Comparison between maximal early diastolic velocity in long-axis direction obtained by M-mode echocardiography and by tissue Doppler in the assessment of right ventricular diastolic function.

Recently the maximal early diastolic velocity in long-axis direction of the right ventricle (RV) obtained by tissue Doppler imaging (MDV TDI) has been introduced in the assessment of RV diastolic function (RVDF). There are reasons to think that also the maximal early diastolic velocity in long-axis direction of the RV obtained using M-mode echocardiography (MDV TAM) could be used to assess RVDF. Therefore, 29 patients were examined with echocardiography and MDV TAM and MDV TDI were measured and compared. A good correlation (r = 0.76, P < 0.001) was found between MDV TAM and MDV TDI indicating that MDV TAM might be used in the assessment of RVDF. However, the velocities obtained by MDV TDI (126.7 +/- 38.9 mm s(-1)) were significantly (P < 0.001) higher than the velocities obtained by MDV TAM (78.3 +/- 27.8 mm s(-1)) and the agreement between MDV TAM and MDV TDI was rather poor probably mainly due to differences in the measuring technique. This means that reference values cannot be used interchangeably between MDV TAM and MDV TDI. If MDV TAM is going to be used in the assessment of RVDF new reference values have to be produced if today's technique and recommendations to measure MDV TAM and MDV TDI are used. However, as most new echocardiographs are equipped with PW-TDI technology it seems preferable to use this technique and compare obtained values with already established reference values.

Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men.

AIMS: To prospectively investigate the association between self-reported psychosocial stress and long-term cardiovascular (CV) morbidity and mortality in a population-based cohort. METHODS AND RESULTS: The Malmö Preventive Project is a population-based screening and intervention programme for cardiovascular disease (CVD) risk factors. Between 1974 and 1980, a total of 13,609 (2741 women) individuals, mean age 45 years, had self-reported chronic stress determined by questionnaire. CV morbidity and mortality were followed up in national registries. Median follow-up time was 21 years. The risk ratio (RR) for a fatal or nonfatal CV incident in the men and women of the group reporting chronic stress was 1.27 (95% CI 1.15-1.39). After stepwise adjustments for known CV risk factors, the RR was reduced to 1.14 (1.02-1.28). The highest RR was found for fatal stroke in men reporting chronic stress, 2.04 (1.07-3.88). For women alone, there was no significant increase in risk after adjustments. CONCLUSION: Self-reported chronic stress is an independent risk factor for CVD, particularly fatal stroke, in middle-aged men; it continues to be a risk factor after adjustment for several other known risk factors. The adjustment itself might reflect mechanisms whereby psychosocial stress directly or indirectly exerts its effects on the body, indicating a possible over-adjustment.

Do Japanese and Swedish peptic ulcer patients respond differently to Helicobacter pylori eradication therapies and what are their histological features?

BACKGROUND: As a consequence of gastric histological differences, Japanese and Swedish peptic ulcer (PU) patients may respond differently to Helicobacter pylori eradication therapies. METHODS: The study was single-blind and compared four eradication therapies in Japanese and Swedish patients with healed gastric (GU) or duodenal (DU) ulcer. Swedish patients received either (a) omeprazole+clarithromycin (OC, where O = 20 mg, C = 500 mg) for 2 weeks, or triple therapy with (b) omeprazole + amoxicillin + clarithromycin (OAC-L where O = 20mg, A = 1 g, C = 250 mg); (c) OAC-H (where O = 20 mg, A-1 g, C-500 mg); or (d) omeprazole + metronidazole + clarithromycin (OMC, where O = 20 mg, M = 400 mg, C = 250 mg) for 1 week. Antibiotic doses were weight-adjusted downwards in Japanese patients. H. pylori was assessed using the urea breath test (UBT), histology and culture pre-entry, with UBT being repeated 4 and 8 weeks after stopping treatment. Histology and culture were repeated if the UBT was positive post-therapy. RESULTS: Recruitment included 120 patients from Japan (43 GU, 61 DU, 16 GU+DU) and 120 from Sweden (119 DU, 1 GU+DU). There were 26 exclusions from a FAS analysis due to H. pylori negativity (14), no drug administration (7) or no data after visit 1 (5). Eradication rates (FAS) from Japan were (a) 63%, (b) 93%, (c) 96% or (d) 96%, and for Sweden (a) 92%, (b) 86%, (c) 93% or (d) 96%. Dual therapy was less effective in patients with gastric atrophy associated with GU disease. Tolerability was good in all treatment groups, with no serious adverse events. CONCLUSION: Triple therapies were safe and effective for H. pylori eradication in Japanese and Swedish peptic ulcer patients. Dual therapy was significantly less effective in the Japanese patients, half of whom had a history of GU and more abnormal histology than in the Swedish patients, all of whom had DU.

