Effect of Lactobacillus casei on Streptococcus bovis in faecal flora.

Bacteraemia caused by Streptococcus bovis is often associated with colorectal tumours. Also, experimental studies have been proposed that S bovis acts as a promoter of tumours. We report the case of a man with colon adenoma who had a high proportion of S bovis in his faecal flora. He was treated with a Lactobacillus casei preparation (BLP) and the effect on the faecal flora was examined. L casei reduced the proportion of S bovis (from 43% down to 9%), and the effect continued after the administration of BLP was stopped. Our data indicate that BLP can repress the excessive colonisation of S bovis.

Randomized trial of dietary fiber and Lactobacillus casei administration for prevention of colorectal tumors.

The epidemiologic evidence that dietary fiber protects against colorectal cancer is equivocal. No large-scale clinical study of the administration of Lactobacillus casei has been reported. We examined whether dietary fiber and L. casei prevented the occurrence of colorectal tumors. Subjects were 398 men and women presently free from tumor who had had at least 2 colorectal tumors removed. Subjects were randomly assigned to 4 groups administered wheat bran, L. casei, both or neither. The primary end point was the presence or absence of new colorectal tumor(s) diagnosed by colonoscopy after 2 and 4 years. Among 380 subjects who completed the study, 95, 96, 96 and 93 were assigned to the wheat bran, L. casei, both and no treatment groups, respectively. Multivariate adjusted ORs for occurrence of tumors were 1.31 (95% CI 0.87-1.98) in the wheat bran group and 0.76 (0.50-1.15) in the L. casei group compared to the control group. There was a significantly higher number of large tumors after 4 years in the wheat bran group. The occurrence rate of tumors with a grade of moderate atypia or higher was significantly lower in the group administered L. casei. No significant difference in the development of new colorectal tumors was observed with administration of either wheat bran or L. casei. However, our results suggest that L. casei prevented atypia of colorectal tumors.

[A case of non-small cell lung carcinoma successfully treated with carboplatin and weekly paclitaxel under renal dysfunction].

A 73-year-old man was admitted to our hospital with productive cough and dyspnea. His chest X-ray and CT scan showed a mass lesion on the lower lung field, pleural effusion on the left side, metastatic lesion in the right lung, and multiple metastases in the liver. The diagnosis was non-small cell carcinoma of the lung. Unfortunately, he had suffered from chronic nephritis; his creatinine level was 2.1, and his creatinine clearance was 29 ml/min. He received 4 courses of combined chemotherapy of carboplatin (AUC 5, day 1) and weekly paclitaxel (60 mg/ m2, day 1, 8, 15) every 4 weeks. His subjective symptoms as side effects were mild except for accidental melena due to colon diverticulum. Almost all lesions identified at admission were regressed by the chemotherapy. Although renal dysfunction often prevents patients with lung cancer from receiving systemic chemotherapies, in this case the combined chemotherapy of carboplatin and weekly paclitaxel proved to be a relatively safe and effective therapy for those patients with renal dysfunction.

Reduction in salivary cortisol level by music therapy during colonoscopic examination.

BACKGROUND/AIMS: Premedication for endoscopy promotes patient cooperation and makes subsequent examinations more acceptable. Music therapy is widely used in the treatment of acute and chronic pain. Therefore, we investigated the effects of music therapy on pain and on salivary cortisol levels in patients undergoing screening colonoscopy. METHODOLOGY: The subjects were 29 consecutive patients undergoing colonoscopy for various reasons. Patients were randomly assigned to undergo colonoscopy while listening to music (n=15) or while not listening to music (n=14). Cortisol levels were measured in samples of saliva obtained before and after colonoscopy. After colonoscopy, patients were asked to rate their maximum pain during colonoscopy. RESULTS: Patients who listened to music during colonoscopy tended to have lower pain scores. Salivary cortisol levels increased significantly less in the group receiving music. CONCLUSIONS: Music therapy during colonoscopy markedly reduces fear-related stress, as indicated by changes in salivary cortisol levels.

Prevention by bovine milk against Helicobacter pylori-associated atrophic gastritis through its adherence inhibition.

