Prevalence of Helicobacter pylori infection and its link to coronary risk factors in Japanese patients with acute myocardial infarction.

The association between Helicobacter pylori (H. pylori) infection and coronary artery disease, as well as the association between H. pylori infection and classic coronary risk factors, is controversial in patients from Western countries. The high prevalence of H. pylori infection in Japanese subjects enables an examination of these associations in a large population, especially in young patients, because coronary risk factors may be more strongly associated with younger individuals than with older individuals. The IgG seropositivity to H. pylori was assessed in 618 cases with acute myocardial infarction (AMI) and in 967 controls. The prevalence of seropositivity to H. pylori was similar between cases and controls, but in subjects younger than 55 years, the rate was significantly higher in cases than in controls (58.7% vs 43.3%, p = 0.009). After adjustment for age, gender, diabetes mellitus, hypertension, smoking, body mass index, total cholesterol, and high density lipoprotein cholesterol, the odds ratio for acute myocardial infarction was 2.97 (95% confidence interval, 1.37-6.41; p = 0.006). Worsening of classic coronary risk factors was not associated with H. pylori infection in subjects younger than 55 years. These results suggest that in younger individuals in Japan, H. pylori infection is significantly associated with AMI independent of the classic coronary risk factors.     

Sweet's syndrome with panuveitis resembling Beh?et's disease

Purpose  

Sweet's syndrome (SS) is a skin disorder clinically characterized by fever, neutrophilia, and painful edematous plaques that occasionally causes posterior uveitis. We present two cases of SS with panuveitis resembling Beh?et's disease (BD).     

Joint effects of Chlamydia pneumoniae infection and classic coronary risk factors on risk of acute myocardial infarction

Background

Although not in itself strongly predictive of coronary heart disease, Chlamydia pneumoniae infection could interact with classic risk factors in determining risk of acute myocardial infarction (AMI).

Methods

We assessed C pneumoniae immunoglobulin (Ig) G and IgA titers and classic risk factors in 618 patients with AMI and in 967 controls.

Results

IgG titers were not related to AMI, but a significant association was seen between IgA titers and AMI. Excess risk of AMI was noted mainly among patients with the highest IgA titers, such as those beyond 2.88 (the 95th percentile cutoff point in control subjects), showing a 1.8-fold increase in risk (odds ratio 1.75, 95% CI 1.04-2.92). Classic risk factors did not differ between subjects with IgA titers above and below the 95th percentile cutoff. However, in multivariate analyses, models incorporating both IgA titers and a classic risk factor such as obesity, hypercholesterolemia, or smoking predicted risk more effectively than single-parameter models. For example, the odds ratio for AMI among subjects with the highest IgA titers plus hypercholesterolemia was greater than the product of individual risks associated with these high IgA titers and with hypercholesterolemia.

Conclusions

Interactions with classic risk factors (ie, obesity, hypercholesterolemia, and smoking), increased the predictive value of C pneumoniae IgA antibody titers in determining risk of AMI.     

Antithrombotic action of the orally available thromboxane A2 receptor antagonist S-1452 (d-s-145 Ca) in rodents

The thromboxane A₂ (TXA₂) receptor antagonist, S-1452, calcium salt of a steroselectively synthesized d-enantiomer of the racemate S-145, calcium 5(Z)-1R,2S,3S,4S-7-[3-phenylsulfonylaminobicyclo[2.2.1]hept-2-yl]-5-heptenoate dihydrate, was examined for its antithrombotic action in vivo, in mice and rats. Orally administered S-1452 dose-dependently prolonged the bleeding time which was measured by a tail transection method. The effect was observed at doses above 1 mg/kg in both animals. S-1452 clearly prevented U46619-induced sudden death in mice and its ED₅₀ value for the prevention was 0.47 mg/kg at 1 h after oral administration. It was more potent and long-acting than reference compounds such as ONO-3708 and SQ-26548. The preventive effect of S-1452 was also observed in arachidonate-induced sudden death, although much larger doses were required in comparison with the case of the U-46619-induced response (ED₅₀: 4.6 mg/kg p.o., at 30 min; 3.1 mg/kg p.o., at 60 min after S-1452). Aspirin, used as a reference compound, was much less active than S-1452 (ED₅₀: 85.9 mg/kg p.o., at 30 min; 88.2 mg/kg p.o., at 60 min after aspirin). The pharmacologically active moiety of S-1452, d-S-145, was several times more potent than the opposite enantiomer 1-S-145 in the prolongation of the bleeding time in rats, and in the prevention of the U46619-induced sudden death in mice. These stereoselective efficacies suggest that S-1452 causes its antithrombotic action by blocking TXA₂ receptors in vivo. S-1452 significantly reduced collagen-induced thrombocytopenia in mice at doses above 0.1 mg/kg p.o. In rats, the compound improved clearly collagen-induced abnormal electrocardiogram. The minimum effective doses were 1 mg/kg for S-1452, 15 mg/kg for ONO-3708, and 10 mg/kg for OKY-046, 60 min after oral administration. It is concluded that S-1452 is a very potent and orally available antithrombotic compound. © 1993 wiley-Liss, Inc.     

Phase I study of recombinant human tumor necrosis factor

Summary A phase I clinical and pharmacokinetic study of recombinant human tumor necrosis factor (rH-TNF) was conducted in a single dose schedule in 33 patients with advanced cancer. rH-TNF was given by i.v. infusion over 30 min with a starting dose of 1x10⁵ units/m². The dose was escalated up to 16x10⁵ units/m² according to the modified Fibonacci scheme. Toxic effects were similar but not identical to those reported with interferons and interleukin-2, and included fever, rigors, nausea and vomiting and anorexia in a non-dose-dependent manner, and hypotension, leukocytosis, thrombocytopenia and transient elevation of transaminases (SGOT and SGPT) in an approximately dose-dependent manner. DIC syndrome was observed in one patient who had received 16x10⁵ units/m². The dose-limiting toxicities were hypotension, thrombocytopenia and hepatotoxicity, and the maximum tolerated dose in a single i.v. infusion of rH-TNF appeared to be 12x10⁵ units/m² when thrombocytopenia and elevation of SGOT and SGPT were taken as the dose-limiting toxicities. However, if hypotension was included, the maximum safely tolerated dose appeared to be 5x10⁵ units/m².     

Temporal aspects of the electroretinogram in cone-rod dystrophy

Twelve patients with cone-rod dystrophy were studied in terms of the temporal aspects of electroretinography (ERG).The peak time of scotopic b-wave was within normal limits in all patients, while the amplitude was reduced in nine patients. The normal peak time of the scotopic-b wave may help explain rod involvement with normal or only slightly elevated final rod thresholds of subjective dark adaptation.The peak time of photopic b-wave and 30-Hz flicker response was normal in four patients and significantly delayed or nonrecordable in eight patients. Such variations of peak time in photopic and 30-Hz flicker ERG may reflect the stage of the disease or may be caused by the different hereditary mode.