Comparison of gastric histology among Swedish and Japanese patients with peptic ulcer and Helicobacter pylori infection.

BACKGROUND: The natural course of Helicobacter pylori gastritis may vary between different ethnic groups. Gastric histopathology and the occurrence of H. pylori organisms in the stomach were investigated in healed duodenal (DU) and gastric (GU) ulcer patients recruited in Sweden (S) and Japan (J) in an identical trial. METHODS: In 203 patients (JGU = 39, JDU = 55, SDU = 109), various morphological gastritis variables and H. pylori were assessed from biopsy specimens obtained using a specific sampling protocol and interpreted according to guidelines of the updated Sydney grading system. RESULTS: The ratio of GU:DU was observed to be very different between the recruited Japanese (39:55) and Swedish (0:109) patients. A comparison of data from SDU and JDU showed that the prevalence of H. pylori infection and the antral predominant gastritis demonstrated by both SDU and JDU were essentially identical. A comparison of data from JDU and JGU demonstrated a greater prevalence of H. pylori infection in the antrum, but not corpus, of JDU compared to JGU patients. The prevalence of atrophy and intestinal metaplasia was higher in both the antrum and corpus of JGU compared to JDU in all patients. CONCLUSIONS: The site specified biopsy methodology and standardized interpretation criteria utilized in this study clearly show that the histotopographic profile of Swedish and Japanese DU patients is essentially the same.

Comparison of Gastric Histology Among Swedish and Japanese Patients with Peptic Ulcer and <emph type="2">Helicobacter pylori</emph> Infection.

BACKGROUND: The natural course of Helicobacter pylori gastritis may vary between different ethnic groups. Gastric histopathology and the occurrence of H. pylori organisms in the stomach were investigated in healed duodenal (DU) and gastric (GU) ulcer patients recruited in Sweden (S) and Japan (J) in an identical trial. METHODS: In 203 patients (JGU = 39, JDU = 55, SDU = 109), various morphological gastritis variables and H. pylori were assessed from biopsy specimens obtained using a specific sampling protocol and interpreted according to guidelines of the updated Sydney grading system. RESULTS: The ratio of GU:DU was observed to be very different between the recruited Japanese (39:55) and Swedish (0:109) patients. A comparison of data from SDU and JDU showed that the prevalence of H. pylori infection and the antral predominant gastritis demonstrated by both SDU and JDU were essentially identical. A comparison of data from JDU and JGU demonstrated a greater prevalence of H. pylori infection in the antrum, but not corpus, of JDU compared to JGU patients. The prevalence of atrophy and intestinal metaplasia was higher in both the antrum and corpus of JGU compared to JDU in all patients. CONCLUSIONS: The site specified biopsy methodology and standardized interpretation criteria utilized in this study clearly show that the histotopographic profile of Swedish and Japanese DU patients is essentially the same.

Dual versus triple therapy in eradication of Helicobacter pylori.

BACKGROUND/AIMS: Duodenal ulcers should be treated by eradication of Helicobacter pylori. This study compared the efficacy of a proton pump inhibitor together with one or two antibiotics in eradication therapy. METHODOLOGY: 177 patients who were H. pylori positive were randomized to receive 14 days of either: lansoprazole 30 mg bd and amoxicillin 1 g bd (LA), omeprazole 20 mg bd and amoxicillin 1 g bd (OA) or lansoprazole 30 mg bd, amoxicillin 1 g bd and clarithromycin 500 mg bd (LAC). The efficacy was assessed at four weeks and at six months after the end of treatment. Biopsies were taken for culture and bacterial sensitivity testing at inclusion and at four weeks after the end of treatment. RESULTS: 149 patients were evaluated for efficacy. The eradication rate was significantly higher in LAC (96%) compared to LA (51%) and OA (64%) treatments (P < 0.001). At baseline 17%, 21% and 19% of the patients in the LA, OA and LAC groups, respectively, were resistant to metronidazole and only one patient was resistant to clarithromycin. Post-treatment, four patients had acquired metronidazole resistance. CONCLUSIONS: LAC is more effective than LA and OA for eradication of H. pylori in duodenal ulcer disease.

