Duodenal ulcer and its relations to Helicobacter pylori

Twenty-one patients with endoscopically proven duodenal ulcers who were found to have H. pylori infection on histology and culture and had successful eradication of H. pylori with combination treatment of colloidal bismuth subcitrate and antibiotics were studied. All patients were endoscoped at entry, four weeks after cessation of treatment and again at one year or sooner if symptoms recurred. At each endoscopy, two antral biopsies were taken and assessed histologically and microbiologically for evidence of H. pylori infection. Recurrence of H. pylori infection occurred in seven patients, four of them had evidence of recurrent peptic disease. In contrast, no one developed evidence of recurrent DU out of the fourteen who remained negative for H. pylori at one year. Overall, DU recurrence in four patients and occurred only in patients reinfected with H. pylori. This relapse rate was compared favorably with patients on maintenance H2-receptor antagonist treatment. These results lend further support to the hypothesis that antral reinfection with H. pylori is associated with relapse of DU

finite element study of an implant and natural tooth-supported mandibular over denture

This work studied the magnitude of stresses around a natural tooth and an osseointegrated implant supporting a m and ibular overdenture when subjected to a functional load applied at three situations. The natural tooth was a canine, while the implant was placed in the site of the other canine. The loading situations included the premolar- molar region of the tooth side, the premolar-molar region of the implant side and incisal region midwary between load was analyzed using the finite element method. By this method, a two-dimensional finite element model was generated to simulate the m and ibular arch, the model contained the implant, the tooth, the acrylic overdenture. Mathematical equations were designed, relating the force to displacements. The equations were solved using a computer. It was concluded that a natural tooth and an implant were used to support an overdenture. All the stresses on the implant were of the compressive types. The vertical component of the axially applied load produced an acceptable distribution of the stresses to both the tooth and the implant. The lateral component of force produced by posterior loading showed more compressive stresses on the distal side of the tooth. The lateral component of force produced by midline loading showed a potential distal movement of the tooth. When a natural tooth and an implant were used to support a m and ibular overdenture, the incisal loading affected the natural tooth more than the posterior loading

Serum potassium levels after moderate exercise in cardiac patients and normal individuals

This study is designed to investigate the effects of exercise on potassium ion, in view of the significant influence of K+ on the heart. We studied 2 groups; the first consisted of 24 patients with known coronary heart disease who had been under our care during the previous three years and who had been in good condition. The second group consisted of 25 healthy volunteers. Postexercise mean K+ levels were higher in both groups than resting levels. Moreover, 3 of the coronary artery disease 24 patients experienced major potassium elevation of 0.9 m mol/L or more, while 6 of the 25 healthy volunteers had the same magnitude of elevation. Interestingly, none of the subjects of the study showed ECG changes during the K+ elevation. This means that coronary artery disease patients who have been clinically stable for reasonable periods may not be vulnerable to conduction or rhythmicity disturbances during moderate exercise. However, to support this conclusion, larger numbers of patients should be included in a similar study

Slow release starch and its metabolic effects in non-insulin dependent diabetics

The present study assesses the impact of slow release starch [SRS] incorporated into instant meals in 7 non-insulin dependent diabetic patients. The SRS was provided by processed beans and rolled cereal grains and compared with standard breakfast and lunch. The effect of 80 g of carbohydrate at each meal on plasma glucose and insulin was measured during 8 hr. Plasma glucose response to the breakfast containing the SRS form was significantly lower as compared to the control meal test over 4 hr [glucose area 12.1 +/- 3.0 mmol L.hr vs 20.0 + 3.6 mmol/ 1. hr, respectively, p < 0.005]. The insulin area was also diminished after both meals containing SRS without reading any statistical significance. In both diets the insulin responses were higher after the lunch and the glucose responses lower compared to the breakfast. In conclusion the use of slow release starch at breakfast may provide an important way to diminish the day long plasma glucose and insulin in diabetic patients. In addition, the diminution of the glucose intolerance and hyperinsulinaemia could decrease the risk of developing coronary disease

Efficacy of B-blockers and calcium channel blockers in the management of unstable angina

Forty-one patients with unstable angina were randomized to treatment with B- blockers [group I] or calcium-channel blockers [group II]. Eighteen patients received B-blockers [6 received propranolol 80 mg/day in two divided doses, 12 received atenolol 100 mg/day], 23 patients received calcium blockers [13 had nifidipine 30 mg/day in 3 divided doses, and 10 had verapamil 80 mg/day]. The baseline characteristics and risk factors were comparable in the two groups. Aspirin was given to 18 patients [9 [50%] and 9 [39%] in the two groups, respectively, P not significant]. Nitrates were given to 21 patients [10 [56%] and 11 [48%] in the two groups, respectively, P=NS]. All patients were followed for 6 to 18 [mean 13] months or till death. Recurrence of attacks of unstable angina necessitating readmission to hospital occurred in one [6%] and 8 [35%] in the two groups, respectively, [P <0.05]. Nonfatal acute myocardial infarction developed in two patients, one in each group. None died in the first group. One died in the second group. Two more patients died after they discontinued nifidipine. In the 18 patients taking aspirin follow-up was uneventful in 15 [83%], in the 23 who did not receive aspirin 15 [65%], had uneventful course [P=NS]. Course was uneventful in 15 out of 21 taking nitrates, and 15 out of 20 not taking nitrates [P=NS]. Five patients discontinued medication with nifidipine and developed acute coronary events later, these events are not included among analysis of efficacy between the two groups. It was concluded that B-blockers are more cardioprotective than calcium blockers in patients with unstable angina, and that discontinuation of treatment with nifidipine can results in acute coronary events

Clinical and electrocardiographic variables predictive of early and late outcome in unstable angina

Fifty patients with unstable angina were studied to define the clinical and electrocardiographic variables predictive of outcome. Based on clinical presentation, patients were stratified into the following types: IA [new onset angina], IB [crescendo angina], IC [angina at rest], II [prolonged angina 20 minutes with ST-T changes on EKG], III [post infarction angina]. Patients were divided into two groups according to the occurrence of complications as acute myocardial infarction, serious arrhythmia [ventricular tachycardia or fibrillation] or death. Nine patients developed complications [group II], five had AMI and four died. Treadmill exercise testing was done in 19 patients if resting EKG was normal or after improvement. Silent ischemia was present in 11, all had no complications and symptomatic [painful] ischemia was noted in eight, two of them were among the complicated group. Patients with unstable angina managed in hospital have an incidence of AMI or death of 18% during a follow-up period of 1 to 27 months [mean 9 +/- 7]. Predictors of a worse prognosis were older age, presence of prolonged chest pain and heart failure. A point score system was developed for better prediction of outcome depending on the following clinical and electrocardiographic variables: Age, history of hypertension, smoking cigarettes, diabetes mellitus, hyperlipidemia, chest pain duration of 20 minutes or more, presence of previous infarction and/or presence of EKG ST-T changes, ventricular premature beats, elevated cardiac enzymes, presence of heart failure. A point value of 0 or 1 is assigned to each variable 0 = absent, 1 = present. Each patient's total score was determined by summing the point values of the 10 variables. A score of 5 or more increased the predictive value of a complicated course. Treadmill exercise testing in some of these patients revealed that silent ischemia does not have a worse prognosis than painful or symptomatic ischemia. It was concluded that this score system helps for better prediction of the course of unstable angina and for selection of patients to be admitted to ICU