for immediate and staged complete revascularisation in patients with ACS and MVD. However, evidence from randomised controlled trials remains scarce and cautious interpretation of these results is recommended. More non-biased evidence is necessary to aid future decision making on the optimal timing of complete revascularisation.

Prognostic value of post-percutaneous coronary intervention diastolic pressure ratio.

AIM: To evaluate the distribution of a generic diastolic pressure ratio (dPR) after angiographically successful percutaneous coronary intervention (PCI) and to assess its association with the 2­year incidence of target vessel failure (TVF), defined as a composite of cardiac mortality, target vessel revascularisation, target vessel myocardial infarction and stent thrombosis. METHODS: The dPR SEARCH study is a post hoc analysis of the prospective single-centre FFR-SEARCH registry, in which physiological assessment was performed after angiographically successful PCI in a total of 1000 patients, using a dedicated microcatheter. dPR was calculated offline with recently validated software in a subset of 735 patients. RESULTS: Mean post-PCI dPR was 0.95 ± 0.06. Post-PCI dPR was ≤ 0.89 in 15.2% of the patients. The cumulative incidence of TVF at 2­year follow-up was 9.4% in patients with a final post-PCI dPR ≤ 0.89 as compared to 6.1% in patients with a post-PCI dPR > 0.89 (adjusted hazard ratio [HR] for dPR ≤ 0.89: 1.53; 95% CI 0.74-3.13; p = 0.249). dPR ≤ 0.89 was associated with significantly higher cardiac mortality at 2 years; adjusted HR 2.40; 95% CI 1.01-5.68; p = 0.047. CONCLUSIONS: In a real-world setting, despite optimal angiographic PCI results, 15.2% of the patients had a final post-PCI dPR of ≤ 0.89, which was associated with a higher incidence of TVF and a significantly higher cardiac mortality rate.

Predictors of postoperative cardiovascular complications up to 3 months after kidney transplantation.

BACKGROUND: Renal transplant patients have a high peri-operative risk for cardiovascular events. Pre-operative screening for cardiac ischaemia might lower this risk, but there are no specific guidelines. METHODS: We conducted a chart review for all renal transplants performed between January 2010 and December 2013. We collected data about patient characteristics, pre-operative cardiac evaluation before referral, diagnostic tests and interventions. Logistic regression analyses were then applied to relate these factors to the composite endpoint of cardiac death, myocardial infarction, coronary revascularisation or admission for heart failure within 3 months after transplantation. RESULTS: A total of 770 kidney transplants were performed in 751 patients. In 750 cases (97%) a referral to the cardiologist was made. Non-invasive ischaemia detection by myocardial perfusion scintigraphy, exercise stress test or dobutamine stress echocardiography was carried out in 631 cases (82%). Coronary angiography was performed in 85 cases, which revealed significant coronary artery disease in 19 cases. Prophylactic revascularisation was done in 7 cases. The incidence of the study endpoint was 8.6%. In multivariable regression analysis, age at transplantation, pre-transplant myocardial infarction or heart failure, post-operative decrease in haemoglobin and positive non-invasive ischaemia testing were significantly associated with the study endpoint. However, when analysed separately, none of the different non-invasive ischaemia detection modalities were related to the study endpoint. CONCLUSION: Especially those renal transplant candidates with a cardiac history carry a high risk for a cardiovascular event post-transplantation. Uniformity in cardiac screening of renal transplant candidates and better pre-operative preparation might lower this post-operative risk. Besides, post-transplant anaemia should be prevented.

Acceptance of guidance to care at the emergency department following attempted suicide.