Cost effectiveness of Helicobacter pylori eradication therapies in patients with duodenal ulcer. An analysis of triple therapy versus two dual therapy alternatives.

OBJECTIVE: Recent research has focused on eradication therapy as the principal treatment of patients with duodenal ulcers and Helicobacter pylori infection. The aim of this study was to analyse the cost effectiveness of triple therapy versus 2 dual therapies. DESIGN: A health economic evaluation of triple therapy with lansoprazole, amoxicillin and clarithromycin versus 2 dual therapies (lansoprazole or omeprazole, each with amoxicillin) in the eradication of Helicobacter pylori in patients with duodenal ulcers was performed in parallel with a randomised clinical trial. Direct and indirect costs were estimated for 1 year using data elicited from patient questionnaires and from the clinical trial. MAIN OUTCOME MEASURES AND RESULTS: Despite the initial drug cost for triple therapy being 650 Swedish kronor (SEK; 1996 values) higher, the average total direct cost in this group was only SEK150 to SEK200 higher than in the dual therapy groups. This was a result of fewer outpatient visits and lower drug use after treatment failure in the triple therapy group. Triple therapy had a more favourable cost-effectiveness ratio than the dual therapies. CONCLUSION: In spite of higher initial antimicrobial costs, triple therapy with lansoprazole, amoxicillin and clarithromycin is more cost effective than dual therapy because of a higher eradication rate and greater symptom relief.

Piperacillin/tazobactam compared with cefuroxime/ metronidazole in the treatment of intra-abdominal infections.

OBJECTIVE: To assess the effect of piperacillin/tazobactam compared with cefuroxime/metronidazole in the treatment of patients with intra-abdominal infections. DESIGN: Randomised open study. SETTING: 16 Swedish and 6 Norwegian hospitals. SUBJECTS: 269 patients with intra-abdominal infections were randomised and treated with at least one dose of each study drug. 205 patients, 105 treated with piperacillin/tazobactam and 100 with cefuroxime, were clinically evaluable for follow up (had been given the full course of treatment). INTERVENTION: Patients were given piperacillin 4g/tazobactam 0.5 g every 8 hours or cefuroxime 1.5 g every 8 hours plus metronidazole 1.5 g every 24 hours. Each patient was to be treated for a minimum of 3 days and not more than 10 days. MAIN OUTCOME MEASURES: Clinical evaluation of infection at the end of and 4-6 weeks after treatment. Evaluation of safety and tolerance to the drugs and bacteriological susceptibility to the treatment drugs. RESULTS: In the intention to treat analysis treatment was equally successful for piperacillin/ tazobactam (103/140, 74%) and the cefuroxime/metronidazole groups (90/129, 70%) (p = 0.6). Corresponding figures for the clinically evaluable group were 102/105 (97%) and 94/100 (94%) for piperacillin/tazobactam and cefuroxime/metronidazole groups, respectively, at the end of treatment. At late follow up, 92/105 (88%) and 83/100 (83%) in the two groups, respectively, remained free of infection. The side effects of the treatment were mild and evenly distributed between the two groups. Most pathogens were susceptible to the drugs in both treatment groups. CONCLUSION: Both piperacillin/tazobactam and cefuroxime/metronidazole are well suited to the treatment of patients with intra-abdominal infections, and we found no significant difference between the two. The drugs were safe and well tolerated in the regimens used.

Ranitidine bismuth citrate with clarithromycin for the eradication of Helicobacter pylori and for ulcer healing.

BACKGROUND: In a pilot study, ranitidine bismuth citrate (RBC; Pylorid, Tritec) in coprescription with clarithromycin achieved a Helicobacter pylori eradication rate (based on 13C urea breath test alone) of 83%. The aim of the current study was to validate this finding by using three diagnostic tests and a larger group of H. pylori-positive patients with active duodenal ulcer. METHODS: In a blinded study, 95 patients were given either 4 weeks of treatment with RBC, 400 mg bid, alone (RBC400, n = 31) or RBC, 400 mg bid or 800 mg bid, in coprescription with clarithromycin, 250 mg qid for 14 days, followed by 14 days of RBC, 400 mg bid, alone (RBC400 + CLAR and RBC800 + CLAR, respectively; n = 32 for each). Rates of ulcer healing at week 4 and of H. pylori eradication (assessed by antral and corpus urease tests and histology and by 13C urea breath test) at week 8 were compared, together with the incidence of adverse events. RESULTS: All three regimens were effective at duodenal ulcer healing and were tolerated well. The coprescription regimens gave significantly higher observed H. pylori eradication rates (82% and 74% for RBC400 + CLAR and RBC800 + CLAR) compared with RBC400 (0%; p < .001). CONCLUSIONS: RBC in dual therapy with clarithromycin provides excellent H. pylori eradication therapy and is an effective duodenal ulcer healing drug.

