The epidemiology of hepatitis B virus among family members in the Middle East.

In 1985, the authors studied the epidemiology of hepatitis B virus (HBV) in a healthy Middle Eastern population. Residents of three remote villages and urban areas of Jordan were assessed for seroprevalence of hepatitis B surface antigen (HBsAg) and HBV infection. Infection was defined as the presence of antibody to hepatitis B core antigen (total) and/or antibody to hepatitis B surface antigen, with or without HBsAg. The overall HBsAg prevalence was 9.9% and was not age-related, although significant differences were noted between the villages (range, 5.7%-12.8%). The prevalence of HBV infection was 36% and increased with age. In addition, there were differences between the villages in patterns of age-specific infection. A newly constructed socioeconomic index showed greater HBsAg prevalence in lower (14.4%) than in upper (2.4%) socioeconomic groups. A history of contact with a jaundiced person and socioeconomic status were independent risk factors for HBsAg-positive status, while contact with a jaundiced person, rural background, and age were independently related to HBV infection. There was evidence of familial clustering of HBV in two of the villages, with HBV carriers and infected children particularly aggregating around HBsAg-positive siblings. There was also a trend toward an association of HBsAg-positive children with HbsAg-positive mothers. HBV carrier prevalence correlated with family size, and HBV infection in the household increased proportionately with the number of carriers in the family. Hepatitis B e antigen was detected most frequently in children and antibody to hepatitis B e antigen in adults. Postnatal early childhood transmission through contact among children of poorer and larger families probably accounts for the high endemicity of HBV in this region.

Comparison of phenolphthalein and phenolphthalein glucuronide on net water transport in rat ileum and colon.

Phenolphthalein is an odorless, tasteless compound, poorly soluble in water, but readily soluble in alcohol or ether. Although its laxative activity was discovered in 1902, the mechanism of action remains unclear. Phenolphthalein has been found to be an ineffective laxative in both jaundiced patients and in experimental animals with ligated common bile ducts. In contrast to the poor solubility of phenolphthalein, phenolphthalein glucuronide is highly water-soluble. In addition, phenolphthalein glucuronide is found in bile following oral phenolphthalein administration, suggesting an enterohepatic circulation. We compared the effect of phenolphthalein and phenolphthalein glucuronide on net water absorption of the ileum and colon of Sprague-Dawley rats using a single-pass perfusion technique. Perfusion of phenolphthalein (10 mg/dl in 154 mM NaCl with 0.5% ethanol and 0.1 g/l gum arabic) resulted in significantly reduced water absorption in both the ileum and colon (66% and 64%, respectively, P less than 0.05). In contrast, phenolphthalein glucuronide did not have a significant effect on net water flux compared to control perfusion in either the ileum or colon. In the ileum only 77 +/- 3% and colon 71 +/- 1.2% of the phenolphthalein infused was recovered, suggesting that much of the infused phenolphthalein was absorbed. In contrast there was no evidence of absorption of phenolphthalein glucuronide, as 98.9 +/- 1.2% was recovered from ileal and colon perfusions. Phenolphthalein glucuronide is not the active form of phenolphthalein, although it may be an effective laxative after deconjugation by colonic bacteria.

Recurrent ulcers after gastric surgery: endoscopic localization to the gastric mucosa.

The traditional teaching has been that ulcers recurring after ulcer surgery occur at, or distal to, the anastomosis of the gastric and intestinal mucosa. These concepts predate the widespread availability of fiberoptic endoscopy. We noted that recurrent ulcers were frequently located in the gastric mucosa proximal to the gastrointestinal anastomosis. We analyzed our cases for the purpose of identifying the location of ulcers that occur after surgery for peptic ulcer disease and to investigate the possible relationship between indication for the original ulcer surgery and the presentation of the recurrent ulcer. Ulcers after peptic ulcer surgery were most frequently located in the gastric mucosa proximal to the intestinal anastomosis. The location of the recurrence was not found to be related to the original diagnosis, to the indication for the operation, or to the presentation of the recurrence. These findings may reflect either a change in the pattern of ulcer recurrence or an altered pattern of recognition related to the routine use of endoscopy.