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Canal Anal , Neoplasias del Ano , Canal Anal/cirugía , Neoplasias del Ano/terapia , HumanosAsunto(s)
Absceso Abdominal , Neoplasias del Colon , Perforación Intestinal , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Absceso/diagnóstico por imagen , Absceso/etiología , Absceso/cirugía , Neoplasias del Colon/complicaciones , Humanos , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Extremidad Inferior , Espacio RetroperitonealRESUMEN
The psyllid Triozoida limbata (Enderlein) (Hemiptera: Triozidae) is a major pest in guava, feeding primarily on new shoots. Despite its importance, there are no studies on the spatial distribution of T. limbata on guava. Such studies are needed to establish sequential sampling plans for decision making in pest control. Thus, an experiment was carried out in a 9-year-old commercial guava orchard divided into 100 sampling units or plots. Double-sided yellow sticky traps were placed on one plant per plot (sample unit) to capture and monitor T. limbata adults from April 2011 to May 2012. To determine the insect distribution in the area, we calculated the variance-to-mean ratio index (I), the Morisita index (I δ ), Green's coefficient (Cx), and the k exponent of the negative binomial distribution. Most of the samples showed that the adults had a moderate to highly aggregated distribution. Statistical models were also used to study the pest spatial distribution by fitting the number of adults captured to the Poisson and negative binomial distributions. The negative binomial distribution model best fitted the data of the number of adult psyllids captured by the traps, which is consistent with an aggregated distribution.
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Distribución Animal , Hemípteros/fisiología , Herbivoria , Psidium , Animales , Control de Plagas , Análisis EspacialRESUMEN
Routinely, diagnostic and microbiology laboratories perform antibiogram analysis which can present some difficulties leading to misreadings and intra and inter-reader deviations. An Automatic Identification Algorithm (AIA) has been proposed as a solution to overcome some issues associated with the disc diffusion method, which is the main goal of this work. AIA allows automatic scanning of inhibition zones obtained by antibiograms. More than 60 environmental isolates were tested using susceptibility tests which were performed for 12 different antibiotics for a total of 756 readings. Plate images were acquired and classified as standard or oddity. The inhibition zones were measured using the AIA and results were compared with reference method (human reading), using weighted kappa index and statistical analysis to evaluate, respectively, inter-reader agreement and correlation between AIA-based and human-based reading. Agreements were observed in 88% cases and 89% of the tests showed no difference or a <4mm difference between AIA and human analysis, exhibiting a correlation index of 0.85 for all images, 0.90 for standards and 0.80 for oddities with no significant difference between automatic and manual method. AIA resolved some reading problems such as overlapping inhibition zones, imperfect microorganism seeding, non-homogeneity of the circumference, partial action of the antimicrobial, and formation of a second halo of inhibition. Furthermore, AIA proved to overcome some of the limitations observed in other automatic methods. Therefore, AIA may be a practical tool for automated reading of antibiograms in diagnostic and microbiology laboratories.
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Algoritmos , Antibacterianos/administración & dosificación , Fenómenos Fisiológicos Bacterianos/efectos de los fármacos , Aprendizaje Automático , Pruebas de Sensibilidad Microbiana/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The main feature of pulmonary emphysema is airflow obstruction resulting from the destruction of the alveolar walls distal to the terminal bronchioles. Existing clinical approaches have improved and extended the quality of life of emphysema patients. However, no treatment currently exists that can change the disease course and cure the patient. The different therapeutic approaches that are available aim to increase survival and/or enhance the quality of life of emphysema patients. In this context, cell therapy is a promising therapeutic approach with great potential for degenerative pulmonary diseases. In this protocol proposition, all patients will be submitted to laboratory tests, such as evaluation of heart and lung function and routine examinations. Stem cells will be harvested by means of 10 punctures on each anterior iliac crest, collecting a total volume of 200mL bone marrow. After preparation, separation, counting and labeling (optional) of the mononuclear cells, the patients will receive an intravenous infusion from the pool of Bone Marrow Mononuclear Cells (BMMC). This article proposes a rational and safe clinical cellular therapy protocol which has the potential for developing new projects and can serve as a methodological reference for formulating clinical application protocols related to the use of cellular therapy in COPD. This study protocol was submitted and approved by the Brazilian National Committee of Ethics in Research (CONEP - Brazil) registration number 14764. It is also registered in ClinicalTrials.gov (NCT01110252).
