Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns / Diagnóstico rápido da síndrome do desconforto respiratório por aspirado bucal em recém-nascidos prematuros

Abstract Objective: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. Method: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. Results: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8 -22) stable microbubbles/mm2; control group = 100 (48 -230) microbubbles/mm2 (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85 -0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. Conclusion: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.

Resumo Objetivo: O teste das microbolhas estáveis no aspirado gástrico e no líquido amniótico foi usado no diagnóstico da síndrome do desconforto respiratório do recém-nascido. Contudo, nenhum estudo fez esse teste nos aspirados bucais de neonatos prematuros. O objetivo deste estudo foi avaliar o desempenho do teste das microbolhas estáveis em aspirados bucais de recém-nascidos prematuros para prever síndrome do desconforto respiratório. Método: Este estudo incluiu neonatos com idade gestacional < 34 semanas. Os fluidos orais foram obtidos imediatamente após o nascimento e os fluidos gástricos foram coletados nos primeiros 30 minutos de vida. As amostras foram congeladas e testadas em 72 horas. Resultados: A amostra foi composta de aspirados pareados de 64 recém-nascidos, divididos em dois grupos: grupo de síndrome do desconforto respiratório (n = 21) e grupo de controle (n = 43). A mediana (intervalo interquartil) da contagem das microbolhas estáveis nas amostras de fluido oral dos neonatos com síndrome do desconforto respiratório foi significativamente menor que a dos neonatos que não desenvolveram sintomas respiratórios: grupo de síndrome do desconforto respiratório = 12 (8-22) microbolhas estáveis/mm2; grupo de controle = 100 (48-230) microbolhas/mm2 (p < 0,001). A correlação entre a contagem das microbolhas nos aspirados gástricos e bucais foi 0,90 (intervalo de confiança de 95% = 0,85-0,95; p < 0,001). Considerando um ponto de corte de 25 microbolhas/mm2, a sensibilidade e a especificidade do teste das microbolhas estáveis foram 81,4% e 85,7%, respectivamente. Conclusão: O estudo sugere que o teste das microbolhas estáveis feito no aspirado bucal é uma opção confiável ao fluido gástrico para a predição da síndrome do desconforto respiratório do recém-nascido.

Eficacia de una intervención educativa para mejorar el conocimiento de las/os enfermeras/os sobre el sondaje gástrico en pediatría / Effectiveness of an educational intervention to improve nurses' knowledge on pediatric nasogastric intubation

Objetivo. Eficacia de una intervención educativa para mejorar el conocimiento de las/os enfermeras/os sobre el sondaje gástrico en pediatría. Métodos. Estudio multicéntrico cuasi experimental pre- y postest mediante intervención educativa teórica basada en la evidencia bibliográfica y la evaluación de su eficacia a los 4 meses. Resultados. Cuestionarios entregados: 1019. Válidos: 557 (54,66 %) pretest, 246 (24,14 %) postest. Las respuestas pre- y postest fueron que el riesgo implícito que conllevaba siempre el procedimiento había sido percibido por el 53,2 % y aumentó al 70,7 % (p < 0,001). El 4,3 % elegía el tamaño de la sonda gástrica (SG) mediante tablas y se elevó al 24,6 % (p < 0,001). La longitud de la SG por introducir medida mediante el método nariz-oreja-distancia media xifoides-ombligo (nose-ear-mid-umbilicus; NEMU, por sus siglas en inglés) ascendió del 34,2 % al 81,3 % (p < 0,001). La comprobación de la ubicación de la SG previa a su uso pasó del 73,1 % al 86,5 % (p < 0,001). La comprobación de los cinco correctos (paciente, medicamento, dosis, vía y hora) previa a la utilización de la SG aumentó del 85,6 % al 91 %. Como métodos de comprobación, mejoró la percepción de inseguridad de la auscultación del 11,7 % al 31,1 % (p < 0,001), y disminuyó su uso del 95,1 % al 81,6 %. Creció la percepción de seguridad de la medición del pH gástrico del 71,3 % al 91,1 % (p < 0,001), y aumentó su uso del 7,6 % al 54,3 % (p < 0,001). Conclusiones. La intervención educativa resultó eficaz para incrementar el conocimiento de enfermería sobre el sondaje gástrico pediátrico.

