Helicobacter pylori and intestinal metaplasia.

Gastric carcinoma of the intestinal type is assumed to develop from precancerous gastric lesions. It is now widely accepted that Helicobacter pylori (HP) infection causes chronic gastritis and, after a period of time, intestinal metaplasia (IM). It was suggested that these gastric lesions may evolve into gastric carcinoma after a lengthy latency period. HP seropositivity is high in Turkey at early ages. This may explain the high incidence of gastric carcinoma in this geographic region. In this study, we examine the relationship between HP and IM in endoscopic gastric biopsy specimens. We examined 840 biopsies taken from 210 patients. HP positivity and the presence of IM were examined in these specimens by histopathologic methods. HP positivity was also determined by CLO testing. HP was positive in 156 of the 210 patients examined (74.3%). The distribution of HP seropositivity did not differ between age groups (p > 0.05). IM was present in 101 patients in the entire study group (48%). Among the 156 HP-positive patients, the rate of IM was 44.8% (n = 70). The rate of IM among the 54 HP-negative patients was 57.4% (n = 31), which was not statistically significant (p > 0.05). IM positivity has been shown to increase in older age, which was statistically significant (p < 0.001). We were not able to show a relationship between HP seropositivity and IM. Increased HP seropositivity at an early age is a common risk factor in our population. We must consider other factors that may contribute to the increased rate of IM in older age groups.

Subtypes of intestinal metaplasia and their relationship to Helicobacter pylori.

The presence of incomplete colonic type of intestinal metaplasia (IM) is regarded as a risk factor for gastric carcinoma. In this study, we attempted to classify the subtypes of IM in our patients and examine their relationship to Helicobacter pylori (HP). Gastric biopsies were obtained from 210 patients. The HP positivity and the presence and type of IM were determined by histopathologic methods. HP positivity was also tested by the CLO test. The subtypes of IM were classified according to Ming's classification. IM was present in 101 of 210 patients (48%). Complete type intestinal metaplasia was present in 72 of 101 patients (71.3%), incomplete type IM was seen in 29 of 101 patients (28.7%), and incomplete colonic type (Type IIc) was found in 7 of 101 patients (6.9%). No significant relationship was found between subtypes of IM and HP positivity (p > 0.05). Although our patient group is small, our findings suggest that the carcinogenity of HP is mostly related to its own mutagenic activity as well as the mutagenic activity of the inflammatory cells present in response to HP rather than to its supposed effect on precancerous gastric lesions.

Multiple myeloma in the region of Bursa, Turkey: a retrospective analysis.

We evaluated the clinical and laboratory features of multiple myeloma in our patients and reviewed the factors that affected their survival. The study included 36 patients (12 women and 24 men) with multiple myeloma whom we followed up until death between October 1978 and June 1995. The age range was 34 to 75 years (mean age, 53.9). The chief complaints on admission were lumbar pain and pain in the extremities (77.8%) and generalized weakness (61.1%). The most common laboratory findings were severe anemia (hemoglobin < 8.0 g/dl) (50%), elevated erythrocyte sedimentation rate (75%), monoclonal spike in the serum protein electrophoresis (44.4%), and lytic skull lesions (72.2%). Twenty-three (64%) patients had a monoclonal IgG, 9 (25%) had IgA, 1 had IgD, 2 had light chain disease, and 1 was nonsecretory. Localized plasmacytoma was detected in 4 patients and 4 patients had amyloidosis in rectal and gingival biopsies. According to the Durie-Salmon staging system, 2 patients were in stage 1, 8 were in stage 2, and 26 were in stage 3. The mean survival was 31.4 +/- 4.3 months (range: 1 to 96). The 5-year survival rate was 11%. Sex, age at diagnosis, stage of the disease, hemoglobin level, platelet count, level of serum calcium, creatinine, serum paraprotein, and type of paraproteinemia were tested as prognostic parameters. We could not establish a statistically meaningful effect of these parameters on survival time. The first and second most common causes of death were renal failure and infection, respectively.

Second primary cancer due to radiotherapy and chemotherapy.

Cancer patients are treated successfully with chemotherapy, radiotherapy, or a combination of both. However, many agents used in cancer chemotherapy as well as ionizing radiation are known carcinogens. The long survival of cancer patients treated successfully for their primary cancer made possible the observations of late effects of radiotherapy and chemotherapy and, in particular, the occurrence of second primary cancers. In this report we review the cases of five patients with second primary malignancies and wish to emphasize the importance of a thorough follow-up of patients treated successfully for and possibly cured of a primary cancer.