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Trasplante de Médula Ósea , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Trasplante de Células Madre , Brasil , Tratamiento Basado en Trasplante de Células y Tejidos , Protocolos Clínicos , Humanos , Enfisema PulmonarRESUMEN
Nitrogen removal via the nitrite pathway results in significant savings in both aeration costs and COD requirements for denitrification when compared to the conventional biological nitrogen removal process. Implementation of the nitrite pathway for simultaneous C/N/P removal in a single sludge system has a major drawback: the aeration phase disfavours denitrifying phosphorus removal. A possible configuration to overcome this issue is the utilisation of a two-sludge system where autotrophic and heterotrophic populations are physically separated. This paper experimentally demonstrates the feasibility of a nitrite-based two-sludge system with sequencing batch reactors (SBR) for the treatment of urban wastewater: a heterotrophic SBR with denitrifying PAOs for P removal and an aerobic SBR for N removal. Partial nitrification was attained in the autotrophic SBR so that shortcut biological nitrogen removal was achieved by using the anoxic dephosphatation activity of DPAOs. Finally, the effect of operating this system without pH control was studied using different influent pH values (pH = 6.8, 7.5 and 8.2) and, despite some efficiency lost due to the pH fluctuations, the system was able to remove most of the C, N and P present in the wastewater.
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Carbono/aislamiento & purificación , Nitritos/metabolismo , Nitrógeno/aislamiento & purificación , Fósforo/aislamiento & purificación , Aguas del Alcantarillado/microbiología , Carbono/metabolismo , Nitrógeno/metabolismo , Fósforo/metabolismo , Eliminación de Residuos LíquidosRESUMEN
Neuromuscular electrical stimulation (NMES) can alter the functioning of muscles and even assist muscle rehabilitation. In this paper, we evaluate the effect of NMES on the conduction velocity (CV) of the brachial biceps' motor units. We used a linear array of electrodes to acquire electromyographic signals, as different subjects perform isometric voluntary contractions (IVCs), with and without prior NMES. Our results show that, after NMES, the CVs at the beginning of the IVCs tend to increase, with respect to the case without NMES. Also, we observed that, while in the absence of NMES, the CVs tend to decrease over time with continued IVCs, this does not happen after 20 minutes of NMES, and the CVs can, in some cases, increase with the contractions.
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Estimulación Eléctrica , Electromiografía/métodos , Contracción Isométrica , Adulto , Electrodos , Humanos , Masculino , Adulto JovenRESUMEN
Despite the implementation control programs, schistosomiasis continues to spread throughout the world. Among modern control strategies, vector control is currently being emphasized. Within this context, analysis of the genetic variability of intermediate host snails (Biomphalaria spp) is important because it allows identification of specific sequences of the genome of this mollusk related to susceptibility/resistance to Schistosoma mansoni infection. We investigated Brazilian albino (non-pigmented) and pigmented (wild type) strains of Biomphalaria glabrata; these strains differ in their susceptibility to S. mansoni infection. Genetic variability was studied by RAPD-PCR using different random primers. The electrophoretic patterns resulting from amplification showed specific polymorphic markers for the albino and pigmented strains of B. glabrata. This information will help in the identification and isolation of genes specifically related to susceptibility, demonstrating that RAPD-PCR is an appropriate and efficient methodological approach for analysis of the genetic variability of schistosomiasis vectors.
