Helicobacter pylori colonization in children with peptic ulcer disease III. Diagnostic value of the 13C-urea breath test to detect gastric H. pylori colonization

The efficiency of the ¹³C-Urea Breath Test (¹³C-UBT) for the detection of Helicobacter pylori colonization in gastric mucosa was evaluated. The ¹³C-UBT was performed in five pediatric and six adult subjects who had had upper gastrointestinal endoscopy within 2 weeks. H. pylori colonization was confirmed in two pediatric and three adult subjects with peptic ulcer combined with antral gastritis, by histological examination of antral biopsy specimens. When an individual with H. pylori colonization ingested a solution containing ¹³C-urea, a significant amount of ¹³CO₂ appeared in the respiratory CO₂ within 10 min. The mean cumulative percentage dose of ¹³C recovered in the breath over 30 min in the cases with H. pylori colonization was significantly higher than that in those who were not colonized (4.91 vs 0.41, P <0.001). In addition, the effect of antibiotic on the eradication of H. pylori from gastric mucosa was monitored by ¹³C-UBT in two cases. The values of cumulative percentage dose of ¹³C over 30 min fell to the same levels as those observed in H. pylori negative subjects after just 2 weeks treatment with amoxicillin; however, positive results were obtained again 1 month after the withdrawal of amoxicillin. In summary, ¹³C-UBT is a simple, reliable, non-invasive method in the diagnosis of gastric H. pylori colonization especially for pediatric patients.     

A Case of Amelanotic Malignant Melanoma of the Female Urethra

We report a case of amelanotic malignant melanoma of the femaleurethra. The clinical course was unusually long and complicatedby asynchronous resectable metastases to the lung and the brain.The patient died of generalized metastasis in spite of successfulresection of the metastatic lesions and postoperative chemotherapy,two years and five months after the first presentation. To thebest of our knowledge this is the second reported case of amelanoticmelanoma in the female urethra.     

Clinical impact of tamsulosin on generic and symptom-specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36-item Health Survey

AIM: To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. METHODS: A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. RESULTS: After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. CONCLUSIONS: Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.     

Preoperative predictors of cancerous involvement of the neurovascular bundles in patients with localized prostate cancer

BACKGROUND: The purpose of this study was to identify preoperative variables that would be useful in objectively selecting prostate cancer patients for nerve-sparing prostatectomy. METHODS: Twenty-six patients with clinical T1c-T2c cancers were evaluated for cancerous involvement in the region of the neurovascular bundles (NVB) from prostatectomy specimens. Preoperative prostate-specific antigen (PSA) and pathologic features in systematic biopsy specimens also were reviewed. RESULTS: A total of eight (31%) patients had cancerous involvement in the region of the NVB, including four on the right side, three on the left side and one on both sides. The percentage of each biopsy specimen occupied by the cancer was scored from zero to four and defined as the positive biopsy score. Preoperative PSA (P = 0.046), mean positive biopsy score (total sum of positive biopsy score divided by number of biopsy specimens; P = 0.001), number of cores containing cancer (P = 0.011), percentage of cores involved (P = 0.036) and maximum positive biopsy score (P < 0.001) were significant for predicting cancerous involvement in the NVB region using univariate analysis. However, only the mean positive biopsy score was independently significant according to multivariate analysis. To predict cancerous involvement in the region of each NVB, we found that ipsilateral mean positive biopsy score (total sum of corresponding positive biopsy score divided by number of ipsilateral biopsy specimens), number of cores involved on the ipsilateral side, percentage of cores involved on the ipsilateral side and maximum positive biopsy score on the ipsilateral side were significant predictive variables: the ipsilateral mean positive biopsy score being most appropriate for clinical practice. CONCLUSION: Ipsilateral mean positive biopsy score in systematic biopsy specimens can be an appropriate variable for selecting patients with localized prostate cancer for nerve-sparing prostatectomy.     

Early intervention in case of child abuse: Co-operation between the hot-line and local facilities

The Center for Child Abuse Prevention (CCAP), a citizens' organization, was started in May 1991 with such members as pediatricians, psychiatrists, lawyers and people working at child welfare offices. A hotline dealing with child abuse was set up immediately after the establishment of CCAP on 20 May 1991, and in the 2 years it has been in operation this hot-line has received 3189 calls out of which we picked 30 cases that CCAP was consulted about by helping persons or therapists affiliated with such facilities as hospitals, public health centers, etc. in order to evaluate how CCAP co-operates with these organizations. We reviewed the CCAP records of these 30 cases, comparing them with the materials concerning other hot-line calls, while at the same time interviewing the helping persons and therapists who had called in those cases, ascertaining their motives and the later course of the cases. This follow-up study was begun in June 1992 so that the longest follow-up period from the first call was 2 years and 7 months and the shortest 7 months. A total of 73.3% of these 30 cases required emergency intervention, and 53.4% were extremely severe, life-threatening cases of child abuse. The age distribution of these 30 victimized children peaked between 4 and 6, and 13 and 15 years. The perpetrator was the biological mother in 55.9% of the cases, the biological father in 29.4% and the stepfather in 8.9%. The abuse was physical in 58.3% of the cases, sexual in 8.9%, emotional in 5.6%, and involved neglect in 22.2%. These percentages differ from the general trend seen in the total hot-line cases, but were very similar to those reported by the Child Guidance Center. In the majority (56.7%) of the cases CCAP was consulted about, CCAP went beyond its hot-line service and co-operated to intervene, organizing network sessions in which the helping persons and therapists involved could discuss how best to deal with the problem at hand in five of these cases. In 22 of these 30 cases, the persons involved are still co-operating with CCAP after successful intervention through which the victimized children were rescued from critical situations. It is vitally important to set up networks between the professionals of the various support agencies involved if we are to intervene successfully in cases of child abuse. Indeed, one should only proceed with the intervention once the various facilities involved have agreed on who should take care of therapy and/or care, and on how to proceed and at what pace.     

