Efficacy of Triple Therapy Plus Cetraxate for the Helicobacter pylori Eradication in Partial Gastrectomy Patients

In the present study, we aimed to establish an additional standardized protocol with a higher H. pylori eradication rate in the remnant stomach. Fifty-five H. pylori–positive patients were randomly allocated to one of three regimens: LAC—lansoprazole, amoxicillin, and clarithromycin b.i.d. for 7 days (n = 17); LAC+CET—LAC b.i.d. plus cetraxate q.i.d. for 7 days (n = 20); and LEFT—LAC for 7 days in a horizontal body position on the left side for 30 min (n = 18). Patient compliance and side effects were checked via interviews. H. pylori eradication was successful in 75, 72, and 41% in LAC+CET, LEFT, and LAC, respectively. The eradication rate was significantly higher in LAC+CET than in LAC (P = 0.024) but not in LEFT (P = 0.058). Adverse events that occurred in each group were almost all mild ones. Cetraxate plus LAC for 1 week is a safe and effective regime for the eradication of H. pylori in patients after partial gastrectomy.     

Remnant lipoproteinemia is a risk factor for endothelial vasomotor dysfunction and coronary artery disease in metabolic syndrome

This study aimed to determine whether elevated levels of remnant lipoprotein, an atherogenic triglyceride-rich lipoprotein, might be associated with coronary artery disease (CAD) and endothelial vasomotor dysfunction in metabolic syndrome. The fasting serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method in 210 patients with metabolic syndrome meeting ATP III criteria. Flow-mediated endothelium-dependent dilatation (FMD) in the brachial artery during reactive hyperemia was examined by high-resolution ultrasound technique. This study found that elevated RLP-C levels were a significant and independent risk factor for impaired FMD and angiographically proven coronary artery disease (CAD). Treatment with bezafibrate (n = 20) or atorvastatin (n = 20) for 4 weeks significantly reduced RLP-C levels, with a concomitant improvement in FMD. The % reduction in RLP-C levels from baseline after the treatment was independently correlated with the magnitude of improvement in FMD after adjustment for the % changes in levels of triglyceride, hsCRP, and IL-6, and HOMA index. Thus, elevated levels of RLP-C are a risk factor for CAD and endothelial vasomotor dysfunction, a predictor of coronary events, in metabolic syndrome. Measurement of RLP-C is useful for assessment of CAD risk and therapeutic effects in metabolic syndrome.     

Fas signaling induces Akt activation and upregulation of endothelial nitric oxide synthase expression

A growing body of evidence has shown that Fas, a death receptor, mediates apoptosis-unrelated biological effects. Here, we report that Fas engagement with Fas ligand induced activation of Akt and upregulation of endothelial nitric oxide synthase expression without induction of apoptosis. In the presence of the phosphatidylinositol 3-kinase inhibitor wortmannin, Fas ligand, however, induced apoptosis instead of upregulation of endothelial nitric oxide synthase expression. In vivo, systolic blood pressure was slightly higher in mutant mice with decreased cell surface Fas expression (lpr mice) compared with wild-type mice. In addition, chronic inhibition of nitric oxide synthesis by N(G)-nitro-l-arginine induced a progressive increase in the levels of blood pressure in wild-type mice, whereas no further increase in the levels of blood pressure was observed in lpr mice. Furthermore, acetylcholine caused a lesser endothelium-dependent relaxation of the strips from lpr mice compared with wild-type mice, although the vasoconstrictor potency of phenylephrine was not different between the two groups. These findings indicate that Fas signaling may have a role in the regulation of endothelial function and blood pressure through modulating endothelial nitric oxide synthase expression in the Akt signal-dependent manner.     

Clinical significance of serum KL-6 and SP-D for the diagnosis and treatment of interstitial lung disease in patients with diffuse connective tissue disorders]

OBJECTIVE: To elucidate the clinical significance of serum KL-6 and SP-D for the diagnosis and treatment of interstitial lung disease in connective tissue disorders. METHODS: 139 patients with various connective tissue disorders were subjected for the study, which included 46 cases of rheumatoid arthritis, 43 cases of Sj?gren's syndrome, 16 cases of SLE, 10 cases of systemic sclerosis, 9 cases of polymyositis/dermatomyositis, 6 cases of vasculitis syndrome, 5 cases of Beh?et's disease and 4 cases of MCTD. Serum levels of KL-6 and SP-D were determined by enzyme-immunoassay. The sensitivity, specificity and accuracy of serum KL-6 and SP-D for the diagnosis of interstitial lung disease were compared with serum LDH. The relationship of serum KL-6 and SP-D levels with high resolution CT (HRCT) of the lung and Gallium scintigraphy findings was analyzed. In some cases, serum levels of the two markers were determined monthly in the course of the disease. RESULTS: When the serum levels of KL-6 and SP-D were measured simultaneously, the sensitivity to diagnose interstitial lung disease was 67.7%, the specificity was 98.1%, and the accuracy was 91.4%, while those of serum LDH were 45.2%, 88.9%, 79.1% respectively. In the patients with interstitial lung disease, those who had elevated serum levels of both KL-6 and SP-D showed parenchymal collapse opacity-dominant pattern in HRCT. On the other hand, the patients with interstitial lung disease who had normal levels of serum KL-6 and SP-D or had elevation either in KL-6 or SP-D levels showed ground glass opacity-dominant pattern in HRCT. There was no significant correlation between serum marker levels and Gallium scintigraphy findings. When serum KL-6 and SP-D were measured monthly, the levels of both markers changed more specifically and sensitively to the lung disease activity compared with serum LDH. CONCLUSIONS: Serum KL-6 and SP-D are more specific and useful markers for the diagnosis and evaluation of interstitial lung disease compared with serum LDH in connective tissue disorders.     