BACKGROUND: Research, aimed at improving the continuity of care after hospital discharge following attempted suicide focuses on the effectiveness of the interventions. Little attention has been paid to patients who immediately decline guidance to advised post-discharge care. We aimed to identify differences between accepters and decliners of guidance to care (GtC) in relation to the characteristics of patients who presented at the emergency department (ED) of an urban hospital in the Netherlands after attempted suicide. METHOD: This cross-sectional study included all patients who presented at the ED of OLVG-West Amsterdam with a suicide attempt or intentional self-harm and were referred for psychiatric evaluation. Data were collected over a period of twenty months using a semi-structured questionnaire. Subgroups were described in relation the acceptance of GtC using univariate and multivariate logistic regression analyses. RESULTS: In total, 257 patients were included. GtC was accepted by 77%. Suicide attempters who reported loneliness as reason for the attempt showed a positive relation to acceptance. No indication was found that patients at higher risk for suicide are more reluctant to accept GtC. Suicide attempters with a non-Western ethnicity, especially patients with a Turkish/Moroccan ethnicity, declined contact by the GtC nurse significantly more often. In addition, patients who currently did not receive care were significantly more often of non-Western ethnicity and younger than 25. CONCLUSION: Acceptance of GtC is high among patients who presented at the ED after attempted suicide. The patients who were the most reluctant to accept GtC were young suicide attempters of non-Western ethnicity who were not in current care. As this study is the first to address the acceptance of GtC, we point out two lines of inquiry for further research. First, reasons to accept or decline need to be investigated further since only interventions that are accepted by patients have a chance to improve clinically relevant outcome. Second, follow-up research is warranted comparing the adherence to advised post-discharge care and attempted or completed suicide among accepters versus decliners of GtC in various ethnic and sociodemographic subgroups.

Therapeutic mild hypothermia improves outcome after out-of-hospital cardiac arrest.

Purpose. Therapeutic mild hypothermia (TMH) is indicated for comatose survivors of an out-ofhospital cardiac arrest (OHCA) to improve general outcome. Although widely used, there are not many reports on its use on a critical care unit (CCU) or on the comparison of cooling methods.Methods. In a retrospective analysis covering January 2005 to December 2006, 75 consecutive comatose subjects post-OHCA due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity) were studied in a single tertiary PCI centre. Subjects treated with conventional post-resuscitation care without TMH served as controls (n=26; Jan 2005-Sep 2005). Outcome from controls at hospital discharge was compared with subjects treated with TMH (n=49; Oct 2005-Dec 2006). During the study period, TMH was induced by either external (n=25; Oct 2005-Feb 2006) or endovascular (n=24; Mar 2006-Dec 2006) approach.Results. Besides more females in the control group, there were no major differences in baseline characteristics present between all groups. TMH improved survival (OR 0.36 [0.13-0.95], p<0.05) and neurological outcome (OR 0.23 [0.07-0.70], p<0.01). After subanalysis, TMH-improved outcome did not differ between the two cooling methods used. However, the times to reach TMH and normothermia were shorter with the endovascular approach.Conclusion. TMH induced on a CCU improves survival and neurological outcome after post-OHCA coma. TMH by endovascular approach was more feasible compared with external cooling, but the two cooling methods did not result in a different outcome. (Neth Heart J 2009;17:378-84.).

Long-term lansoprazole treatment for gastro-oesophageal reflux disease: clinical efficacy and influence on gastric mucosa.

BACKGROUND: Long-term acid suppression is believed to accelerate atrophic gastritis in Helicobacter pylori-positive patients. The influence of long-term therapy with lansoprazole has not been examined. AIM: To study the clinical and endoscopic efficacy and histological evolution of gastric mucosa during 5 years of maintenance treatment with lansoprazole, 30 mg. METHODS: Seventy-eight patients with endoscopically proven oesophagitis were followed for 5 years. Biopsies taken at the start of the study, during follow-up and after 5 years were available for 73 patients. RESULTS: The total endoscopic relapse rate was 14.1%. At the start of the study, 34 patients were Helicobacter pylori negative and 39 were Helicobacter pylori positive (two atrophy, 25 antral gastritis, 12 pangastritis). At 5 years, no histological changes had occurred in Helicobacter pylori-negative patients. In the Helicobacter pylori-positive group, 20 patients developed pangastritis, six had normal histology and one had antral gastritis. Ten of the 12 patients with pangastritis had reduced antral activity. There was no increase in intestinal metaplasia, but there was a tendency towards regression of atrophy in the antrum and towards increased atrophy in the body of the stomach. CONCLUSIONS: Maintenance treatment with lansoprazole, 30 mg, is efficacious. The development of glandular atrophy and intestinal metaplasia was not accelerated in Helicobacter pylori-positive patients. Helicobacter pylori eradication must be considered only because of the higher cancer risk associated with chronic Helicobacter pylori-related gastritis.

WBC-reduced platelet concentrates from pooled buffy coats in additive solution: an evaluation of in vitro and in vivo measures.

