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Biomedical subjects

Y Elitsur

Publications and source records attributed to Y Elitsur.

At least 37 records · Page 2Linked to original sources
PubMed1998

Prospective comparison of rapid urease tests (PyloriTek, CLO test) for the diagnosis of Helicobacter pylori infection in symptomatic children: a pediatric multicenter study.

OBJECTIVE: Rapid urease tests are reliable methods to diagnose Helicobacter pylori (HP) infection in the endoscopy suite. The PyloriTek test kit is a new rapid urease test that has the advantage of a 1-h final reading. The aim of this study was to compare the accuracy of PyloriTek and the test in the diagnosis of H. pylori infection in children. METHODS: Children from four different pediatric gastroenterology centers were recruited prospectively into the study. These children were >5 yr old and had an upper endoscopy procedure. Antral biopsies were examined for both rapid urease tests in the endoscopy suite, and others were sent for routine histological examination. RESULTS: A total of 242 children were recruited into the study over approximately 1 yr. The concordance between PyloriTek and CLO test was 98% (238 of 242). Twenty-five children were positive for HP organisms by PyloriTek and CLO test, whereas four children were positive by PyloriTek but negative by CLO test. PyloriTek was comparable to CLO test for the diagnosis of HP organisms and HP-associated gastritis. Moreover, in 48% of the positive results, PyloriTek gave significantly faster results than CLO test. CONCLUSIONS: We conclude that PyloriTek is an appropriate rapid urease test to use in children and may have an advantage over the CLO test because of its shorter reading time.

Biopsy↗
PubMed1998

Identification of a hereditary pancreatitis mutation in four West Virginia families.

Hereditary pancreatitis (HP) is the second most common cause of chronic childhood pancreatitis in the United States. Mutations in the cationic trypsinogen gene on chromosome 7 are known to cause HP. We identified four families in West Virginia with symptoms consistent with HP. To determine whether members of these families had defects in the trypsinogen gene, we tested for linkage between the HP gene and simple tandem repeat markers on chromosome 7q and screened for a specific mutation in the cationic trypsinogen gene. Two-point linkage analysis indicated that the disease gene is closely linked to three 7q markers (D7S661, D7S2511, and D7S1805). Restriction fragment length polymorphism analysis showed that all clinically affected members and nonpenetrant carriers from the four families carried a G to A mutation in the third exon of the trypsinogen gene. These findings indicate that this mutation is the cause of HP in the families in our study. The observation that most individuals who carry the mutation have symptoms of HP is consistent with the high but incomplete penetrance of the trait. The presence of a single mutation and a common linked haplotype indicates that the defective allele arose in an ancestor common to all four families.

Child↗
PubMed1998

Human vaginal mucosal immune system: characterization and function.

OBJECTIVE: The mucosal immune system has been recognized as the first line of defense against foreign antigens. The limited information available on the mucosal immunity of the lower reproductive organs have restricted our ability to fight infections, especially, the sexually transmitted disease. The aim of this study was to characterize in-vitro the human vaginal lamina propria lymphocytes (VLPL), their cell surface phenotypes, and cellular function. METHODS: VLPL were isolated from human vaginal mucosa by enzymatic techniques. Cell surface characteristics were investigated by immunohistochemistry and flow cytometric analysis. Cellular immune function was evaluated by 3H-thymidine incorporation studies and ornithine decarboxylase (ODC) activity. RESULTS: Immunohistochemistry and flow cytometric analysis showed that the CD4/CD8 ratio of the human vaginal mucosa is reversed compared to the gut lamina propria lymphocytes (0.55 +/- 0.17). PHA and ConA mitogens enhanced VLPL thymidine incorporation, while PWM did not have any significant effect. Very high level of ODC activity was observed in VLPL after PHA stimulation. CONCLUSIONS: The human VLPL can be isolated, characterized, and respond to a mitogenic stimulus. We postulate that further analysis of the vaginal immune system will enhance our understanding of local defence mechanisms which will help in the development of new therapeutic modalities against vaginal infections.

CD4-CD8 Ratio↗
PubMed1997

Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group.

