Has education about Helicobacter pylori infection been effective? Worldwide survey of primary care physicians

BACKGROUND: Confusion exists among physicians about the management of Helicobacter pylori (H. pylori) infection. We aimed to survey primary care physicians' (PCP) knowledge and management of H. pylori-related diseases. METHODS: Four-hundred and seventy randomly selected PCP from 29 countries were surveyed. RESULTS: The pathological role of H. pylori was of less concern in South Africa than the rest of the world (63% compared to 93%). The causal relationship between H. pylori and gastric and duodenal ulcers and gastric cancer was accepted by 81%, 85%, and 61% of respondents, respectively. Endoscopy was used by 62% of respondents to diagnose the infection. Histology was used by 61% of European participants for diagnosis compared to 3% in North American and 0% in South Africa. Proton-pump inhibitor (PPI)-based triple therapies were prescribed by 89% of respondents. Physicians in Oceania (35%) and South Africa (45%) were less concerned about bacterial resistance than respondents elsewhere. Sixty-three percent of respondents considered H. pylori relevant to dyspepsia management and 66% treated new dyspepsia empirically, compared to 18% who chose endoscopic diagnosis and 13% who used a H. pylori test and treat strategy. For persistent or recurrent infection, 56% of South African physicians treated with another regimen compared to 33% of PCP from elsewhere. Ninety-one percent of European participants agreed that current information on H. pylori management is helpful and 68% of PCP from other regions considered the information to be adequate. CONCLUSIONS: Current guidelines on the management of H. pylori infection have been useful for PCP worldwide. Contrasting answers to some questions may reflect differences in health care systems, epidemiology and approaches to the management of H. pylori infection between countries.     

Efficacy of a Modified Pharmacomechanical Thrombolysis Technique for Endovascular Treatment of Thrombosed Prosthetic Arteriovenous Grafts

Objective

We applied a modified pharmacomechanical thrombolysis (PMT) technique to endovascular treatment of thrombosed arteriovenous (AV) grafts without the use of any mechanical thrombectomy devices. The aim of this study was to evaluate the efficacy of the PMT technique in the treatment of thrombosed AV grafts by analyzing the long-term patency.

Materials and Methods

Eighty-two patients with thrombosed AV grafts were treated with the PMT technique. AV graft surveillance to detect failing/failed access was followed by endovascular treatment.

Results

The technical and clinical success rates were 95% and 95%, respectively. The total number of thrombolysis sessions was 279. A post-intervention primary patency rate was 45% and 22% at 12 and 24 months, respectively. The secondary patency rate was 96% and 91% at 12 and 24 months, respectively. No major complications were noticed.

Conclusion

The modified PMT technique is effective in endovascular treatment of thrombosed AV grafts.     

Combined resection of hepatoblastoma and intracaval right atrial extension with profound hypothermia and circulatory arrest

Hepatoblastoma is an uncommon liver neoplasm in children but its intraatrial extension through the inferior vena cava is extremely rare. The case described is a 3-year-old boy in whom profound hypothermia and circulatory arrest were used to resect a hepatoblastoma and its extension to the right atrium. This technique allows maximal resection and relief of venous obstruction from atrial extension of hepatoblastoma.     

Traumatic posterior dislocation of the hip--a local experience and review of the literature

The results of 30 patients who sustained traumatic posterior dislocation of the hip treated in both Departments of Orthopaedic Surgery in the Singapore General Hospital from January 1980 to May 1987 were analysed. The most common cause was motorcycle accidents. Young adult males formed the majority of affected cases. 90% of the dislocations were of the Types I and II. Associated injuries were common. The primary treatment was closed reduction under anaesthesia. The subsequent period of traction and non-weight bearing was variable, but it did not seem to affect the final results. Avascular necrosis of the femoral head and secondary osteoarthritis were the major complications. The overall functional results were good.     

Cerebral abscess associated with an intrauterine contraceptive device.

The present communication is the first report of a metastatic brain abscess occurring as a complication of severe intrauterine device (IUD)-related pelvic inflammatory disease (PID). The diagnostic and therapeutic problems are discussed, and a suggestion is made for the reporting of all IUD-associated infections to a central agency.     

Effect of mechanical strain on human limbal epithelial cells in vitro

PURPOSE: To investigate the effects of the mechanical cyclic strain on the extracellular matrix (ECM) production by cultivated human limbal epithelial cells (HLECs) in vitro. METHODS: HLECs were repetitively stretched and relaxed by 20% of their original length. Morphology of HLECs was observed, and concentrations of fibronectin and laminin V were measured. RESULTS: The strained HLECs were elongated and aligned perpendicular to the direction of force. Fibronectin and laminin V were highly expressed in the strain group compared with the control. CONCLUSIONS: Cyclic strain induces the synthesis of fibronectin and laminin V in cultivated HLECs.     

Cyclin-dependent kinase 2 functions in normal DNA repair and is a therapeutic target in BRCA1-deficient cancers

Abnormal regulation of progression from G(1) to S phase of the cell cycle by altered activity of cyclin-dependent kinases (CDKs) is a hallmark of cancer. However, inhibition of CDKs, particularly CDK2, has not shown selective activity against most cancer cells because the kinase seems to be redundant in control of cell cycle progression. Here, we show a novel role in the DNA damage response and application of CDK inhibitors in checkpoint-deficient cells. CDK2(-/-) mouse fibroblasts and small interfering RNA--mediated or small-molecule--mediated CDK2 inhibition in MCF7 or U2OS cells lead to delayed damage signaling through Chk1, p53, and Rad51. This coincided with reduced DNA repair using the single-cell comet assay and defects observed in both homologous recombination and nonhomologous end-joining in cell-based assays. Furthermore, tumor cells lacking cancer predisposition genes BRCA1 or ATM are 2- to 4-fold more sensitive to CDK inhibitors. These data suggest that inhibitors of CDK2 can be applied to selectively enhance responses of cancer cells to DNA-damaging agents, such as cytotoxic chemotherapy and radiotherapy. Moreover, inhibitors of CDKs may be useful therapeutics in cancers with defects in DNA repair, such as mutations in the familial breast cancer gene BRCA1.