Vincenzo Casale

Basophil-bound and serum immunoglobulin E directed against Helicobacter pylori in patients with chronic gastritis.

The immunoglobulin (Ig) E immune response in patients with Helicobacter pylori-associated chronic gastritis has been evaluated. Of 26 patients with H. pylori infection, 22 (84%) tested positive for basophil-bound specific IgE (determined by the histamine release test) and 18 (69%) for serum specific IgE (determined by an enzyme-linked immunosorbent assay). In contrast, only 1 of 17 persons in whom the bacterium was not detected presented cell-bound and serum specific IgE. In the 4 histamine release test--positive but enzyme-linked immunosorbent assay--negative patients, removal of antibody from the basophil surface by acid elution showed that histamine release occurred through an IgE-dependent mechanism. When normal basophils, passively sensitized with serum from IgE-positive patients, were exposed to the H. pylori antigen, a significant release was observed, confirming the class specificity of the response. Inhibition experiments with bacteria other than H. pylori showed that the IgE antibody was specifically directed against this organism. The percentage of antigen-induced histamine release did not correlate with serum specific IgE level. However, the response of basophils to antigenic challenge was proportional to IgE-dependent cellular releasability. This finding suggests that target cell sensitivity may be the most important factor in determining the entity of biological response to the antigenic challenge. The ability of H. pylori to induce a specific IgE immune response could answer key questions regarding the mechanisms inducing gastric inflammation.

Quantitative analysis of CEA expression in colorectal adenocarcinoma and serum: Lack of correlation

Tissues and sera from 110 patients diagnosed with colorectal primary carcinoma, 20 patients with benign colorectal diseases and 31 healthy donors were subjected to quantitative CEA analysis. Multiple samples from tumor lesions and autologous histologically normal mucosa (10 cm from the tumor) were obtained at the time of surgery (cancer patients) or endoscopy (benign patients and healthy volunteers). CEA content was measured in protein extracts obtained from these tissues using a quantitative RIA method. A limit of normality for CEA content was established as 300 ng/mg of protein. When this was taken as cut‐off, 104 of 110 (94.5%) tumor lesions and 51 of 110 (46.4%) autologous histologically normal colonic mucosa from cancer patients had elevated CEA levels. No correlation with stage of disease was found, while a correlation was observed with degree of tumor differentiation. A statistically significant difference between CEA content in tumor lesions and in histologically normal mucosa from cancer patients was observed (p = −0.001). Moreover, CEA content was statistically higher in the normal mucosa from cancer patients than in that from healthy donors (p = 0.005). CEA content in tissue specimens from benign lesions differed significantly from that in tissue from healthy donors (p = 0.005) and in carcinoma lesions (p < 0.001). The highest CEA content was observed in benign lesions with severe dysplasia. No statistical correlation between CEA content in carcinoma tissues and serum CEA levels (r = 0.195, p = .13) was found. Therefore, in considering diagnosis or therapy with anti‐CEA MAbs for colorectal‐carcinoma patients, or potential therapies with anti‐CEA recombinant vaccines, serum CEA levels should not be taken as indicating CEA expression in tumor lesions. Int. J. Cancer 72:949–954, 1997.

Flexible sigmoidoscopy: A potential advance in cancer control

The ACMI F91-S flexible fiberoptic sigmoidoscope was used for routine screening examinations in 468 subjects. The mean level reached was 63 cm (usually with less discomfort to the patient when compared with rigid proctosigmoidoscopy), and the average time required for the examination was 6 minutes. Of the polypoid lesions found, 53% were above the 25 cm level. The authors recommend the incorporation of flexible pansigmoidoscopy in mass screening programs.