BACKGROUND: Hereditary pancreatitis is an autosomal-dominant disease, with a variable expression and an estimated penetrance of 80%. The gene for this disease has recently been mapped to chromosome 7q35, and the defect is believed to be caused by a mutation in the cationic trypsinogen gene. Acute attacks of abdominal pain begin early in life and the disease often progresses to chronic pancreatitis. Although the risk of pancreatic cancer is thought to be increased in more common types of chronic pancreatitis, the frequency of pancreatic cancer in the inherited type of pancreatitis is uncertain. PURPOSE: The aim of this study was to assess the frequency of pancreatic cancer and other tumors in patients with hereditary form of pancreatitis. METHODS: To determine the natural history of hereditary pancreatitis, we invited all members of the American Pancreatic Association and the International Association of Pancreatology to participate in a longitudinal study of this rare form of pancreatitis. The initial criteria for patient eligibility were as follows: early age (< or = 30 years) at onset of symptoms, positive family history, and absence of other causes. From April 1995 through February 1996, 37 physicians from 10 countries contributed medical records of 246 (125 males and 121 females) patients thought to have hereditary pancreatitis as the most likely diagnosis. This group included 218 patients where the diagnosis appeared to be highly probable and 28 additional patients where the diagnosis of hereditary pancreatitis was less certain: 25 patients who had relatively late onset of disease and a positive family history and three patients with onset of disease before age 30 years but with an uncertain family history. We reviewed all causes of death and compared the observed to the expected frequency of cancer in this historical cohort of patients with hereditary pancreatitis. The strength of the association between pancreatitis and pancreatic cancer was estimated by the standardized incidence ratio (SIR), which is the ratio of observed pancreatic cancer cases in the cohort to the expected pancreatic cancers in the background population, adjusted for age, sex, and country. RESULTS: The mean age (+/- standard deviation [SD]) at onset of symptoms of pancreatitis was 13.9 +/- 12.2 years. Compared with an expected number of 0.150, eight pancreatic adenocarcinomas developed (mean age +/- SD at diagnosis of pancreatic cancer: 56.9 +/- 11.2 years) during 8531 person-years of follow-up, yielding an SIR of 53 (95% confidence interval [CI] = 23-105). The frequency of other tumors was not increased: SIR = 0.7 (95% CI = 0.3-1.6). Eight of 20 reported deaths in the cohort were from pancreatic cancer. Thirty members of the cohort have already been tested for the defective hereditary pancreatitis gene: all 30 carry a mutated copy of the trypsinogen gene. The transmission pattern of hereditary pancreatitis was known for 168 of 238 patients without pancreatic cancer and six of eight with pancreatic cancer. Ninety-nine of the 238 patients without pancreatic cancer and six of the patients with pancreatic cancer inherited the disease through the paternal side of the family. The estimated cumulative risk of pancreatic cancer to age 70 years in patients with hereditary pancreatitis approaches 40%. For patients with a paternal inheritance pattern, the cumulative risk of pancreatic cancer is approximately 75%. CONCLUSIONS: Patients with hereditary pancreatitis have a high risk of pancreatic cancer several decades after the initial onset of pancreatitis. A paternal inheritance pattern increases the probability of developing pancreatic cancer.

Adolescent↗
PubMed1997

Vitamin A and retinoic acids immunomodulation on human gut lymphocytes.

Epidemiological studies have suggested an important immunomodulatory role for vitamin A and other related vitamin A compounds in adults and children. Although vitamin A is absorbed via the gastrointestinal tract, its affect on the gut mucosal immune cells has not been adequately investigated. We investigated the in-vitro effect of vitamin A (retinol) and its retinoid acid (RA) compounds (13-cis- and all trans-retinoic acids) on the human gut mucosal immune system as represented by colonic lamina propria lymphocyte (LPL) proliferation, and ornithine decarboxylase (ODC) activity. Results showed that retinol suppressed and trans-retinoic acid enhanced thymidine incorporation into LPL. 13-cis retinoic acid did not significantly affect LPL DNA synthesis. Similarly, retinol (0.025 microgram/ml and 10 micrograms/ml) and 13-cis retinoic acid (conc. 10 micrograms/m) suppressed, while all trans-retinoic acid (conc. 10 micrograms/ml) enhanced ODC activity in PHA-stimulated LPL. Interestingly, the effects of retinol and all trans-RA were abolished when LPL were previously depleted of macrophages. Addition of monocyte-associated lymphokines, IL-1 and IL-6, showed that IL-1 partially replaced the enhancing effect of all trans-RA previously observed on LPL thymidine incorporation. IL-6 did not affect LPL DNA synthesis irrespective of the vitamin A compound used. We conclude that retinol and retinoid acids (13-cis, all trans-) may alter the human colonic immune system possibly via IL-1 cytokine, but not via IL-6. The data suggest that vitamin A and its retinoid compounds may participate in the modulation of the gut immune system.