Two fatal cases of methotrexate-induced interstitial pneumonitis]

We report two cases of methotrexate-induced pneumonitis. Both patients died despite steroid pulse therapy. Postmortem lung tissue revealed diffuse alveolar damage, and focal lung fibrosis. Physicians should be aware of the possibility of MTX-induced interstitial pneumonitis in diagnosing RA patients with MTX when diffuse pulmonary infiltration is present.     

Early appendiceal adenocarcinoma. A review of the literature with special reference to optimal surgical procedures

Received: October 23, 2000 / Accepted: February 2, 2001     

Pulmonary emboli caused by iliac compression syndrome without leg symptoms

Iliac compression syndrome is a clinical condition that occurs as a result of compression of the left common iliac vein by the overlying right common iliac artery. This syndrome most often affects young to middle-aged women, and patients usually have left leg symptoms. We report the unusual case of an 18-year-old male who had pulmonary emboli caused by iliac compression syndrome without leg symptoms. Combined venography and aortography confirmed the diagnosis. The patient was successfully treated with anticoagulants and vena cava filter insertion. Iliac compression syndrome should be considered when pulmonary embolism appears without obvious cause.     

Adsorption of Endotoxin by Beta2‐Microglobulin Adsorbent Column (Lixelle): The New Approach for Endotoxinemia

Abstract: We previously reported that Lixelle, which was used for beta₂‐microglobulin (BMG) adsorption columns, could adsorb not only BMG but also inflammatory cytokines. We became interested in the application of Lixelle for patients with endotoxinemia and researched its ability to adsorb microorganism components in vitro using lipopolysaccharide (LPS) (Escherichia coli B8), endotoxin (ET) contaiminated water. The initial concentrations of each water solution were LPS (ET 29,135 EU/L) and contaminated water (ET 3,523 EU/L) whole blood solution was LPS (ET 1,197.6 EU/L). Each 2.5 ml of the stock solution and adjusted diluted solutions contained 0.5 ml of Lixelle beads. After shaking at 37°C for 2 h, ET in the solutions was determined using the endotoxin specific‐limulus amebocyte lysate method. The results revealed that even though ET concentrations in LPS and contaminated water incubated in water solution and in whole blood were high, the samples containing Lixelle beads showed significant decreases. Thus, Lixelle beads can adsorb not only BMG but also microorganism components such as LPS and ET. These findings together with the ability of Lixelle to adsorb ET show the possibility of the application for treatment of endotoxinemia.     

Types of nuclear endonuclease activity capable of inducing internucleosomal DNA fragmentation are completely different between human CD34+ cells and their granulocytic descendants

A hallmark of apoptosis is internucleosomal DNA fragmentation resulting from the activation of endonucleases. We characterized the endonuclease activity of human myeloid cell nuclei that cleaved their own nuclear chromatin to oligonucleosomal length fragments. Polymorphonuclear leukocytes (PMNs) of normal peripheral blood contained both Ca2+/Mg(2+)- dependent and DNase II-like acidic endonuclease activities in their nuclei. Immature myeloid cells of normal bone marrow at various stages of granulocytic maturation had similar nuclease activities. In contrast, a clear difference was shown in the circulating CD34+ cells, in that only Mg(2+)-dependent, Ca(2+)-independent endonuclease activity was detected. Consistent with these findings is the emergence of the Ca2+/Mg(2+)-dependent and acidic endonuclease concomitantly with the disappearance of the Mg(2+)-dependent endonuclease when CD34+ cells were induced to differentiate in vitro toward granulocytes. Leukemic cell lines of all lineages also had Mg(2+)-dependent nuclease activity. Our results suggest an association of the Mg(2+)-dependent endonuclease with hematopoietic progenitor cells and that the relative activities of the nuclear nuclease in human myeloid cells change substantially during granulocytic differentiation.