Campylobacter pylori et gastrite: étude biologique, immunologique, histologique et endoscopique

RÉSUMÉLe rôle pathogène du Campylobacterpylori) dans l’étiologie de la gastrite a été suspecté par de nombreuses investigations. La présente étude a pour but une meilleure compréhension de ce problème. 83 patients examinés en ambulatoire ont subi une gastroscopie avec biopsies de la muqueuse antrale pour examen histologique et culture deC. pylori. Les anticorps anti-C. Pylori spécifiques ont été dosés dans le sérum.C. pylori était présent chez 79 % des patients présentant une gastrite superficielle, 68 % de ceux porteurs d’une gastrite atrophique. Aucun patient à muqueuse normale ne s’est révélé porteur duC. pylori. Les taux d’anticorps IgG anti-C. pylori étaient élevés chez les patients souffrant de gastrite, tant superficielle qu’atrophique, mais étaient absents chez les porteurs d’une muqueuse normale. Ces résultats suggèrent que l’immunoassay sérique peut constituer une méthode de diagnostic non invasive, fiable, particulièrement adaptée au dépistage de ce type de gastrite. Des investigations ultérieures seront nécessaires à la confirmation de cette hypothèse.SummaryThe possible role of Campylobacter pylori (Cp) in the aetiology of gastritis has been suspected in many investigations. The present study is a further contribution to a better understanding of this problem. In 83 outpatients we performed gastroscopy associated with biopsy of antral mucosa for histological and cultural search of Cp. Blood samples was also taken to determine specific circulating IgG anti-Cp. Campylobacter Pylori was present in 79 % of the patients with superficial gastritis, and in 68 % of those with atrophic gastritis. No patients with normal mucosa was found to be bearer of Cp. The level of anti-CP IgG was found elevated in patients with gastritis, superficial as well as atrophic, and absent in those with normal mucosa. It is suggested that immunological assay in serum might constitute a valid non invasive diagnostic tool that could be particularly useful for the screening of gastritis. Further investigations are in progress to obtain more data to support this hypothesis.ResumenEl papel del Campylobacter pylori) en la etiología dela gastritis ha sido motivo desospecha en numerosas investigaciones. El presente estudio tiene como objetivo una mejor comprensión de éste problema. 83 pacientes examinados ambulatoriamente sufrieron una gastroscopio con biopsia de la mucosa antral para examen histológico y cultivo de C. pylori. Se dosificaron los anticuerpos anti-C. pylori específicos en suero. El C. pylori se detectó en el 79 % de pacientes que presentaban una gastritis superficial, y en el 68 % de los que sufrían una gastritis atrófica. Ningun paciente con mucosa normal era portador de C. pylori. La tasa de anticuerpos IgG anti-C. pylori era alta en el grupo de pacientes que tenian gastritis, tanto superficial como atrófica, pero no habia trazas de los mismos en los pacientes con mucosa normal. Estos resultados sugieren que el inmunoensayo sérico puede ser un método de diagnóstico no invasivo, fiable, adaptado muy especialmente al despistaje de éste tipo de gastritis. Serum necesarias posteriores investigaciones que confirmen ésta hipótesis.

Improved local control and survival with the “sandwich” technique of pelvic radiotherapy for resectable rectal cancer

PURPOSE: The following study was done to evaluate the therapeutic value of radiotherapy as an adjunct to surgery for rectal cancer patients. METHODS: One-hundred twenty-four patients underwent curative resection by one surgeon (RC) from 1982 to 1991. Forty patients received combined preoperative and postoperative (sandwich) radiotherapy, 30 patients received postoperative radiotherapy, and 54 patients were treated by surgery alone. During the study period sandwich radiotherapy was primarily offered as a free treatment option for patients with tumors which were believed to be transmurally invasive, whereas postoperative radiotherapy was an alternative therapeutic option offered to patients with tumor classified as Dukes B and C at histopathologic examination. RESULTS: Operative mortality was 2 percent in the sandwich radiotherapy groupvs.7 percent in the surgery alone group. After a median follow-up of 60 months, the actuarial locoregional recurrence rate at five years was 3 percent for the sandwich radiotherapy group compared with 18 and 30 percent for the postoperative radiotherapy and surgery alone groups, respectively (P=0.019). A multivariate analysis using the Cox model confirmed the favorable independent influence of sandwich radiotherapy on local tumor control, especially in distal tumors. The therapeutic benefit of sandwich radiotherapy translated into increased survival in the low-rectum Dukes B subgroup of patients. The actuarial five-year survival rates were 86 percent, 50 percent, and 28 percent in the sandwich radiotherapy, postoperative radiotherapy and surgery alone groups, respectively (P=0.05). CONCLUSIONS: Preoperative radiotherapy has a significant effect on the prognosis of rectal cancer patients.

