Acute WNT signalling activation perturbs differentiation within the adult stomach and rapidly leads to tumour formation

A role for WNT signalling in gastric carcinogenesis has been suggested due to two major observations. First, patients with germline mutations in adenomatous polyposis coli (APC) are susceptible to stomach polyps and second, in gastric cancer, WNT activation confers a poor prognosis. However, the functional significance of deregulated WNT signalling in gastric homoeostasis and cancer is still unclear. In this study we have addressed this by investigating the immediate effects of WNT signalling activation within the stomach epithelium. We have specifically activated the WNT signalling pathway within the mouse adult gastric epithelium via deletion of either glycogen synthase kinase 3 (GSK3) or APC or via expression of a constitutively active β-catenin protein. WNT pathway deregulation dramatically affects stomach homoeostasis at very short latencies. In the corpus, there is rapid loss of parietal cells with fundic gland polyp (FGP) formation and adenomatous change, which are similar to those observed in familial adenomatous polyposis. In the antrum, adenomas occur from 4 days post-WNT activation. Taken together, these data show a pivotal role for WNT signalling in gastric homoeostasis, FGP formation and adenomagenesis. Loss of the parietal cell population and corresponding FGP formation, an early event in gastric carcinogenesis, as well as antral adenoma formation are immediate effects of nuclear β-catenin translocation and WNT target gene expression. Furthermore, our inducible murine model will permit a better understanding of the molecular changes required to drive tumourigenesis in the stomach

Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is an atopic condition of the esophagus that has become increasingly recognized over the last decade. Diagnosis of the disorder is dependent on the patient’s clinical manifestations and histologic findings on esophageal mucosal biopsies. Patients with eosinophilic esophagitis should be referred to both an allergist and gastroenterologist for optimal management, which may include dietary modifications, pharmacologic agents such as corticosteroids, leukotriene modifiers and biologics as well as mechanical dilatation of the esophagus. The epidemiology, pathophysiology, diagnosis, treatment, and prognosis of EoE are discussed in this review

Use of radiofrequency hepatic parenchymal transection device in hepatic hemangioma resection: early experience and lessons learned

Background. Control of intraoperative hemorrhage represents a significant challenge in hepatic surgery, particularly during resection of large, hypervascular hepatic hemangiomata (HH). Various devices to minimize blood loss from hepatic parenchymal transection are currently under investigation. Herein, we present our experience with a radiofrequency (RF)-powered multiarray for resection of HH. Patients and methods. From September 2005 to January 2006, we conducted a retrospective review of our hepatobiliary database to identify patients with symptomatic giant cavernous HH undergoing resection with a RF multiarray device. The purpose of this review was to assess the technical aspects of using RF energy to assist in the resection of HH. Results. The extent of operation varied depending on the size and location of the tumor. Two patients underwent two atypical subsectionectomies and two underwent trisectionectomies. The Habib™ sealer provided a safe and effective method for hepatic parenchymal transaction. No patients required blood transfusion, and no injuries to major biliary or vascular strictures were observed at 1 year follow-up. A seroma developed in one patient 6 months postoperatively, but was drained percutaneously. Conclusions.Hepatic parenchymal transection with the Habib sealer device is a feasible approach to resect HH. Further study is needed to objectively compare the efficacy of RF-assisted parenchymal transection with that of traditional parenchymal transection techniques