A randomised trial of amoxycillin versus clarithromycin in combination with omeprazole for eradication of Helicobacter pylori infection in Singapore

Dual therapy has been reported to produce H.pylori eradication rate of 75-80%. This study is designed to determine the efficacy of omeprazole 20 mg bd in combination with amoxycillin 500 mg tid (Group A), amoxycillin 750 mg tds (Group B) and clarithromycin 500 mg tid (Group C) in Singapore. One hundred and forty-eight patients with H. pylori positive duodenal ulcers between ages of 22 and 69 were enrolled from two centres. There were 48 patients in Group A, 50 patients in Group B and 50 patients in Group C. The medication was given for 14 days. The patients were re-evaluated with an upper GI endoscope 4 weeks after cessation of treatment Successful eradication was defined as H.pylori negative on histology and culture. Based on intention to treat analysis, the eradication rate was 47.8% in Group A, 68% in Group B and 66% in Group C. The difference between GroupA and B were statistically significant (p = 0.04). Based on all patient treated analysis, the eradication rate was 57.5% in Group A, 70.7% in Group B and 75% in Group C. The difference in eradication rates was not statistically significant. Adverse events were reported in 21% of all patients with no difference in the adverse event rate between all groups. The eradication rate achieved with dual therapy in this study was similar to that attained in Western population. Higher dose amoxycillin regime gives a significantly higher eradication than a lower dose amoxycillin.     

Morphology of the Developing Human Endolymphatic Sac

The adult human endolymphatic sac (ES) has been described as a complex network of interconnected tubules. Embryologic examination describes the human ES as a single-lumen, pouch-like structure. Transition from saccular shape to tubules during the entire fetal period has not been previously reported. Tubular ES structure is thought to be unique to humans. Animal investigations describe similar saccular appearance, but without tubules in mature sacs. The authors examined 45 human fetal temporal bones to trace ES development and reviewed six types of animal sacs. Results in humans reveal tubular structure as early as 26 weeks' gestation. Maturation variably occurred in the fetal period and postnatally. For the first time, the tubular system is noted in the animal, the rhesus monkey. These findings suggest that the tubular system may represent more advanced specialized function.     

Mastoid size and otitis media with effusion: Question of correlation

Objectives/Hypothesis: To determine the incidence of otitis media (OME) with effusion on histologic examination in temporal bones with mastoid cavities reduced by the fenestration procedure for otosclerosis. Study Design: Temporal bone histologic study. Methods: Light-microscopic examination of serially sectioned temporal bones. Results: The incidence of otitis media with effusion in temporal bones with prior fenestration operation was not any more frequent than the control group of temporal bones with surgically unaltered mastoid cavity. Conclusions: There is no increased incidence of otitis media with effusion in temporal bones with prior fenestration operation.     

Diffuse panbronchiolitis: Case report and review of the literature

Diffuse panbronchiolitis is an uncommon disease of unknown aetiology mainly occurring in Asian races. Treatment with erythromycin acting through unclarif ied mechanisms is promising and may improve the poor prognosis currently associated with the disease. A case is presented illustrating how the imaging features of the disease, particularly on high-resolution computed tomography, may be used to support a diagnosis suggested on clinical grounds.     

Expression of immunoregulatory cytokines in neurons of the lateral hypothalamic area and amygdaloid nuclear complex of rats immunized against human IgG

Present results showed that interleukin-1 (IL-1), IL-6 and transforming growth factor-beta (TGF-beta) were constitutively expressed in the supraoptic and paraventricular nuclei of the rat hypothalamus. Immunoreactive cells were also detected, but to a lesser extent, in other parts of hypothalamus as well as in the cerebral cortex. In rats immunized with IgG, there was moderate increase in immunoreactivities of the cytokines. A notable feature, however, was the induction of the cytokine expression in the lateral hypothalamic area and the amygdaloid nuclear complex, suggesting that the neurons in these two areas are involved in possible immune regulation.     

Nitric oxide, microglial activities and neuronal cell death in the lateral geniculate nucleus of glaucomatous rats

The present study was initiated to investigate neuronal degeneration, microglial reactivity and possible roles of NO in the lateral geniculate nucleus (LGN) of glaucomatous rats. An experimental one-eye glaucoma model was created by cauterization of the limbal-derived veins. Neuronal cell viability was studied by immunostaining with antibody against neuronal nuclei. Changes of expressions of nitric oxide synthase I (NOS I), NOS II, ED 1, OX6 and OX42 in the LGN were studied by immunohistochemistry. NADPH-d histochemistry was also employed. In the experimental glaucomatous rats, the number of NeuN labelled neurons was significantly decreased in both the ipsi- and contra-lateral sides of the ventral LGN (vLGN) but not the dorsal LGN (dLGN) at 1 month post-operation and beyond. Expressions of NOS I and NADPH-d were notably increased from 1 week post-operation in the ipsilateral vLGN. In the contralateral side of the vLGN, however, this change was only observed from 1 month post-operation. No NOS II immunoreaction was observed in LGN of both the normal control and glaucomatous rats. Increased microglial reactivity as indicated by OX-42 immunoreactivity was first observed in both sides of the LGN at 1 week post-operation, and this was most significant especially at 1 and 2 months post-operation. The present results suggest that NO and microglial cells may play some important roles in the pathologic processes of neuronal degeneration in the LGN of glaucomatous rats.     

Nephrolithiasis associated with autosomal dominant polycystic kidney disease: contemporary urological management

PURPOSE: We evaluate the role of contemporary urological intervention in patients with nephrolithiasis associated with autosomal dominant polycystic kidney disease. MATERIALS AND METHODS: Intervention for upper tract stones associated with autosomal dominant polycystic kidney disease was performed in 5 women and 2 men 29 to 65 years old (mean age 47). Indications for intervention consisted of flank pain in 6 patients and/or hematuria in 2. A total of 12 procedures (mean 1.7 per patient) were performed, including shock wave lithotripsy in 6 patients, percutaneous nephrolithotomy in 2, retrograde endoscopy or manipulation in 3 and extended pyelonephrolithotomy in 1. RESULTS: All patients were rendered stone-free or had only residual "dust." Hospital stay for 5 patients was 1 night or less and there were no complications. Renal function for each patient was stable or improved as measured by serum creatinine. CONCLUSIONS: Most patients with autosomal dominant polycystic kidney disease who require intervention for nephrolithiasis can be safely and effectively treated with essentially any or all contemporary, minimally invasive techniques. The choice of intervention can be based primarily on size and location of the upper tract stones rather than the associated presence of polycystic kidneys.