Helicobacter pylori infection and ischaemic heart disease: an overview of the general literature.

In the last years, a considerable number of studies have been performed on the correlation between Helicobacter pylori infection and ischaemic heart disease. The reason is the supposed role of some chronic infections in the genesis and development of vessel wall injury and atheromatous plaque, as already reported for Chlamydia pneumoniae and herpes viruses. While this association may be theoretically conceivable, it still remains debated from a practical point of view. Epidemiological and animal studies as well as some eradicating trials gave conflicting results, while studies investigating the specific molecular mimicry mechanisms induced by H. pylori strongly support the association. Moreover, none of the studies performed so far did take into account the effect of the genetic susceptibility to develop ischaemic heart disease or to respond to H. pylori infection. In particular, while the exposure to some known risk factor for atherosclerosis should lead to develop ischaemic heart disease, no condition or exposure, either individual or in combination, completely explains the occurrence and the progression of the disease, as many patients develop ischaemic heart disease in the absence of any risk factor. Based on these concepts, can we state that H. pylori infection may cause the same effect in patients with ischaemic heart disease as in healthy subjects? Further studies are needed in order to clarify this issue.

Real time endoscopic imaging of oxyradical generation in pig stomach during ischemia-reperfusion.

BACKGROUND: Oxygen-free radicals generation is considered to be a major cause of gastric injury during reperfusion. Chemiluminescence has been used to assess real-time free radical release on the surface of isolated organs. AIMS: To evaluate the combined use of chemiluminescence and gastroendoscopy techniques and to assess the real-time production of free radicals during ischemic damage of the gastric wall in an animal model. PATIENTS AND METHODS: For the experiment, an optical junction was set up between a fibroendoscope and a luminograph apparatus. Three pigs were submitted to gastrofibroendoscopy before, during and after 30 min of clamping of the coeliac artery. Under basal conditions, at the end of the ischemic phase and at the beginning of reperfusion, 1 mM of lucigenin, a specific superoxide enhancer, was injected in the left gastric artery of the animal. The endoscopic live images and chemiluminescence emission were recorded and successively superimposed to measure rate and spatial distribution of photon emission (photons/s). RESULTS: Free radical production was not observed under basal conditions or during the ischemic phase, but significantly increased during reperfusion reaching a maximum peak after 15 min (0.6+/-0.2 photons x 10(5)/s) and decreased progressively thereafter. The superimposition of live and chemiluminescence images allowed the determination of the regional production rate and distribution of photons. CONCLUSIONS: Preliminary observations, in an animal model, on an innovative imaging system which allows the visualization of rate and spatial distribution of reactive oxygen species formation are presented. This new endoscopic technique could be useful for the assessment of oxidative gastric mucosal injury in several gastric diseases; however, further studies remain necessary to determine the applicability of this technique in humans.

An unusual case, in Italy, of hepatocarcinoma characterized by portal hypertension and absence of cirrhosis.

We report a case of a 40-year-old man of Bantu origin, affected by both HBV infection and primitive hepatocarcinoma in the absence of cirrhosis. The fine-needle aspiration specimen reported a rare variant of liver cancer resembling an adenocarcinoma. The neoplasm was certainly a hepatic primitive carcinoma, because chest X-ray, cranial computed tomography, colonoscopy, and abdominal computed tomography did not detect neoplastic lesions and alpha-fetoprotein was > 1000 ng/mL. The present neoplasm, characterized by severe portal hypertension and absence of cirrhosis, is rare in Italy, but largely diffused in Bantu people in Africa.

Pharmacokinetics of cyclosporin microemulsion in patients with inflammatory bowel disease.

