Multivariate analysis of risk factors for development of duodenal ulcer in Helicobacter pylori-infected patients

BACKGROUND: Although Helicobacter pylori is a significant etiologic factor of peptic ulcer disease, it remains unknown why ulcers develop only in the minority of infected individuals. AIM: The aim of this cross-sectional study was to evaluate the association between the presence of duodenal ulcer in H. pylori-infected patients and different risk factors. METHODS: A total of 122 H. pylori-infected patients were enrolled; 79 had duodenal ulcer and 43 gastritis. Univariate analysis was conducted using either Fisher's exact test or exact Cochrane-Armitage trend test. In multivariate analysis the logistic model was used. RESULTS: Univariate analysis indicated six factors (male sex, smoking, antral H. pylori density, CAGA presence in antrum, and VACA s1a presence in antrum and corpus). Four factors (sex, smoking-alcohol index, H. pylori density index, and CAGA index) were found to be significant in multivariate analysis. The best model predicting duodenal ulcer included male sex, smoking, presence of H. PYLORI on histopathology in antrum and CAGA presence in corpus. CONCLUSION: Although several risk factors were significantly associated with duodenal ulcer, we failed in the identification of either a single risk factor or a set of factors that can unequivocally differentiate patients with ulcer from those with gastritis.     

Use of covered Cheatham-Platinum stents in aortic coarctation and recoarctation

We inserted covered Cheatham-Platinum stents in 4 patients, ranging in age from 12 to 19 years, who weighed between 45 and 94 kg. All the patients had aortic coarctation, with surgical repair having been attempted previously in one, and with balloon dilation having been performed as the primary treatment in two, resulting in formation of aneurysms. The fourth patient had not received any treatment. The gradients were reduced from 10 to 40 mmHg before insertion of the stent to 0 to 5 mmHg after stenting. No complications were encountered. All the patients are well at an interval of 3 to 14 months after stenting.     

Beziehungen zwischen Kalium- und Kohlenhydratstoffwechselstörungen bei Diabetes Mellitus

Zusammenfassung Bei 84 Personen mit stabilem Kohlenhydratstoffwechsel wurde die Glucosetoleranz und ihre Beziehung zum Kaliumspiegel im Serum, Plasma und in Erythrocyten untersucht. Bei 43 Fettsüchtigen wurde mehrmals oral 2 mg eines Salureticums Polythiazid-Renese, Pfizer verabreicht. Die danach auftretende Hypokaliämie verursachte eine Verminderung der Glucosetoleranz, die bei 23 Kranken mit Diabetes mellitus am ausgeprägsten war. Bei 12 Kranken mit latentem Diabetes wurde eine mittelstarke und bei 8 Fettsüchtigen ohne Kohlenhydratstoffwechselstörungen nur eine schwache Verschlechterung der Glucosetoleranz gefunden. 36 Patienten mit Hypokaliämie erhielten eine Kaliumacetatund Bromkaliummischung bis zur Erlangung der Normokaliämie. Daraufhin normalisierte sich die Glucosetoleranz. Die gleichzeitige Verabreichung von Renese und der Kaliummischung in 15 Fällen führte zu einer unbedeutenden Erniedrigung des Kaliumspiegels ohne wesentliche Glykämieveränderungen. Beim Altersdiabetes erreichte man nach Anwendung der Kaliummischung allein bei 33 von 36 Behandelten eine deutliche Verbesserung der Glucosetoleranz und gleichzeitig einen geringgradigen Anstieg des Kaliumspiegels im Serum. Bei 5 Gesunden waren die Veränderungen unwesentlich. Sämtliche Ergebnisse sind statistisch gesichert. — Schlußfolgerung: Bei Beurteilung des latenten Diabetes und Diabetes mellitus sollte der mögliche Einfluß einer Störung des Kaliumstoffwechsels mit in Betracht gezogen werden.

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Relationships between disturbances in Potassium and carbohydrate metabolism in diabetes mellitus

Summary The glucose tolerance was measured in 84 patients examined under controlled conditions, and related to the potassium concentration of serum, or plasma and that in erythrocytes. Forty-three obese patients were given 2 mg of Polythiazid-Renese [Pfizer] by mouth for 7 days to promote elimination of salt. The resulting hypokaliaemia caused a reduction in glucose tolerance. This was greatest in 23 patients with diabetes mellitus, moderate in 12 patients with latent diabetes, and least in 8 obese patients with normal carbohydrate metabolism. Thirty-six hypokaliaemic patients were given a mixture of potassium acetate and potassium bromide for several days until serum potassium was normal. This brought about a return to normal of the values obtained in the glucose tolerance test. Simultaneous administration of Renese and the potassium mixture in 15 cases caused only an insignificant fall in serum potassium without any appreciable change in blood glucose. In 33 out of 36 patients with maturity-onset diabetes, the administration of the potassium mixture alone caused a noticable improvement in the glucose tolerance test and at the same time a small rise in serum potassium. In 5 normal subjects the changes were unimportant. The results obtained were statistically significant. — Conclusion: In the assessment of latent diabetes and of diabetes mellitus the role of disturbances in potassium metabolism should not be overlooked.

Nach einer Mitteilung auf der II. Tagung der Europäischen Gesellschaft für Diabetologie in Aarhus am 6. 7. 1966.     

First heart sound and opening snap in patients with mitral valve disease. Phonocardiographic and pathomorphologic study

Patients with exercise angina >2 months (n:13) showed significantly lower SigmaST elevation during 120 s balloon coronary occlusion than those with =<2 months (n:7), or those with angina at rest <=2 days (n:8) but similar to patients with angina at rest >2 days (n:7). These results underscore the importance of the kind and duration of angina in limiting the extent of ischemia during coronary occlusion.     

