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We report a 15 years old girl presenting with severe hematochezia with secondary anemia and hemodynamic decompensation, rectal prolapse and spontaneous anal elimination of polyps. She had no family history of polyposis and a search for the disease in her close relatives was negative. A complete diagnostic work up did not find polyps in other segments of the digestive tract. Colonoscopy showed more than 200 polyps between the cecum and the rectum. Pathological analysis confirmed the presence of retention polyps with adenomatous areas and mild atypia. The patient was subjected to a proctocolectomy with ileal pouch and sphincteric preservation, using a mechanical suture. Postoperative evolution was uneventful and after 24 months of follow up, the patient is asymptomatic, with two stool movements per day and without incontinence.

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BACKGROUND: Sucrose permeability has been used as a marker to detect gastric lesions in children. As CagA status of Helicobacter pylori is an important factor in determining the evolution of the gastric lesion, CagA-positive strains being more frequently associated with severe mucosal lesions, the aim of this study was to determine the prevalence of CagA-positive strains in Helicobacter pylori-colonized children and to evaluate whether the sucrose permeability test might discriminate between colonization by CagA-positive or negative strains. PATIENTS AND METHODS: A series of 38 children (11.1+/-3.6 years) who required upper endoscopy for diagnostic purposes were included in the study. Endoscopy was carried out after the sucrose permeability test, and gastric biopsies were obtained for histologic examination, Helicobacter pylori detection by Giemsa staining and CLO-test, and determination of CagA status of the colonizing Helicobacter pylori strains by polymerase chain reaction. RESULTS: Helicobacter pylori was detected in 26 subjects (68.4%) and of these, 16 (61.5%) were colonized by CagA-positive strains. The intensity of the histologic findings was significantly associated with the presence of Helicobacter pylori and with CagA status of the infecting strains (chi2=21.2, p=0.0017). However no significant difference in the urinary excretion of sucrose between children not colonized and children with CagA- negative or positive strains was observed (0.027% [0.012-0.035%]; 0.027% [0.016-0.047%] and 0.026% [0.016-0.038], median [range], respectively; Kruskal-Wallis analysis of variance F=0.75, p=0.69). CONCLUSIONS: These results indicate that in Chile, about 60% of the Helicobacter pylori infected children are colonized by CagA-positive strains, in association with more intense lesions of the gastric mucosa, but that gastric permeability to sucrose does not discriminate between colonization by CagA-negative and positive strains of Helicobacter pylori.

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BACKGROUND: Helicobacter pylori produces a gastric mucosal inflammation characterized by neutrophil infiltration, due to the liberation of interleukin-8. AIM: To measure interleukin-8 levels in gastric mucosa samples from children colonized by H. pylori. PATIENTS AND METHODS: Thirty one children that required an upper gastrointestinal endoscopy for diagnostic purpose were studied. Antral biopsies were obtained for pathological study, H. pylori detection using CLO-test and interleukin-8 determination by ELISA. RESULTS: Nine children were not infected with H. pylori. Of these, six had a pathologically normal gastric mucosa and three had a mild chronic gastritis. Twenty two children were infected by H. pylori and all had a chronic gastritis with activity signs in 13. Mucosal interleukin-8 was higher in infected than in non infected children (59.7 (range 6.1-379.7) and 15.8 (range 3.9-104.1) pg/mg respectively p = 0.029). Colonized children with an active chronic gastritis had higher interleukin-8 levels than those with inactive gastritis (84.4 (range 33.3-379.0) and 26.8 (range 6.1-372.6) pg/ml respectively p = 0.04). CONCLUSIONS: Stomach colonization by H. pylori is associated with higher mucosal levels of interleukin-8. This phenomenon probably plays a role in the genesis and intensity of gastric mucosal inflammation in children.

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BACKGROUND: Increased permeability to sucrose has been recently shown to be a good marker of gastric mucosal damage in adults. METHODS: This test was evaluated in 40 children consulting for recurrent abdominal pain and the results were correlated with endoscopic and histologic findings and with the presence of H. pylori. RESULTS: The gastric mucosa was considered endoscopically normal in 31 children; 3 had duodenitis and 6 had mild gastritis. Abnormal endoscopic findings were associated with increased urinary sucrose excretion (MANOVA F = 7.30; p = 0.002). In the 6 children with mild gastritis, mean sucrose excretion was twice that of controls (0.060 +/- 0.024 vs. 0.029 +/- 0.018, respectively; p = 0.019) and significantly higher than the group with duodenitis (0.037 +/- 0.013; p = 0.038). The specificity and sensitivity of sucrose permeability test for detection of gastric damage were 90.3% and 83.3%, respectively. H. pylori was detected in 62.5% of children including all patients with mild gastritis, in 2 out of 3 with duodenitis and 17 out of 31 endoscopically normal controls. No differences in sucrose excretion were observed in relation with the presence of H. pylori or histological findings in the control group. CONCLUSIONS: Urinary sucrose excretion is a good marker of mucosal gastric damage in children and may be used as a screening test in large groups of populations.

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A case of fetal hamartoma cyst diagnosed prenatally was successfully removed surgically after birth.

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Premature amnion rupture occurs in about 5%-7% of normal pregnancies. Early and prolonged decreased amount of amniotic fluid determines deformities and impairment of fetal lung development. We report a case of a 35 year old mother with severe oligohydramnios since 25 weeks gestation, secondary to premature rupture of membranes. A male baby was born a 31 weeks with unmanageable asphyxia dying eleven hours later. Pathologic findings revealed a Potter phenotype including severe lung hypoplasia. The fall in intrauterine volume affects, through diverse mechanisms lung growth and maturation. The duration and severity of oligohydramnios are important elements in predicting the risk of pulmonary hypoplasia and neonatal morbidity.

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Two families in which insulin-dependent diabetes was associated with coeliac disease were studied. All patients had the HLA B 8 antigens. In one case there was an association of HLA B 8 with BW 15. The HLA B 8 determinant was found in that of the parents with a familial diabetic trait. These findings contribute to replace the association diabetes-coeliac disease in the larger frame of auto-immune diseases.

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