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Biomphalaria/genética , Biomphalaria/parasitología , Schistosoma mansoni/fisiología , Esquistosomiasis mansoni/genética , Esquistosomiasis mansoni/fisiopatología , Animales , Predisposición Genética a la Enfermedad/genética , Variación Genética/genética , Reacción en Cadena de la Polimerasa , Técnica del ADN Polimorfo Amplificado AleatorioRESUMEN
OBJECTIVE: To investigate whether performing a low-intensity, single-joint exercises for knee extensors was an efficient strategy for increasing the number of motor units recruited in the vastus lateralis muscle during a subsequent multi-joint exercises. METHODS: Nine healthy male participants (23.33+/-3.46 yrs) underwent bouts of exercise in which knee extension and 45 degrees , and leg press exercises were performed in sequence. In the low-intensity bout (R30), 15 unilateral knee extensions were performed, followed by 15 repetitions of the leg presses at 30% and 60% of one maximum repetition load (1-MR), respectively. In the high-intensity bout (R60), the same sequence was performed, but the applied load was 60% of 1-MR for both exercises. A single set of 15 repetitions of the leg press at 60% of 1-MR was performed as a control exercise (CR). The surface electromyographic signals of the vastus lateralis muscle were recorded by means of a linear electrode array. The root mean square (RMS) values were determined for each repetition of the leg press, and linear regressions were calculated from these results. The slopes of the straight lines obtained were then normalized using the linear coefficients of the regression equations and compared using one-way ANOVAs for repeated measures. RESULTS: The slopes observed in the CR were significantly lower than those in the R30 and R60 (p<0.05). CONCLUSIONS: The results indicated that the recruitment of motor units was more effective when a single-joint exercise preceded the multi-joint exercise. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12609000413224.
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Ejercicio Físico/fisiología , Músculo Esquelético/fisiología , Electromiografía , Humanos , Pierna , Masculino , Adulto JovenRESUMEN
BACKGROUND: The androgen-secreting tumors constitute fewer than 1% of ovarian tumors. Leydig cell tumor is one of the most common of this type of lesion and it is usually benign, small and unilateral. CASE REPORT: A 67 year old woman was referred to the Endocrine clinic due to hirsutism (score 22 Ferriman-Gallwey) and male type alopecia with 3 years of evolution and progressive worsening. Biochemically she had high levels of serum testosterone - 662 ng/dl (N < 62 ng/dl). Transvaginal ultrasonography and abdomen-pelvic CT scan didn't show any signs of adrenal or ovarian tumors. Bilateral oophorectomy was performed and histopathologic exam revealed bilateral Leydig cell tumors, measuring 1cm each. Four months after surgery, the patient had a marked improvement of the signs (score 3 Ferriman-Gallwey) and normalized testosterone levels (35.9 ng/dl). DISCUSSION: Androgen-secreting tumors are rare, but they should be excluded in cases of rapid onset of virilization and elevated androgen levels. Tumors are frequently undetectable by imaging techniques because of their small dimensions, exploratory surgery by a skilled team is frequently necessary and is often the best treatment for the majority of these cases. In this case report we present a rare case of bilateral Leydig cell tumor. Only five cases have been reported in the literature.The clinical history and the elevated levels of testosterone had suggested the presence of an androgen-producing tumor, despite the difficulty of the diagnosis on imaging techniques. Due to the fact that our patient was in a post-menopausal stage, we decided that the appropriate treatment would be bilateral oophorectomy. The histopathologic disclosed the diagnosis and allowed the patient's cure.
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Hirsutismo/etiología , Tumor de Células de Leydig/complicaciones , Neoplasias Ováricas/complicaciones , Anciano , Femenino , HumanosRESUMEN
OBJETIVO: Verificar se a execução de um exercício monoarticular de baixa intensidade para os extensores do joelho é uma estratégia eficaz para aumentar o número de unidades motoras recrutadas no músculo vasto lateral durante a realização de um exercício multiarticular subsequente. MÉTODOS: Nove sujeitos saudáveis do sexo masculino (23,33±3,46 anos) foram submetidos a rotinas de treinamento nas quais os exercícios cadeira extensora e leg press 45° eram realizados em sequência. Na rotina de baixa intensidade (R30), foram realizadas 15 extensões unilaterais de joelho, seguidas de 15 repetições de leg press 45° com cargas de 30 por cento e 60 por cento de uma repetição máxima (1-RM), respectivamente. Na rotina de alta intensidade (R60), a mesma sequência foi executada, porém a carga dos dois movimentos foi de 60 por cento de 1-RM. Uma série simples de 15 repetições leg press 45° com carga de 60 por cento de 1-RM foi utilizada como exercício controle (RC). A eletromiografia de superfície foi registrada no músculo vasto lateral por meio de um arranjo linear de eletrodos. O valor RMS foi calculado para cada repetição do leg press 45° e, a partir desses resultados, foram calculadas regressões lineares. As inclinações das retas obtidas foram então normalizadas pelos coeficientes lineares das equações de regressão e comparadas por meio da ANOVA de um fator para medidas repetidas. RESULTADOS: As inclinações observadas na rotina RC foram significativamente inferiores às de R30 e às de R60 (p<0,05). CONCLUSÕES: Os resultados indicaram um recrutamento mais efetivo de unidades motoras nas rotinas de exercício multiarticular precedidas de exercício monoarticular.
