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Mast cells proteases, tryptase and chymase are directly involved in the growth and progression of solid tumors due to their important role in tumor angiogenesis. We examined the density of tryptase positive mast cells and the mean density of new blood vessels in gastric malignant tumors of patients with and without Helicobacter pylori infection, using immunohistochemical staining for tryptase (for mast cells) and CD 105 (for new vessels). Tryptase and CD 105 expression was detected in gastrectomy specimens. In this study, mast cell density correlates with angiogenesis and the growth and progression of gastric cancer. It also shows that the participation of Helicobacter pylori infection in the growth and progress of gastric neoplasia is due to an increase of peritumoral angiogenesis, with subsequent local and distant tumor spread and perivascular growth, but without perineural and nodal involvement.

An introduction to the journal is presented in which the editor discusses various reports within the issue on topics including impasse and working-through, child and adolescent psychoanalysis, and some exceptional psychoanalytic figures who passed away.

While Westerners - English, Dutch, French, Germans, Italians - live, speak and write about "Hate and Love in Psychoanalytic Institutions" (Jurgen Reeders, 2004), about fanaticism, schisms and queries on the apparent decline of psychoanalysis, Easterners - and we among them - having gone through their own historical-political metamorphoses, interrogate and selfinterrogate, hopeful, to what extent the psychoanalytic institution can become the necessary and viable third party who will sublimate personal anxieties, narcissistic excesses, envy or hate or just adaptive inabilities, placing them contained in an institutional environment full of respect, able to support the evolution and independence of thought of every practitioner of psychoanalysis. Do we head, with candor and hope, for something that others who had already gone through these stages, seek to overcome, discontent with the proposed solutions?. [ABSTRACT FROM AUTHOR]

Even since the fundamental book of psychoanalysis, Dreams interpretation, 1900, Sigmund Freud considered that the symbol has a universal value, and E. Jones added in 1919 the difference between the conscious symbol and the unconscious symbol. Enlightening the unconscious wish, the primitive anguish, the archaic conflicts, dreams could be often a metaphoric working through of them, but sometimes they could be also a symptomatic manifestation. In the analytic cure, the patient records his or her significant dreams, he or she is elaborating the nightmares or those dreams that produce pain and grief, and anguish, dreams that exceed the capacity of dreaming or of reverie, as we could find in the works of H. Segal, or Bion or Ogden. Some dreams are reflections of the psychotic aspects or foreclosed contains of the patients personality, other dreams are from the neurotic parts of the patients personality. During the analytic process, of the working together on the day-dreams and night-dreams, the analyst could know and could making known to the analysand the unconscious aspect of his/her mind, and even of the analytic relationship. [ABSTRACT FROM AUTHOR]

It is a certified fact that the therapeutic meeting psychoanalyst-patient during the preliminary interview engages the protagonists in an explicitly convergent intercession, an agreement in the conscious register for a joint effort that aims to cure suffering and ameliorate self-knowledge. This facet of the relation defines the therapeutic alliance. However, what happens in parallel, in the subsurface of the meeting implies, likewise from the beginning, the more cryptic register of the unconscious, subtly looms in both the patient's precocious transferential movements and in the therapist's countertransference response. The paper, centered mainly on the latter aspect, sets to give a possible answer to such inquiries as how much, in what way and if they could be traced so early in the cure, and especially, to what extent are or could be considered (in) the key of the future analysis. [ABSTRACT FROM AUTHOR]

This case report describes a gastric small submucosal tumor endosonographically resembling a gastrointestinal stromal tumor (GIST). The presence of calcifications inside prompted for the surgical excision, and the pathologic examination revealed in fact the presence of a glomangioma (glomus tumor). The presented case is an illustration of the fact that not all masses arising from the muscularis propria layer are GISTs, and the endosonographer must always think of alternative diagnoses. [ABSTRACT FROM AUTHOR]

The author reflects on the idea of pluralism in psychoanalysis. She cites the need to distinguish between the pluralism of valid ideas and the clutter of arbitrary ideas. She mentions the affirmation of the unity of psychoanalysis based on the psychoanalytic method described by Austrian psychologist Sigmund Freud.