Objective. To establish the effectiveness of an educational intervention to improve nurses' knowledge on pediatric nasogastric intubation. Methods. Multicenter, quasi-experimental, pre- and post-test study using a theoretical educational intervention based on bibliographic evidence and assessment of its effectiveness after 4 months. Results. Delivered questionnaires: 1019. Valid questionnaires: 557 (54.66 %) pre-test and 246 (24.14 %) post-test. Pre- and post-test answers indicated that the implied risk always entailed by the procedure had been perceived by 53.2 % and then increased to 70.7 % (p < 0.001). Nasogastric (NG) tube size was chosen using tables by 4.3 % of participants, and increased to 24.6 % (p < 0.001). The length of NG tube to be inserted as measured by the nose-ear-midumbilicus distance (NEMU) method increased from 34.2 % to 81.3 % (p < 0.001). Confirmation of NG tube placement prior to use increased from 73.1 % to 86.5 % (p < 0.001). Confirmation of the five rights (patient, drug, dosage, route, and timing) prior to NG tube use increased from 85.6 % to 91 %. In relation to confirmation methods, the perception that auscultation was unsafe improved from 11.7 % to 31.1 % (p < 0.001), and its use reduced from 95.1 % to 81.6 %. The perception that the measurement of gastric pH was safe increased from 71.3 % to 91.1 % (p < 0.001), and its use rose from 7.6 % to 54.3 % (p < 0.001). Conclusions. The educational intervention was effective to increase nurses' knowledge on pediatric nasogastric intubation.

Tolerance Tests of Alcaligenes faecalis BW1 Extract.

Aims: To highlight whether metabolites of Alcaligenes faecalis BW1 extract can be administered orally for their possible antimycobacterial effects. Study Design: Study of the influence of certain parameters on the extract of Alcaligenes faecalis by using either discs or well diffusion methods against M. smegmatis. Place and duration of study: Laboratory of Microbial Biotechnology, Department of Biology, Faculty of Sciences and Technical, University Sidi Mohamed Ben Abdellah, BP 2202, Road of Immouzer, Fez, Morocco. From April to August, 2012. Methodology: The impact of acidic pH of gastric juice, bile, hydrogen peroxide, pancreatic enzymes and lysozyme on the antimycobacterial activity of Alcaligenes faecalis BW1 extract was evaluated by agar diffusion method. Detection whether or not antibacterial metabolites having a synergistic effect with rifampicin against M. smegmatis was also explored. Results: Antibacterial metabolites of Alcaligenes faecalis BW1 extract resist to the action of gastric pH, gallbladder bile and hydrogen peroxide. In addition, they are not affected by pancreatic enzymes and lysozyme. Moreover, they have a synergistic effect with rifampicin against M. smegmatis. Conclusion: Anti-mycobacterial metabolites of Alcaligenes faecalis BW1 extract are compatible with rifampicin and could be administered orally as antitubercular agents after their purification, identification in further work.

Diagnóstico de la infección por Helicobacter pylori por PCR en jugo gástrico y biopsias gastroesofágicas de pacientes dispépticos / Diagnosis of Helicobacter pylori infection by PCR in gastric juice and gastroesophageal biopsies from dyspeptic patients