Cytologie dirigée dans les lésions précancéreuses du tractus digestif supérieur

RésuméL’endoscopie diagnostique du tractus digestif supérieur recourt à des techniques complémentaires telles que la cytologie dirigée et la biopsie qui, utilisées ensemble, procurent une précision de diagnostic proche de 100% dans les cas de cancer superficiel.Au niveau de l’œsophage, l’œsophagite chronique est associée à une fréquence accrue de cancer, en particulier dans les régions ou l’incidence de ce type de néoplasme est très élevée. Un projet de coopération a été mis au point avec le IARC-OMS en vue d’étudier le cancer œsophagien dans une région à haut risque située en Chine. Sur 185 patients soumis à une cytologie dirigée, 20 (1,8 %) se sont révélés porteurs de lésions de dysplasie, de différents degrés, non diagnostiquées par l’endoscopie et l’histologie.L’importance de la cytologie à la brosse a été soulignée dans les cas où il s’agit de confirmer ou de réfuter la présence d’une tumeur maligne dans une sténose œsophagienne inaccessible à la vision directe. La cytologie à la brosse s’est aussi révélée particulièrement utile dans le diagnostic précis de lésions précancéreuses de l’estomac telles que la gastrite chronique atrophique et 1’ulcere gastrique. En fait, en utilisant des critères basés sur les ≪ degrés ≫ de maturation cellulaire, un groupe de 116 cas de gastrite atrophique a putre isolé parmi 400 patients porteurs à l’endoscopie de lésions de gastrite en ≪ plaques≫. Une excellente corrélation (90,5 %) a été observée entre les données de la cytologie et de l’histologie. Dans une autre étude concernant 107 patients atteints d’ulcère gastrique, 8 cas d’ulcéro-cancer ont été mis en évidence. Chez 5 d’entre eux (71,5 %), la cytologie à la brosse a joué un rôle déterminant dans le diagnostic et dans un cas a permis de déceler un cancer ≪ in situé situ ≫ au niveau ďun ulcère classé comme bénin par l’histologie.La cytologie à la brosse est également utile dans la surveillance des patients gastrectomisés. Ceux-ci sont souvent porteurs de lesions diffuses du moignon et les processus de cicatrisation peuvent entraîner des doutes à propos du diagnostic histologique et même donner lieu à des résultats faussement négatifs. Dans ces cas, la cytologie à la brosse prélěve des échantillons sur la totalitè de la zone suspecte et permet ainsi un diagnostic précoce de dysplasie ou de malignitè.SummaryDiagnostic endoscopy of the upper digestive tract employs complementary methods such as aimed brush cytology and biopsy which, when used together, provide a diagnostic accuracy of almost 100 % in cases of early cancer.In the esophagus, chronic esophagitis is correlated with an increasing frequency of esophageal cancer, particularly in high incidence areas for this type of cancer. A cooperative project with the IARC-WHO was carried out to study esophageal cancer in a high risk area of China. Of 185 patients who underwent aimed cytology, 20 (1.8 %) were found to be carriers of various degrees of dysplasia which could not be endoscopically or hisiologically diagnosed.The importance of brush cytology should be stressed to confirm or rule out the presence of a malignant tumor in cases of esophageal stenosis which prevents having a direct view of the lesion. Brush cytology has also proven to be particularly useful in the diagnostic assessment of precancerous lesions of the stomach, such as chronic atrophic gastritis and gastric ulcer. In fact, by using criteria based on the grading of cell maturation, 112 cases of atrophic gastritis, out of a group of 400 patients with endoscopic findings of ≪ patchy ≫ gastritis, could be identified. A good agreement (95.5 %) was found between the cytologic and histologic diagnoses. In another study involving 117 subjects with gastric ulcer, 8 cases of ulcer-cancer were revealed. In 5 of these cases (71.5 %), brush cytology was crucial in the diagnosis and permitted diagnosing 1 case of ≪ in situé situ ≫ gastric cancer which developed on a histologically negative ulcer.Gastric brush cytology is also useful when dealing with subjects with a history of gastric surgery. These patients are often carriers of widespread lesions of the stump and the healing processes can often raise doubts at histology or even give false negative results. In these cases, brush cytology takes cell samples from the entire suspect area and may therefore permit the early diagnosis of dysplasia and malignancy.