Acute pneumonia was and still is one of the most important causes of morbidity and mortal­ity. A patient with typical CAP presents sudden onset with chill, fever, pleural pain, cough, expectora­tion, dyspnea. Elderly patients may present an atypical clinical presentation: confusion, decompensation of underlying diseases. Chest radiography is recommended to patients suspected of having CAP. It is important to perform a severity assessment of CAP in order to decide whether to treat the patient with CAP as outpatient or as inpatient, in the ward or in the ICU. A lot of patients with CAP could be cor­rectly treated with oral antimicrobial drugs. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases (IBD) are a complex, heterogeneous, idiopathic, inflammatory, chronic entity with common clinical, endoscopical and histological features including some well-defined diseases (UC and CD), but also a group of indeterminate colitis. Ulcerative colitis is the most frequent and prominent member of IBD. The current study is trying to evaluate the impact of various histologic features on UC's evolution and outcome--an issue that has generated considerable interest in the academical environment. We gathered a cohort of 20 consecutive patients with positive clinical, endoscopical, histologic and imagistic diagnosis of UC who were prospectively enrolled for close clinical, biochemical, endoscopic and histologic surveillance. Every patient underwent an ileo-colonoscopy and multiple biopsies were taken from inflamed and normal areas of the mucosa. All these procedures were repeated after a year (12 months) of follow-up. This study is presenting the correlation between Mayo score for assessment of ulcerative colitis activity and several histologic features: Geboes histologic score for ulcerative colitis, basal plasmacytosis and vascular lesions using Pearson correlation test. The most promising prognosis value has basal plasmacytosis, confirming previous studies. These data emphasize the need of a more complex, clinical, endoscopic and histologic system of semi-quantitative assessment of UC lesions in order to stratify patients according to their risk to relapse.

Helicobacterpylori (HP) infection is the most common cause of many gastric diseases. One of its pathogenic mechanisms involves the production of a wide spectrum of alterations in different components of the gastric enteric nervous system. Changes in neural circuitry encompass structural abnormalities, sensitive and motor function impairment, altered content and release of neurotransmitters, and seem to be related rather to the inflammatory response of gastric wall than to the bacterial colonization. Although gathered data provide new insights into the complex mechanisms underlying the interactions between HP and enteric nervous system, there still are some controversial aspects. Interestingly, it has been suggested that impaired neural activity might have a potential role in gastric carcinogenesis, but this hypothesis requires further investigation. Future studies shall, therefore, elucidate the neuromodulatory influences of Helicobacter pylori infection on the enteric nervous system. A better comprehension on neural changes during HP-induced inflammation could help in identifying new therapeutic options.

Ulcerative colitis (UC) is a chronic, relapsing inflammatory disease of the colon and rectum. Its etiology and pathogenesis are incompletely elucidated, although there are many studies concerning these problems. Chronic inflammation and immunosuppressive treatment are risk factors for epithelial and lymphoid malignancies. We present a case of a 39-year-old man who died after a long-standing untreated UC complicated with mantle cell colonic lymphoma and then with transformation towards a high grade diffuse large B cell lymphoma. Multiple colonic biopsies were collected in various moments of the disease. Microscopic and immunohistochemical features are comparatively presented. This case emphasizes the importance of constant surveillance for UC patients and reaffirms the role of multidisciplinary approach in UC management.

Whipple's disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei. The infection usually mainly involves the small bowel, but sometimes other organs are affected as well. Since the current standard clinical and biological tests are nonspecific, diagnosis is very difficult and relies on histopathology. Here we present the case of a 52-year-old man with chronic diarrhea and weight loss whose symptoms had been evolving for 2 years and whose diagnosis came unexpectedly after capsule examination. Diagnosis was confirmed by the histopathologic examination of endoscopic biopsy samples, and treatment with co-trimoxazole resulted in remission of symptoms. We present the first images of Whipple's disease obtained with the Pillcam Colon 2 video capsule system.

The first medical hypothesis about the possible relationship between chronic inflammatory response and carcinogenesis belongs to Virchow and it was published in 1893. In these days, multiple studies demonstrate the certain involvement of chronic inflammation as trigger of progression towards malignancy. The fact that in 1994, the International Agency for Research on Cancer considered Helicobacter pylori as first class carcinogenic agent, is postulating the existence of the pathogenical chain carcinogenesis, of chronic inflammatory lesions as it was described by Correa, as a first step. Our study including 75 patients who underwent surgical procedures for gastric lesions uses immunohistochemical studies for lymphocytes phenotyping, to identify the nature of inflammatory cells involved, correlating the results with the presence of Helicobacter pylori. We tried to bring new information needed for establish to what extent the chronic inflammation of gastric mucosa is a response to the presence of bacteria and is implicated in tumorigenesis. We used T cells antibodies: CD3, CD4, CD5, CD8, CD57, GranzymeB and B cells antibodies: Cd20 and CD23. Our results revealed the presence of immune cellular response to Helicobacter pylori in gastric mucosa, based on T helper, cytotoxic and NK cells. B cells have a minor role in this response. CD4+ cells seem to be involved in local protection response as well as in carcinogenesis, while CD8+ have a minor or no role in carcinogenesis.