Helicobacter pylori es el principal agente bacteriano implicado en lesiones gastroduodenales inflamatorias en humanos y una de las bacterias patógenas más comunes, con una alta prevalencia en Venezuela. El diagnóstico de la infección por H. pylori se realiza frecuentemente en biopsias gástricas mediante PCR; sin embargo, el jugo gástrico y las biopsias esofágicas podrían también ser utilizadas como muestras alternativas para determinar la infección. En el presente trabajo se evalúo la infección por H. pylori en diferentes muestras del tracto digestivo superior de pacientes dispépticos, mediante la detección por PCR de genes esenciales (glmM y ureA) y de virulencia (cagA). De los 104 pacientes estudiados, H. pylori fue encontrado en 53,8; 69,2 y 58,7% de las muestras de jugo gástrico y biopsias gástricas y esofágicas, respectivamente, con una predominancia de cepas tipo I (cagA+) en jugo y biopsias gástricas y cepas tipo II (cagA-) en biopsias esofágicas. La detección de H. pylori en jugo gástrico y biopsias esofágicas mostró una alta sensibilidad y especificidad en relación a la detección en biopsias gástricas, lo cual sugiere que ambos tipos de muestras pueden ser utilizados eficazmente para un diagnóstico seguro de la infección por H. pylori.

Helicobacter pylori is the main bacterial agent implicated in human gastroduodenal inflammatory pathologies; being one of the most common bacterial pathogens, with a high prevalence in Venezuela. The diagnosis of H. pylori infection is performed primarily in gastric biopsies through PCR; however, string-absorbed gastric juice and esophageal biopsies could be also used as alternative specimens to determine the infection. In this study the H. pylori infection was assessed in different specimens of the upper tract digestive of dyspeptic patients, though the detection by PCR of essential genes (glmM and ureA) and genes encoding virulence factors (cagA). Of 104 patients studied, H. pylori was found in 53.8, 69,2 and 58,7% of gastric juice, and gastric and esophageal biopsies, respectively; with predominance of the strains type I (cagA+) in juice and gastric biopsies, and strains type II (cagA-) in esophageal biopsies. The detection of H. pylori in gastric juice and esophageal biopsies showed high sensitivity and specificity, in comparison with the detection in gastric biopsies, suggesting that both types of specimens may be used efficiently for a secure diagnosis of H. pylori infection.

In vitro evaluation of the microhardness of bovine enamel exposed to acid solutions after bleaching

Acid erosion is a superficial loss of enamel caused by chemical processes that do not involve bacteria. Intrinsic and extrinsic factors, such as the presence of acid substances in the oral cavity, may cause a pH reduction, thus potentially increasing acid erosion. The aim of this study was to evaluate the microhardness of bleached and unbleached bovine enamel after immersion in a soda beverage, artificial powder juice and hydrochloric acid. The results obtained for the variables of exposure time, acid solution and substrate condition (bleached or unbleached enamel) were statistically analyzed by the ANOVA and Tukey tests. It was concluded that a decrease in microhardness renders dental structures more susceptible to erosion and mineral loss, and that teeth left unbleached show higher values of microhardness compared to bleached teeth.

Gastroprotective effect of Cissus quadrangularis extract in rats with experimentally induced ulcer.

BACKGROUND & OBJECTIVES: Most of the non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin cause gastric ulcer. In order to study the gastroprotective effect of Cissus quadrangularis extract (CQE), this study was undertaken on aspirin-induced ulcerogenesis in pyloric ligated (ASP-PL) model in rats. METHODS: To assess the possible antiulcer effect of CQE, lesion index, gastric secretions glycoprotein levels, non-protein sulphydryls (NPSH) and adherent mucus content were determined in ASP-PL induced gastric mucosal injury in rats. RESULTS: Pretreatment with CQE significantly prevented the gastric mucosal lesion development and decreased the gastric toxicity produced by ulcerogen. In addition, ulcerated rats showed depletion of gastric wall mucus, glycoproteins and NPSH levels whereas treatment with CQE reverted this decline in ASP-PL induced rats. Histological studies confirmed the results. INTERPRETATION & CONCLUSION: The present finding suggests that CQE promotes ulcer protection by the decrease in ulcer index, gastric secretions and increase in the glycoprotein level, gastric mucin content and NPSH concentration. CQE may protect the gastric mucosa against ulceration by its antisecretory and cytoprotective property.

Antiulcerogenic effect of Justicia prostrata Gamble.

