Prospective, randomized, investigator-blind trial of Helicobacter pylori infection treatment in patients with refractory duodenal ulcers. Healing and long-term relapse rates.

In this study, 26 patients with duodenal ulcers refractory to treatment with H2-receptor antagonists for 8-12 weeks were randomly assigned to eight weeks of treatment with colloidal bismuth subcitrate (120 mg four times a day) alone (N = 12) or in combination with tetracycline hydrochloride (500 mg four times a day, days 0-14) and metronidazole (500 mg three times a day, days 15-28). Symptoms were scored and endoscopy, histology, and CLO tests were performed before, on completion of treatment, and 3, 6, 12, and 18 months after treatment. Treatment was considered successful when Helicobacter pylori was not detected by CLO tests and Warthin-Starry stains on gastric biopsies taken from antrum, body, and fundus. On triple therapy, ulcers healed in 12/14 patients (85.71%) and 10/14 (71.42%) patients became Helicobacter pylori-negative. On bismuth, only one patient became Helicobacter pylori-negative (8.33%, P < 0.0001), but ulcers healed in 8/12 patients (67%, P = NS). Six patients on bismuth, whose ulcers remained unhealed or relapsed early after healing, were offered triple therapy, which resulted in ulcer healing in three and Helicobacter pylori clearance in two patients. At 18 months, none of the Helicobacter pylori-negative patients had ulcer relapse. On the contrary, ulcers relapsed in all but one patient, who remained Helicobacter pylori-positive. Smoking and drinking did not influence the therapeutic outcome. The data confirm previous reports that many duodenal ulcers are infectious and therefore curable.

Amount and distribution of solid and fatty tissues in the female breast and their relationship to carcinoma.

The study is based on 112 consecutive mastectomy specimens with carcinoma. Breasts were grossly divided into three basic types: solid, when showing a sizable cone of solid tissue (mammary tissue and fibrous stroma), fatty when almost completely replaced by fat, and intermediary types Ia and Ib. It appears that these types represent stages of an evolutionary process involving the anatomical structure of the breast during life. Mammary alterations gradually lead to lobular atrophy. Generalized lobular atrophy characterizes mainly fatty breasts. Lesions of fibrocystic disease are frequent in breasts of all types. In all three types of breast carcinomas were more frequently located in the outer portion of the breast. Rare locations of carcinomas are associated with the type of breast: a central location is more frequent in fatty, an inner location in intermediary and a diffuse in solid breasts. In fatty breasts irregular tumors are common while in solid breasts tumors without clear borders appear to develop. Multicentric carcinomas were much more frequent in solid breasts than in the other types of breasts. Most multicentric carcinomas are accompanied by multicentric carcinoma in situ. Infiltrative lobular and mixed (lobular-ductal) carcinomas are accompanied by lobular carcinoma in situ, lobular cancerization or both. In infiltrative ductal and the special types of carcinomas the histology of carcinoma in situ differs according to whether or not the infiltrative tumor is single or multicentric. The difference concerns the complete lack of lobular cancerization from cases with single infiltrative tumors.