Carpenter, Herschel A.

Currently in pancreas transplantation, only indirect evidence of graft dysfunction is used as the mainstay of diagnosing a rejection episode. However, histologic specimens obtained by open surgical procedures are required for diagnostic dilemmas. After demonstrating the safety and efficacy of a cystoscopically‐directed biopsy technique to obtain adequate histologic specimens in a canine pancreaticoduodenal allograft model, we began using a similar technique in our human recipients. Between December 1987 and January 1989, 16 patients received a pancreaticoduodenal allograft with a duodenocystostomy at the Mayo Clinic. Cystoscopically‐directed needle biopsy specimens of the pancreas were obtained at the time of graft dysfunction (hypoamylasuria) and at 10 days after transplantation. The biopsy procedure consisted of obtaining pancreatic core tissue specimens with an 18‐gauge Menghini biopsy needle introduced through a rigid side‐viewing néphroscope that had been inserted transurethrally through the urinary bladder into the transplanted duodenal segment. The specimens were identified to be adequate histologically if acinar tissue was present. Each biopsy procedure was followed closely by clinical and ultrasonic examinations and serum amylase determinations. In 12 recipients, we performed 23 cystoscopically‐directed biopsies and 14 specimens (61%) were adequate. However, of our last 13 biopsy specimens, 12 (92%) were adequate. The follow‐up time per biopsy was an average of 103 d (range, 4 to 290 d). We had only two complications. Both were episodes of moderate hematuria that resolved with less than 24 hours of urinary catheter drainage. No fistulae, pseudocysts, hematomas, episodes of pancreatitis, or infections related to the biopsy procedure were documented. We have demonstrated that the cystoscopically‐directed biopsy technique is a safe procedure in human pancreaticoduodenal transplantation. This procedure can be used to differentiate the many causes of graft dysfunction.

Enzyme-linked immunosorbent assays (ELISAs) have been developed to diagnose Helicobacter pylori infection. However, the methods are not standardized. We therefore prospectively evaluated the sensitivities and specificities of ELISAs developed in the United States and the United Kingdom in a study population comprising 41 consecutive symptomatic outpatients and 35 volunteers. At endoscopy, multiple biopsies were obtained for histology and culture and stained sections were graded for chronic gastritis, active chronic gastritis, and density of H. pylori. Serum samples were analyzed for H. pylori by ELISA. The first set of assays for immunoglobulin G (IgG) and IgA used a pool of sonicated isolates of H. pylori from five patients in the United States (antigen A). The second set of assays, developed in the United Kingdom, used three different antigens: antigen 1, an acid-extractable surface antigen; antigen 2, an acid-extractable antigen from an aflagellate variant; and antigen 3, a urease-containing fraction. Cutoff scores for positive results were determined a priori on the basis of previous serological studies. There was close agreement between histology and culture. In the study population, 36% of the individuals were H. pylori positive. The diagnostic value of the different ELISAs were highly comparable, and the crude antigens performed as well as the more purified antigens. The antigen A IgG had a sensitivity and specificity of 96 and 94%, respectively; the values for antigen 1 were 93 and 96%, respectively. The antigen A IgA and antigen 3 assays were the least sensitive tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract Early gastric cancer comprises more than 30 per cent of gastric carcinomas treated in Japan but remains an uncommon entity in the western hemisphere. A retrospective review of 48 patients with early gastric cancer undergoing operative treatment between 1965 and 1984 was carried out. The mean patient age was 70 years, in 31 men and 17 women. Preoperative diagnosis was made in 88 per cent of patients undergoing oesophagogastroduodenoscopy with biopsy but upper gastrointestinal radiography was diagnostic in only 20 per cent. Surgical management consisted of subtotal gastrectomy (86 per cent), total gastrectomy (10 per cent) and wide local excision (4 per cent). The operative mortality and morbidity rates were 0 and 38 per cent, respectively. Mean follow-up was 7.7 years, with 44 per cent of patients still alive. Multivariate analysis disclosed only a healthy. Eastern Cooperative Oncology Group score (P = 0.002) and a diploid DNA tumour pattern (P = 0.05) as significant prognostic variables of survival. The overall survival rate of patients with early gastric cancer (70 per cent at 5 years) was equivalent to that of an age- and sex-matched control population.