ABSTRACT
BACKGROUND/AIMS: Helicobacter pylori (H. pylori) treatments fail at least in 10-20% of patients. However, retreatment strategies after failure of initial treatment have not been established. This study was conducted to evaluate the eradication rate of retreatment choices. METHODS: Twenty-seven peptic ulcer patients who were retreated with OAC (omeprazole + amoxicillin + clarithromycin) or BMT (bismuth + metronidazole + tetracycline) after failure of BMT or OAC were included. Quadruple therapy (omeprazole + BMT) was also tried after failure of two successive triple therapies. Furthermore, the effect of resistance of metronidazole or clarithromycin on the eradication of H. pylori was evaluated. RESULTS: Among 13 patients who were retreated with OAC after failure of BMT regimen, H. pylori was eradicated in 10 patients (76.9%). Among 14 patients retreated with BMT after failure of OAC regimen, H. pylori was eradicated in 11 patients (78.6%). Resistance of H. pylori to metronidazole or clarithromycin decreased the efficacy of BMT or OAC, respectively. CONCLUSIONS: Eradication regimen should be decided considering the resistance to H. pylori. However, in case of unknown state of resistance, OAC can be chosen if BMT fails. Similarly, BMT can be tried in cases that OAC therapy failed. After failures of both triple therapies, quadruple therapy can be tried as the next step.
Subject(s)
Adult , Humans , Male , Middle Aged , Anti-Bacterial Agents/administration & dosage , Anti-Ulcer Agents/administration & dosage , Drug Therapy, Combination , Helicobacter Infections/drug therapy , Helicobacter pylori , Peptic Ulcer/drug therapy , RetreatmentABSTRACT
OBJECTIVE: This study was conducted to establish an ideal treatment regimen for H. pylori eradication in three aspects: clinical, microbiological, and reinfection. METHODS: Four hundred thirty two patients with H. pylori positive peptic ulcer were randomized to receive two types of triple therapy: one includes colloidal bismuth subcitrate, metronidazole and tetracycline (BMT), and the other includes omeprazole, amoxicillin and clarithromycin (OAC). RESULTS: More than 50% of symptom reduction within 1 week was 94.4% both in OAC and in BMT group. The percentages of side effects were 21.6% and 27.1% in OAC and BMT regimen, respectively. Good compliance with at least 85% intake was 99.0% and 95.2% in OAC and BMT regimen. The eradication rates of H. pylori were 85.9% and 89.1% in OAC and BMT regimen. Resistance rates to metronidazole and clarithromycin were 40.6% and 10.2% by E test, 74.3% and 27.0% by broth microdilution, and 45.3% and 10.9% by disk diffusion method. The eradication rates for H. pylori was 100% and 77.8% by BMT in patients with metronidazole-sensitive and -resistant strains, and 100% and 80.0% by OAC with clarithromycin- sensitive and -resistant strains, without significance by their resistances. The recrudescence rate within 1 year after eradication was 21.2% and 14.2% for OAC and BMT regimen without significant difference. The reinfection rate after 1 year was 4.0% and 5.0% for OAC and BMT regimen. CONCLUSION: Because the eradication rate of BMT regimen is 89.1% in spite of high metronidazole resistance rate, and there was no statistical difference in the aspects of symptom reduction, side effect, compliance, recrudescence and reinfection rate, BMT regimen is as favorable as OAC to eradicate H. pylori.
Subject(s)
Humans , Amoxicillin , Bismuth , Clarithromycin , Colloids , Compliance , Diffusion , Drug Resistance , Helicobacter pylori , Helicobacter , Metronidazole , Omeprazole , Peptic Ulcer , Recurrence , TetracyclineABSTRACT
BACKGROUND: Umbilical cord blood (UCB) has been increasingly utilized for reconstituting hematopoiesis in a variety of congenital disorders and hematologic malignancies. In this report, we evaluated the maximum collection volume, the efficacy of red cell depletion, cell viability and phenotypic analysis before and after cryopreservation. METHODS: Forty units of UCB (17 from NSVD and 23 from cesarean section) were collected into blood donation bag with ACD-A. Red cells were depleted using 3% gelatin sedimentation or buffy coat separation. UCB units were cultured in methylcellulose media, and phenotypic analyses were performed with monoclonal antibodies for CD34, HLA-DR, CD38, CD13, CD33, c-kit, CD45/CD3, CD45/CD19, CD3/CD4, CD3/CD8. RESULTS: The mean volume of one unit of UCB was 109.2 +/- 32.5 mL and one unit contained 1.20 +/- 0.51x19(9) nucleated cells. Cell counts after red cell depletion by 3% gelatin sedimentation or buffy coat separation revealed recovery rates of 77.5 +/- 14.9% and 64.5 +/- 7.4%, respectively. Cell viabilities and the number of colony forming units - granulocyte and monocyte from fresh and cryopreserved UCB were were 98.1 +/- 1.6%, 88.7 +/- 4.8%, and 6.48 +/- 2.14x10(5), 7.35 +/- 0.65x10(5). The mean percentage of CD34+ cells was 1.02 +/- 1.6% and those of CD34+/HLA-DR+, CD34+/CD38+, CD34+/CD13+, CD34+/CD33+, CD34+/c-kit+ cells were 68.6%, 58.0%, 5.6%, 46.8%, and 29.8%, respectively. Lymphocyte subsets were composed of CD45+/CD3+ (59.0%), CD45+/CD19+ (13.8%), CD3+/CD4+ (42.7%), and CD3+/CD8+ cells (17.1%). There was no significant difference in phenotypic characteristics between fresh and cryopreserved UCB. CONCLUSION: We established the protocols for UCB collection, red cell depletion, cryopreservation, culture and phenotypic analyses. These results would be very useful for future UCB transplantation and preservation/storage.
Subject(s)
Humans , Antibodies, Monoclonal , Blood Donors , Cell Count , Cell Survival , Congenital, Hereditary, and Neonatal Diseases and Abnormalities , Cryopreservation , Fetal Blood , Gelatin , Granulocytes , Hematologic Neoplasms , Hematopoiesis , HLA-DR Antigens , Lymphocyte Subsets , Methylcellulose , Monocytes , Stem Cells , Umbilical CordABSTRACT
No abstract available.
Subject(s)
Mesenteric Lymphadenitis , Yersinia pseudotuberculosis , YersiniaABSTRACT
No abstract available.