Reliability of Diagnostic Tests for Helicobacter pylori Infection.

Introduction. Helicobacter pylori (H. pylori) infection is very common worldwide. A reliable diagnosis is crucial for patients with H. pylori-related diseases. At followup, it is important to confirm that eradication therapy has been successful. There is no established gold standard for the diagnosis of H. pylori infection. Material and Methods. A sample of 304 volunteers from the general population was screened for H. pylori infection with serology, (13)C-urea breath test (UBT), rapid urease test (RUT) on fresh biopsy, culture from biopsy, and histological examination. Culture was used as gold standard. Results. The sensitivity was 0.99 for serology, 0.90 for UBT, 0.90 for RUT, and 0.90 for histological examination. Corresponding specificities were 0.82, 0.99, 0.98, and 0.97, respectively. The accuracy was 0.86 for serology, 0.96 for UBT, 0.95 for RUT, 0.93 for culture, and 0.95 for histology. There was a strong correlation between the results of UBT and the histological scores of H. pylori colonisation as well as between the results of UBT and the scores of RUT. Conclusion. There were only minor differences in accuracy between the three invasive tests for H. pylori infection in this population. RUT may be recommended as the first choice since a result is obtained within hours. The accuracy of UBT was comparable to the invasive tests, and it is recommended for situations when endoscopy is not needed.

Inflammatory laboratory tests after joint replacement surgery.

Objective criteria for suspected early postoperative infections after arthroplastic surgery are sparse. In order to establish the usual time course of some inflammatory laboratory values after hip and knee arthroplasty, these values were followed prospectively in nine patients. C-reactive protein in serum was normalised within about two weeks. On discharge 14 days postoperatively the erythrocyte sedimentation rate was still high (mean 64 mm/h), but at follow-up four months after operation it was restored to normal. The total blood leucocyte count remained essentially within normal limits throughout the postoperative period. The morning temperature was slightly raised, to about 38 degrees C in a few patients on the first and second days postoperatively, but was otherwise normal.

Granulomatous hepatitis in a patient receiving carbamazepine.

A 60-year-old woman, previously in good health, received carbamazepine in a total dose of 10 g during 1 month. Fever, upper abdominal pain and abnormal liver function appeared after 3 weeks. Liver biopsy showed non-caseating granulomas. One week after withdrawal of carbamazepine the patient was clinically well with normal liver function. Carbamazepine was then reinstituted for 4 days, resulting in fever, upper abdominal pain and deteriorating liver function. One month after this provocation test the patient was clinically well with normal liver function and normal liver biopsy showing only slight fatty vacuolization but no granulomas. A reversible positive mitochondrial antibody test was seen.

Serum ferritin and erythrocyte 2,3-DPG during quantitated phlebotomy and iron treatment.

Serum ferritin and erythrocyte 2,3-DPG levels were followed in 3 healthy males who were phlebotomized to iron depletion and a moderate anaemia. In 2 of the subjects, the expected rise in DPG levels was seen but not in the third, in spite of a Hb concentration of 95 g/1. Serum ferritin levels were found to reflect changes in iron stores, and subnormal serum ferritin indicated depleted iron stores. However, there was no correlation between pre-phlebotomy ferritin levels and calculated iron stores. The conclusion is that no fixed ratio can be established between serum ferritin and iron stores. A single ferritin value within the normal range does not tell how large iron stores a person has. Changes in an individual's iron stores can, however, be detected by repeated ferritin estimations.

Ferastral treatment of three healthy phlebotomized males.

Iron deficiency anaemia was produced by repeated phlebotomies in three healthy males. The storage iron was estimated as 666, 522 and 750 mg. After treatment with 1 000 mg of Ferastral the blood haemoglobin concentration rose at an average daily rate of 0.1 g/100 ml/day. Ninety per cent of the injected iron could be accounted for, and the utilization was estimated to about 70-80%. Side effects comprised pain and discolouration at the injection site.

Formation of multinucleated giant cells from circulating blood cells cultivated in diffusion chambers.

Autologous circulating rabbit blood cells have been cultivated in Millipore diffusion chambers implanted intraperitoneally for 13 days. During this period multinucleated giant cells were formed within the diffusion chambers, confirming a hematogenous origin of these cells. The diffusion chamber technique might be helpful for the investigations of factors initiating the formation of multinucleated giant cells.