ISOLATED GRANULOMATOUS GASTRITIS SHOWING DISCOLORATION OF LESIONS AFTER HELICOBACTER PYLORI ERADICATION

We report a case of isolated granulomatous gastritis (IGG) with a submucosal tumor and multiple ulcer scars which showed discoloration after Helicobacter pylori (Hp) eradication. Furthermore, other discolored areas were newly observed after Hp eradication in the present case. Although IGG is extremely rare, the relation between IGG and Hp infection has attracted recent attention, and some case reports of IGG with Hp eradication have appeared in the literature. Discoloration after Hp eradication, however, has never been noted in any case reports and, therefore, this feature made the present case clinically interesting.     

幽门螺杆菌耐药性检测

目的 体外观察北京地区人群幽门螺杆菌（Ｈｐ）菌株对临床常用４种抗菌药物的敏感性和耐药性。方法 ①菌株：Ｈｐ菌株２０株（２株国际标准菌株,１８株临床分离株）,同时以金黄色葡萄球菌ＡＴＣＣ２５９２３为质控菌株。②药物：羟氨苄青霉素,克拉霉素,甲硝唑,呋喃唑酮。③药敏试验：滤纸片琼脂扩散法。结果 甲硝唑耐药率９４．４％,克拉霉素、呋喃唑酮耐药率５．６％,羟氨苄青霉素耐药率０。结论 北京地区人群Ｈｐ菌株甲     

USEFULNESS OF DOUBLE BALLOON ENTEROSCOPY AND VIDEO CAPSULE ENDOSCOPY FOR THE DIAGNOSIS AND MANAGEMENT OF PRIMARY FOLLICULAR LYMPHOMA OF THE GASTROINTESTINAL TRACT IN ITS EARLY STAGES

Aim: The aim of this study is to evaluate the usefulness of double balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in patients with primary follicular lymphoma (FL) of the gastrointestinal (GI) tract. Furthermore, we estimate the effectiveness of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) including rituximab for them. Methods: Thirteen consecutive patients who were diagnosed of having FL in the duodenum between July 2005 and September 2008 were studied. All patients were given the conventional staging examinations, including total enteroscopy using DBE and/or VCE procedures. Chemotherapy was performed after written informed consent. Response assessment was performed every 6‐12 months. The median follow‐up period was 30.2 months. Results: FL was diagnosed in each patient as low grade (grade 1, n = 7; 2, n = 6) and, in all but 4 patients, localized lymphoma (stage I, n = 8; II₁, n = 1; II₂, n = 4). DBE revealed multifocal lesions in the jejunum in 10 of the patients, and in the ileum in 6. VCE showed similar findings in the jejunum in the recent 2 patients. Eleven of 13 patients finally received chemotherapy, and all of them achieved complete regression. They showed no evidence of recurrence after that. Conclusion: Total examination of the small intestine using DBE should be performed before treatment to choose a suitable treatment procedure for primary FL of the GI tract. On the other hand, VCE is useful for screening and following the small intestine in the patients with it. Chemotherapy is effective to achieve complete regression of primary FL of the GI tract.     

吡喹酮治疗对日本血吸虫病人抗幽门螺杆菌抗体的影响

目的探讨吡喹酮治疗对日本血吸虫病患者血清抗幽门螺杆菌HpIgG水平的影响。方法利用Hp全菌抗原对流行区94例日本血吸虫病人治疗前后血清抗HpIgG进行检测。结果治疗后3、6个月,Hp感染阳性率分别为73.4％和70.2％(治疗前为75.5％),HpIgG抗体水平分别为0.71±0.30和0.65±0.21(治疗前为0.80±0.23),对照组均有轻度升高。各年龄组Hp感染阳性率和血清HpIgG水平均随治疗进展而降低,其中0～20岁年龄组血清HpIgG下降最快。血清抗HpIgG和同期对应的日本血吸虫31／32kDa(Sj31／32)IgG抗体平均水平及阴转值之间高度相关(治疗后3个月r分别为0.85和0.65,治疗后6个月r分别为0.85和0.50)。结论日本血吸虫病人经吡喹酮治疗后Hp感染阳性率及血清HpIgG水平降低,日本血吸虫与Hp感染高度相关,血吸虫可能作为Hp感染的危险因素之一。     

A randomized controlled comparison of three quadruple therapy regimens in a population with low Helicobacter pylori eradication rates

