Eradication therapy with rabeprazole versus omeprazole in the treatment of active duodenal ulcer.

BACKGROUND: Rabeprazole has been demonstrated to be a potent antisecretory agent and has been shown to be clinically effective in the treatment of acid-related diseases. AIMS: It was to determine the efficacy of rabeprazole at 20 and 40 mg in addition to amoxicillin and clarithromycin in the treatment of active Helicobacter pylori-positive duodenal ulcers compared with omeprazole 40 mg. PATIENTS AND METHODS: One hundred and twenty-seven patients were randomised into three treatment groups: 40 patients were treated with rabeprazole 40 mg daily, 42 patients with rabeprazole 20 mg daily and 45 patients with omeprazole 40 mg daily for 10 days. All patients received amoxicillin 1 g twice a day and clarithromycin 500 mg twice a day for 5 days. All patients were re-assessed at least 4 weeks after the end of the treatment. RESULTS: According to the intention-to-treat (ITT) protocol, ulcer healing was observed in 90% of patients in the rabeprazole 40 group, in 85.7% in the rabeprazole 20 group and in 93.3% in the omeprazole 40 group. We observed H. pylori eradication in 90% ITT in the rabeprazole 40 group, in 80.9% ITT in the rabeprazole 20 group and in 88.8% ITT in the omeprazole 40 group. Statistical analysis did not show significant differences among the three groups. CONCLUSIONS: A 10-day rabeprazole 20 mg regimen represents an efficacious and safe regimen for H. pylori eradication and ulcer healing.

Characterization of the vasculogenic block in the absence of vascular endothelial growth factor-A.

Vascular endothelial growth factor (VEGF) signaling is required for both differentiation and proliferation of vascular endothelium. Analysis of differentiated embryonic stem cells with one or both VEGF-A alleles deleted showed that both the differentiation and the expansion of endothelial cells are blocked during vasculogenesis. Blood island formation was reduced by half in hemizygous mutant VEGF cultures and by 10-fold in homozygous mutant VEGF cultures. Homozygous mutant cultures could be partially rescued by the addition of exogenous VEGF. RNA levels for the endothelial adhesion receptors ICAM-2 and PECAM were reduced in homozygous mutant cultures, but ICAM-2 RNA levels decreased substantially, whereas PECAM RNA levels remained at hemizygous levels. The quantitative data correlated with the antibody staining patterns because cells that were not organized into vessels expressed PECAM but not ICAM-2. These PECAM+ cell clumps accumulated in mutant cultures as vessel density decreased, suggesting that they were endothelial cell precursors blocked from maturation. A subset of PECAM+ cells in clumps expressed stage-specific embryonic antigen-1 (SSEA-1), and all were ICAM-2(-) and CD34(-), whereas vascular endothelial cells incorporated into vessels were PECAM(+), ICAM-2(+), CD34(+), and SSEA-1(-). Analysis of flk-1 expression indicated that a subset of vascular precursor cells coexpressed PECAM and flk-1. These data suggest that VEGF signaling acts in a dose-dependent manner to affect both a specific differentiation step and the subsequent expansion of endothelial cells. (Blood. 2000;95:1979-1987)

A randomized study comparing methylprednisolone plus chlorambucil versus methylprednisolone plus cyclophosphamide in idiopathic membranous nephropathy.

To assess whether chlorambucil or cyclophosphamide may have a better therapeutic index in patients with idiopathic membranous nephropathy, we compared two regimens based on a 6-mo treatment, alternating every other month methylprednisolone with chlorambucil or methylprednisolone with cyclophosphamide. Patients with biopsy-proven membranous nephropathy and with a nephrotic syndrome were randomized to be given methylprednisolone (1 g intravenously for 3 consecutive days followed by oral methylprednisolone, 0.4 mg/kg per d for 27 d) alternated every other month either with chlorambucil (0.2 mg/kg per d for 30 d) or cyclophosphamide (2.5 mg/kg per d for 30 d). The whole treatment lasted 6 mo; 3 mo with corticosteroids and 3 mo with one cytotoxic drug. Among 87 patients followed for at least 1 yr, 36 of 44 (82%; 95% confidence interval [CI], 67.3 to 91.8%) assigned to methylprednisolone and chlorambucil entered complete or partial remission of the nephrotic syndrome, versus 40 of 43 (93%; 95% CI, 80.9 to 98.5%) assigned to methylprednisolone and cyclophosphamide (P = 0.116). Of patients who attained remission of the nephrotic syndrome, 11 of 36 in the chlorambucil group (30.5%) and 10 of 40 in the cyclophosphamide group (25%) had a relapse of the nephrotic syndrome between 6 and 30 mo. The reciprocal of plasma creatinine improved in the cohort groups followed for 1 yr for both treatment groups (P < 0.01) and remained unchanged when compared with basal values in the cohort groups followed for 2 and 3 yr. Six patients in the chlorambucil group and two in the cyclophosphamide group did not complete the treatment because of side effects. Four patients in the chlorambucil group but none in the cyclophosphamide group suffered from herpes zoster. One patient per group developed cancer. It is concluded that in nephrotic patients with idiopathic membranous nephropathy both treatments may be effective in favoring remission and in preserving renal function for at least 3 yr.

[Treatment of stage IV breast carcinoma]. / Il trattamento del carcinoma della mammella al IV stadio.