Antiulcerogenic effect of the alcoholic (ALJP) and aqueous (AQJP) extracts of the whole plant of Justicia prostrata was studied in aspirin+pylorus ligated rat models and analysed for gastric volume, ulcer index, free and total acidity. Biochemical parameters like total proteins, total hexoses, hexosamine, fucose and sialic acid were also estimated. Both extracts (ALJP and AQJP) significantly reduced both the gastric volume and the acidity of gastric juice. It also significantly promoted gastric mucus secretion by increasing total carbohydrates and decreasing the protein concentration in aspirin+ pylorus ligated rats. The results suggest that both the extracts (ALJP and AQJP) possess antiulcer activity, whereas AQJP is more effective when compared with ALJP in aspirin+pylorus ligated rat models. The results were compared with the standard drug Rantidine, a H2 receptor antagonist.

Correlations Among Gastric Juice pH and Ammonia, Helicobacter Pylori Infection and Gastric Mucosal Histology

BACKGROUND: To assess the relationships among gastric pH and ammonia level, H. pylori infection, and gastric mucosal histology, we determined the gastric juice pH and ammonia concentration in H. pylori gastritis. METHODS: The pH levels and ammonia concentrations were determined in gastric juice collected from 143 patients with dyspepsia during an endoscopy and compared according to a H. pylori infection. We also looked for correlations between two chemical parameters, between each of these parameters and H. pylori density, and histology. RESULTS: Gastric pH levels and ammonia concentrations were higher in 94 infected patients than in the uninfected (3.16 vs. 1.55, p=0.0001; 5.58 +/- 2.69 vs. 2.00 +/- 1.49 moL/L, p=0.0001). Among 28 patients who received eradication therapy, 19 (67.9%) were successful, and their gastric pH levels and ammonia concentrations were significantly lower than those in the eradication failure group (1.60 vs. 2.33, p=0.007; 1.77 +/- 1.28 vs. 4.02 +/- 1.20 micro moL/L, p=0.0001). Gastric pH was significantly associated with intragastric ammonia concentration (p=0.025) and gastritis activity (p=0.018). Gastric pH and the ammonia level were significantly correlated with each other (rs=0.495, p< 0.01), and with H. pylori density (rs=0.467; rs=0.735, p< 0.01), gastritis severity (rs=0.343; rs=0.478, p< 0.01), and gastritis activity (rs=0.418; rs=0.579, p< 0.01). CONCLUSION: Gastric juice pH and ammonia concentration reflect well the status of a H. pylori infection, and significantly correlate with each other and with H. pylori density, gastritis severity and activity. These findings suggest that intragastric ammonia produced by H. pylori may have a partial role in an increased gastric juice pH, and has a pathogenic role in H. pylori gastritis.

The Changes of Ammonia and Epidermal Growth Factor Concentration in Gastric Juice before and after the Helicobacter pylori Eradication / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection is the cause of peptic ulcer diseases, and gastric cancer. Hydrolysis of urea generating ammonia may cause cytotoxic effects on the gastric epithelium. The ammonia may induce the synthesis of epidermal growth factor (EGF) in gastric epithelium as an adaptive cytoprotective mechanism. The first aim was to examine the concentration of ammonia and EGF in gastric juice before and after H. pylori eradication in functional dyspepsia patients. The second aim was to examine the correlation among ammonia concentration, EGF concentration, and inflammatory score of gastritis. METHODS: The concentration of ammonia and EGF were measured by ELISA. The grade and severity of gastritis were measured according to the updated Sydney system. RESULTS: The concentration of ammonia in gastric juice was much higher in the H. pylori positive subjects (10,787 +/- 6,584 micro mol/L) than in the negative subjects (2,339 +/- 1,158 micro mol/L, p<0.0001). The concentrations of EGF in gastric juice was much higher in the positive subjects (1,462 +/- 393 pg/mL) than in the negative subjects (1,088 +/- 499 pg/mL, p<0.005). The concentration of ammonia and EGF in gastric juice showed significant correlation (r=0.63, p<0.0001). The concentrations of ammonia and histologic severities showed significant correlation (r=0.41, p<0.0001). Moreover, the level of EGF in gastric juice and histologic severities showed positive correlation (r=0.20, p<0.005). CONCLUSIONS: As the concentration of ammonia in gastric juices increased, the concentration of EGF was also increased in functional dyspepsia with H. pylori infection. The concentration of EGF in gastric juice may play a role in the adaptive cytoprotection in H. pylori- induced gastritis.