BACKGROUND AND AIM: We sought to compare the efficacy and tolerability of an omeprazole/clarithromycin/bismuth/tetracycline-based quadruple therapy to that of a ranitidine/metronidazole/bismuth/tetracycline-based quadruple therapy of 2 or 3 weeks duration in a population with a high prevalence of metronidazole-resistant Helicobacter pylori and low triple therapy eradication rates. METHODS: Two hundred and twenty-one patients who presented endoscopically proven duodenal ulcers and a positive rapid urease test were randomized to receive either: (i) omeprazole 20 mg b.i.d., clarithromycin 250 mg b.i.d., bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d (OCBT) for 2 weeks; (ii) ranitidine 300 mg b.i.d., metronidazole 500 mg b.i.d, bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d. (RMBT2) for 2 weeks; or (iii) ranitidine 300 mg b.i.d., metronidazole 500 mg b.i.d, bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d. (RMBT3) for 3 weeks. Patients were interviewed 2 weeks after the completion of therapy to review compliance and side-effects. Eradication of H. pylori was assessed 8 weeks after the completion of therapy with the use of a 14C-urea breath test. RESULTS: The per-protocol eradication rate was significantly higher with OCBT (88%) than RMBT2 (73%) or RMBT3 (71%) (P<0.05). The intent-to-treat eradication rate was numerically higher with OCBT (80%) than RMBT2 (68%) or RMBT3 (68%), although this difference did not reach statistical significance (P=0.09). Per-protocol or intent-to-treat eradication rates were similar with RMBT2 and RMBT3. There were significantly greater side-effects with the RMBT2 regimen. CONCLUSIONS: The omeprazole/clarithromycin/bismuth/tetracycline-based quadruple therapy provides higher H. pylori eradication rates than the ranitidine/metronidazole/bismuth/tetracycline-based quadruple therapy when administered per protocol. The prolongation of the latter regimen from 2 to 3 weeks did not increase eradication rates.     

CAN DENTAL TREATMENT BE THE INFECTION ROUTE OF H. PYLORI TRANSMISSION IN ADULTS? THREE CASES OF ACUTE GASTRIC MUCOSAL LESIONS AFTER DENTAL TREATMENT

Acute gastric mucosal lesions (AGML) comprise a typical clinical entity in patients with acute gastritis, which is characterized by severe erosion, hemorrhage, and ulceration. It is thought that most Helicobacter pylori (H. pylori) infections are established during childhood through human‐to‐human contact. Initial H. pylori infection in an adult is rare, and the transmission route is unknown. The first patient was a 27‐year‐old woman whose chief complaint was epigastric pain. She underwent dental treatment for 30 min and developed sudden epigastric pain 6 h after the treatment. Endoscopic examination revealed multiple hemorrhagic erosions in the antrum. Rapid urease test and histology for H. pylori were positive, but serum anti‐H. pylori IgG antibody was negative at the onset. Serology and urea breath test were positive for H. pylori 2 months after the dental treatment. The second and third patients were diagnosed as having AGML 2 and 4 days after dental treatment, respectively. Culture for H. pylori was positive and serology was negative at the onset, but serology showed seroconversion 2 months after the dental treatment in both patients. These findings indicate that dental treatment is a possible route for H. pylori infection in patients with AGML.     

消化性溃疡的治疗及远期疗效观察

本文报告ＣＢＳ甲氰咪胍雷尼替丁对１６２例消化性溃疡伴幽门螺杆菌阳性的治疗及远期疗效观察，结果：ＣＢＳ对ＨＰ的转阴率（９５％）显著高于甲氰咪胍（２３％）和雷尼替丁（２２％）。一年后ＨＰ阳转率ＣＢＳ组显著低于其它两组，三组分别为５％，１００％和９０％（Ｐ＜０．００１）。消化性溃疡治愈率三组之间无显著差异，分别为８０％、８４．６％和７８％（Ｐ＞０．０５）。但一年以后溃疡复发率ＣＢＳ组（１２．５％）显著低于甲氰咪胍（７１．５％）和雷尼替丁（５０％）（Ｐ＜０．００１）。伴随慢性胃炎好转率及活动性胃炎消失率ＣＢＳ组也优于其它两组。结论：ＨＰ感染与溃疡发生，延迟愈合及复发有密切关系；清除ＨＰ有助于溃疡愈合，改善胃窦炎症，降低溃疡复发率。     

原发性胃恶性淋巴瘤与幽门螺杆菌感染的相关性初探

为了探讨原发性胃恶性淋巴瘤（ＰＧＭＬ）与幽门螺杆菌（Ｈｐ）感染的相关性，收集３９例ＰＧＭＬ与２２例淋巴性胃炎、３２例Ｈｐ无关疾病的胃粘膜作病例对照研究；Ｈｐ感染的确定采用改良的Ｇｉｅｍｓａ染色；ＰＧＭＬ的分类结合组织学和免疫组化染色。结果：ＰＧＭＬ组Ｈｐ检出率为８７．１８％，显著高于对照的６３．６４％及５３．１３％（Ｐ＜０．００５）。粘膜相关淋巴样组织（ＭＡＬＴ）来源的淋巴瘤占９２．３１％，Ｈｐ检出率达８６．１１％，瘤周慢性活动性胃炎及淋巴滤泡检出率分别为８４．６２％及５６．４１％。组织学检测的初步结论为：胃Ｂ细胞ＭＡＬＴ淋巴瘤与Ｈｐ感染相关。     

