Gastritis due to spiral shaped bacteria other than Helicobacter pylori: clinical, histological, and ultrastructural findings.

An intensive histological search for Helicobacter pylori in gastric biopsy specimens has led to the detection of other spiral shaped bacteria in the human gastric mucosa. The clinical and morphological findings of 39 cases (0.25% of all gastric biopsies performed in the observation period) are reported for 34 patients (87.2%) complaining of upper abdominal discomfort. Five patients (12.8%) had chronic gastritis and 34 (87.2%) chronic active gastritis. The organisms were seen by light microscopy deep in the gastric foveolae and intracellularly. The scanning and transmission electron microscopic findings show bacteria which invade and damage gastric mucosal cells. These organisms are similar to the spiral shaped bacteria found in the stomachs of cats and dogs and non-human primates. In eight patients organisms were not detected after four weeks of treatment with bismuth salts. The disappearance of the organisms coincided with resolution of the chronic active gastritis and the symptoms.

[Epidemiology of Helicobacter pylori infection]. / Epidemiologie der Helicobacter-pylori-Infektion.

The endemic behaviour of Helicobacter pylori (H.p., formerly known as Campylobacter pylori) among the population of the town (57,000 inhabitants) and rural district (116,000 inhabitants) of Landshut was investigated with consideration being given to nationality, socio-economic status, housing and the local supply of drinking water. The study involved 894 patients, whose consecutive gastric biopsies were sent to the pathological institute of the Municipal Hospital in Landshut. The overall H.p. incidence was 51.1%, the average age of those infected being 56.9 years. No difference was found in the rate of infection between the municipal and rural populations (54.5%, average age 57.4 years/48.3%, average age 56.4 years). The population of foreigners revealed a significantly higher H.p.-positive rate (72.3%, average age 41.7 years) as compared with the native population (49.9%, average age 57.7 years). In the case of parts of the town whose inhabitants generally lived in smaller apartments with a lower standard of hygiene a considerable greater incidence of H.p. (up to 73.6%, average age 54.2 years) was observed as compared with areas with a low population density and detached houses (38.5%, average age 59.2 years). Considerable differences in rates of infection were established in the individual small towns and marketplaces of the rural district (between 40 and 71.4%, average age 58.6-59.1 years). No correlation was found to the supply of drinking water. Overall, the results of this study indicate a person-to-person transmission of H.p., possibly favoured by more frequent physical contact under more cramped living conditions in socio-economically disadvantaged strata of the population and by ethnological factors.

[Intragastric formation of ammonia in Campylobacter pylori associated gastritis. Diagnostic and pathogenetic significance]. / Intragastrale Ammoniakbildung bei Campylobacter-pylori-assoziierter Gastritis. Diagnostische und pathogenetische Bedeutung.

The diagnostic relevance of measurement of ammonia (NH3) in not stimulated gastric juice in patients with campylobacter pylori associated gastritis (CPAG) is in discussion. The role of CP-urease induced NH3 in pathogenesis of active gastritis is unclear. In answering to this questions we evaluated the sensitivity and specifity of NH3-test and CLO-test in cases of CPAG (n = 50), non CPAG (n = 16) and normal gastric mucosa (n = 20). We found a 88% sensitivity and a 86% specifity for NH3-test, a sensitivity for CLO-test of 80% and a specifity rate of 87%. NH3-test correlated well with CLO-test (n = 51, p less than 0.01) and semiquantitative histological identification of CP (p less than 0.01, n = 22). On the other hand we tried to correlate the amount of NH3 in the gastric juice and the histological degree of gastritis activity (infiltration of leucocytes of the lamia propria) in CPAG (n = 78) and Non-CPAG (n = 32) and before and after therapy in CPAG (n = 9) with bismuthsubnitrate (2 g/d, 14 d). There was no correlation between the amount of NH3 and the degree of active chronic gastritis in patients with CPAG (with or without therapy) and patients with non CPAG. It seems that NH3 has a diagnostic but no pathogenetic role in the process of inflammatory activity of CPAG.