OBJECTIVE: To investigate whether performing a low-intensity, single-joint exercises for knee extensors was an efficient strategy for increasing the number of motor units recruited in the vastus lateralis muscle during a subsequent multi-joint exercises. METHODS: Nine healthy male participants (23.33±3.46 yrs) underwent bouts of exercise in which knee extension and 45°, and leg press exercises were performed in sequence. In the low-intensity bout (R30), 15 unilateral knee extensions were performed, followed by 15 repetitions of the leg presses at 30 percent and 60 percent of one maximum repetition load (1-MR), respectively. In the high-intensity bout (R60), the same sequence was performed, but the applied load was 60 percent of 1-MR for both exercises. A single set of 15 repetitions of the leg press at 60 percent of 1-MR was performed as a control exercise (CR). The surface electromyographic signals of the vastus lateralis muscle were recorded by means of a linear electrode array. The root mean square (RMS) values were determined for each repetition of the leg press, and linear regressions were calculated from these results. The slopes of the straight lines obtained were then normalized using the linear coefficients of the regression equations and compared using one-way ANOVAs for repeated measures. RESULTS: The slopes observed in the CR were significantly lower than those in the R30 and R60 (p<0.05). CONCLUSIONS: The results indicated that the recruitment of motor units was more effective when a single-joint exercise preceded the multi-joint exercise.
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Humanos , Masculino , Adulto Joven , Ejercicio Físico/fisiología , Músculo Esquelético/fisiología , Electromiografía , Pierna , Adulto JovenRESUMEN
Nitrogen removal via nitrite has recently gained a lot of interest because it results in significant savings in both aeration costs and COD (chemical oxygen demand) requirements for denitrification, when compared to the conventional biological nitrogen removal via nitrate. The effectiveness of two different control strategies to achieve the nitrite pathway in systems with sludge retention has been experimentally demonstrated: (i) control of aerobic phase length, with which aeration is terminated as soon as ammonia is completely oxidised; (ii) operation at low DO setpoints in the aerobic phase. These strategies have been extensively studied in nitrifying reactors and are currently applied in real systems achieving biological carbon, nitrogen and phosphorus removal. In this work, we aim to demonstrate, through modelling and simulation, that the competition between nitrite reducers and nitrite oxidisers for nitrite, rather than kinetic selection plays a major role in NOB washout. Moreover, the results show that the occurrence of simultaneous nitrification and denitrification under "aerobic" conditions is very helpful for the nitrite pathway obtainment and for a more efficient COD utilisation.
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Reactores Biológicos , Simulación por Computador , Modelos Teóricos , Nitritos/metabolismo , Eliminación de Residuos Líquidos/métodos , Aerobiosis , Nitritos/química , Contaminantes Químicos del Agua/química , Contaminantes Químicos del Agua/metabolismo , Purificación del Agua/métodosRESUMEN
BACKGROUND: Two-dimensional echocardiography (2D-echo) allows the evaluation of cardiac structures and their movements. A wide range of clinical diagnoses are based on the performance of the left ventricle. The evaluation of myocardial function is typically performed by manual segmentation of the ventricular cavity in a series of dynamic images. This process is laborious and operator dependent. The automatic segmentation of the left ventricle in 4-chamber long-axis images during diastole is troublesome, because of the opening of the mitral valve. METHODS: This work presents a method for segmentation of the left ventricle in dynamic 2D-echo 4-chamber long-axis images over the complete cardiac cycle. The proposed algorithm is based on classic image processing techniques, including time-averaging and wavelet-based denoising, edge enhancement filtering, morphological operations, homotopy modification, and watershed segmentation. The proposed method is semi-automatic, requiring a single user intervention for identification of the position of the mitral valve in the first temporal frame of the video sequence. Image segmentation is performed on a set of dynamic 2D-echo images collected from an examination covering two consecutive cardiac cycles. RESULTS: The proposed method is demonstrated and evaluated on twelve healthy volunteers. The results are quantitatively evaluated using four different metrics, in a comparison with contours manually segmented by a specialist, and with four alternative methods from the literature. The method's intra- and inter-operator variabilities are also evaluated. CONCLUSIONS: The proposed method allows the automatic construction of the area variation curve of the left ventricle corresponding to a complete cardiac cycle. This may potentially be used for the identification of several clinical parameters, including the area variation fraction. This parameter could potentially be used for evaluating the global systolic function of the left ventricle.