Since 1973, when Steinman and Cohn highlighted the importance of dendritic cells as mediators of immunity, a large series of subsequent researches have been registered concerning these amazing cells and their implications in different pathologies. Although in small number, they are widely distributed and represent crucial elements in immune responses against pathogens. Data gathered in the last period, mostly based on in vitro studies, helped us understand the early events of HIV-host interactions, the important roles of dendritic cells in this phase, but fails to fully explain the complex mechanisms underlying these interactions, such as the ways developed by HIV to evade the immune system and to facilitate viral dissemination. Improved knowledge of these mechanisms may provide a basis in the attempt to find new therapeutic targets and elaborate immunologic therapies.

In our days, Helicobacter pylori is considered to be the bacterium responsible for the most frequent and persistent chronic infection worldwide, involving half of the entire world population. Untreated, the infection is lasting for the whole life. In Romania, the number of carrying people is variable between 90-94%, while in western countries, the prevalence of this infection is much lower, under 50-60%, with a high tendency to decrease, due both to the higher socio-economic level and to advanced methods of diagnosis and treatment, with a special focus on prevention. Because a percentage of 10-11% of the infected people develop in time an ulcerous disease, and 5-6% will have premalignant changes on the gastric mucosa and even gastric cancer in 1% of the cases, the goal to detect and treat H. pylori infection is, in our opinion, very much justified by both theoretical and practical reasons. Diagnosis methods for the infection's detection are numerous and diverse, the choice for one or another depending on several factors, among which: accessibility, advantages and disadvantages specific to each method (particularly the method's invasive or non invasive character), the cost, the aim (diagnosis, epidemiological, the treatment's efficiency, etc.). From a clinical point of view the patient's age, antecedents and digestive symptoms, as well as his psychological state and associated treatments are also important. Once the diagnosis of infection is proved, the treatment of the Helicobacter pylori infection supposes the simultaneous administration of antibiotics and proton pump inhibitors. The idea to create a vaccine for Helicobacter pylori is the evident result of the need to avoid the costs imposed by the diagnosis and treatment of the infection, especially in view of the high percentage of failure in eradicating the infection. If we add to these the socio-economic costs brought by the treatment of gastric ulcers and cancers, the idea of using a vaccine with double role, both in preventing, as well as in treating the infection, is even more attractive.

It was accepted several years ago that, in the carcinogenesis process of human cancers, biologic agents, especially the viruses, are playing an etiologic role. This is the case of lymphomas (retroviruses), hepatocarcinoma (hepatic viruses) and cervical carcinoma (papilloma viruses). Helicobacter pylori is the first bacteria recognized as a first class carcinogen for gastric cancer. Nevertheless, comparing with the most validated human carcinogens, the activity of H. pylori is very little studied. As a consequence, at this moment, in its case, explanation of carcinogenesis mechanism is more or less hypothetical.

Gastric cancer is one of the most aggressive malignancies, as incidence and as evolution as well. Although, due to the new findings about etiology, carcinogenesis, precancerous conditions and their detection, as well as the treatment, in the latest decade, there is an improvement in these data, gastric cancer remains a redoubtable enemy because of its incidence, prevalence and mortality. Researches are focusing on early detection of precursor lesions and on establishing their reversibility potential by bringing more clinical and statistical information and by setting new clinical hypotheses. In this context, the present article is trying to study immunohistochemical expression of two oncogenic markers, the cell adhesion protein antibodies E-cadherin and beta-catenin. Cell to cell and cell to extracellular matrix interactions are crucial for neoplastic transformation and for metastasizing process. The importance of these antibodies in maintaining cell adhesion suggests that their abnormal expression is playing an important role in tumorigenesis. In this article, authors are presenting a study about E-cadherin and beta-catenin expression in 75 patients who underwent gastrectomy for suspicions of gastric malignancies. The variables of the study are the presence or absence of Helicobacter pylori, type I carcinogenetic agent for gastric carcinoma (especially intestinal type adenocarcinoma) and the presence of tumoral or non-tumoral gastric lesions.