[Fibrolamellar liver cell cancer. A case report]. / Das fibrolamelläre Leberzellkarzinom. Ein Fallbericht.

Fibrolamellar hepatocellular carcinoma of the liver is a rare variant of hepatocellular carcinoma with characteristic morphological patterns and a good prognosis. Preoperatively the tumor is rarely diagnosed. Surgical treatment is resection, hemihepatectomy or transplantation of the liver. We report a case of a 51 years old patient with fibrolamellar hepatocellular carcinoma of the liver.

[A rapid urease test in Campylobacter pylori colonization of the gastric mucosa]. / Urease-Schnelltestes bei Campylobacter-pylori-Besiedlung der Magenschleimhaut.

Biopsies from the gastric mucosa (antrum, corpus) of 145 patients investigated by endoscopy were analysed for Campylobacter pylori. The results of bacteriological, histological, enzymatic and chemical methods were compared. Urease activity was determined both in biopsies (CLO-test) and in gastric secretion. Furthermore, the concentration of urea was measured in gastric secretion. 71% of gastritis, 86% of ulcus duodeni and 83% of ulcus ventriculi diagnosed by endoscopy produced positive histological and/or cultural results, while 100% of control persons exhibited negative for both parameters. The sensitivity of the CLO-test (n = 112) was 95% and its specificity 78% when compared with bacteriological and histological results. The majority of false positive results was due to delayed and incomplete reactions. However, when compared with endoscopic-histological results the specificity of the CLO-test was 100%. The results of a modification of CLO-test (without culture medium) were up to 5 hours comparable. There was no positive correlation between the concentration of urea in gastric secretion and the histological or cultural identification of Campylobacter pylori. However, the measurement of ammonia turned out to be promising (sensitivity 80%). None of the tests was sufficiently specific on its own, whereas a 100% specificity was achieved when both the CLO-test and the determination of ammonia in gastric secretion were performed.

The transitional polyp of the colorectal mucosa.

45 cases of small polypoid lesions occurring in the colorectal mucosa free of inflammatory or neoplastic disease are presented. The lesions were removed at colonoscopy and displayed neither features of hyperplastic (metaplastic) polyps nor features of a neoplastic proliferation. Morphologically these small lesions were characterized by elongated and widened crypts, enlarged goblet cells with an increase in mucous production. Histochemically there was a reversion of the usual pattern of mucin production in the colorectal mucosa: an increase in sialomucin production and a decrease in sulfomucins. Thus these lesions demonstrate the same morphological and histochemical features as the transitional mucosa surrounding carcinoma and adenoma in the large bowel. These "transitional" polyps could represent an early step in the development of neoplastic processes in the colorectal mucosa and precede adenomas.

Morphology and histochemistry of the mucosa surrounding small oligotubular adenomas of the large bowel.

The transitional mucosa surrounding adenomas and carcinomas of the large bowel is characterized by a reversion of mucus secretion from sulphomucin to sialomucin and a hyperplasia of crypts and epithelial cells. The specificity of this phenomenon is still a controversial issue. Therefore we studied 72 oligotubular adenomas of the large bowel and the adjacent mucosa by means of histochemistry and morphometry. The peak of sialomucin production is found within the crypts immediately adjacent to the adenoma, whereas the more distant crypts secrete less. The cellular diameter and the depth of the crypts behave in a similar manner, they decrease with increasing distance from the adenoma, still being much higher than in the normal mucosa. The crypt depth correlates well to sialomucin production. The existence of the transitional mucosa around small oligotubular adenomas may indicate, that this mucosal change is not merely secondary to the presence of carcinoma but may be of importance as a precursor lesion of neoplastic changes of the colon and rectum.

[Risk findings of the gastric mucosa--a clinicopathologic discussion]. / Risikobefunde der Magenschleimhaut--ein klinisch-pathologisches Gespräch.