Adjuvants, Immunologic↗
PubMed1997

Comparison between a rapid office-based and ELISA serologic test in screening for Helicobacter pylori in children.

BACKGROUND: The rapid diagnostic serological test for detection of Helicobacter pylori (H. pylori) infection in children has a significant advantage over the standard enzyme immunoassay (EIA) method, for its simplicity and rapid availability of results in a physician's office setting. We compared the immunochromatographic test with a standard enzyme immunoassay test in the pediatric population. MATERIALS AND METHODS: A retrospective analysis of 1147 serum samples from asymptomatic children and prospective analysis of 62 serum samples from symptomatic children undergoing diagnostic upper endoscopy were evaluated for the detection of H. pylori antibody by two commercially available serology tests. Each serum sample was tested by a rapid test (FlexSure HP, SmithKline Diagnostics, Inc.) and compared to the standard EIA method (HM-CAP, Enteric Products, Inc.). RESULTS: The rapid test, FlexSure HP, was comparable to the rapid EIA test in screening for H. pylori infection in symptomatic and asymptomatic children with sensitivity and specificity of 83-90% and 90-100%, respectively. Both methods had a comparable sensitivity and specificity for the detection of H. pylori-associated gastritis (60-70% and 94%, respectively). CONCLUSION: The rapid test is comparable to the standard EIA test and may be used by physicians in symptomatic children. The use of FlexSure HP as a screening tool for the prevalence of H. pylori infection in asymptomatic children may be limited by its low positive predictive value compared to the EIA method.

Adolescent↗
PubMed1997

Is duodenal gastric metaplasia a consequence of Helicobacter pylori infection in children?

BACKGROUND: Duodenal gastric metaplasia (DGM) is commonly found in association with Helicobacter pylori (Hp)-associated gastritis in adults. DGM is also considered a risk factor for duodenal ulcer development. The prevalence of DGM in children and its association with gastritis, duodenitis, or the presence of Hp organisms is not clear. We investigated the prevalence of DGM in children and explore its association with several possible risk factors, including age, gender, gastritis, duodenitis, or Hp presence in the gastric antrum. METHODS: A retrospective analysis of 173 upper endoscopy procedures performed between 1993 and 1995 at Cabell Huntington Hospital, Huntington, WV, was done. Gastric and duodenal biopsies were stained with Giemsa for Hp detection, periodic acid-Schiff for DGM, and hematoxylin and eosin for histologic assessment. Gastric mucosal inflammation was graded according to Sydney criteria. RESULTS: Duodenal gastric metaplasia was identified in 23 of 173 (13%) patients. Duodenitis but not age, gender, gastritis, or the presence of Hp in the gastric antrum was associated with DGM development. In 4 of 23 DGM foci, Hp was identified. CONCLUSIONS: In children, DGM is not the consequence of Hp infection.

Adolescent↗
PubMed1995

FK-506 and cyclosporine A (CsA) immunomodulation of the human gut mucosal immune system.

FK-506 and cyclosporine A (CsA) are two immunosuppressive drugs used in the treatment of patients after liver and small intestine transplantation. A clinical advantage of FK-506 over CsA has been observed in these patients. Although the immunomodulation of both drugs has been well documented in the circulatory immune system, their effect on the mucosal immune system is not well established. In this study, the effect of FK-506 on the human gut mucosal immune system was compared to CsA. Proliferation of human colonic lamina propria lymphocytes (LPL) was measured by DNA synthesis and ornithine decarboxylase (ODC) activity. Results show that FK-506 and CsA suppress LPL DNA proliferation in a dose-dependent manner. FK-506 had a stronger antiproliferative effect compared to CsA. Moreover, the antiproliferative effect of both drugs was not dependent on monocytes or monocyte-associated factors (IL-1 beta, IL-6). In addition, exogenous addition of IL-2 did not restore the suppressive effect of either drug on LPL DNA synthesis. We conclude that: (1) both drugs have an antiproliferative effect on the human mucosal immune system; and (2) the stronger effect of FK-506 on human LPL compared to CsA may explain its superior clinical response observed in patients after liver/small intestine transplantation.