BACKGROUND: The use of a platelet additive solution (PAS-II, Baxter) may have benefits over plasma for storage of platelets. It was the aim of this study to develop a method to produce WBC-reduced platelet concentrates (PCs) in PAS-II with >240 x 10(9) platelets and <1 x 10(6) WBCs per unit, which can be stored for 5 days at pH >6.8 and that will give sufficient platelet increments after transfusion: a 1-hour CCI of >7.5 and a 20-hour CCI of >2.5. STUDY DESIGN AND METHODS: PCs were made from five pooled buffy coats and 250 g of PAS-II. After centrifugation the PCs were WBC-reduced with a filter (Autostop BC, Pall Biomedical) and stored in a 1000-mL polyolefin container. CCIs were assessed in stable hemato-oncologic patients after 5-day old PCs were transfused. RESULTS: Routinely produced PCs contained a median of 310 x 10(9) platelets (n = 5,363) with 3.5 percent containing <240 x 10(9) platelets, in a median volume of 320 mL (n = 11,834). The median number of WBCs was <0.03 x 10(6) (n = 694). The WBC count exceeded 1 x 10(6) in three PCs, but it was always <5 x 10(6), giving 99-percent confidence that more than 99.5 percent of the units will contain <1 x 10(6) WBCs. The pH remained >6.8 on Day 8, provided the concentration was below 1.1 x 10(9) platelets per mL (n = 32). After 28 transfusions in 28 patients, the 1-hour CCI was 12.6 +/- 4.3 (mean +/- SD, with 2/28 CCIs <7.5) and the 20-hour CCI was 8.9 +/- 5.6 (with 4/28 CCIs <2.5). Limitations of this study include the absence of a control group of patients receiving platelets stored in plasma and of in vivo radiolabeled survival studies, but a comparison of these data with previously published data suggested that the in vivo survival of platelets stored in PAS-II is less than that of platelets stored in plasma. CONCLUSION: The WBC-reduced PCs conformed to specifications. These WBC-reduced PCs could be stored at least 5 days with maintenance of pH, and they gave sufficient increments after transfusion to patients.

Acute pancreatitis in peritoneal dialysis and haemodialysis: risk, clinical course, outcome, and possible aetiology.

BACKGROUND: It has been suggested that the incidence of acute pancreatitis in patients with end stage renal failure is increased. AIMS: To assess the risk of acute pancreatitis in patients on long term peritoneal dialysis and long term haemodialysis compared with the general population, to evaluate its clinical course and outcome, and to identify possible aetiological factors. PATIENTS: All patients who were maintained on long term peritoneal dialysis and/or haemodialysis (total dialysis time more than six weeks) from January 1989 to March 1998 in a large general hospital in The Netherlands. METHODS: Retrospective cohort study. Standardised ratios (as an approximate relative risk) between the incidence of acute pancreatitis in haemodialysis or peritoneal dialysis and the general population were calculated. Possible risk factors were identified. Patients with and without acute pancreatitis were compared. RESULTS: In 269 patients on haemodialysis (total of 614 person years), one patient developed an attack of acute pancreatitis. Patients on haemodialysis did not show an increased risk for acute pancreatitis compared with the general population (standardised ratio 11; 95% confidence interval (CI) 0.275 to 60.5). In 128 patients on peritoneal dialysis (total of 241 person years), seven patients had nine attacks of acute pancreatitis. Patients on peritoneal dialysis had a significantly and highly increased risk for acute pancreatitis (standardised ratio 249; 95% CI 114 to 473). Mortality in this series of nine attacks was 11%. No single aetiological risk factor could be identified. CONCLUSIONS: The risk of acute pancreatitis in patients on long term peritoneal dialysis is significantly and highly increased compared with the general population. The underlying causal mechanisms remain to be elucidated.

Lack of cyclin D1 overexpression in gastric carcinogenesis.

