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Background: Helicobacter pylori is the primary cause of gastric cancer, but about 9% of cases harbor Epstein-Barr virus (EBV) in the tumor cells. There is limited evidence on the possible interaction or antagonism between these infectious agents in gastric carcinogenesis., Methods: We compared H. pylori serologic profiles of EBV-positive (n = 58) and EBV-negative (n = 111) noncardia gastric cancer patients from the United States National Cancer Institute's International EBV-Gastric Cancer Consortium. EBV positivity of tumors was assessed by in situ hybridization. Serum levels of 15 antibodies to immunogenic proteins of H. pylori (Cad, CagA, Cagδ, CagM, Catalase, GroEL, HcpC, HP0231, HP0305, HpaA, HyuA, NapA, Omp, UreA, VacA) were assessed using bead-based multiplex serology. Logistic regression models were used to adjust odds ratios (OR) for country, age, sex, and year of diagnosis., Results: Seropositivity to individual proteins ranged up to 90% overall. Antibodies to Catalase were borderline associated with tumor EBV positivity (adjusted OR = 3.15, p = .0024, Bonferroni corrected p = .036). Distributions of other antibodies did not vary by tumor EBV status., Conclusion: Similarity of host-response indicates the essential etiological role of H. pylori in EBV-positive gastric cancer., Competing Interests: none reported, (© 2015 John Wiley & Sons Ltd.)

Objective: We present a case report of appendiceal mucocele and gangrenous cholecystitis., Setting: Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México, D.F., Clinical Case: An 80-year-old man was admitted to the hospital with diagnosis of acute cholecystitis and abdominal tumor under study, with complaints of abdominal pain for 10 days located in the right upper quadrant, without fever or significant weight loss. Laboratory analyses revealed moderate leucocytosis. CT of the abdomen revealed thickening of the gallbladder wall and acute local inflammation, as well as the presence of abdominal tumor in the right lower quadrant. The patient was surgically explored with the following findings: gangrenous cholecystitis and appendiceal tumor of 20 cm length. Cholecystectomy and appendectomy was performed. The postoperative period was normal. The final histological report was appendiceal mucocele and the patient was discharged after 5 days. The patient is currently without complaints at 5 months postoperatively.

Objective: We report on a patient with gallstone ileus and cholecystoduodenal fistula at the Hospital de Especialidades, Centro Medico Nacional Siglo XXI (IMSS) Mexico City, Mexico., Clinical Case: A 54-year-old male patient was admitted to the hospital with a diagnosis of acute cholecystitis. He had undergone an appendectomy at 34 years of age. There was no history of biliary disease. He was afebrile, with moderate abdominal distention and right upper quadrant pain, Murphy (+). His white blood cell count was 8,900/mm(3) with 40% bands. His liver function tests, amylase and lipase, were all within normal limits. Ultrasound revealed edema and thickening of the gallbladder wall with calculi. He underwent exploratory surgery, which provided the following findings: sclerotrophic gallbladder with intense surrounding inflammation. We therefore decided to perform a cholecystostomy. Two days postoperatively the patient presented abdominal distention and vomiting as well as the presence of intestinal material through the cholecystostomy catheter. Plain abdominal film showed the bowel to be dilated and an aberrantly located gallstone. Cholecystography was performed and showed a cholecystoduodenal fistula. Computed tomography was carried out and disclosed the bowel to be slightly dilated and with an intraluminal gallstone. A laparotomy with enterolithotomy was performed. Sized of the gallstone found was approximately 3 cm. Presently the patient is asymptomatic.

Background: Ascaris lumbricoides is the most common nematode found in the human gastrointestinal tract with a greater prevalence found in developing tropical and subtropical countries. Most cases of ascariasis follow a benign course. In some cases the adult parasite can invade the biliary or pancreatic ducts and cause obstruction with development of cholecystitis, cholangitis, pancreatitis, and hepatic abscesses. We report a case of a patient with biliary ascariasis., Clinical Case: A 40-year-old woman, born and residing in San Cristobal de las Casas, Chiapas, was admitted with right upper quadrant pain of 2-week duration. Pain was accompanied by nausea, vomiting and fever. Exploration revealed pain upon deep palpation of right hypochondria. Laboratory examinations demonstrated elevation of alkaline phosphatase without jaundice, leukocyte count of 14,300 and ultrasonography with ascaris within the gallbladder and intra- and extrahepatic ducts without evidence of dilatation. Medical treatment with mebendazol was begun orally; nevertheless, on the second day the patient reported an increase of the right hypochondria pain, vomiting and fever of 38 degrees C. Surgical treatment was decided upon. An open cholecystectomy was performed without evidence of parasites within the gallbladder. Expansion of the extrahepatic bile ducts was observed and a formal biliary exploration was carried out with extraction of 19 ascarids and colocalization of choledocostomy T-tube. At the third postoperative day, a T-tube cholangiography was done, showing residual ascarids in the biliary ducts that were resolved with a retrograde endoscopic cholangiopancreatography. The patient's evolution was without complications or fever and with adequate oral feeding posterior to biliary instrumentation., Conclusions: In obstructive biliary pathology, biliary ascariasis is a diagnosis that needs to be explored in our country. Knowledge of clinical symptoms, complications, and diagnostic and therapeutic options are of paramount importance for all health professionals in our country.