Helicobacter pylori and hepatic encephalopathy.

Several extra-intestinal diseases have been associated with Helicobacter pylori infection. Hepatic encephalopathy has been linked to H. pylori infection because of the ammonia produced by the organism in the stomach. H. pylori infection is commoner in cirrhotic patients with hepatic encephalopathy than in those without. Increased ammonia levels have been observed in the gastric juice and blood more commonly in cirrhotics with H. pylori infection than in those without. Though the amount of ammonia produced by H. pylori may be too small to contribute to hepatic encephalopathy, eradication of H. pylori has been shown to improve the blood ammonia levels and hepatic encephalopathy.

relationship between nitric oxide [No] and gastric secretion

The role of NO in the regulation of gastric acid secretion was examined in the anaesthetized adult male albino rats. Continuous i.v. infusion of the NO donor, sodium nitroprusside [SNP, 12mg/kg/h] significantly inhibited both basal and stimulated gastric acid secretion which was mediated neuronally by gastric distension [20 cm H2O or i.v. bolus administration of 2-deosxy -D- glucose [150 mg/kg], as well as gastric acid responses induced by i.v infusion of submaximal doses of pentagastrin [8 micro g/kg/h]. By contrast, gastric acid responses to i.v. infusion of submaximal doses of histamine [1 mg/kg/h] were not influenced by the NO donor. Pretreatment with N[G] - nitro-L-arginine methylester[L-NAME, 10mg/kg, i.v.] did not affect basal acid secretion, but significantly potentiated the increase in acid secretion induced by 2-deoxy-D- glucose which was almost completely antagonized by coadministration of L-arginine [500 mg/kg, i.p.] and slightly augmented the acid secretory response to pentagastrin. Moreover, it was found that pentagastrin infusion caused an increase in luminal release of histamine and this response was significantly suppressed by i.v infusion of the NO donor.Intraperitoneal [i.p] administration of cimetidine [60 mg/kg], a histamine H2-receptor antagonist, significantly inhibited the increase in acid secretion in response to 2-deoxy-D-glucose [150 mg/kg, i.v.], pentagastrin [8 micro g/kg/h, i.v] and histamine [I mg/kg/h, i.v.] infusion. In conclusion, the present study suggests that NO has an inhibitory action on gastric acid secretion that may be through suppression of histamine release from enterochromaffin like [ECL] cells

El efecto de los bloqueadores H2 en la flora bacteriana gástrica / Effect of H2 hisamine antagonists on gastric bacterial flora