AIMS: Cyclin D1 overexpression was examined in early gastric carcinomas and precursor lesions with the following aims; (1) to assess the chronology of cyclin D1 overexpression in various stages of gastric carcinogenesis, (2) to correlate cyclin D1 overexpression with the Lauren type, the grade of differentiation and the type of growth pattern of the tumours and (3) to correlate cyclin D1 overexpression with clinical parameters, in particular lymph node metastasis and overall prognosis. METHODS AND RESULTS: Forty-five paraffin-embedded gastrectomy specimens from early carcinomas were examined for the presence of various precursor lesions. The Lauren type, the grade of differentiation and the type of growth pattern were reassessed for all early carcinomas. Cyclin D1 overexpression was examined using the monoclonal antibody DCS-6. Cyclin D1 overexpression was absent from all precursor lesions. Ten early carcinomas (22%) were cyclin D1 positive without significant differences when stratified according to Lauren type, grade of differentiation, type of growth pattern or lymph node status. Univariate analysis failed to show a significant difference in 5-year surival rate between cyclin D1 positive and negative early carcinomas (90% vs. 94%). CONCLUSIONS: Cyclin D1 protein overexpression does not play a role in the progression from normal to neoplastic gastric mucosa and does not discriminate between intestinal and diffuse type early gastric carcinomas of Caucasian origin. Moreover, mechanisms other than cyclin D1 protein overexpression underlie the reported difference in biological behaviour of early gastric carcinomas with different types of growth pattern. Finally, although it appears that cyclin D1 does not have prognostic significance, studies on larger numbers, including advanced carcinomas, are warranted.

Collection of heparinized plasma by plasmapheresis.

BACKGROUND AND OBJECTIVES: Heparinized plasma can be used for exchange transfusions in neonates and is usually collected by drawing whole blood using heparin as anticoagulant. The heparinized red blood cells and buffy coat cannot be used and are therefore discarded. To collect heparinized plasma more efficiently, a method was developed using an apheresis machine. MATERIALS AND METHODS: With an MCS3p apheresis machine (Haemonetics), plasma was collected from volunteer donors as anticoagulant, heparin in saline (30,000 IU/l) was added in a 1:9 ratio. The activated partial thromboplastin time (APTT) of the donors was measured before and immediately after the procedure, and various parameters were determined in the collected plasma. RESULTS: In 2 collection cycles, an average of 456+/-52 ml (mean +/- SD; n = 20) of heparinized plasma was collected, and 504+/-57 ml (n = 2; donors with a high hemoglobin level) when 3 cycles were performed. The leukocyte and platelet contamination in the plasma (n = 22) was 1.11+/-0.92x10(6) and 0. 05+/-0.22x10(9) per unit, respectively, which conformed to national specifications. Sodium levels were normal, but due to dilution of the plasma with heparin solution, potassium and calcium levels were about 20% lower than the serum levels in the donors. The donor APTT values were slightly longer after the procedure than before, but remained all within normal values. CONCLUSION: For the collection of heparinized plasma, apheresis has the advantage that (1) high-quality heparinized plasma can be harvested; (2) no blood components need to be discarded; (3) more plasma can be harvested with each donation, and (4) these procedures can be performed more often than whole blood donations.

Preparation of leukodepleted platelet concentrates from pooled buffy coats: prestorage filtration with Autostop BC.

BACKGROUND AND OBJECTIVES: Our requirements for leukocyte-depleted platelet concentrates (LD-PC) for an adult patient are: platelets >240x10(9), leukocytes <5x10(6), volume of 150-400 ml; and at the end of storage a pH between 6.8 and 7.4 and presence of the swirling effect. Our aim was to develop a standardized, semiautomated method for the production of LD-PC, by pooling of buffy coats (BC), and prestorage leukoreduction by filtration. MATERIALS AND METHODS: Whole blood was collected in Top and Bottom systems, and separated automatically with the Compomattrade mark G3 equipment into a red cell concentrate, a plasma and a BC. Subsequently, a pool of 5 BC was made, and 200 g plasma from one of the donors was added. Then, after soft spin centrifugation, the platelet rich plasma was leukocyte depleted by filtration using the Autostoptrade markBC filter, and stored in a 1,000 ml polyolefin platelet storage bag. RESULTS: BC (n = 60) had a volume of 51+/-2 ml (mean +/- SD) with a hematocrit of 0.44+/-0.03 l/l and contained 80+/-5% of the platelets and 74+/-12% of the leukocytes of the whole blood. Routinely prepared LD-PC (n = 15,037) contained a median of 341x10(9) platelets (range 49-599x10(9)), with only 104/15,037 (0.7%) containing fewer than 240x10(9) platelets; the median volume was 263 ml (range 134-373 ml). In 118/917 (13%) LD-PC leukocytes were observed in the Nageotte hemocytometer, but only twice exceeding 1x10(6) leukocytes per unit, and none exceeding 5x10(6) (median <0. 6x10(6); range <0.6-1.41x10(6)). Storage experiments of the LD-PC (n = 12) revealed adequate oxygenation and maintenance of pH and swirling effect up to 9 days. CONCLUSIONS: This method warrants with 99% confidence that LD-PC contain more than 240x10(9) platelets; with 97.5% confidence that 100% of the LD-PC contain <5x10(6) leukocytes, and with 95% confidence that more than 99% of the LD-PC contain fewer than 1x10(6) leukocytes; these LD-PC can be stored satisfactorily for up to 9 days.

