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Resumen: Introducción y objetivo: La infección por Helicobacter pylori (H. pylori) representa el factor etiológico más importante en numerosas enfermedades gastroduodenales. A pesar de haberse utilizado múltiples esquemas antibióticos para modificar su morbimortalidad asociada, la prevalencia de esta infección bacteriana continúa siendo desproporcionadamente alta en todo el mundo, debido principalmente a la resistencia antibiótica. A los efectos de evaluar la eficacia no inferior y la seguridad de 2 regímenes de triple terapia durante 10 días para la erradicación de H. pylori comparamos claritromicina 500 mg, lansoprazol 30 mg y amoxicilina 1 g, 2 veces al día (terapia triple estándar o CLA, grupo 1) vs. pantoprazol 80 mg, levofloxacina 500 mg y 500 mg de azitromicina, 1 vez al día (PLA, grupo 2). Los 2 regímenes fueron comparados en pacientes previamente no tratados. Material y métodos: Entre junio del 2012 y marzo del 2014 se llevó a cabo un estudio abierto de fase iiib aleatorizado y de no inferioridad que comparó CLA versus PLA en un periodo de 10 días. La erradicación se verificó con pruebas de aliento con 13C-urea. Las biopsias gástricas se analizaron para resistencia a claritromicina por hibridación fluorescente in situ, anterior a la administración de cualquier antibiótico. Los resultados de eficacia y seguridad fueron analizados siguiendo la metodología de no inferioridad. Resultados: De los 227 sujetos positivos a H. pylori que fueron aleatorizados, finalmente se analizaron 194 por protocolo solamente. La tasa de erradicación del grupo 2 fue del 63%, no inferior a la tasa de erradicación del grupo 1 del 58.5% (límite superior IC 95% = 0.11608; margen de no inferioridad = 0.1200). La resistencia a la claritromicina evaluada fue del 28.2%. Los eventos adversos fueron significativamente mayores en el grupo 1 que en el grupo 2 (86% vs. 65.4%, p = 0.001). Conclusiones: La erradicación de H. pylori en primera línea con terapia combinada de pantoprazol/levofloxacina/azitromicina resulta tan efectiva como con la terapia triple estándar, aunque con mejor tolerabilidad y una dosificación más fácil. La resistencia a la claritromicina debe considerarse en los tratamientos de erradicación del H. pylori.ClinicalTrials.gov identificación: NCT02726269. Abstract: Introduction and aims: Helicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 2 10-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500 mg, lansoprazole 30 mg, and amoxicillin 1 g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80 mg, levofloxacin 500 mg and azithromycin 500 mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients. Materials and methods: An open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified with 13C-urea breath testing. Gastric biopsies were tested for fluorescence in situ hybridization (FISH)-clarithromycin resistance prior to any antibiotic administration. Efficacy and safety results were analyzed according to the noninferiority methodological approach. Results: From the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p = 0.001). Conclusions: First-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments.ClinicalTrials.gov identifier NCT02726269. Palabras clave: Helicobacter pylori, Claritromicina, Levofloxacina, Inhibidores de bombas de protones, Keywords: Helicobacter pylori, Clarithromycin, Levofloxacin, Proton pump inhibitors

Introduction and aims: Helicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 2 10-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500 mg, lansoprazole 30 mg, and amoxicillin 1 g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80 mg, levofloxacin 500 mg and azithromycin 500 mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients. Materials and methods: An open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified with 13C-urea breath testing. Gastric biopsies were tested for fluorescence in situ hybridization (FISH)-clarithromycin resistance prior to any antibiotic administration. Efficacy and safety results were analyzed according to the noninferiority methodological approach. Results: From the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p = 0.001). Conclusions: First-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments.ClinicalTrials.gov identifier NCT02726269. Resumen: Introducción y objetivo: La infección por Helicobacter pylori (H. pylori) representa el factor etiológico más importante en numerosas enfermedades gastroduodenales. A pesar de haberse utilizado múltiples esquemas antibióticos para modificar su morbimortalidad asociada, la prevalencia de esta infección bacteriana continúa siendo desproporcionadamente alta en todo el mundo, debido principalmente a la resistencia antibiótica. A los efectos de evaluar la eficacia no inferior y la seguridad de 2 regímenes de triple terapia durante 10 días para la erradicación de H. pylori comparamos claritromicina 500 mg, lansoprazol 30 mg y amoxicilina 1 g, 2 veces al día (terapia triple estándar o CLA, grupo 1) vs. pantoprazol 80 mg, levofloxacina 500 mg y 500 mg de azitromicina, 1 vez al día (PLA, grupo 2). Los 2 regímenes fueron comparados en pacientes previamente no tratados. Material y métodos: Entre junio del 2012 y marzo del 2014 se llevó a cabo un estudio abierto de fase iiib aleatorizado y de no inferioridad que comparó CLA versus PLA en un periodo de 10 días. La erradicación se verificó con pruebas de aliento con 13C-urea. Las biopsias gástricas se analizaron para resistencia a claritromicina por hibridación fluorescente in situ, anterior a la administración de cualquier antibiótico. Los resultados de eficacia y seguridad fueron analizados siguiendo la metodología de no inferioridad. Resultados: De los 227 sujetos positivos a H. pylori que fueron aleatorizados, finalmente se analizaron 194 por protocolo solamente. La tasa de erradicación del grupo 2 fue del 63%, no inferior a la tasa de erradicación del grupo 1 del 58.5% (límite superior IC 95% = 0.11608; margen de no inferioridad = 0.1200). La resistencia a la claritromicina evaluada fue del 28.2%. Los eventos adversos fueron significativamente mayores en el grupo 1 que en el grupo 2 (86% vs. 65.4%, p = 0.001). Conclusiones: La erradicación de H. pylori en primera línea con terapia combinada de pantoprazol/levofloxacina/azitromicina resulta tan efectiva como con la terapia triple estándar, aunque con mejor tolerabilidad y una dosificación más fácil. La resistencia a la claritromicina debe considerarse en los tratamientos de erradicación del H. pylori.ClinicalTrials.gov identificación: NCT02726269. Keywords: Helicobacter pylori, Clarithromycin, Levofloxacin, Proton pump inhibitors, Palabras clave: Helicobacter pylori, Claritromicina, Levofloxacina, Inhibidores de bombas de protones

Helicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 210-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500mg, lansoprazole 30mg, and amoxicillin 1g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80mg, levofloxacin 500mg and azithromycin 500mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients.An open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified withFrom the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p=0.001).First-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments. ClinicalTrials.gov identifier NCT02726269.

With the routine use of prostate specific antigen, focal carcinomas and atypical small acini proliferation (ASAP) are currently detected more frequently. The number of sections per cylinder needed to detect most of them is still unknown.We reviewed 250 sextant prostate biopsies in the 2008-2011 period. The average number of cylinders per biopsy was 14. In each case, in addition to the original sections with three histological levels, three more sections were performed with three levels (total: 12 levels). Biopsies with focal lesion were analyzed immunohistochemically. The frequency of focal lesions was compared to a previous study of 1000 biopsies in which a single section was made with three histological levels. The main clinical and laboratory data were recorded.There were 16 focal lesions (6.4%). Seven (2.8%) corresponded to focal carcinomas and nine (3.6%) to atypical proliferation. In the previous study, thirteen (1.3%) focal carcinomas and 29 (2.9%) cases with atypical proliferation were found.There was an increase of 4.2% to 6.4% of focal lesions carcinomas increased from 1.3% to 2.8%. Making additional sections in all biopsies may have practical drawbacks. However, they could be performed in patients with high clinical suspicion of carcinoma (especially in young patients), or when there is a history of atypical glandular proliferations consistent with carcinoma in previous biopsies.

Varieties of prostatic adenocarcinoma whose architectural and cytological appearance mimicked benign lesions have been reported in recent decades. Such neoplasms include xanthomatous (foamy) carcinoma and pseudohyperplastic carcinoma. We recently studied five carcinomas showing a cytoarchitectural combination of both neoplasms which were confused with benign glandular proliferations.Five cases (1.8%) of pseudohyperplastic carcinoma showing xanthomatous changes were selected from a total of 280 biopsies showing prostate carcinoma. Glandular prostatic hyperplasia was originally diagnosed in four of such cases.Patient age ranged from 54 and 78 years (mean, 64 years). All patients had high prostate-specific antigen levels, and digital rectal examination showed abnormalities in four of them. Neoplasms showed minimal atypia and consisted of mid- to large-sized glands arranged in nests resembling hyperplastic nodules. Glands showed papillary projections, infoldings, and undulations. Most nuclei were basal, small and hyperchromatic, and nucleomegaly was only seen in two biopsies in isolated histological fields. Several useful criteria for diagnosis of acinar carcinoma, such as perineural infiltration, mitosis, crystalloids, blue secretions, and prostatic intraepithelial neoplasm, were absent.Prostatic carcinoma with a pseudohyperplastic pattern and xanthomatous changes mimics hyperplastic glands. Timely detection is critical to avoid treatment delay.