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Algoritmos , Ecocardiografía/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Humanos , Aumento de la Imagen/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
We present a rare case of retrosternal goiter complicated with superior vena cava síndrome (SVCS) with impressive clinical signs. After clinical and imagiologic confirmation, total thyroidectomy was performed with complete remission of compressive signs.
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Bocio Subesternal/complicaciones , Síndrome de la Vena Cava Superior/complicaciones , Anciano , Femenino , Bocio Subesternal/cirugía , Humanos , TiroidectomíaRESUMEN
UNLABELLED: Inspiratory muscles training in COPD is controversial not only in relation to the load level required to produce muscular conditioning effects but also in relation to the group of patients benefiting from the training. Consequently, inspiratory muscular response assessment during Threshold therapy may help optimizing training strategy. The objective of this study was to evaluate the participation of the diaphragm and the sternocleidomastoid (SMM) muscle to overcome with a 30% Threshold load using surface electromyography (sEMG) and to analyze the correlation between SMM activation, maximum strength level of inspiratory muscles (MIP) and obstruction degree in COPD patients (FEV1). We studied seven healthy elderly subjects, mean age of 68+/-4 years and seven COPD patients, FEV1 45+/-17% of the predicted value, with mean age 66+/-8 years. sEMG analysis of SMM muscles and diaphragm were obtained through RMS (root-mean-square) during three stages: pre-loading, loading and post-loading. RESULTS: In the COPD group, the RMS of the SMM increased 28% during load (p<0.05) while the RMS of the diaphragm remained constant. In the elderly there was a trend of a 11% increase in diaphragm activity and of 7% in SMM activity but, without reaching significance levels. SMM activity demonstrated good correlation with the obstruction level (r=-0.537). CONCLUSION: To overcome the load required by Threshold therapy, COPD patients demonstrated an increase of accessory muscles activity, represented by SMM. For the same relative load this increase seems to be proportional to the degree of pulmonary obstruction.
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Ejercicios Respiratorios , Terapia por Ejercicio/métodos , Inhalación , Contracción Muscular , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Músculos Respiratorios/fisiopatología , Anciano , Electromiografía , Terapia por Ejercicio/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función/fisiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To assess the efficacy of lamivudine treatment on hepatitis B e antigen (HBeAg) and/or hepatitis B surface antigen (HBsAg) seroconversion, on other virological and serological markers of response including hepatitis B virus (HBV) DNA and serum aminotransferases, and the safety of lamivudine treatment in hepatitis B patients. PATIENTS: This phase III open-label study evaluated the virological and biochemical response to lamivudine in 70 Portuguese patients with HBeAg positive chronic hepatitis B. Patients were treated with lamivudine 100mg once daily for 12 months. METHODS: Antiviral activity was assessed by measuring alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels at all protocol visits, and hepatitis B serology and HBV DNA were performed at baseline and at month 12 visits. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses. RESULTS: The primary endpoint was virological response at month 12, defined as loss of detectable HBeAg from serum with a reduction of HBV DNA to undetectable levels, and this was observed in 19/69 (27.5%) of patients. Almost half of the patients were HBV DNA negative by this time. Mean ALT values decreased steadily during treatment and by 12 months 61% of patients had values within the normal range. HBeAg seroconversion (HBeAg negative, HBeAb positive) was achieved in 27.9% of patients by 12 months, although all patients remained HBsAg positive. CONCLUSION: Lamivudine was well tolerated and the incidence of adverse events was similar to those reported in previous studies. Lamivudine treatment resulted in virological and biochemical improvements in HBeAg positive chronic hepatitis B patients, with HBeAg seroconversion in one-third of patients.