Total and inorganic mercury in breast milk in relation to fish consumption and amalgam in lactating women.

Total mercury concentrations (mean +/- standard deviation) in breast milk, blood, and hair samples collected 6 wk after delivery from 30 women who lived in the north of Sweden were 0.6 +/- 0.4 ng/g (3.0 +/- 2.0 nmol/kg), 2.3 +/- 1.0 ng/g (11.5 +/- 5.0 nmol/kg), and 0.28 +/- 0.16 microg/g (1.40 +/- 0.80 micromol/kg), respectively. In milk, an average of 51% of total mercury was in the form of inorganic mercury, whereas in blood an average of only 26% was present in the inorganic form. Total and inorganic mercury levels in blood (r = .55, p = .003; and r = .46, p = .01 6; respectively) and milk (r = .47, p = .01; and r = .45, p = .018; respectively) were correlated with the number of amalgam fillings. The concentrations of total mercury and organic mercury (calculated by subtraction of inorganic mercury from total mercury) in blood (r = .59, p = .0006, and r = .56, p = .001; respectively) and total mercury in hair (r = .52, p = .006) were correlated with the estimated recent exposure to methylmercury via intake of fish. There was no significant between the milk levels of mercury in any chemical form and the estimated methylmercury intake. A significant correlation was found between levels of total mercury in blood and in milk (r = .66, p = .0001), with milk levels being an average of 27% of the blood levels. There was an association between inorganic mercury in blood and milk (r = .96, p < .0001); the average level of inorganic mercury in milk was 55% of the level of inorganic mercury in blood. No significant correlations were found between the levels of any form of mercury in milk and the levels of organic mercury in blood. The results indicated that there was an efficient transfer of inorganic mercury from blood to milk and that, in this population, mercury from amalgam fillings was the main source of mercury in milk. Exposure of the infant to mercury from breast milk was calculated to range up to 0.3 microg/kg x d, of which approximately one-half was inorganic mercury. This exposure, however, corresponds to approximately one-half the tolerable daily intake for adults recommended by the World Health Organization. We concluded that efforts should be made to decrease mercury burden in fertile women.

Mercury levels in the hair of pregnant women in a polluted area in Sweden.

Total mercury concentration in hair, sampled at delivery, was determined in women living in an area polluted with atmospheric emissions of mercury from a metal smelter, (n = 122) and in a control area (n = 75). Information on fish consumption was obtained at the 10th week of pregnancy. The average mercury concentration in hair was 0.27 mg/kg (range 0.07-0.96 mg/kg), which is somewhat lower than previously reported for pregnant women in Sweden and very low compared with levels in fish-eating populations in other parts of the world. Women living in the polluted area had significantly lower mercury levels in hair than women in the control area when comparing groups with quantitatively similar consumption of freshwater fish. Possibly, the population in the smelter area does not catch fish in the neighbourhood and/or the fish in the control area has elevated mercury levels. Consumption of freshwater fish > or = once a week resulted in approximately twice as high hair mercury levels as in those who did not eat freshwater fish at all. Also consumption of saltwater fish > or = once a week resulted in significantly higher hair mercury levels than in those consuming saltwater fish < once a month. Hair levels from the 10th week of pregnancy were similar to the levels at delivery in women with high (> or = once a week) consumption of freshwater fish but decreased during this period in women who did not eat freshwater fish at all, which could be explained by decreased exposure during pregnancy and measurement in recently formed hair.

Effects of maternal dietary supplementation with selenite on the postnatal development of rat offspring exposed to methyl mercury in utero.

Female Sprague-Dawley rats were fed a control standard diet or a selenite (Se) supplemented diet (1.3 p.p.m. Se) for 8 weeks before mating and during gestation and lactation. Blood glutathione peroxidase activity (GSH-Px) was measured as a biomarker of Se in dames. After mating, the females from two dietary groups were divided into three subgroups (6 groups with 10 animals in each) given 0 (vehicle), 2 or 6 mg/kg methyl mercury (MeHg) by gavage on days 6-9 of gestation. Day 2 post parturition all litters were standardized to 6 pups per litter and remaining pups were used for determination of blood and brain total Hg contents. Behavioural testing was performed at two months of age. The results of the study showed that supplementing the diet with Se partly antagonized some adverse effects of the MeHg such as hypoactivity especially in the high MeHg dose group. There were no changes in physical development or body weight except a tendency to decreased body weight in offspring of mothers exposed to 6 mg Hg/kg. The GSH-Px activity was significantly increased in animals fed on Se supplemented diet. The dietary Se supplementation resulted in considerably increased concentrations of mercury in the blood of the offspring despite milder signs of CNS toxicity and no increase in brain concentrations of mercury.