Resistance to activated protein C in a patient with multiple myocardial infarctions and stroke--a case report

A case of a 49-year-old female with a history of two myocardial infarctions (MI) and ischaemic stroke is presented. The patient was admitted to the hospital due to a third acute MI. Laboratory investigations revealed resistance to activated protein C due to factor V Leiden mutation. Diagnosis and treatment of patients with this condition are discussed.     

Physiotherapeutic assessment and management of chronic pelvic pain syndrome: A case report

Introduction:Chronic pelvic pain syndrome is difficult for the diagnosis and therapy and that means the patient attending the physician or physiotherapist may present various symptoms. There are no guidelines concern physiotherapy diagnosis and treatment of chronic pelvic pain syndrome. This study presents the physiotherapeutic assessment and management in men with pelvic pain symptoms.Patient concerns:Forty-six-year-old man attended the physiotherapy consulting room due to symptoms of pain in the perineum, lower abdomen, urethra, and scrotum for a year. Earlier, the patient had consulted a urologist who made a diagnosis of cystitis and prescribed medications that did not get results.Diagnosis:Ultrasound imaging and manual inspection (per rectum) of the pelvic floor was conducted by physiotherapist. Also, the abdominal and lower extremities muscles were assessed. Patient reported pain symptoms during examination of the musculus ischiocavernosus, puboanalis, pubococcygeus, iliococcygeus, coccygeus, and canalis pudentalis seu Alcocki.Interventions:The patient was given physiotherapeutic interventions consisting in the manual therapy of the lumbopelvic hip complex and the manual therapy per rectum.Outcomes:During 10th session of the physiotherapeutic treatment, patient reported improvement in pain symptoms. A month later, patient reported total alleviation of the pain symptoms during control visit.Conclusion:Therapy of chronic pelvic pain syndrome is a process that involves application of different therapies and different approaches. Functional and structural assessment and also therapy conducted by physiotherapist is becoming an integral part of urology and represents 1 possible conservative treatment form.     

“Cerebral small vessel disease and other influential factors of cognitive impairment in the middle-aged: a long-term observational cohort PURE-MIND study in Poland”

GeroScience - A complex picture of factors influencing cognition is necessary to be drawn for a better understanding of the role of potentially modifiable factors in dementia. The aim was to assess...     

The clinimetric properties of the World Health Organization Disability Assessment Schedule II in early inflammatory arthritis

OBJECTIVE: To assess the clinimetric properties of a new health-related quality of life (HRQOL) instrument, the World Health Organization Disability Assessment Schedule II (WHODAS II), in patients with early inflammatory arthritis. METHODS: Internal consistency as well as criterion, construct, and discriminative validity of the WHODAS II were assessed in 172 patients with early inflammatory arthritis who completed the WHODAS II, the Medical Outcomes Study Short Form 36 (SF-36), and other measures of disease severity, functioning, pain, depression, and resource use. Test-retest reliability of the WHODAS II was assessed by having a subset of 20 patients complete the WHODAS II a second time, 1 week after the first assessment. RESULTS: The WHODAS II had high internal consistency (Cronbach's alpha = 0.96 for patients working or in school and 0.93 for patients not working or in school). Test-retest intraclass correlation coefficients of the WHODAS II total score and subscales ranged from 0.82-0.96. The WHODAS II total score was strongly correlated with the SF-36 physical component score (Kendall's tau-b 0.51, P < 0.001) and moderately correlated with the SF-36 mental component score (tau-b 0.43, P < 0.001). WHODAS II correlations with disease outcomes ranged from Kendall's tau-b 0.15-0.55. The WHODAS II significantly differentiated between every aspect of disease severity assessed with the exception of measures of health resource use. CONCLUSION: The WHODAS II is a valid and reliable measure of HRQOL in cross-sectional studies of patients with early inflammatory arthritis. Research is still required to investigate potential item redundancy and determine its usefulness in longitudinal studies.     

Phospholamban gene ablation improves calcium transients but not cardiac function in a heart failure model

Decreased amplitude and slower kinetics of cardiomyocyte intracellular calcium (Ca(i)(2+)) transients may underlie the diminished cardiac function observed in heart failure. These alterations occur in humans and animals with heart failure, including the TNF1.6 mouse model, in which heart failure arises from cardiac-specific overexpression of tumor necrosis factor alpha (TNF alpha). OBJECTIVE: Since ablation of phospholamban expression (PLBKO) removes inhibition of the sarcoplasmic reticulum (SR) Ca(2+) pump, enhances SR Ca(2+) uptake and increases contractility, we assessed whether ablation of phospholamban expression could improve cardiac function, limit remodeling, and improve survival in the TNF1.6 model of heart failure. METHODS: We bred PLBKO with TNF1.6 mice and characterized the progeny for survival, cardiac function (echocardiography), cardiac remodeling (hypertrophy, dilation, fibrosis), and Ca(2+)(i) transients and contractile function of isolated cardiomyocytes. RESULTS: PLB ablation did not improve survival, cardiac function, or limit cardiac chamber dilation and hypertrophy in TNF1.6 mice (TKO mice). However, contractile function and Ca(2+)(i) transients (amplitude and kinetics) of isolated TKO cardiomyocytes were markedly enhanced. This discordance between unimproved cardiac function, and enhanced Ca(2+)(i) cycling and cardiomyocyte contractile parameters may arise from a continued overexpression of collagen and decreased expression of gap junction proteins (connexin 43) in response to chronic TNF alpha stimulation. CONCLUSIONS: Enhancement of intrinsic cardiomyocyte Ca(2+)(i) cycling and contractile function may not be sufficient to overcome several parallel pathophysiologic processes present in the failing heart.