Tubulovillous adenoma developing after urinary reconstruction using ileal segments

A case of tubulovillous adenoma arising in an augmented bladder is described. Ureteroileal substitution and ileocystoplasty was performed when the patient was 18 years old. She noticed gross hematuria 44 years after the surgery. Cystoscopy revealed a non-papillary multiple tumor at the site of ileovesical anastomosis and transurethral resection biopsy was performed. Histopathological examination revealed a tubulovillous adenoma. A tubulovillous adenoma developing at the augmented bladder is rare. To our knowledge, this is the second case in which a tubulovillous adenoma developed in an augmented bladder.     

Social support and pregnancy:I. Factorial structure and psychosocial correlates of perceived social support

Abstract In a questionnaire survey among 1329 first-trimester pregnant women, social support providers were divided by factor analysis into husband, 'premarital network' (parents and friends) and 'postmarital network' (children and mother-in-law), while social support contents were divided into 'given' (emotional, informational and instrumental support) and 'giving' (nurturing opportunity and general confiding). The husband was most frequently nominated by the woman as the support provider in both of these categories. Multiple regression analyses revealed that a husband's poor 'given' support was predicted by the presence of premenstrual irritability, a lower level of the woman's own education, her smoking habits and past experience of pregnancy termination, while a husband's poor 'giving' support was predicted by current older age, smoking habits and past experience of delivery.     

Effects of Bepridil Versus E‐4031 on Transmural Ventricular Repolarization and Inducibility of Ventricular Tachyarrhythmias in the Dog

Background: Bepridil (a multiple channel blocker) may markedly prolong the QT interval and induce polymorphic ventricular tachyarrhythmias (VTA). We compared the transmural ventricular repolarization characteristics and inducibility of polymorphic VTA after administration of bepridil versus the pure I_Kr blocker, E‐4031, each administered to five open‐chest dogs. Methods: We used plunge needle electrode to record transmural left ventricular (LV) repolarization and activation‐recovery interval (ARI) to estimate local repolarization. The correlation between paced cycle length and ARI was separately examined in the LV endocardium, mid‐myocardium (Mid), and epicardium. Attempts to induce VTA were made during bradycardia and sympathetic stimulation. Results: Bepridil and E‐4031 prolonged QT interval and ARI in all LV layers, though the magnitude of prolongation was greatest in Mid, increasing the transmural ARI dispersion, particularly during bradycardia. Compared with E‐4031, bepridil caused mild, reverse use‐dependent changes in ventricular repolarization, and less ARI dispersion than E‐4031 during slow ventricular pacing. Both drugs increased ARI_max and cycle length at 50% of ARI_max, though the changes were smaller after bepridil than after E‐4031 administration. Bradycardia after the administration of each drug induced no VTA; however, sympathetic stimulation induced sustained polymorphic VTA in two of five dogs treated with E‐4031 versus no dog treated with bepridil. Conclusions: Unlike the pure I_kr blocker, E‐4031, bepridil exhibited weak properties of reverse use‐dependency and protected against sympathetic stimulation‐induced VTA. It may be an effective supplemental treatment for recipients of implantable cardioverter defibrillator. (PACE 2010; 950–959)     

Indications and Techniques for Endoscopic Mucosal Resection in the Lesions of A Colorectal Tumor

We evaluated the possibility of an extended application of endoscopic treatment for submucosal‐invading colorectal cancers, and describe the method of endoscopic mucosal resection (EMR) using a one channel colonoscope. A total of 328 submucosal‐invading cancers were examined from July 1985 to September 2002. The patterns of infiltrating growth into the submucosal layer were further divided into two groups: expanding growth, and infiltrating growth. Lymph node metastasis occurred in sm2 and extension cancer in more advanced stages. The lowest measurement of submucosal invading cancer with lymph node metastasis was 1250 µm. As for patterns of invasion, the frequencies of lymph node metastasis in the groups of expanding growth and infiltrating growth were 0% (0/87) and 14.5% (16/110), respectively, (P = 0.0002, Fisher's direct method). Results showed that endoscopic treatment is suitable for sm1 extension without vessel invasion, but there is a possibility that some sm2 extension cancers can be cured radically when the pattern of submucosal invasion shows expanding growth with a distinct border.