Effect of cisapride on relapse of reflux oesophagitis, healed with an antisecretory drug.

Maintenance treatment with cisapride was evaluated in 298 patients in whom reflux oesophagitis had been healed with antisecretory drugs. Initially, 34% of the patients had grade-I oesophagitis, 33% had grade II, and 33% had grade III. The patients were treated with 20 mg cisapride twice daily or placebo for 6 months or until endoscopic relapse was shown if this occurred earlier. Survival analysis showed that cisapride significantly prolonged the time to endoscopic relapse in grade-I patients (P = 0.02). The intergroup difference in symptomatic relapse in all patients was also significant (P = 0.010). The effect of cisapride was less clearcut in grade II or III, and/or in patients healed with omeprazole. Factors associated with early relapse were placebo therapy, prior omeprazole therapy, duration of pre-trial symptomatic period, and initial endoscopic severity grade. Adverse experiences were limited; diarrhoea was reported by 9% of the cisapride patients.

Lead, cadmium, arsenic and mercury in meat, liver and kidney of Swedish pigs and cattle in 1984-88.

During the period 1984-88 several hundred samples of meat, liver and kidney from Swedish pigs and cattle were analysed for lead, cadmium, arsenic and mercury. Analysis was performed by AAS and extensive quality assurance was carried out. The mean lead levels in pig meat, liver and kidney were less than 0.005, 0.019 and 0.016 mg/kg, respectively: the mean levels in the corresponding bovine tissues were less than 0.005, 0.047 and 0.097 mg/kg. The mean cadmium levels in pig meat, liver and kidney were 0.001, 0.019 and 0.11 mg/kg, whilst those in the corresponding bovine tissues were 0.001, 0.070 and 0.39 mg/kg. The mean arsenic levels in pig meat, liver and kidney were 0.024, 0.023 and 0.019, respectively and those in the corresponding bovine tissues were lower, none exceeding 0.015 mg/kg. The mean mercury levels in pig meat, liver and kidney were 0.009, 0.015 and 0.019 mg/kg respectively, while those in the corresponding bovine tissues were 0.005, 0.006 and 0.010 mg/kg. A decrease in the levels of both arsenic and mercury in pig tissues was found during the period studied, which may be due to a decrease in the use of fish meal in pig feed.

Mercury levels in hair from people eating large quantities of Swedish freshwater fish.

Mercury concentrations in hair were related to fish-eating habits in a group of 50 people reported to have a high consumption of freshwater fish. Mercury levels in hair ranged from 0.3 to 10.8 mg/kg with a mean +/- SD of 3.2 +/- 2.3 mg/kg. The average mercury level in hair from men was significantly higher than that in hair from women (3.8 +/- 2.6 mg/kg versus 2.4 +/- 1.8 mg/kg. Seven individuals (14%) had levels above 6 mg/kg. In people with equal fish consumption, significantly higher mercury levels were found in the hair of those eating fish from lakes Mälaren and Vättern than in those eating fish from Lake Hjälmaren. It has been reported that fish from the latter lake contains approximately 0.2 mg/kg mercury, whereas fish from the other two lakes contains approximately 0.4 mg/kg. The mean mercury level in hair was higher in the group eating freshwater fish more than three times a week (greater than or equal to 500 g fish flesh/week) than in the group eating less, although the difference was of borderline significance. Within couples (n = 16) eating equal numbers of fish meals per week, the men had significantly higher levels (mean 3.7 mg/kg) than the women (mean 2.5 mg/kg). The results from the present study show that people with a high consumption of Swedish freshwater fish have elevated levels of mercury in their hair, when compared with previously reported levels in the hair of Swedish pregnant women.

Specimen fixation in urinary cytology.

Several solutions were evaluated with regard to the preservation and preparation of urine for cytologic evaluation, using a Millipore filtration method. An adequate quantitative yield and good cellular morphology were obtained with formaldehyde-based mixtures as well as with several commercially available solutions. A pure transport medium inhibiting bacterial growth and enzymatic activity preserved cell samples equally well.