Loss of E-cadherin expression in early gastric cancer.

AIMS: Reduction or loss of E-cadherin expression was examined in early gastric carcinomas and precursor lesions with the following aims: (1) to assess overall E-cadherin expression in various stages of gastric carcinogenesis; (2) to correlate E-cadherin expression with the Lauren type, the grade of differentiation and the type of growth pattern of the tumours; and (3) to correlate E-cadherin expression with lymph node metastasis and overall prognosis. METHODS AND RESULTS: Forty-five paraffin-embedded gastrectomy specimens from early carcinomas were examined for the presence of various precursor lesions. The Lauren type, the grade of differentiation and the type of growth pattern were reassessed for all early carcinomas. E-cadherin expression was examined using antibody HECD-1. Whereas E-cadherin was strongly and evenly expressed in the gastric foveolar epithelium, intestinal metaplasia and early gastric carcinomas showed a lower expression. A significant difference in E-cadherin expression was found between the Lauren types (P < 0.0001). Moreover, an inverse correlation was found between E-cadherin expression and histological grade (P < 0.0001). Neither a difference in E-cadherin expression between the various growth types nor an association with lymph node metastasis and overall prognosis was found. CONCLUSIONS: The Lauren types differ in E-cadherin expression, although reduced E-cadherin expression in all probability rather reflects poor differentiation than a diffuse growth pattern 'genotype'. Moreover, E-cadherin expression does not underlie the difference in biological behaviour of early carcinomas with different types of growth pattern. Finally, E-cadherin expression is not associated with lymph node status and 5-year survival rate, at least not in early gastric carcinomas.

[Whipple's disease in a man with weight loss and diarrhea]. / Ziekte van Whipple bij een man met gewichtsverlies en diarree.

In a 45-year-old man with diarrhoea, upper abdominal pain and malabsorption Whipple's disease was diagnosed by gastroduodenoscopy with small bowel biopsies. The disease is rare and can present with gastrointestinal problems but also with cardiac or neurological complaints. Tropheryma whippelii, the aetiological organism, can be demonstrated by pathological investigation of biopsies and with the polymerase chain reaction (PCR). Treatment with trimethoprim-sulfamethoxazole 160-800 mg twice daily is the therapy of choice: it must be continued for a year, otherwise there is a high possibility of relapse. Correct diagnosis, based mostly on gastroduodenoscopy, can lead to the right therapy and recovery of the patient.

Six filters for the removal of white cells from red cell concentrates, evaluated at 4 degrees C and/or at room temperature.

BACKGROUND: Six filters were tested for their ability to remove white cells from buffy coat-depleted red cell concentrates at various temperatures. STUDY DESIGN AND METHODS: Cellselect FR, BPF4, and Sepacell filters were tested at both room temperature (RT) and 4 degrees C. The Leucoflex filter was tested only at 4 degrees C, while the Cellselect Optima Plus and Imugard filters were tested only at RT. Donor-dependent differences were excluded by pooling and subsequently dividing 9 red cell concentrates; 12 sets of experiments were performed. RESULTS: With all filters, red cell concentrates containing <5 x 10(6) white cells per unit were obtained. The lowest numbers of residual white cells were achieved with the Leucoflex (at 4 degrees C, 0.15 +/- 0.11 x 10(6), the Sepacell (at 4 degrees C, 0.23 +/- 0.14 x 10(6), the Imugard (at RT, 0.24 +/- 0.14 x 10(6), and the BPF4 (at 4 degrees C, 0.25 +/- 0.24 x 10(6); differences not significant). With the Cellselect FR, filtration at 4 degrees C resulted in 0.86 +/- 0.37 x 10(6) white cells per unit, a level not significantly different from that obtained with the BPF4 and Sepacell filters at RT (1.16 +/- 0.43 x 10(6) and 0.80 +/- 0.36 x 10(6) white cells, respectively). Filtration at RT with the Cellselect FR and Cellselect Optima Plus resulted in red cell concentrates with 1.79 +/- 0.69 x 10(6) and 2.29 +/- 0.69 x 10(6) white cells, respectively (p<0.01). CONCLUSION: All filters conformed to the current standards for white cell reduction; the process was less efficient at RT than at 4 degrees C. For routine application, the composition of the red cell concentrate, the temperature, and logistic preferences should be taken into account in the final choice of filter; before implementation, the chosen filter must be validated under routine conditions.