PREDICTIVE VALUE OF ENDOSCOPY AND ENDOSCOPIC ULTRASONOGRAPHY FOR REGRESSION OF GASTRIC DIFFUSE LARGE B‐CELL LYMPHOMAS AFTER HELICOBACTER PYLORI ERADICATION

Background: Some gastric diffuse large B‐cell lymphomas have been reported to regress completely after the successful eradication of Helicobacter pylori. The aim of this study was to investigate the clinical characteristics of gastric diffuse large B‐cell lymphomas without any detectable mucosa‐associated lymphoid tissue (MALT) lymphoma that went into complete remission after successful H. pylori eradication. Patients and Methods: We examined the effect of H. pylori eradication in 15 H. pylori‐positive gastric diffuse large B‐cell lymphoma patients without any evidence of an associated MALT lymphoma (clinical stage I by the Lugano classification) by endoscopic examination including biopsies, endoscopic ultrasonography, computed tomography, and bone marrow aspiration. Results: H. pylori eradication was successful in all the patients and complete remission was achieved in four patients whose clinical stage was I. By endoscopic examination, these gastric lesions appeared to be superficial. The depth by endoscopic ultrasonography was restricted to the mucosa in two patients and to the shallow portion of the submucosa in the other two patients. All four patients remained in complete remission for 7–100 months. Conclusion: In gastric diffuse large B‐cell lymphomas without a concomitant MALT lymphoma but associated with H. pylori infection, only superficial cases and lesions limited to the shallow portion of the submucosa regressed completely after successful H. pylori eradication. The endoscopic appearance and the rating of the depth of invasion by endosonography are both valuable for predicting the efficacy of H. pylori eradication in treating gastric diffuse large B‐cell lymphomas.     

A CASE WITH PERFORATION AFTER ENDOSCOPIC BALLOON DILATATION FOR STRICTURE OF MALIGNANT LYMPHOMA

We have experienced a case with perforation after endoscopic balloon dilatation. The patient was diagnosed as having malignant lymphoma in the terminal ileum, and treated with eradication of H. Pylori and chemotherapy. The severe stenosis appeared at the same site of the tumor after the medical treatment. The first dilatation with a 15 mm balloon was successful. The lower small bowel obstruction occurred 14 months after the first balloon dilatation. The second dilatation with an 18 mm balloon was performed. The stricture site was remarkably dilated and could be passed by the scope. Perforation was confirmed because of the complaint of severe abdominal pain. The laparotomy finding showed the hole at the stricture site and remarkable fibrosis without tumorous tissue. The fragility of the tissue, the excessive inflation of the balloon and the insertion of the scope might be causes of the perforation. The case with severe stricture having almost no flexibility should be considered carefully in the determination of treatment procedures for the balloon dilatation.     

DEVELOPMENT OF SPORADIC GASTRIC FUNDIC GLAND POLYP AFTER ERADICATION OF HELICOBACTER PYLORI

The pathogenesis of sporadic gastric fundic gland polyps (FGP) without familial adenomatous polyposis remains unclear. However, development of FGP is associated with normal gastric mucosa without Helicobacter pylori infection. We report two cases of FGP newly developed after successful eradication therapy of H. pylori infection. H. pylori‐associated gastric ulcers occurred in the two patients; H. pylori eradication was performed in the patients and was successful. The patients have not received medication of long‐term proton pump inhibitors. Follow‐up gastrointestinal endoscopy demonstrated a FGP in the fundus of the stomach of each patient after eradication therapy. Regression of sporadic FGP can be observed to coincide with the acquisition of H. pylori infection. Conversely, the present cases demonstrated that the curing of H. pylori infection could lead to the development of FGP.     

DIFFUSE HISTIOCYTIC LYMPHOMA: THE 20-YEAR EXPERIENCE OF AN AUSTRALIAN TEACHING HOSPITAL

There is a paucity of information regarding the natural history and treatment outcome of diffuse histiocytic lymphoma (DHL) in Australia. Case records from 80 patients treated for DHL at the Royal Adelaide Hospital between 1965 and 1985 were reviewed to determine treatment outcome and prognostic information. Pathological review of biopsy specimens confirmed the correct diagnosis in 78 patients. The Ann Arbor staging criteria were unsatisfactory for prognostic purposes. We identified three prognostic groups: Localised disease (82% five-year survival), Advanced disease marrow negative (36% five-year survival), and Advanced disease marrow positive (11 % five-year survival). An elevated plasma lactate dehydrogenase (LDH) and calcium (Ca⁺⁺) predicted a poorer outcome; no patient with a LDH > 500 IU achieved longterm survival (p < 0.001). Survival was identical for patients reclassified histologically as intermediate grade or high grade (Working Formulation). Localised disease was associated with a good prognosis (82% five-year survival) regardless of treatment modality. The outcome of patients with advanced disease has markedly improved over the last two decades, particularly with the introduction of combination chemotherapy containing doxorubicin in 1974 (p < 0.005). Using these regimens, complete remission was achieved in 65% of patients, with a 39% five-year survival.     

