Increased gastric epithelial cell proliferation in Helicobacter pylori associated follicular gastritis.

AIMS: An increase in the proliferative state of the gastric epithelium has been attributed to infection with Helicobacter pylori. In order to obtain a more precise estimate of the magnitude of this change, the proliferative state of 17 cases of florid H pylori associated follicular gastritis was examined using the antibody MIB-1. METHODS: Comparable results were produced from control and gastritis cases by using a combination of two reproducible measures of the labelled cells. Dividing cells in the gastric mucosa are concentrated within a proliferating compartment, situated at the base of the crypts. This compartment was measured and expressed as a proportion of the total crypt length. The proportion of positively labelled cells within the compartment was also counted. RESULTS: The proliferation compartment in the gastritis cases occupied 45.6% of the gastric crypt compared with 15.4% in the control group. Of the cells in the proliferating compartment, 79.5% were positively labelled in the gastritis cases and 33.4% in the control group. CONCLUSIONS: The convoluted nature of the gastric crypt does not make it a forgiving experimental model. The use of long lengths of mucosa obtained from gastrectomy specimens permitted the production of consistent results, using a morphometric method. The greater than 100% difference in the proportion of proliferating cells between the two groups suggests that further investigation is warranted.     

Primary amenorrhoea: the ambiguous non-entity.

Hypothalamic-pituitary activity was investigated in 20 women with primary amenorrhoea, in whom gonadal dysgenesis and lower Müllerian duct anomalies had been excluded. There was no specific or uniform pattern of response to luteinising hormone-releasing hormone and no evidence of a common defect at pituitary-hypothalamic level to account for the absence of spontaneous menstruation. Six women had hyperprolactinaemia; of these five had radiological evidence of pituitary enlargement. The conventional distinction between "primary" and "secondary" amenorrhoea should be abandoned, and, in common with current practice for other endocrine glands, primary amenorrhoea should indicate an abnormality of the gonad itself and secondary amenorrhoea an abnormality that results from hypothalamic-pituitary dysfunction.     

The reliability of British Sign Language and English versions of the Clinical Outcomes in Routine Evaluation – Outcome Measure with d/Deaf populations in the UK: an initial study

Previous research has argued that the mental well‐being of d/Deaf people is poorer than that of hearing populations. However, there is a paucity of valid and reliable mental health instruments in sign language that have been normalised with d/Deaf populations. The aim of this study was to determine the reliability of the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) with d/Deaf populations. A British Sign Language (BSL) version was produced using a team approach to forward translation, and a back‐translation check. The CORE‐OM was incorporated into an online survey, to be completed in either BSL or English, as preferred by the participant. From December 2010 to March 2011, data were collected from 136 d/Deaf people. Cronbach's α was used to measure the internal consistency of items in the CORE‐OM. Comparisons were made between versions, including comparisons with the non‐clinical hearing population (not in receipt of mental health services) in a previous study. The reliability of the overall score, as well as the non‐risk items in both the BSL and English versions, was satisfactory. The internal reliability of each domain in the BSL version was good (Cronbach's α > 0.70) and comparable to the English version in the hearing population. This was true for most domains of the CORE–OM in the English version completed by d/Deaf people, although the Functioning domain had a relatively low α of 0.79 and the Risk domain had an α of only 0.66 This raised the question whether it is advisable to use a mental health assessment with d/Deaf populations that has been standardised with hearing populations. Nevertheless, this study has shown that it is possible to collect data from d/Deaf populations in the UK via the web (both in BSL and English), and an online BSL version of the CORE‐OM is recommended for use with Deaf populations in the community.     

The assessment of prognosis of surgically resected oesophageal cancer is dependent on the number of lymph nodes examined pathologically

Aims:  The prognosis in surgically resected oesophageal carcinoma (OC) is dependent on the number of regional lymph nodes (LN) involved, but no guidance exists on how many LNs should be examined histopathologically to give a reliable pN status. The aim of this study was to determine whether the number of LNs examined after OC resection has a significant effect on the assessment of prognosis.
Methods and results:  Routinely generated pathology reports from 237 consecutive patients undergoing oesophagectomy for OC were examined and analysed in relation to survival. The main outcome measure was survival from date of diagnosis. Lymph node count (LNC) correlated strongly with survival; a plateau was reached after a count of 10. Median and 2-year survival was 30 months and 42%, respectively, if <10 nodes were examined ( n  = 88), compared with 51 months and 61% if >10 nodes were examined ( P  = 0.005). This effect was greatest in pN0 cases. The prognostic value of the absolute number of LN metastases (<4) and LN ratio (<0.4) was strongly dependent on a LNC of >10.
Conclusions:  These results demonstrate the importance of careful pathological examination and lymph node retrieval after OC resection. At least 10 nodes should be examined to designate an OC as pN0.     

Non-specific abdominal pain: the resource implications.

Non-specific abdominal pain (NSAP) is responsible for a significant proportion of emergency surgical admissions with resultant resource implications. The extent of the problem was assessed in a consecutive group of 100 patients, aged between 15 and 35 years, admitted with lower abdominal pain to one general surgical firm. No less than 67 of these patients (67%) were diagnosed as having NSAP (13.29% of all general surgical admissions), most (75%) being female and having a mean hospital stay of 4.1 days. Only 11 patients (11%) had appendicitis and the remaining 22 had miscellaneous gynaecological, urological or gastrointestinal problems. Detailed analysis of the resources used revealed that the mean cost to the NHS of each case of NSAP was 807 pounds, the bulk of which was attributable to the hospital stay. Wider assessment of the problem (by means of postal questionnaire) suggests that the cost to the NHS in Wales is in the region of 6 million pounds per year and may be over 100 million pounds per year in the UK as a whole.