Automated separation of whole blood in top and bottom bags into components using the Compomat G4.

BACKGROUND AND OBJECTIVES: Whole blood can be separated by hard spin centrifugation into layers of blood components according to their specific gravity. The aim was to develop a program for an automatic separator to subsequently express the various components into their respective satellite bags in top and bottom systems with the following requirements: a red cell concentrate with a low leukocyte and platelet contamination, a 'cell-free' plasma, and a buffy coat with a volume of about 50 ml with an acceptable loss of red cells. MATERIALS AND METHODS: The Compomat G4 possesses an independently moving upper and lower press, to automatically express plasma or red cells to satellite bags of top and bottom systems. The influence of the extension of the lower press was studied by pooling and dividing two units of whole blood, and separating these units after centrifugation (2,960 g, 10 min) either with a program where the lower press was completely extended (program C), or with a program that left approximately 1 mm between the door and the lower press (program D). RESULTS: The program (program D), where the lower press was not completely extended, yielded a buffy coat with a volume of 52+/-1 ml (mean +/- SD, n = 36), which contained >75% leukocytes and >90% platelets of the original whole blood unit, with a red cell loss in the buffy coat of 21+/-1 ml (10.8+/-0.8% of the original volume). The leukocyte content of the red cell concentrates was 775+/-379x10(6) per unit, whereas the plasma contained 3+/-3x10(6) leukocytes and 4+/-3x10(9) platelets per unit. The pooling experiment indicated that complete extension of the lower press (program C) resulted in a significantly higher leukocyte contamination of the red cell concentrate (788+/-431x10(6 ) vs. 658+/-419x10(6); n = 12; p = 0.03), while there was no difference in the yield of red cells or plasma. The buffy coat produced with program D contained significantly more leukocytes (2,242 +/-396x10(6) vs. 2,065+/-327x10(6), p = 0.005) and more platelets (96+/-14x10(9) vs. 92+/-17x10(9), p = 0.02) per unit than with program C, probably because buffy coat cells sticking to the container wall are not expressed to the red cell concentrate, and thus remain in the buffy coat bag. Therefore, program D met our specifications for blood products. CONCLUSIONS: The Compomat G4 warrants reproducible separation of whole blood in top and bottom bags into red cells, buffy coat and plasma meeting our specifications.

Molecular alterations in early gastric carcinomas. No apparent correlation with Helicobacter pylori status.

Data on the differences in molecular profile between H pylori-positive and H pylori-negative early gastric carcinomas, if any, are almost nonexistent. We therefore investigated whether molecular differences can be observed between H pylori-positive and H pylori-negative early gastric carcinomas. Forty-five early gastric carcinomas were analyzed for alterations in certain oncogenes (ras, MDM2, c-erbB-2, cyclin D1), the p53 tumor suppressor gene, and the e-cadherin gene. Of these 28 carcinomas were H pylori-positive, and 17 were H pylori-negative. No significant differences were found in the groups irrespective of Lauren type; ras (0% vs 0%), MDM2 (0% vs 0%), c-erbB-2 (0% vs 0%), cyclin D1 (18% vs 29%), p53 (68% vs 47%), and e-cadherin (46% vs 41%). Helicobacter pylori-positive and H pylori-negative early gastric carcinomas do not differ in molecular profile. Although they may prove different when tested for other abnormalities, our findings suggest that the acquisition of molecular alterations occurs via an H pylori independent pathway.