丙硫咪唑和噻嘧啶混合疗法驱除肠道线虫的效果观察

本文报道丙硫咪唑４００ｍｇ、２００９与噻嘧啶７５０ｍｇ（基质２５０ｍｇ）的两种混合疗法，一次量顿服的钩虫、蛔虫和鞭虫的虫卵阴转率分别为７２．８％和６８．８％、１００％和９９．２％及２８．９％和３０．０％，两者对３种线虫的疗效差异均不显著（Ｐ均＞０．０５）；驱除钩虫效果均显著优于丙硫咪唑和噻嘧啶对照组（Ｐ均＜０．０１）．显示混合疗法具有协同作用；驱除蛔虫和鞭虫的效果均与两个对照组相近（Ｐ均＞０．０５）。淘虫结果证明其驱虫作用均明显较丙硫咪唑为快。副作用轻微短暂，无蛔虫游走所致的副反应。     

THE FIRST WEEK AFTER DRUG TREATMENT: THE INFLUENCE OF TREATMENT ON DRUG USE AMONG WOMEN OFFENDERS

Over the last decade, there has been a dramatic rise in the number of women arrested for drug offenses, and many have serious drug abuse problems. Increasingly, these women have been mandated to drug treatment, often in community-based settings. This article examines the impact of the treatment programs on the short-term posttreatment drug use of women offenders (N = 165) leaving two community-based treatment programs in Portland, Oregon. Our analyses indicate that women who abstained from drug use during the first week after treatment were more likely than those who used drugs during this time to have remained in treatment longer, received a plan to make a successful transition out of treatment, avoided associations with other drug users after leaving treatment, and obtained encouragement from individuals and groups in support of abstinence.     

200例脑囊虫病患者抗囊治疗前后CT分析

为了提高脑囊虫病的治愈率 ,把握好治疗时机 ,减少后遗症发生率 ,对 2 0 0例脑囊虫病病人抗囊治疗前后CT影像进行了研究分析。结果发现 ,不同类型、不同时期的脑囊虫病其疗效不同。早期脑囊虫病经治疗后病灶全部吸收者为 5 5例 (78.5 7% ) ,中期为 16例 (4 4.44 % ) ,而晚期经治疗后则无 1例全部吸收。早期与中期相比较差异有显著性 (P<0 .0 1) ,中期与晚期相比 ,差异亦有显著性 (P<0 .0 1)。结果表明 ,活的囊尾蚴抗囊治疗后可被完全吸收 ,不留有后遗症     

ANALYSIS OF PROGNOSTIC FACTORS IN PATIENTS WITH GASTRIC VARICES AFTER ENDOSCOPIC TREATMENT

Background: The prognostic factors, including gastric variceal bleeding itself, in patients with gastric varices (GV) after endoscopic treatment remain unclear. The aim of this study was to analyze prognostic factors in patients with GV after endoscopic treatment as well as to evaluate safety and efficacy of our endoscopic treatment. Patients and Methods: This study enrolled 115 patients who underwent endoscopic treatment for GV between October 1988 and December 2003 using cyanoacrylate and 5% ethanolamine oleate. Successful hemostasis, recurrence rates, rebleeding rates, survival rates, complications and prognostic factors after the treatment were retrospectively reviewed. Results: Treatment sessions for GV were performed 3.4 ± 2.5 times. All cases, including 14 emergency cases, were treated successfully. The cumulative recurrence rates at 1, 3 and 5 years after the treatment were 7.0%, 15.6% and 20.0%, respectively, and the cumulative rebleeding rates at 1, 3 and 5 years were 3.5%, 8.7% and 14.8%, respectively. The overall survival rates were 78.3%, 63.7% and 51.5% at 1, 3 and 5 years, respectively. Grade B or C in Child–Pugh classification, emergency or elective cases, and association with hepatocellular carcinoma were identified as significant negative prognostic factors after endoscopic treatment by multivariate analysis. Although several complications were observed, there was no mortality. Conclusions: Grade B or C in Child–Pugh classification, emergency or elective situation, and association with hepatocellular carcinoma are negative prognostic factors after endoscopic treatment.