El objetivo del presente trabajo es indagar, si hay crecimiento bacteriano y qué bacterias se encuentran en el estómago, después de la administración de bloqueadores H2, a diferentes dosis. Se formaron cuatro grupos de 10 pacientes cada uno en forma aleatoria en un estudio prospectivo, experimental, transverasal, comparativo y abierto. Se incluyeron pacientes menores de 50 años, sin antecedentes de enfermedad úlcero-péptica, y que fueron sometidos a cirugía electiva (colecistectomía), el grupo IV se formó con pacientes de la Unidad de Cuidados Intensivos, a los cuales se les administró bloqueadores H2 como parte de su terapéutica, y con diagnóstico de sepsis severa. El grupo I se tomó como control, a los grupos II y III se les administró cimetidina a dosis de 200 mg y 40 mg respectivamente, por vía endovenosa, 8 y 2 horas previas a la cirugía. A todos los grupos se les tomó muestra de jugo gástrico. Para determinar pH, y realizar cultivo del mismo para gérmenes aerobios. El grupo I presentó desarrollo en el 20 por ciento de casos con pH medio de 2.1; los grupos II y III desarrollaron gérmenes en el 100 por ciento de casos y pH promedio de 7.1 y 7.2 respectivamente, el grupo IV desarrolló gérmenes en el 70 por ciento de casos y pH promedio 3.4. A partir de un pH de 4 se observa mayor crecimiento bacteriano. El análisis estadístico fue la t de Student la cual mostró r=0.4 y P=< 0.05. Se puede concluir que los bloqueadores H2, a dosis terapéuticas elevan el pH gástrico en el paciente sano, no así en el paciente séptico. Este incremento produce desarrollo bacteriano tanto de gérmenes aerobios como anaerobios. En este estudio, la administración de bloqueadores H2 en pacientes que se operaron en forma electiva, no produjo sepsis postoperatoria. La administración de antibióticos en el paciente grave no reduce el crecimiento bacteriano gástrico aerobio, sí el anaerobio

Acetylsalicylic acid-induced biochemical changes in gastric juice: a failure of adaptation?

BACKGROUND: Acetylsalicyclic acid (ASA) causes gastric mucosal damage which diminishes with continued use due to adaptation. METHODS: To determine the net effect of these processes on the gastric juice, we estimated acid, osmolality, bicarbonate concentration in nonparietal gastric juice, calcium, potassium and sodium in 18 patients (9 men; mean age 32 years, range 20-46) with irritable bowel syndrome, before and after 600 mg of ASA taken post-cibum thrice daily for 4 weeks. Osmolality was determined by an osmometer, acidity by titration, and Na+, K+ and Ca++ using a sodium-potassium-calcium analyzer; bicarbonate was derived from the two-component model of Feldman. RESULTS: Gastric juice K+ and Na+ increased significantly from mean (SE) 14.6 (0.5) and 197.5 (16.3) to 16.7 (0.4) and 256.8 (18.1) mEq/L, respectively. The other parameters remained unchanged. CONCLUSION: After four weeks of ASA ingestion there is a dichotomy of gastric mucosal injury and adaptation, with preservation of acid secretion but continued loss of Na+ and K+.

Concentracao de lidocaina no suco gastrico de recem-nascidos apos anestesia locorregional em partos normais / Concentration of lidocaine in the gastric content of neonates after local anesthesia in vaginal delivery

O objetivo desse estudo foi verificar a transferencia placentaria de lidocaina utilizada em parto normal e a sua possivel presenca no suco gastrico de neonatos, logo apos o nascimento. Foram selecionados 19 recem-nascidos sadios pertencentes a Neonatologia do Hospital Universitario da USP, cujas maes recebem 400mg de lidocaina para anestesia da regiao pudenda. Foram colhidas amostras de sangue para determinar a concentracao plasmatica do anestesico na mae, no cordao umbilical, no neonato e tambem no suco gastrico do recem-nascido...

Serum pepsinogen A and pepsin secretion in duodenal ulcer: helicobacter pylori influence

El pepsinageno sérico A (PGA) y la actividad péptica total (PA) en jugo gástrico, son investigados en 87 pacientes con úlcera duodenal. Los resultados indican un significativo aumento del PGA y PA en relación a controles. Los pacientes con úlcera duodenal, Helicobater Pylori positivo muestran el aumento del PGA no habiendo variaciones en el PA. Este contraste puede deberse a varios factores: dado que los dos parámetros son expresión de actividades celulares distintas y el PA en jugo gástrico es expresión del pepsinógeno total. Se puede concluir que el daño del HP sobre la mucosa duodenal es debido a su acción y no a la alteración de la actividad péptica en jugo gástrico

Gastric fluid fibronectin, transferring and prealbumin in children with bacterial pneumonia

