Prediction of Helicobacter pylori Infection Status via Close Observation of Gastric Mucosal Pattern by Standard Endoscopy

BACKGROUND/AIMS: Common endoscopic findings in stomachs with Helicobacter pylori infections include antral nodularity, thickened gastric folds, and visible submucosal vessels. These findings are suggestive but not diagnostic of H. pylori infection. Magnifying endoscopy can reveal more precisely the abnormal mucosal patterns in an H. pylori-infected stomach; however, it requires more training, expertise, and time. We aimed to establish a new classification for predicting H. pylori-infected stomachs by non-magnifying standard endoscopy alone. MATERIALS AND METHODS: A total of 617 participants who underwent gastroscopy were prospectively enrolled from August 2011 to January 2012. We performed a careful close examination of the corpus at the greater curvature maintaining a distance < or =10 mm between the endoscope tip and the mucosal surface. We classified gastric mucosal patterns into four categories: normal regular arrangement of collecting venules (numerous minute red dots), mosaic-like appearance (type A; swollen areae gastricae or snakeskin appearance), diffuse homogenous redness (type B), and mixed pattern (type C; irregular redness with groove) to predict H. pylori infection status. RESULTS: The frequencies of H. pylori infection in patients with a normal regular arrangement of collecting venules pattern and types A, B, and C patterns were 9.4%, 87.7%, 98.1%, and 90.9%, respectively. The sensitivity, specificity, and positive and negative predictive values of all abnormal patterns for prediction of H. pylori infection were 93.3%, 89.1%, 92.3%, and 90.6%, respectively. The overall accuracy was 91.6%. CONCLUSIONS: Careful close observation of the gastric mucosal pattern with standard endoscopy can predict H. pylori infection status.

Difference of Urine MCP-1 in Inflammatory and Non-Inflammatory Glomerular Diseases and Its Realtion to the Proteinuria / 대한신장학회잡지

Monocyte chemoattractant protein-1(MCP-1) has been known to play a role in pathophysiology of inflammatory glomerular disease through selective monocyte attraction and activation. The levels of urine and serum MCP-1 in 20 inflammatory glomerular diseases(IgA nephropathy 16, lupus nephritis 4), 17 non-inflammatory glomerular diseases(membranous nephrothy 9, minimal change disease 8), and 10 normal controls were evaluated by ELISA. The secretion of MCP-1 by peripheral blood mononuclear cells(PBMC) was examined in 5 patients with IgA nephropathy, membranous nephropathy, and minimal change disease respectively and 5 normal controls. After 4 week treatment with steroid, the urine and serum MCP-1 levels were followed up in eighteen patients who received steroid therapy. Urinary excretion of MCP-1 was significantly higher in patients with inflammatory glomerular disease(0.78+/-0.51ng/mg creatinine) compared to normal controls(0.18+/-0.12ng/mg creatinine). There were no differences in serum MCP-1 levels and MCP-1 production by PBMC between normal controls and patients. Positive correlation between urinary excretion of MCP-1 and proteinuria were observed in the patients with inflammatory glomerular disease but not in the patients with non-inflammatory glomerular disease. Any correlation between serum MCP-1 levels and urinary excretion of MCP-1 or proteinuria was not found. Urinary excretion of MCP-1 and proteinuria were decreased after steroid therapy. However, reduction in urinary excretion of MCP-1 does not seem to be related with decrease in proteinuria. Further studies are necessary to clarify the clinical significances of reduction in urinary excretion of MCP-1 with steroid therapy. In conclusion, our data support some role of MCP-1 in the pathophysiology of inflammatory glomerular diseases. MCP-1, however, does not seem to play an important role in those of membranous nephropathy and minimal change disease.

Clinical and Echocardiographic Features of Pulmonic Valve Endocarditis in patients with Ventricular Septal Defect

The pulmonic valve is the least commonly affected valve in infective endocarditis. Pulmonic valve endocarditis usually occurs in IV drug addicts or patients with congenital heart disease, most commonly pulmonic stenosis, patent ductus arteriosus, tetralogy of Fallot, and ventricular septal defect. The diagnosis of pulmonic valve endocarditis is difficult clinically and echocardiography is a reliable method to detect the presence of pulmonic valve endocarditis. Diagnostic finding is vegetations on the pulmonic valve appear as shaggy echo-dense masses or thickening of the pulmonic valve during diastole and/or systole. The prevalence of pulmonic valve endocarditis has increased significantly recent years, especially among intravenous drug addicts. However, few reports have dealt with the echocardiographic and clinical features of pulmonic valve endocarditis. We, therefore, reviewed the clinical spectrum and echocardiographic features of pulmonic valve endocarditis in two patients with ventricular septal defect.