Eradication of Helicobacter pylori infection in patients with duodenal ulcer and non-ulcer dyspepsia and analysis of one-year reinfection rates

Helicobacter pylori (HP) infection is endemic worldwide. The proposed treatment is expensive and there are few reports regarding reinfection rates in Brazil. The aim of this study was to compare the eradication rates obtained with two therapeutic options and to evaluate reinfection one year after treatment. This was a prospective randomized trial with 55 patients. Thirty-nine patients had active duodenal ulcer (DU) and 16 non-ulcer dyspepsia (NUD), and all tested positive for HP. Diagnosis was based on at least two positive tests: ultrarapid urease test, histology and/or culture. Patients were randomized to two groups: group OMC treated with 40 mg omeprazole (once a day), 500 mg metronidazole and 250 mg clarithromycin (twice daily) for 7 days, or group NA treated with 300 mg nizatidine (once a day) and 1000 mg amoxicillin (twice daily) for 14 days. Those patients in whom HP was eradicated were followed up for one year to evaluate reinfection. Twenty-five patients were randomized for OMC and 30 for NA. HP eradication occurred in 20/25 patients (80 per cent) treated with OMC and 13/30 (43 per cent) treated with NA (P = 0.01). After reallocation because of initial treatment failure, the overall eradication rate was 44/51 patients (86 per cent). After an average follow-up of one year, we evaluated 34 patients (23 with DU and 11 with NUD). Reinfection occurred in 3/34 patients (7.6 per cent). We conclude that OMC is effective for HP eradication, and that NA should not be used. Reinfection occurs in 7.6 per cent of the patients in the first year after eradication.

Biliary and pancreatic stent blockage by bacterial biofilm: presentation of two cases

Biliary and pancreatic stents are effective tools in the management of obstructive jaundice (both malignant and benign), pancreatic pseudocyst drainage, and as treatment for biliary and pancreatic fistulae. Unfortunately, stents may become blocked and require replacement in a number of patients. In the present study a blocked stent from a patient with transpapillary drainage of pancreatic pseudocyst and another from a patient with obstructive jaundice resulting from cancer of the head of the pancreas associated with Mirizzi syndrome were characterized by electron microscopy. Stent blockage was diagnosed by a pressure test and stent cultures were performed. Electron microscopy of the blocked stents revealed the sludge to consist of microcolonies of bacteria mixed with amorphous material, and cultures of both stents were positive for Klebsiella sp and E. coli.

Transferencia e contratransferencia. / Transference and countertransference

A autora faz um historico sobre os conceitos de transferencia e contratransferencia na teoria psicanalitica. A partir de Charcot, atraves dos trabalhos de S. Freud e de autores pos-freudianos, a autora considera o tema da Transferencia como agente especifico de mudanca no processo psicanalitico, visto do angulo do cliente. Quanto ao tema da Contratransferencia, a autora mostra a evolucao havida tambem em relacao a este conceito mais especifico para os sentimentos do psicanalista, e as diversas conotacoes que lhe sao dadas pelos varios autores psicanaliticos