OBJECTIVE: To obtain a pharmacokinetic profile of cyclosporin microemulsion formulation in patients with inflammatory bowel disease. PATIENTS AND PARTICIPANTS: 58 consecutive patients (19 women and 39 men), aged 16 to 64 years (mean age 38 years), with a diagnosis of ulcerative colitis (29 patients) or Crohn's disease (29 patients). METHODS: Patients were treated with oral doses of cyclosporin microemulsion ranging from 200 to 400 mg daily. Blood samples were collected after 7 days of treatment; blood was drawn at 0, 0.5, 1, 2, 3, 5, 7 and 12 hours after the morning dose. In 23 patients out of 29 with ulcerative colitis and 23 out of 29 with Crohn's disease, these profiles were repeated immediately before hospital discharge, which took place an average of 18 days after admission. Blood specimens were assayed for cyclosporin immunoreactivity on the day of blood withdrawal by a radioimmunoassay technique. MAIN OUTCOME MEASURES AND RESULTS: In the range of doses employed, the average peak plasma drug concentration (Cmax) and area under the concentration-time curve to 12 hours tended to increase linearly with the dose (from 782.35 to 1,607.98 microg/L and from 3,612 to 7,221 microg x h/L for doses of 200 mg and 400 mg, respectively), whereas the time to Cmax (tmax) and elimination half-life (t 1/2beta) ranged between 78 and 95.2 min and 85.5 and 162 min, respectively, and did not appear to change with the dose. After dose-normalisation by transformation of data into percentage increase over baseline (trough) concentration for each patient, single kinetic parameters for the whole study population (n = 58) could be calculated (Cmax 620% vs baseline. tmax 86.5 min, t 1/2 115 min). Comparison between patients with Crohn's disease and ulcerative colitis showed that the latter had higher Cmax values (702% compared with 543% vs baseline, p < 0.05) whereas tmax and t 1/2beta values overlapped. CONCLUSIONS: The pharmacokinetic parameters of cyclosporin microemulsion in patients with inflammatory bowel disease are broadly similar to those previously measured in healthy volunteers and in other disorders requiring cyclosporin treatment.

An apparent idiopathic case of relapsing acute pancreatitis.

We describe a case of relapsing acute pancreatitis apparently idiopathic in a 55-year-old man. The patient did not smoke and was a modest and irregular drinker of wine. Endoscopic retrograde cholangiopancreatography showed an initial dilatation of secondary ducts like a chronic pancreatitis of class I of Cremer. Ultrasound and computed tomography resulted negative for pancreatic lesions. In the follow-up however, magnetic resonance cholangiopancreatography detected the presence of an intraductal mucin-hypersecreting neoplasm, a duct-ectatic mucinous cystic tumor of the pancreas, in the uncinate process. This is a benign lesion clearly recognized nowadays by magnetic resonance cholangiopancreatography, because this radiological technique shows the grape-like clusters of cystic lesions in secondary ducts communicating with the main duct on the same plane. The radiological picture above excludes a malignant lesion and a biopsy specimen is not required. Furthermore, an intraductal mucin-hypersecreting neoplasm of the pancreas does not require an immediate surgical resection because of its slow evolution and can be followed-up. Conversely cystoadenocarcinoma spreads in peripheral ducts and does not communicate with the Wirsung duct. It requires both surgical resection and a biopsy specimen for histological diagnosis. In the last episode of acute pancreatitis, a sphincterotomy was performed at endoscopic retrograde cholangiopancreatography and our patient had no more pain for one year.

Prevalence of and risk factors for Helicobacter pylori infection among healthcare workers at a teaching hospital in Rome: the Catholic University Epidemiological Study.

OBJECTIVES: To evaluate the prevalence of and the risk factors for Helicobacter pylori in a population of medical and non-medical workers at a teaching hospital in Rome, Italy. DESIGN: A cross-sectional study. METHODS: From January to October 1998, 655 subjects (65% of the total population) underwent a 13C-urea breath test to assess H. pylori infection. Subjects completed a questionnaire concerning sociodemographic characteristics, work departments and history of some gastrointestinal symptoms. Differences in means and proportions were evaluated and independent predictors of H. pylori infection status were assessed by multiple logistic regression analysis. RESULTS: Forty percent of the subjects were found to be H. pylori infected. The mean age of positive subjects was significantly higher than that of negative ones (38 +/- 14 versus 34 +/- 12 years; P < 0.01). No significant difference was found between males and females concerning the infection status (40.2% males versus 39.9% females). Lower years of father's education [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.9-5.1] and age older than 35 years (OR, 2.0; 95% CI, 1.3-3.1) were the only independent predictors of the likelihood of H. pylori positivity. Prevalence of gastrointestinal symptoms was similar in infected and uninfected subjects. Physicians were significantly less infected than nurses and auxiliary personnel (26% versus 47% versus 55%, respectively); however, a loss of association was observed after adjustment by multiple logistic regression (OR, 1.8; 95% CI, 0.9-3.7). In all groups, some specific departments appear to be associated with a higher infection status. CONCLUSIONS: Among healthcare workers, H. pylori infection was associated with specific sociodemographic characteristics, such as age and level of father's education. The prevalence of H. pylori infection was not associated with different professional categories. However, some specific departments seem to increase infection risk.

