It is concluded that two biopsies taken from A3 are sufficient for confirmation of presence of H. pylori and associated gastritis for initiation of treatment. However, additional biopsies from B3 will help in deciding the topographic pattern of gastritis.

SummaryTo determine the diagnostic accuracy of the one-minute ultra-rapid urease test for diagnosing Helicobacter pylori infection, two biopsies were taken from both the gastric corpus and antrum from 1000 patients undergoing upper gastrointestinal endoscopy. All the biopsies were subjected to the one-minute ultra-rapid urease test before imprint smears were prepared from them. Thereafter, the biopsies were fixed in 10% formalin and histological sections were examined for the presence of H pylori by a pathologist who was not aware of the clinical details or the results of the urease test. The prevalence of H pylori in the gastric antrum and corpus was 86.7% and 53.3%, respectively. The sensitivity, specificity, positive and negative predictive value and the overall diagnostic accuracy of the ultra-rapid urease test to diagnose H pylori infection in the gastric antrum were 92%, 100%, 100%, 66%, and 93%, respectively. The corresponding figures for the gastric corpus were 83%, 100%, 100%, 85%, and 91%, respectively. It is concluded that the one-minute ultra-rapid urease test has a high sensitivity and specificity and may be used as a rapid and cheap method to diagnose H pylori infection. Keywords: diagnosis; Helicobacter pylori; urease testingThere are several methods of diagnosing Helicobacter pylori infection. 1 The fact that the bacterium produces urease that splits urea has been exploited to develop several rapid urease tests. Although several of these are available commercially, 2 they are relatively expensive and may therefore not be available to all clinicians, especially in developing countries. However, there are several locally made urease tests that are very easy to prepare and are inexpensive. [3][4][5] There are, however, doubts about the sensitivity and specificity of these tests. We have been using the one-minute ultra-rapid urease test (URUT) 3 for most of our studies. This study was undertaken to assess the reliability of the URUT compared to histology.We first carried out a pilot study on 20 gastric biopsies to see whether the same gastric biopsy could be used for URUT, imprint smears and histology. The results of this pilot study showed that the same biopsy tissue could be used to perform the URUT and prepare imprint smears without adversely aVecting the tissue for subsequent histological examination. Patients and methodsOne thousand patients undergoing upper gastrointestinal endoscopy were studied. Patients who were receiving proton pump inhibitors, antibiotics or bismuth-containing agents and patients who had received therapy aimed at eradication of H pylori were excluded from the study. Four gastric mucosal biopsies were taken: two from the antrum within 4 cm of the pylorus (one from the greater and the other from the lesser curvature) and two from the corpus of the stomach.The one-minute ultra-rapid urease test was freshly prepared as described by Thillainayagam et al. 3 Briefly, each biopsy tissue was placed immediately into a capped Eppendorf tube containing 0.5 ml of a freshly prepared s...

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Somatic malignant transformation of germ cell tumours is a well-described but poorly understood phenomenon. It is characterized by differentiation of pluripotent teratoma cells into somatic tumour cells. Following malignant transformation, the most common histologies are sarcomas and primitive neuroectodermal tumours; however, other subtypes have been recognized including melanoma, leukaemia, and renal cell carcinoma. We report a case of a 38-year-old male who had recently completed treatment for a mediastinal germ cell tumour with teratomatous components. He presented several months after completion of chemotherapy with metastatic lesions in his spine and liver accompanied with severe pancytopenia. He was subsequently diagnosed with acute megakaryoblastic leukaemia (AMKL), and a biopsy of a liver lesion was consistent with metastatic melanoma. This case illustrates the simultaneous development of 2 rare malignant entities: mediastinal germ cell tumour-associated AMKL and somatic malignant transformation to melanoma. It also highlights the importance of close surveillance to detect these metastatic sequelae and the emerging role of tumour sequencing to establish targetable pathways.

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