Introducción y objetivos: En las últimas décadas se han descrito variedades de adenocarcinoma prostático que por su arquitectura y su aspecto citológico semejan lesiones benignas. Estas neoplasias incluyen al carcinoma xantomatoso (espumoso) y al carcinoma pseudohiperplásico. Recientemente hemos estudiado cinco carcinomas que mostraron una combinación citoarquitectónica de ambas neoplasias y fueron confundidas con proliferaciones glandulares benignas. Métodos: De un total de 280 biopsias con carcinoma prostático se seleccionaron cinco casos (1,8%) de carcinoma pseudohiperplásico que mostraron cambios xantomatosos. Cuatro de ellos fueron diagnosticados originalmente como hiperplasia glandular prostática. Resultados: La edad de los pacientes varió de 54 a 78 años (promedio: 64 años). El antígeno prostático estuvo elevado en todos, y en el examen digital rectal se encontraron alteraciones en cuatro. Las neoplasias mostraron atipia mínima y estuvieron constituidas por glándulas de mediano y gran tamaño que se disponían en nidos semejantes a nódulos hiperplásicos. Las glándulas mostraron proyecciones papilares, plegamientos y ondulaciones. La mayoría de los núcleos fueron basales, pequeños e hipercromáticos, y sólo ocasionalmente se observó nucleomegalia. Varios criterios útiles en el diagnóstico de carcinoma acinar, incluyendo infiltración perineural, mitosis, cristaloides, secreciones azules y neoplasia intraepitelial prostática, estuvieron ausentes. Conclusiones: Los carcinomas prostáticos con patrón pseudohiperplásico y cambios xantomatosos semejan glándulas hiperplásicas. Su reconocimiento oportuno es crucial para evitar retardo en el tratamiento. Introduction and objectives: Varieties of prostatic adenocarcinoma whose architectural and cytological appearance mimicked benign lesions have been reported in recent decades. Such neoplasms include xanthomatous (foamy) carcinoma and pseudohyperplastic carcinoma. We recently studied five carcinomas showing a cytoarchitectural combination of both neoplasms which were confused with benign glandular proliferations. Methods: Five cases (1.8%) of pseudohyperplastic carcinoma showing xanthomatous changes were selected from a total of 280 biopsies showing prostate carcinoma. Glandular prostatic hyperplasia was originally diagnosed in four of such cases. Results: Patient age ranged from 54 and 78 years (mean, 64 years). All patients had high prostate-specific antigen levels, and digital rectal examination showed abnormalities in four of them. Neoplasms showed minimal atypia and consisted of mid- to large-sized glands arranged in nests resembling hyperplastic nodules. Glands showed papillary projections, infoldings, and undulations. Most nuclei were basal, small and hyperchromatic, and nucleomegaly was only seen in two biopsies in isolated histological fields. Several useful criteria for diagnosis of acinar carcinoma, such as perineural infiltration, mitosis, crystalloids, blue secretions, and prostatic intraepithelial neoplasm, were absent. Conclusions: Prostatic carcinoma with a pseudohyperplastic pattern and xanthomatous changes mimics hyperplastic glands. Timely detection is critical to avoid treatment delay.

Resumen Introduccion y objetivos En las ultimas decadas se han descrito variedades de adenocarcinoma prostatico que por su arquitectura y su aspecto citologico semejan lesiones benignas. Estas neoplasias incluyen al carcinoma xantomatoso (espumoso) y al carcinoma pseudohiperplasico. Recientemente hemos estudiado cinco carcinomas que mostraron una combinacion citoarquitectonica de ambas neoplasias y fueron confundidas con proliferaciones glandulares benignas. Metodos De un total de 280 biopsias con carcinoma prostatico se seleccionaron cinco casos (1,8%) de carcinoma pseudohiperplasico que mostraron cambios xantomatosos. Cuatro de ellos fueron diagnosticados originalmente como hiperplasia glandular prostatica. Resultados La edad de los pacientes vario de 54 a 78 anos (promedio: 64 anos). El antigeno prostatico estuvo elevado en todos, y en el examen digital rectal se encontraron alteraciones en cuatro. Las neoplasias mostraron atipia minima y estuvieron constituidas por glandulas de mediano y gran tamano que se disponian en nidos semejantes a nodulos hiperplasicos. Las glandulas mostraron proyecciones papilares, plegamientos y ondulaciones. La mayoria de los nucleos fueron basales, pequenos e hipercromaticos, y solo ocasionalmente se observo nucleomegalia. Varios criterios utiles en el diagnostico de carcinoma acinar, incluyendo infiltracion perineural, mitosis, cristaloides, secreciones azules y neoplasia intraepitelial prostatica, estuvieron ausentes. Conclusiones Los carcinomas prostaticos con patron pseudohiperplasico y cambios xantomatosos semejan glandulas hiperplasicas. Su reconocimiento oportuno es crucial para evitar retardo en el tratamiento.

There is just one case report dealing with neutropenic enteropathy associated with autoimmune diseases.An autopsy analysis of neutropenic enteropathy in autoimmune and hematologic diseases was carried on. Gross findings and slides were reviewed. A blind analysis is of the mucosal lesions in small and large intestine as well as of the clinical course was made.Seventeen cases of neutropenic enteropathy were found a once period of 13 years (1,068 autopsies). Fourteen cases were seen in patients with hematologic diseases and three in patients with autoimmune diseases. Acute symptoms had a 6-day evolution and were characterized by abdominal pain, diarrhea, ascitis, and fever in autoimmune diseases. Extension of colonic damage was 58 and 13% in small bowel. Cases associated with hematologic diseases had longer clinical course with fever abdominal pain and colonic lesions in 21% of the surface and small bowel lesions in 6% of the mucosa. No acute inflammatory infiltrate around the necrotic zones was observed in either group Azathioprine, steroids, methotrexate, and alkylating agents were associated to neutropenia.Clinical evolution and morphologic findings were more severe in neutropenic enteropathy associated with autoimmune diseases than in patients with hematologic diseases.