Evaluation of endoscopy-based diagnostic methods for the detection of Helicobacter pylori.

BACKGROUND: Helicobacter pylori is an etiological factor in duodenal ulcer. Few studies have objectively assessed the accuracy of diagnostic methods for the detection of H. pylori. METHODS: The sensitivity and specificity of histology, touch smear, rapid urease test (RUT) and brush cytology of endoscopic antral biopsy from patients with duodenal ulcer were compared. Forty-nine patients were evaluated before, and 34 after, eradication therapy. Each time, sampling was done for all 4 tests. The infection status for each sample was established by a positive concordance of results of three of four tests. RESULTS: The highest degree of agreement was between RUT and cytology (kappa = 0.69). Brush cytology (100%) followed by RUT (94.5%) were the most sensitive tests. Histology had the highest specificity (89.3%). A combination of RUT or brush cytology with histology had the maximum chance of detecting H. pylori. As single tests, brush cytology and touch smear had high diagnostic accuracies with a Youdin J value of 1.79 and 1.78, respectively. CONCLUSION: The best method for diagnosis of H. pylori is a combination of the rapid urease test or brush cytology with histology. Brush cytology or touch smear are diagnostic tests of choice if a single test is desired.

Sonographic signs in portal hypertension: a multivariate analysis.

A prospective case controlled study was conducted to evaluate the value of real time ultrasound in establishing the diagnosis and the etiology of portal hypertension. Patients attending the outpatient department of a tertiary care centre were included. There were 324 consecutive patients with portal hypertension due to cirrhosis (n = 229), non cirrhotic portal fibrosis (NCPF: n = 64) and extrahepatic portal venous obstruction (EHPVO: n = 31). During this period, 146 patients with dyspepsia, 35 with splenomegaly and 32 with ascites due to varied causes served as negative and positive controls. Real time ultrasonography using a 3.5 MHz linear array scanner was performed in a fasting state in all subjects. Portal and splenic vein diameter greater than 10 mm, splenomegaly, hepatic and splenic hilar collaterals were suggestive of portal hypertension. Non visualization of the portal vein which was replaced by a cavernoma had a diagnostic accuracy of 98% in EHPVO. Splenic infarcts and absence of ascites were features of non cirrhotic portal hypertension (NCPF and EHPVO). Sonography had an overall diagnostic accuracy of 80%. A stepwise logistic regression with multivariate analysis using discriminate function showed that collaterals at the hepatic and splenic hilum, hepatomegaly, ascites and splenic infarcts were independent markers to differentiate cirrhotic from noncirrhotic causes of portal hypertension. The discriminate equation generated had a mismatch of 9.8%. Correlations between the sonographic signs demonstrated that the variceal grade correlated positively with the presence of splenic hilar collaterals and the liver size inversely correlated with presence of ascites. It was concluded that real time ultrasonography is an accurate method to establish the presence and etiology of portal hypertension.

Dual isolation technique for paediatric lung surgery.

This report describes a dual isolation technique adopted to isolate the lungs from one another at the time of right pneumonectomy in a child (age: 5 yrs, 10 kg weight) with evidence of infective lung disease associated with copious purulent secretion and compromised respiratory function. The isolation of right lung from left was achieved by placing Fogarty embolectomy catheter in right main bronchus and a plain polyvinylchloride endotracheal tube (which was aseptically preshaped to have a distal 45 degrees angulation towards left) in left main bronchus. No soiling of left lung occurred during surgery and patient remained hemodynamically stable. In the same child, post-thoracotomy pain was relieved for five days with buprenorphine, administered through a lumbar epidural catheter. The child had an uneventful post-operative course and cooperated for physiotherapy.

Hypotensive anaesthesia for spine surgery--nitroglycerin vs halothane.

Thirty patients (ASA I or II) requiring spine surgery under general anesthesia were studied. To induce hypotension, halothane 0.5 to 2.5% (n = 15) or nitroglycerin infusion (1-2 micrograms/kg/min) (n = 15) was used. The parameters studied were blood pressure, blood loss, operating time and recovery score. The systolic blood pressure was maintained between 80-100 mmHg during surgery in both the groups. The blood loss with nitroglycerin was significantly less (202 +/- 114 ml) than halothane group (602 +/- 312 ml). All the patients were alert at the end of surgery in the nitroglycerin group (recovery score 9.8 +/- 0.76) as against the halothane group (7.98 +/- 0.9 p < 0.01). Tachycardia or tachyphylaxis was not observed with nitroglycerin. This study suggests that continuous intravenous infusion of nitroglycerin is effective and safe in reducing blood loss and operating time during spine surgery.