Intestinal permeability increases with the severity of abdominal trauma: a comparison between gas liquid chromatographic and enzymatic method.

BACKGROUND/AIMS: Increased intestinal permeability was found in humans after multiple trauma, burn injury and major vascular surgery. However, no data are reported regarding possible correlation between trauma and intestinal permeability degree. This study was undertaken to compare gas-liquid chromatographic and enzymatic method for the evaluation of intestinal permeability impairment in patients after severe abdominal trauma. METHODOLOGY: Five traumatized patients with an injury severity score of more than 24 and 5 cross-matched healthy volunteers were studied. The intestinal permeability was performed using a test solution, containing 10 g lactulose and 5 g mannitol. Gas-liquid chromatographic method was applied to measure sugar standards and 5-hour urine samples and the results were compared with those obtained employing a specific enzymatic method. RESULTS: Linearity of myoinositol, lactulose and mannitol measured by gas-liquid chromatographic method was from 0.2-1 microgram injected. Using the enzymatic method, the response was linear between mannitol concentrations of 0.34 and 5.49 mM. Linearity of lactulose standard was from 0.18-2.92 mM. The gas-liquid chromatographic and enzymatic methods showed a good agreement using the Bland-Altman procedure. The mean lactulose/mannitol ratio was 0.085 +/- 0.025 in patients and 0.009 +/- 0.001 in controls (P < 0.001). The higher the injury severity score (30.8 +/- 5) the larger the ratio of lactulose to mannitol (R2 = 0.74). CONCLUSIONS: The enzymatic method--inexpensive, easy-to-perform and timesaving--is suitable for intestinal permeability studies. An abdominal trauma, without injury requiring surgical operation, modifies the intestinal mucosa permeability possibly favoring passage of bacteria and subsequent sepsis.

Efficacy of different Helicobacter pylori eradication regimens in patients affected by insulin-dependent diabetes mellitus.

BACKGROUND: Patients with insulin-dependent diabetes mellitus (IDDM) are often affected by chronic infections; antibiotic absorption, however, may be influenced by the disease. H. pylori eradication appears to be reduced in IDDM patients. The aim of the study was to evaluate the efficacy of the most common H. pylori eradication regimens in a population of IDDM-infected patients. METHODS: One hundred and seventy-two IDDM patients were evaluated. H. pylori infection was assessed through the 13C-urea breath test. Infected patients were randomly assigned to three different standard 7-day eradication regimens: 1) amoxicillin, clarithromycin, pantoprazole; 2) tinidazole, clarithromycin, ranitidine bismuth citrate; or 3) tinidazole, clarithromycin, pantoprazole. Patients in whom eradication was not successful in the first cycle were subsequently submitted to a 7-day therapy with tinidazole, tetracycline, bismuth, and pantoprazole. RESULTS: Thirty-seven per cent of IDDM patients were infected. None of the triple therapies used provided an eradication higher than 62%. Conversely, the quadruple regimen was successful in 88% of the patients. Ten per cent of the subjects undergoing the triple therapies showed minor side effects, without significant differences among groups, whereas side effects occurred in 25% of the patients treated with the quadruple therapy (P < 0.05). CONCLUSIONS: IDDM patients show a low H. pylori eradication rate with a standard triple therapy regardless of the regimen utilized, the dosage and/or the duration of the therapy used appearing not to be sufficient to eradicate the infection efficiently. The use of a quadruple regimen leads to the cure of a large percentage of the infected patients in whom the eradication was unsuccessful in the first therapy, although it is accompanied by a greater incidence of minor side effects.