Long-term effects of eradication of Helicobacter pylori on relapse and histology in gastric ulcer patients: a two-year follow-up study.

BACKGROUND: The main purpose of this study was to compare omeprazole (ome) plus two antibiotics (OMC) with omeprazole plus placebo (OP) with regard to gastric ulcer relapse for a period of 2 years in patients who were Helicobacter pylori-positive at inclusion. METHODS: Using double-blind randomization 125 patients with gastric ulcer were treated with either OMC (ome 20 mg b.i.d., metronidazole 400 mg b.i.d., clarithromycin 250 mg b.i.d.) (n = 64) or OP (ome 20 mg and placebo) (n = 61) for 1 week, followed by ome 20-40 mg o.d. until healing was confirmed endoscopically after 4, 8 or 12 weeks. Endoscopy and H. pylori diagnostics using culture, histology and serology were performed 6, 12 and 24 months after treatment or at symptomatic relapse. At inclusion, 35% of the OMC group and 38% of the OP group were taking non-steroidal anti-inflammatory drugs (NSAIDs). Nine percent (11/125) of the ulcers were malignant. RESULTS: The prevalence of H. pylori was 82% and the eradication rate 88% in the OMC group and 3% in the OP group. More than 90% of the ulcers were healed after 12 weeks. After 2 years, 76% of patients in the OMC group were in remission compared with 28% in the OP group (ITT) (P < 0.001). Sixty percent of patients in the OMC group that continued to take NSAIDs were in remission after 2 years compared with none in the OP group. Atrophy but not intestinal metaplasia decreased after treatment. CONCLUSIONS: Gastric ulcers are mainly caused by H. pylori, and relapse is effectively prevented by H. pylori eradication, even in patients on NSAIDs.

Short-term starvation alters the free amino acid content of the human intestinal mucosa.

1. The effects of short-term starvation and refeeding on the free amino acid concentrations of the intestinal mucosa were characterized in male subjects (n = 6), using endoscopically obtained biopsy specimens from the duodenum and from all four segments of the colon. 2. The alterations in the amino acid concentrations in response to short-term starvation were overall uniform in both duodenal and colonic mucosa as well as in plasma. Most amino acids decreased, whereas branched-chain amino acids increased. 3. In the colon, glutamic acid and glutamine decreased during the starvation period, whereas they remained unaltered in the duodenum. This was the major difference in response to short-term starvation between the amino acid concentrations in the intestinal mucosa of the duodenum and colon. 4. Refeeding for 3 days normalized the amino acid concentrations except for glutamic acid, asparagine and histidine, which remained low in the colon, and threonine, which showed an overshoot in both parts of the intestine. 5. The changes in mucosal amino acid concentrations seen in response to starvation and refeeding were uniform in the four segments of the colon. This suggests that sampling from the rectum/sigmoid colon will give representative values for the free amino acid concentrations of the entire large intestine.

Absence of Helicobacter pylori in dental plaques in Helicobacter pylori positive dyspeptic patients.

To test the validity of reports on detection of Helicobacter pylori in the mouth, samples were obtained simultaneously from the gastric mucosa and dental plaques for culture in 94 patients examined consecutively by endoscopy. Histological examinations and serological tests were also performed. Helicobacter pylori was not found in the mouth of any of the patients including 52 who had culture-positive gastric biopsies. Thus earlier results could not be confirmed, however, other techniques such as the polymerase chain reaction might give different results.

Gray-scale sonography in torsion of the testicular appendages.

The reliability of gray-scale ultrasonography in diagnosing torsion of the testicular appendages was studied in a series of 54 boys with acute non-traumatic scrotal pain. All boys were operated upon, and the appendages extirpated irrespective of their appearance at exploration; the final diagnosis was based on histological examination. Forty-two boys had appendicular torsion, 2 had testicular torsion and 10 had other diagnoses. Using the sign of appendicular torsion--an echogenic extratesticular structure situated between the head of the epididymis and the upper pole of the testis--as the criterion, 37 displayed a true positive, 9 a true negative, 3 a false positive and 5 a false negative diagnosis. Thus, the sensitivity was 88%, the specificity 75% and the positive predictive value 93% respectively. The echogenic mass varied in size from 3 to 17 mm in diameter. In 34 of the 42 cases of appendicular torsion extratesticular fluid was present, and 19 patients showed enlargement of the head of the epididymis. It is concluded that gray-scale sonography is an accurate and valuable tool in diagnosing torsion of the testicular appendages.

Immunochemical and immunohistochemical evaluation of lung permeability in ventilated newborn rabbits.

These experiments were designed to quantify the vascular-to-alveolar leakage albumin in the neonatal lung and to analyze the distribution of leaking airspaces in the lung parenchyma. Immediately after delivery, newborn rabbits with gestational age 27-29 days received an intravenous injection of human albumin as a marker and were ventilated for 15 min with standardized tidal volume (10 ml/kg). After the period of ventilation the lungs were either lavaged via the airways or fixed for histological studies. The median amount of albumin in lung lavage fluid, determined by immunodiffusion, was 4.8% of the injected dose after 27 days, 1.3% after 28 days, and 0.4% after 29 days of gestation; it was inversely correlated with the compliance of the respiratory system (r = -0.78; p less than .001). Immunohistochemical examination of lung section revealed that the leak was not diffuse; even in animals with gestational age 27 days it involved only a median of 48% of total alveoli. The median amount of alveoli containing the label fell to 6% after 28 days and to 0% after 29 days gestation, correlating inversely with the compliance of the respiratory system (r = -0.53; p less than 0.01). We suggest that our experimental model is useful for histological demonstration of serum proteins leaking into the airpaces under experimental conditions and for evaluating the effect of therapeutic regiments on neonatal lung permeability.

Liver resection with the Sonocut ultrasonic knife.

Previous reports and our findings suggest that resection by ultrasound is of appreciable merit in liver surgery. Blood can be saved and bile leakage diminished as the larger vessels and bile ducts can be skeletonized unharmed, whereas the dissector selectively carries away the parenchyma. Otherwise virtually inaccessible tumours can be approached. The ultrasonic dissector/aspirator does not harm the tissue in depth beyond the resection surface and thus not much devitalized tissue is left in the wound.

Polyarteritis nodosa of the penis.

The course of polyarteritis nodosa in a patient showing an isolated nodule localized to the glans penis is described. The underlying disease was not recognised and the patient was wrongly thought to have a penile cancer. Treatment with radiotherapy and Bleomycin had no effect and he subsequently died in uraemia. Postmortem examination revealed polyarteritis nodosa involving the kidneys and also causing localized changes to the glans penis.