The study included 103 patients with bacterial pneumonia as well as 20 controls. Their ages ranged from 2-36 months. Patients with any disease that could affect plasma proteins were excluded from the patients and controls. Patients were classified according to Downe's score for respiratory distress into mild, moderate and severe. The patients were subjected to full clinical examination chest x-ray, full blood picture, tuberculin test and early morning fasting gastric aspirate for bacteriological studies as well as for determination of fibronectin [Fn] transferrin [Tn] and prealbumin [PA] initial and on follow up after 10 days. Similarly gastric aspirate to plasma ratio [G/P] of Fn, Tn and PA were done initially and on follow up. Controls were subjected to the same gastric aspirate studies. Patients with bacterial pneumonia showed significantly higher values of gastric fluid as well as G/P ratio of Fn and Tn and significantly lower gastric aspirate and G/P ratio of PA than controls. Cases with both severe and moderate bacterial pneumonia showed significantly lower values of gastric fluid and G/P ratio of Fn and PA and significantly higher values of gastric fluid and G/P ratio of Tn than mild ones. Mild cases that became worse showed significantly lower values of gastric fluid and G/P ratio of Fn and PA and significantly higher values of gastric fluid and G/P ratio of Tn than mild cases that became better, cases who died from bacterial pneumonia showed significantly lower values of gastric fluid Fn initially than cases that improved either within or after 10 days treatment. There was a marked and significant decline of gastric fluid Fn in cases that died at deterioration of their state than cases that improved. These data suggest that gastric fluid Fn, Tn and PA may have a prognostic value during the management of bacterial pneumonia. The addition of I.V. fibronectin during the treatment of bacterial pneumonia in the cases that show either significant initial low or significant decline in gastric fluid Fn during the course of the disease may be worthy trial

Refluxo enterogástrico: estudo através da dosagem de bilirrubinas em suco gástrico de 17 pacientes submetidos a endoscopia digestiva alta / Enterogastric reflux: study by bilirrubin dosing in gastric juice of 17 patients submitted to upper digestive endoscopy

Os autores pesquisaram, aleatoriamente, o refluxo enterogástrico avaliado pela presença de bilirrubinas no lago mucoso de 17 pacientes que se submetiam à endoscopia digestiva alta, por queixas digestivas diversas. Todos os pacientes foram observados quanto à tolerância ao exame endoscópico (presença ou näo de náuseas), aspecto do suco gástrico e analisados de acodo com o diagnóstico endoscópico. O refluxo enterogástrico foi elevado nos pacientes que tiveram náuseas, bem como nos que näo tiveram. Dos oito pacientes que tiveram náuseas, a bilirrubina foi positiva em quatro (50%), assim como em três (33,3%) dos nove que näo as apresentaram. O aspecto visual claro do lago mucoso näo afasta a possibilidade de refluxo enterogástrico. No único paciente em que a secreçäo gástrica era amarelo-esverdeada, a bilirrubina estava presente. Contudo, em seis dos 16 pacientes com lago mucoso claro (37,5%), a pesquisa foi positiva. Refluxo enterogástrico foi encontrado em dois de cinco portadores de úlcera duodenal, em um de dois portadores de úlcera gástrica, em três de quatro com gastrite/duodenite, em um paciente portador de úlcera jejunal em estômago operado com "Y" de Roux, em três de três com hérnia de hiato e esofagite e em um de dois pacientes com exame endoscópico normal

Thoracic stomach: comparative evaluation of endoscopy, gastric aspirate analysis and hepatobiliary scintigraphy in the diagnosis of duodeno-gastric reflux.

Twenty patients with thoracic stomach were subjected to hepatobiliary scintigraphy for the diagnosis of duodenogastric reflux. The results of the radionuclide studies were correlated with those of endoscopy and biochemical estimation of total intragastric bile acid. Hepatobiliary scintigraphy was found to be more sensitive (91.6%) and accurate (95%) than endoscopy (25% and 55% respectively) and biochemical estimation of total intragastric bile acid content (66.6% and 80% respectively). Being noninvasive and physiological, radionuclide study appears suitable for routine clinical use in the diagnosis of duodeno-gastric reflux.