Editor-in-Chief, Deputy Editor 2017-2019





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Gastric malt-lymphoma, gastrin and cyclooxygenases

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Malt-lymphoma, gastrin and COX-2 interaction. Low grade, mucosal associated lymphoid tissue (MALT)-lymphoma is an unique among gastric malignancies where causal involvement of Helicobacter pylori (H. pylori) infection has been proposed based on complete regression of the tumor following the eradication therapy. In this report ten primary, low-grade MALT-lymphomas have been examined before and 6 months after one week of successful eradication therapy (clarithromycin + amoxicillin + omeprazole). Gastric biopsy samples from tumor and intact antrum and corpus mucosa were obtained during endoscopy before and after eradication for assessment of expression of gastrin and gastrin receptor (CCKB-R) as well as cyclooxygenase (COX)-1 and COX-2 using RT-PCR. The gastric lumen and serum gastrin and mucosal and tumor tissue PGE2 biosynthesis were determined by RIA before and after H. pylori eradication. Eradication of H. pylori resulted in complete endoscopic and histological remission of MALT-lymphoma in 9 out of 10 patients as assessed 6 months after this eradication. Before eradication, the mRNA expression for gastrin and CCKB-R as well as mRNA expression for COX-1 and COX-2 were observed in tumor tissue and infected mucosa, while corpus mucosa expressed only CCKB-R and antrum mucosa only gastrin. Six months upon the eradication when MALT-lymphoma completely regressed both endoscopically and histologically in 9 of 10 tested subjects, the expression of gastrin and COX-2 disappeared from the former area of MALT-lymphoma tumor. Gastrin mRNA remained detectable only in antrum mucosa, CCKB-R mRNA in corpus mucosa and COX-1 mRNA both in antrum and corpus mucosa. Gastric luminal and serum gastrin levels and gastric mucosa and tumor PGE2, which were greatly elevated before eradication, became normalized after this procedure. This study demonstrates that low-grade MALT-lymphoma is linked to H. pylori infection which may promote the expression and excessive release of gastrin and COX-2 expression that could be involved in the pathogenesis of MALT-lymphoma. [Product Details...]

Management of primary sclerosing cholangitis and its complications in adult patients

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Introduction Primary selerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive destruction of the extra- and intrahepatic bile ducts. The cause of the disease is unknown, although it is supposed that immunological and genetic mechanisms may be involved in its pathogenesis (1). The pathologic process is variable but usually leads to obliteration of the bile ducts, to cirrhosis and premature death due to liver failure or cholangiocarcinoma (2). The mean age at diagnosis is 32-42 years but with a wide range of 1 to 90 years. About two thirds of the patients are men (3,4,5,6). The clinical presentation of PSC in childhood is somewhat different from that in adults and this presentation focus on PSC in adults (7). Overlapping features of Autoimmune hepatitis are frequently seen in patients with PSC (8,9,10). However, with the revised scoring system for Autoimmune hepatitis recently published the possibility of excluding Autoimmune... [Product Details...]

Other helicobacters involved in human diseases

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Introduction Spiral, motile bacteria have evolved to inhabit the mucus of the intestinal crypts. The best known of these spiral, microaerobic organisms is Campylobacter jejuni. We now recognize that the intestinal crypts of a variety of animals, as well as humans are also the natural reservoir of many members of the genus Helicobacter. Indeed, H. cinaedi and H. fennelliae, previously classified as camyplobacters, were first isolated from inflamed tissues of homosexual males suffering from procitits and colitis (1). Other recently named helicobacters, H. pullorum, H. canis, H. canadensis and ‘H. rappini’ have been isolated from the diarrheic feces of humans (2,3,4, 5). With the exception of H. canadensis, these helicobacters also have been isolated from the feces of animals with and without diarrhea (3). Rodent helicobacters, H. hepaticus and H. bilis have been linked to both chronic hepatic and intestinal disease and are increasingly being used in mouse models to understand the pathogenesis of helicobacter induced gastrointestinal disease (6,7,8). Of the gastric helicobacters, H. pylori,... [Product Details...]

The history of digestive endoscopy in the last century of the second millenium

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Endoscopy : the early attempts In recent years, there was been a renwed interest on the history of digestive endoscopy, fostered by the development of endoscopic organizations (1,2). Although probably other people before him had tried to insert devices in the human body, most medical historians mention Phillip Bozzini as the first physician who tried to inspect abdominal cavities by means of appropiate instruments (3). Bozzini was born in Mainz in 1775 and died in Frankfurt a.M. in 1809, in spite of this short life-span, he lead a very productive life ; he designed an illuminated speculum, the “Lichleiter” (Light conductor) which consisted of a sort of a vase provided with a candle fixed to the lower part of the instrument for light, and a series of specula of various widths fixed to one side to allow inspection of specific orifices. Around 1853 A.J. Desormeaux (4), a French urologist devised an instrument, possibly based on Bozzini’s light conductor, which included several attachments which could be introduced into the urethra and the rectum. A relatively potent illumination was provided by a bright lamp flame obtained by burning a mixture of alcohol and turpentine. Many consider Desormeaux as the father of endoscopy. However, the first instrument using electricity my means of a lamp made of platinum wire was conceived by another urologist, Max Nitze, together with Joseph Leiter, an instrument maker from Vienna. Later, the incandescent Edison lamp became available and was fitted.... [Product Details...]

The Treatment of Acute Diarrhea in the Third Millennium : a Pediatrician’s Perspective

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Diarrheal diseases continue to be a major cause of morbidity and mortality worldwide. Although new, potentially useful drugs such as acetorphan are appearing at the horizon, the cornerstone of treatment remains a proper oral rehydration (ORT). Yet, rates at which ORT is used are still disappointingly low. Despite dramatic progresses in the understanding of the pathophysiology of diarrhea, the list of available drugs is indeed short. Recently however, several new options have appeared that may bear a potential in the near future. The first is a potential improvement of ORS. It was recently shown that the addition of a resistant starch to oral rehydration solution reduces fecal fluid loss and shortens the duration of diarrhea in patients with cholera. Starches that are resistant to hydrolysis by amylase in fact generate in the colon short-chain acids, which are known to enhance sodium absorption. The second development in treating diarrheal disease is acetorphan (racecadotril). This enkephalinase inhibitor has in fact shown to be effective in reducing by almost half the stool output 135 young children with acute diarrhea. Finally, probiotics. In the last few years, they have attracted great deal of renewed interest, particularly focusing on effects in treating and preventing diarrheal diseases. Lactobacillus GG proved effective in several clinical trials, mostly randomized and placebo-controlled, in the prevention and/or treatment acute diarrheal disease in children. We have recently shown (6) safety and efficacy in its administration in the ORS, especially Rotavirus-induced diarrheas, in a large multicenter, randomized, double blind and placebo-controlled study conducted on behalf the ESPGHAN Working Group on Acute Diarrhea. [Product Details...]

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