Histological results of gastric biopsies necessitate a careful discussion between the gastroenterologist and pathologist in order evaluate the significance of the findings and to determine, what should be done next. Risk factors may be defined on the basis of clinical and endoscopic as well as of histological findings. Circumscript lesions of the gastric mucosa are such risk factors; histological examination of these lesions has to be done in quite a few cases repeatedly in order to confirm the diagnosis. Especially precancerous changes maybe considered as risk factors; according to WHO-definition they are subdivided in precancerous conditions and precancerous lesions. Precancerous conditions are type A gastritis, status after surgery of the stomach, hyperplasiogenic polyps of the stomach, increased familiar incidence of carcinoma, Ménétrier's disease, and acanthosis nigricans. Precancerous lesions on the other side are circumscript, histologically definable tissue changes, like for instance adenoma of the stomach, where formation of carcinoma can be observed with higher than normal incidence. Chronic atrophic gastritis has been overestimated considerably as a precancerous lesion. Control biopsies are indicated only in large time intervals and if special, well defined histological conditions prevail. Carcinoma incidence after Billroth II-resection of the stomach is lower in Middle Europe and U.S.A. than has been assumed before. Regular gastroscopic check-ups seem only to be justified in persons over 50 years of age, or in persons who have been operated upon more than 15 years ago. The procedures to be taken if gastric polyps are present depend upon localisation and size of the tumor and histology of the forceps biopsy. If adenoma are found or borderline lesions, which are to be considered as real precancerous lesions total excision by endoscopy, or if necessary by surgery is indicated.

[Alcohol consumption and chronic gastritis]. / Alkoholkonsum und chronische Gastritis.

History of alcohol intake was evaluated in 1,500 patients who had gastroscopy for different reasons. Alcohol intake was related to histological findings of antrum and corpus mucosa. No statistically significant correlation between lesions and alcohol intake could be found. There was a correlation between incidence and severity of gastritis on the one hand and increasing age on the other. The patients under investigation were beer drinkers in the first line. For this reason our findings do not allow any conclusions in regard to persons, who usually drink higher concentrated alcohol beverages. The conclusion can be drawn however that even excessive drinking of beer does not seem to cause chronic gastritis.

[Prenatal ultrasound findings in a case of cystic adenomatoid malformation of the lung with generalized hydrops of the fetus]. / Pränatale Ultraschallbefunde bei einem Fall von zystisch-adenomatoider Malformation der Lunge mit generalisiertem Hydrops des Feten.

The sonographic findings of polyhydramnion, foetal ascites, generalised hydrops, as well as tumour in the right thoracic or upper abdominal regions are described as an expression of a uniform disease pattern of the foetus. The case under discussion concerns a congenital cystic-adenomatoid malformation of the right lung. The characteristic features of differential diagnosis are discussed.

[Reflux disease of the esophagus]. / Refluxerkrankung der Speiseröhre.

An attempt is made to correlate clinical respectively endoscopic and histomorphological findings in patients with gastroesophageal reflux disease. The histological stage Ia cannot be identified endoscopically. However, certain correlations can be found between endoscopic stage I (the "red spot") on the one hand and the histological stage Ib (hyperemic capillaries) on the other, just as well as between subsequent endoscopical and histological stages. The histomorphological stage IV corresponds to the clinical stage IV and represents the ultimate complication of the reflux disease, esophageal stenosis caused by ulceration plus endobrachyesophagus. In this stage no restitutio ad integrum is possible anymore. The initial changes of the gastroesophageal reflux disease occur within the epithelium and the papillae and can be recognized microscopically in biopsies taken during endoscopy. Changes in the submucosal layer are of no importance during the early reversible stages. The lining of the endobrachyoesophagus with cylindrical epithelium ("Barrett mucosa") is probably the consequence of reflux. This type of lining presents an irregular picture from the morphological as well as from the clinical point of view and is to be considered as a pre-stage of adenocarcinoma of the esophagus.