As a Group 1 carcinogen for gastric cancer, Helicobacter pylori (H. pylori) was involved in many studies and researches focused on physiopathology and morphopathologic changes induced by this bacterium. The study included 3069 gastric endoscopies performed between January 2005 and December 2009 in "Colentina" Clinical Hospital. During upper endoscopy biopsies from antro-pyloric and corporeo-fundic region were collected. Histopathologic diagnosis of these biopsies was made using Sydney criteria. The patients were divided in two groups, based on the presence or absence of H. pylori: group A included 1414 H. pylori positive patients and group B included 1653 H. pylori negative patients. We evaluated several histopathological parameters, correlating the degree of inflammation, atrophy, metaplasia, regenerative hyperplasia and dysplasia with the presence of H. pylori infection. Our study identifies an overall tendency towards regression of premalignant lesions of gastric epithelium (regenerative epithelial hyperplasia, atrophy and intestinal metaplasia) after H. pylori eradication, as well an increasing number of patients diagnosed with early gastric cancer, thus consolidating the results of studies who foretell the significant decrease of gastric cancer mortality. These lesions are present years before becoming clinically manifest, and consequently treatable. In respect of carcinogenic mechanisms, some of our results confirm the carcinogenic cascade triggered by the H. pylori infection, as it was proposed by Correa et al. in 1975. However, we obtained data leading to the idea that the "precursor lesions" could appear (and subsequently histopathologically evaluated) independent one to the other, through other steps then Correa's model.

We present two rare cases of rectal leiomyoma originating in muscularis mucosae. The lesions were incidentally discovered in a 58-years-old woman and 53-years-old man during colonoscopy performed for unrelated symptoms. Both presented as small polyps and were removed by conventional colonoscopic snare polypectomy without clinical recurrence. Gross examination revealed pedunculated polyps covered by non-ulcerated mucosa. Histologically the lesions represent smooth muscle cells proliferation originating in muscularis mucosae. Both lesions were uniformly positive for SMA and DESM and negative for CD34, CD117 and S100. These tumors have a different clinical course than gastrointestinal stromal tumors; since morphologic appearance is sometimes confusing, CD117 staining is mandatory for an accurate diagnostic. We decided to present these cases because of the rarity of this condition concerning both the location and the origins of tumors. We stress the importance of the proper classification of this rare lesion, considering its outmost importance.

Since 1982, when Marshall and Warren highlighted the presence of H. pylori at the apical pole of the epithelial gastric cells, the medical literature has registered a cascade of subsequent researches concerning this amazing bacterium, its action on the human body and the body response. The apogee of these studies and conclusions about the pathogenic role of HP was touched with its certain recognition as class one carcinogenic agent (Peura 1997, WHO), becoming the first bacteria with such an action. The data gathered in the last period identify different virulence factors of HP, but fail to fully explain the relatively low incidence of gastric cancer in HP carriers; therefore, it is now considered that the carcinogenic potential related to HP infection in humans is due to the synergic and complementary association of the bacterial genetic equipment with diet and host response.

Peutz Jeghers (PJ) polyps are rare hamartomatous tumors of the gastrointestinal tract frequently associated with skin and mucosal pigmentation. Despite their benign nature there is a certain increased risk of progression to malignancy in some cases, justifying a sustained follow-up of the patients. We present 3 cases of Peutz Jeghers syndrome (PJS) diagnosed in our hospital on gastrointestinal specimens obtained by endoscopy and opened surgery. We analyzed different degrees of dysplastic changes, epithelial intussusception, association with other types of polypoid lesions and other various aspects possibly related with disease progression. Clinico-pathological correlations were made. Two of these cases were related (mother and daughter); both of them were operated in another hospital for small bowel tumors with a subsequent diagnosis of adenocarcinoma. The daughter (28 years old) was referred to our hospital for endoscopic follow-up; a small polyp of the transverse large bowel was excised by colonoscopy with a histopathologic diagnosis of PJ polyp; a careful histopathologic reevaluation of both specimens of enterectomy (slides and paraffin blocks) revealed an overdiagnosis of cancer due to the epithelial cystic dilatation and pseudoinvasion in both patients. The other case showed diagnostic changes of PJS and also various aspects of adenomatous polyps some of them with mild and moderate dysplastic changes. When a PJ polyp is diagnosed, the possibility of pseudoinvasion should be kept in mind, in order to avoid overdiagnosis of malignancy; also, due to the fact that the malignant transformation of a PJ polyp is still on debate (hamartoma-dysplasia-carcinoma sequence versus malignant transformation of an adenomatous aria of a hamartoma versus coincidental association of a digestive cancer due to genetic aberrations of PJS), all the other associated microscopic aspects of the lesion should be carefully analyzed.

Malignant melanoma is one of the most aggressive skin neoplasms with histopathological-based therapeutic approach. Unfortunately, in some cases, even the elementary issue of dealing with a primary or metastatic lesion may be sometimes incredible difficult to settle. We studied 11 cases of malignant melanomas that required careful histopathological and immunohistochemical analysis to differentiate between primary and secondary tumor. We evaluated epidermotropism of primary MM including synchronous tumors, local recurrences and metastases.