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BACKGROUND/AIMS: The aim of this study was to determine the one-year outcome of an eradication therapy with ranitidine bismuth citrate and antibiotics in Helicobacter pylori-positive duodenal ulcer patients in respect to ulcer and Helicobacter pylori relapse rates. METHODOLOGY: This multicenter, randomized, double-blind study involved 648 duodenal ulcer patients and had been carried out to compare the following regimens: ranitidine bismuth citrate b.i.d. co-prescribed with either clarithromycin 250 mg q.i.d. or clarithromycin 500 mg b.i.d. or clarithromycin 500 mg b.i.d. plus metronidazole 400 mg b.i.d. for 2 weeks, followed by a further 14 days of treatment with ranitidine bismuth citrate 400 mg b.i.d. to facilitate ulcer healing. H. pylori eradication was assessed by 13C-urea breath test and histology at least 4 weeks, 26 weeks and 52 weeks after the end of treatment. Ulcer relapse and H. pylori status were assessed 4 weeks, 26 weeks and 52 weeks post-treatment or if ulcer symptoms recurred. For the remainder of the follow-up period only serious adverse events were collected. RESULTS: At 12 months data of 438 (69%) patients were evaluable. The observed H. pylori eradication rates were 88-91%. H. pylori relapse rates were 2.1% after 26 weeks and 3.9% after 52 weeks. At the week 26 visit 26 patients (5.6%) and at the week 52 visit 25 patients (5.7%) had documented gastroesophageal reflux disease. CONCLUSIONS: Our data confirm the reduction of duodenal ulcer relapses after the cure of Helicobacter pylori infection.
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Antibacterianos/uso terapéutico , Bismuto/uso terapéutico , Claritromicina/uso terapéutico , Úlcera Duodenal/tratamiento farmacológico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Ranitidina/análogos & derivados , Ranitidina/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Claritromicina/administración & dosificación , Método Doble Ciego , Quimioterapia Combinada , Úlcera Duodenal/microbiología , Humanos , Metronidazol/administración & dosificación , Metronidazol/uso terapéutico , Persona de Mediana Edad , Prevención Secundaria , Resultado del TratamientoRESUMEN
OBJECTIVE: Ranitidine bismuth citrate (RBC) b.i.d. with clarithromycin q.i.d. eradicates Helicobacter pylori (H. pylori) in 82-94% of patients, and heals duodenal ulcers in 88-90% of patients. This double blind, placebo-controlled study examines the efficacy of a simpler b.i.d. treatment regimen, and examines the potential benefit of including a second antibiotic, metronidazole, to the b.i.d. treatment regimen. METHODS: A total of 648 patients with active duodenal ulcer received RBC 400 mg b.i.d. for 4 wk, coprescribed with clarithromycin 250 mg q.i.d., clarithromycin 500 mg b.i.d., or clarithromycin 500 mg b.i.d. with metronidazole 400 mg b.i.d. for the first 2 wk of treatment. Endoscopies were performed prestudy, after 4 wk of treatment, and at least 4 wk posttreatment. H. pylori status was assessed by CLOtest, 13C-urea breath test (UBT), and histology prestudy, and by UBT and histology at least 4 wk posttreatment. Adverse events were recorded at each visit. RESULTS: All three regimens were highly effective and well tolerated. H. pylori eradication rates were 84-94% and duodenal ulcer healing rates were 92-96% (observed data). Highest H. pylori eradication and ulcer healing rates were achieved with RBC 400 mg b.i.d. with clarithromycin 500 mg b.i.d. CONCLUSION: Ranitidine bismuth citrate with clarithromycin 500 mg b.i.d. provides an effective, simple and well tolerated regimen for the eradication of H. pylori and healing of duodenal ulcers.