Identification of amyloid A protein in a sporadic Muckle-Wells syndrome. N-terminal amino acid sequence after isolation from formalin-fixed tissue.

The amyloid of a patient (WAL) with a sporadic Muckle-Wells syndrome was analyzed in tissue sections and after it had been isolated from formalin-fixed tissue. The predominant amyloid fibril protein was the amyloid A (AA) type determined by the following criteria. (a) Only antiserum against protein AA gave a strong specific reaction, whereas the other antisera with specificity against amyloid of immunoglobulin origin, i.e., A-lambda and A-kappa, did not stain using the indirect immunoperoxidase technique on formalin-fixed, paraffin-embedded tissue sections. (b) In immunodiffusion, the predominant amyloid fibril protein from WAL isolated in pure form from formalin-fixed tissues precipitated in a line of identity with anti-AA and a purified and chemically identified protein AA from another patient. (c) Amyloid fibril protein from WAL had a molecular weight of 8000 to 9000 in sodium dodecyl sulfate polyacrylamide gel electrophoresis and, thus, is in the same range as the commonly found protein AA. (d) The N-terminal amino acid sequence analysis was that of protein AA. In addition to the pure amyloid fibril protein AA (WAL), proteins of higher molecular weights with AA-antigenic determinants were also isolated. These proteins may represent protein AA in a complex form or protein AA linked to other proteins. Since an inflammation is the most likely cause of amyloidosis complicating the Muckle-Wells syndrome an antiinflammatory therapy (as in other AA-type amyloidoses) is recommended.

[Gastritis - a risk factor in carcinogenesis; epidemiological and morphological findings (author's transl)]. / Die Gastritis als Krebsrisikoerkrankung - epidemiologisch-morphologische Untersuchungen.

A comparison was made between 239 gastric biopsies from persons in Columbia, district of Nariño, not suffering from carcinoma of the stomach and an equal number of biopsies from a german control group matched for age and sex. Carcinoma risk in columbian population is about four fold as high as in german people (150 resp. 40/100,000). 46% of the columbian and 23% of the german group had gastritis of the antrum with atrophic changes; its incidence is independent of age. This type of gastritis is characterized by significantly more areas of necrotic epithelial lesions in the glandular neck region, proliferation and dysplasia of neck cells, as well as by intestinal metaplasia. This active and progredient type of gastritis may be perceived as a preliminary stage of the intestinal ("epidemiological") type of gastric carcinoma. This is the predominant type of carcinoma in Germany as well. Prospective studies are necessary to show, if patients with increased risk of stomach carcinoma can be identified by diagnosing this type of gastritis.

Thermal coagulation of puncture lesions in the cholestatic rabbit liver with Nd: YAG laser and and high-frequency current.

The coagulatory effect of the Nd: YAG laser after puncture of the cholestatic liver was compared with the effect of electrocoagulation. In 11 rabbits, the liver was punctured 7 days after ligature of the common bile duct with a Menghini needle 1.2 mm. The site of injury was coagulated by laser light in 5 animals and by unipolar electrocoagulation in 6 animals. Bleeding and bile leakage was stopped in all cases. Histologically there was no crucial difference between the two methods in their effect on the liver tissue. Autopsy 14 days after common bile duct ligature revealed no bile peritonitis in any rabbit.

[Gastric diseases in foreign workers in the German Federal Republic (author's transl)]. / Magenerkrankungen bei ausländischen Arbeitnehmern in der Bundesrepublik Deutschland.

Gastric biopsies from foreign workers were compared with those from German patients of the same age group. With reference to population statistics investigations showed that a far higher percentage of foreign workers are gastric patients than are Germans of the same age. Chronic atrophic antral gastritis occurs in foreigners twice as often as in a comparative group of Germans. 77% of the duodenal ulcers and 88% of the gastric ulcers are found in the group of foreign workers examined aged from 21 to 40 years. The German patients, on the other hand, show normal gastric mucosa with more than chance frequency compared with foreign workers of corresponding age and sex.