Helicobacter pylori-positive duodenal ulcer: a long-term double-blind randomized study in patients healed with H2-receptor antagonists.

BACKGROUND: The NIH Consensus Conference in 1994 (1) concluded that all patients with peptic ulcer disease should be tested and treated for Helicobacter pylori and that further evaluation was needed for patients in remission. MATERIALS AND METHODS: We evaluated in a double blind randomization 30 patients whose duodenal ulcers had been healed with H2-receptor antagonists and who remained in remission on maintenance therapy. After ulcer healing and the presence of H. pylori had been confirmed, these patients were randomized to receive eradication therapy or placebo and were followed for a mean period of 23 months. RESULTS: Almost all patients receiving placebo had ulcer recurrence, whereas the patients treated with antibiotics demonstrate a low recurrence rate. CONCLUSION: These data suggest, for the first time to our knowledge, the importance of treating with antibiotics duodenal ulcer patients whose disease is in remission.

[Resistance to cephalosporin in hospital strains of the KES group]. / Resistenze alle cefalosporine in ceppi ospedalieri del gruppo KES.

In our laboratory KES group bacteria account for about 11% of all strains isolated from in-patients and are responsible for serious infections. Their well known increasing tendency to become resistant to beta-lactams prompted us to the KES strains isolated in medical or surgical patients in 1986.87. 30 Klebsiella retrospectively review the susceptibility to antibiotics of strains out of 59 had been isolated in that period from patients previously treated with beta-lactams: no significant variation in resistance to cephalosporins, compared to the 29 strains from non treated patients, was noted. However in the treated group one strain of Klebsiella pneumoniae out of 24 showed resistance to ceftazidime and one of Klebsiella oxytoca was resistant both to cefotaxime (1 out of 16) and ceftriaxone (1 out of 12). 19 strains of Enterobacter spp. out of 32 had bees isolated from treated patients; a significant increase in resistance to 3rd generation cephalosporins (p less than 0.01), compared to the 13 strains isolated from non treated patients, was noted. Our findings suggest that it is advisable to review the in-use antibiotic policy keeping in mind the severity of the infections caused by KES group bacteria.

Impaired fibrinolysis in uremia: partial and variable correction by four different dialysis regimes.

In addition to a hemorrhagic diathesis, uremia is accompanied by a clotting tendency, caused by a marked fall in fibrinolytic capacity. Measurement of lysis time of whole blood diluted with phosphate and acetate buffers and of euglobulin lysis times showed that accumulation of inhibitors is primarily responsible. These probably belong to the class of small molecules abnormally retained in uremia. Hemodialysis (HD) offers the best method of correction, mainly because of better elimination of these inhibitors. In contrast, hemofiltration (HF) and, particularly, intermittent peritoneal dialysis (IPD) are much less effective. In IPD, protein loss via the peritoneum is also responsible for a loss of fibrinolytic activators, so that fibrinolysis becomes even poorer, exposing the patient to an increased risk of vascular complications.