BACKGROUND/AIMS: The effects of Helicobacter pylori infection on the development of atrophic gastritis and intestinal metaplasia in relation to lifestyle and diet and the effect of the bovine milk on H. pylori adherence to gastric antral mucosa were investigated. METHODOLOGY: H. pylori infection was investigated in 63 patients without endoscopic evidence of gastroduodenal disease. Presence of H. pylori infection was assessed by culture and histologic examination of antral and corpus biopsy samples. Grades of atrophic gastritis and intestinal metaplasia were judged with chromoendoscopy (Congo red-methylene blue test). Adherence of H. pylori was evaluated with scanning electron microscopic examination of antral mucosa in Mongolian gerbils. RESULTS: Cross-sectional analysis of lifestyle and diet showed that a high intake of bovine milk was significantly related to prevention of H. pylori infection and the developments of atrophic gastritis and intestinal metaplasia. H. pylori adherence to the gastric mucosa was inhibited by bovine milk in a dose-dependent manner. CONCLUSIONS: Bovine milk prevents the development of atrophic gastritis and intestinal metaplasia through its defense mechanisms against the attachment of H. pylori to the gastric mucosa.

Randomized controlled trial of the effect of bifidobacteria-fermented milk on ulcerative colitis.

BACKGROUND: Alterations of intestinal flora, such as reduction in the concentration of bifidobacteria and increase in that of Bacteroides species, are apparently associated with the severity of ulcerative colitis. OBJECTIVE: We conducted a randomised clinical trial of the use of a bifidobacteria-fermented milk (BFM) supplement as a dietary adjunct in the treatment of ulcerative colitis. METHODS: The subjects were randomly divided into two groups: a group with BFM supplementation (BFM group, 11 subjects) and a control group (control group, 10 subjects). The BFM group was given 100 mL/day of BFM for one year. Colonoscopies, general blood markers and examinations of intestinal flora including the analysis of fecal organic acids were performed at the commencement of the study and after one year. RESULTS: Exacerbation of symptoms was seen in 3 out of 11 subjects in the BFM group and in 9 out of 10 in the control group. Log rank statistic analysis of the cumulative exacerbation rates showed a significant reduction in exacerbations for the BFM group (p = 0.0184). The analysis of microflora and the organic acids in the feces showed a significant reduction in the relative proportion of B. vulgatus in Bacteroidaceae and butyrate concentration, respectively, after supplementation with BFM, in comparison with before. CONCLUSION: Supplementation with the BFM product was successful in maintaining remission and had possible preventive effects on the relapse of ulcerative colitis.

Study of Prevention of Colorectal Cancer through Lifestyle Modification: an Introduction to the Protocol.

Previous epidemiological studies have suggested that lack of exercise and a high fat diet increase the risk of colorectal cancer. We planned a clinical trial to test these propositions, using subjects with multiple colorectal adenomas and/or carcinomas. Enrolment in this study was conducted in two stages. First, patients were invited to participate in the dietary modification part of the study. Those agreeing to participate were given dietary advice, and 3 months later all subjects to whom the exercise exclusion criteria do not apply were invited to participate in the exercise part of the study. The subjects were randomized to two groups. A total of two hundred and eleven patients meeting the entry criteria have been invited to join the trial, of whom 165 (78%) consented to participate in the dietary modification part of the study. After excluding those unsuitable according to the exclusion criteria for the exercise regimen, the remaining 124 subjects were further invited to participate in the exercise regimen part of the study. One hundred and three (83%) subjects have given their consent. Obtaining informed consent in two stages and the free provision of lifestyle modification measures were factors that contributed to this favorable participation rate.

Prevention of infectious complications subsequent to endoscopic treatment of the colon and rectum.

We investigated the effect of antibiotics for the prevention of infectious complications subsequent to endscopic treatment of the colon and rectum. Thirty-three patients who underwent endoscopic polypectomies and/or hot-biopsies were divided into two groups: (A, n = 17) with and (B, n = 16) without prophylactic administration of antibiotics. The oral lavage solution method with isotonic magnesium citrate was used for bowel preparation. For group A, 250 mg of kanamycin was administered orally four times, at 30-min intervals, after the oral lavage solution of isotonic magnesium citrate was administered, and 3.2 g of clavulanic acid-ticarcillin was administered by drip infusion after the endoscopic treatment. Latent inflammatory reactions were assessed based on blood cell analysis, erythrocyte sedimentation rate, serum C-reactive protein, and serum phospholipase A2 activity before and the day after the endoscopic treatment. Postoperative platelet, white blood cell, and neutrophil counts were significantly increased in group B, while increases in these parameters were all suppressed in group A. These results suggested that bacterial infections developed subsequent to endoscopic surgery on the colon and rectum. Although we do not need to administer antibiotics to all patients, in patients at high risk of infection, such as those with leukemia or diabetes mellitus, endoscopic polypectomy or hot-biopsy of the colon and rectum should be performed with the administration of antibiotics.