Cell Division↗
PubMed1995

Ornithine decarboxylase and tyrosine kinase activity in juvenile polyps of childhood.

Juvenile polyps (JP) are the most common colonic tumor in children. Although considered benign, malignant transformation has been reported in JP. Ornithine decarboxylase (ODC) and tyrosine kinase (TyK) enzymes are markers for a rapid cell proliferation index. DNA aneuploidy score and p53 gene expression are late malignant changes seen in patients with colon cancer. In this study, we investigated ODC and TyK activities as well as DNA aneuploidy score and p53 expression in juvenile polyps compared with the adjacent normal colonic mucosa. Results showed that ODC was significantly increased in JP compared with the adjacent normal colonic mucosa. TyK activity was increased in 3/5 polyps and decreased in 2/5 polyps compared with the mucosa. Mean TyK activity was higher in JP compared with normal mucosa but did not reach significance (707 and 632 pmol/mg pmol, respectively). Moreover, changes in phosphorylization of TyK proteins was also observed in JP but not in normal mucosa. JP had a normal DNA aneuploidy score and showed no expression of p53 gene. We conclude that JP do not express p53 gene and aneuploidy but had higher activity of ODC and TyK enzymes, suggesting a higher stage of cell proliferation.

Adolescent↗
PubMed1995

Keep the change, doc!: coins in the upper GI tract of children.

Many children are brought to the Emergency Room each year because they have swallowed foreign bodies (FBs), particularly coins. Whether to remove these foreign bodies or let them pass through naturally is a constant dilemma for ER physicians. This article reviews our experiences in treating pediatric patients who underwent FB retrieval for coins, food particles and toy parts, and discusses their clinical and endoscopic findings. The vast majority (82%) of the swallowed FBs were lodged in the esophagus. A review of the literature and a suggested medical protocol to manage patients who have swallowed coins are also discussed in this article.

Adolescent↗
PubMed1994

Ornithine decarboxylase (ODC) levels in children with reflux esophagitis.

Reflux esophagitis is a common disease in infants and can be diagnosed largely by esophageal biopsy. In adults, chronic esophagitis may lead to Barrett's esophagus, a premalignant condition for esophageal cancer development. Ornithine decarboxylase (ODC) is used as an early marker for colon cancer development. No data are available on the role of ODC in reflux esophagitis in the pediatric population. In this study we retrospectively analyzed ODC activity in esophageal biopsies of children who underwent upper endoscopy. According to the esophageal histology, patients were divided into three groups: normal mucosa, mild, and moderate/severe esophagitis. None of our patients had esophageal metaplasia or cancer. ODC level was significantly higher in the moderate/severe esophagitis group compared to mild and normal mucosa group. We conclude that ODC activity is directly proportional to the severity of the esophageal inflammation/regenerative process in children with reflux esophagitis.

Biopsy↗
PubMed1994

Neuropeptide Y (NPY) enhances proliferation of human colonic lamina propria lymphocytes.

Neuropeptide Y (NPY) is one member of a family of peptides with a wide range of physiological effects on the CNS, cardiovascular, and respiratory systems. NPY is widely distributed throughout the peripheral and central nervous systems. It has also been found within the colon, liver and gallbladder in close anatomic proximity to the mucosal immune system. In this study, we investigated the effect of NPY on human gut mucosal immune function. We examined colonic lamina propria lymphocyte (LPL) proliferation by measuring DNA synthesis, ornithine decarboxylase (ODC) activity, and polyamine biosynthesis. NPY enhanced ODC activity and polyamine biosynthesis in Con A-stimulated LPL, and enhanced thymidine incorporation into Con A-stimulated LPL but not into monocyte-depleted LPL. Moreover, exogenous IL1-beta partially restored NPY's stimulatory effect on monocyte-depleted LPL DNA synthesis. Our results demonstrate that NPY enhances human colonic LPL proliferation and that this effect is partially IL1-beta dependent. Our data also suggest that NPY's effect may be mediated via polyamine biosynthesis. We postulate that the NPY may have an important impact on human mucosal immune function.