The authors report a study carried out in 4 patients with stage 4 breast cancer. The treatment protocol was selected according to age and the general conditions of patients. Two out of four patients were treated with adjuvant chemotherapy associated with cyclophosphamide, adriblastin, 5-fluorouracil and folic acid; one patient received neoadjuvant chemotherapy with the same treatment protocol, while the fourth patient was treated with hormone and immunotherapy. Results were satisfying given that survival was considerably increased in 3 patients together with an improvement in general conditions.

[Venereal perihepatitis: Fitz-Hugh-Curtis syndrome]. / La periepatite venerea: sindrome di Fitz-Hugh-Curtis.

A case of Fitz-Hugh-Curtis syndrome (venereal perihepatitis) is reported. This syndrome is observed almost exclusively in women as a complication of genital gonococcal or chlamydial infections. A sudden, acute biliary-type pain generally characterizes the disease; only a few cases present symptoms related to associated genital infection. The real clinical incidence of venereal perihepatitis is quite high; in fact, a lot of the emergency admitted patients diagnosed with biliary colic or acute cholecystitis as a matter of fact suffer from this syndrome. If haematological investigations, ultrasonography and cholangiography do not confirm a suspected biliary lithiasis, it will be needed to investigate the genital tract. After clinical and ultrasound examinations, neisseria gonorrhoeae and chlamydia trachomatis must be sought in vaginal and cervical secretions and serum antichlamydial antibodies level is to be sought too. Through these examinations, the venereal perihepatitis can usually be diagnosed. In uncertain cases laparoscopy can be useful: in fact, it can reveal the typical violin-string-like adhesions between the anterior liver capsule and the anterior abdominal wall, and, in the same session, it allow to resect them. Tetracycline, doxycycline and, more recently, ofloxacine gave good results in the syndrome's treatment.

[Laparoscopic appendectomy]. / L'appendicectomia per via laparoscopica.

The authors report their experience of 6 cases of appendicectomy using a laparoscopic route of which 5 were performed under local anesthesia and 1 under general anesthesia. The results indicate that this new technique is easy to perform and as rapid and safe as the traditional operation. The possibility of using local anesthesia, the lack of complications when operating on obese patients, the lower incidence of wound infections and rapid postoperative mobilisation all argue in favour of this alternative approach to conventional open surgery.

Reversible acute renal failure from gross haematuria due to glomerulonephritis: not only in IgA nephropathy and not associated with intratubular obstruction.

Seven patients with acute renal failure due to gross haematuria caused by glomerulonephritis are described. Gross haematuria lasting 4-40 days led to acute impairment of renal function of variable severity (peak plasma creatinine 1.3-12 mg/dl) and duration. While partial recovery of renal function occurred in all patients within few days, complete remission was observed only some months later. Three patients had IgA nephropathy (2 the primary form and 1 nephritis secondary to Schönlein-Henoch purpura), two patients had acute postinfectious glomerulonephritis, and two others had focal necrotizing (pauci-immune) glomerulonephritis. The glomerular changes seen in the renal biopsy were not enough to explain per se the renal function impairment. Tubular changes, however, were severe and consisted of tubular necrosis, erythrocyte casts, erythrocyte phagocytosis by tubular cells, accompanied by interstitial damage (oedema, red-cell extravasation, and inflammatory infiltrates). Study of the renal biopsies by immunofluorescence revealed no retrodiffusion of Tamm-Horsfall protein into the glomerular Bowman's space, a sign of obstructed tubular flow in any case. It is concluded that acute renal failure due to gross haematuria in glomerulonephritic patients may not occur only in IgA nephropathy, as reported so far, and is not associated with intratubular obstruction.

[Current etiopathogenic guides in pulmonary embolism]. / Attuali orientamenti etiopatogenetici dell'embolia polmonare.

Pulmonary embolism is still a dangerous postoperative complication in spite of antithrombotic prophylaxis. The paper examines the etiopathogenetic stages of the disease and stresses the relevance of Wircov's triad today, even in the light of recent acquisitions which highlight the role of endothelium as a modulator of the fibrinolytic process.

[Phyllodes tumors of the breast. Clinico-statistical data from the division of Obstetrics and Gynecology of the S. Giacomo Hospital for the years 1981-1985]. / Tumore filloide della mammella. Rilievi clinico-statistici della divisione di Ostetricia e Ginecologia dell'Ospedale S. Giacomo negli anni 1981-1985.

In the light of twenty cases encountered in only five years, the peculiar characteristics of cystosarcoma phyllodes of the breast are described, with an analysis of its morphological, diagnostic, therapeutic and prognostic aspects.

Effects of haemodialysis on active and inactive renin in nephric and anephric patients.

To investigate the origin, the mechanisms of regulation and the possible biological significance of inactive renin we examined the effects of haemodialysis on plasma active and inactive (cryoactivatable) renin in four anephric and in 10 nephric patients. Before haemodialysis inactive renin was similar in anephric and in the majority of nephric patients; this suggests that the source of the inactive enzyme is predominantly extrarenal. In response to haemodialysis active renin rose significantly in nephric patients whereas inactive renin showed minor and inconsistent increments in both groups. These results indicate that the response of the inactive enzyme to haemodialysis is less than that of its active counterpart and is unaffected by the presence of the kidneys. Therefore, it appears unlikely that inactive renin represents a circulating precursor of active renin.