Cell Division↗
PubMed1994

A study of Helicobacter-pylori in 100 pediatric patients from the Tri-State area.

Helicobacter pylori (HP) is a newly discovered pathogen implicated in the pathophysiology of peptic ulcer disease. The aim of this study was to review all pediatric patients who were evaluated by upper endoscopy through the Pediatric Gastroenterology Service at the Marshall University School of Medicine between July 1990 and March 1993. A total of 100 charts were retrospectively reviewed. HP was diagnosed by CLO-test and confirmed histologically. Results showed that the major presenting symptom was abdominal pain (53%). GI mucosal inflammation was found in 77 patients, and 41% of these cases were associated with HP. Two patients had duodenal ulcer; both were HP+. The incidence of gastritis was significantly higher in patients with HP+ compared to HP-. Follow-up on the HP-associated gastritis showed no significant difference in their clinical response irrespective to the treatment, we conclude that HP in children is highly associated with gastritis, but not duodenitis or esophagitis; and in our experience, that CLO has a high failure rate in identifying HP in the mucosa.

Adolescent↗
PubMed1993

ODC activity and polyamine levels in isolated human colonocytes.

Ornithine decarboxylase (ODC) is the first and often rate-limiting enzyme in polyamine biosynthesis. ODC and polyamines (putrescine, spermidine, spermine, and cadaverine) have an essential role in cell proliferation. In this study, we investigated ODC activity and the polyamine levels of normal human colonocytes isolated from the upper and lower crypt regions. We found no significant differences in ODC activity between upper and lower crypt regions (mean +/- SEM: 105 +/- 60 and 103 +/- 52 pmol CO2/mg protein/hr, respectively). This result was further substantiated by ODC immunoreactive antibody staining technique. Levels of polyamines (putrescine, spermidine, spermine, and cadaverine) were similar in the upper and lower crypt regions (mean +/- SEM; upper/lower: 79 +/- 29/79 +/- 18; 189 +/- 116/ 137 +/- 38; 174 +/- 58/204 +/- 35; and 52 +/- 10/51 +/- 10 nmol/mg protein, respectively). Acetyl-polyamines (acetyl-putrescine, acetyl-spermidine, and acetyl-spermine) levels in human colonocytes showed no significant differences between upper and lower crypt regions (mean +/- SEM; U/L: 368 +/- 109/408 +/- 89, 63 +/- 22/51 +/- 12, and 39 +/- 12/41 +/- 14 nmol/mg protein, respectively). Our results suggest that in isolated normal human colonocytes, ODC activity and polyamine levels are similar in the upper and the lower crypt regions.

Acetylation↗
PubMed1993

A prospective randomized study with mineral oil and oral lavage solution for treatment of faecal impaction in children.

Faecal impaction with or without encopresis is a very common problem. We performed a randomized, open-label, prospective study to compare the efficacy and acceptability of the treatment of faecal impaction using either mineral oil or pineapple-flavoured isotonic intestinal lavage solution containing polyethylene glycol-3350 (Colyte). Thirty-six patients over 2 years of age were randomized to receive either mineral oil or flavoured lavage solution. The dose of mineral oil was 2 to 8 tablespoons twice a day for two days (17 patients--Group I) and of lavage solution was 20 ml/kg/h for 4 hours on two consecutive days (19 patients--Group II). The patients were assessed for the presence of abdominal faecal masses, presence and consistency of rectal mass, perineal soiling before and two days after either of the randomly assigned treatment. The patients and parents were asked regarding the compliance with treatment, side-effects, number of bowel movements after treatment and willingness to try similar treatment if faecal impaction recurred. Patients in the lavage group had more frequent bowel movements, and showed more effective clearance of abdominal and rectal lumps (P < 0.01) at the time of repeat examination at two days. However, they had some vomiting and were less compliant (P < 0.01) when compared to mineral oil patients. We conclude that balanced lavage solution effectively relieves faecal impaction, however, compliance with its use is poorer than that with mineral oil.

Administration, Oral↗